Low-dose Perioperative Dexamethasone Improves 24-hour Post-Operative Pain after Anterior Cruciate Ligament Reconstruction

@#Introduction: Post-operative pain following anterior cruciate ligament reconstruction remains an important challenge. Steroids are used in various surgical procedures to decrease post-operative nausea, vomiting and pain. However, only a few studies have reported the effect of systemic administration of steroids in controlling postoperative pain after anterior cruciate ligament surgery. Materials and methods: We have conducted a prospective randomised trial with 109 patients divided into two groups to determine if administration of dexamethasone in the perioperative period improves pain in the post-operative period. The patients were divided into two groups: D, treatment (dexamethasone) and P, control placebo (saline). Patients in the D treatment group were given the first dose of 10mg of intravenous dexamethasone intravenously intraoperatively and the second dose on transferring of the patient to the inpatient department. The patients in the placebo P group, were administered normal saline in the perioperative period in a similar manner. Result: Post-operative pain was significantly less in the dexamethasone group at rest and on walking (p<0.001) for the first 24 hours after surgical procedure. Subsequently, the VAS pain scores were almost similar in both groups at 48 and 72 hours. The administration of dexamethasone resulted in less requirement of antiemetic and rescue analgesia medication There was no difference in range of motion and wound complications rate during the follow-up period at six months. No adverse side effect, like osteonecrosis of the hip, was detected. Conclusion: The pain following anterior cruciate ligament reconstruction is severe during the first 24 hours and perioperative administration of dexamethasone can decrease the post-operative pain substantially.

Bipartite Atlas –A Rare Entity, a Study of Its Incidence in North Indians

Background:Combined anterior and posterior C1 bifidityi.e BIPARTITE ATLAS or SPLIT ATLAS is a rare entity Our goal in this study was to examine the incidence of this anomaly in North India. review the literature and the clinical implications of this cleft defects.. Methods:It is retrospective study ofNCCT evaluation in 1735 patients who underwent CECT neck[900 patients] NCCTwith spine evaluation[835patients]in Pankaj diagnostic set up between jan 2012 to December 2016, and department of radiodignosis Sarojini Naidu Medical college Agra during the time interval between dec 2016 to july 2017 the images were reviewed retrospectively to identify patients with BIPARTITE ATLAS defects . Posterior arch defects of the atlas were grouped in accordance with the classification of Currarino et al ,anomalies were subsequently grouped. Results: We found only 4(4/1735) patients of bipartite atlas i.e .2% of total . anterior ach defects were midline and have a reported width ranging from 1-5 mm The type A posterior arch defect was found in 3 patients and the type B posterior arch defect was found in one patients. No type C, D, or E defects were observed in these bipartite atlas defect The CT scans of the patients show midline clefts of the anterior and the posterior arches of C1 with similar imaging features:smooth margins lined by cortical bone and no lateral offset. The patients had no neurological symptoms relating to the C1 abnormality, and no follow-up was performed.Conclusion:Bipartite atlas is a rare entity as it’s incidence was found to be just .2% . knowledge is essential as it can predispose to certain neurological compressive disorders.awareness helps in clinicoradiological diagnosis, management in patient of trauma as appearance of cleft simulate Jefferson fracture.

Heterologous osseous differentiation in Malignant Phyllodes tumour – A rare case report

Breast sarcomas are rare neoplasms accounting for less than 1% of breast malignancy. Phyllodes tumors have biphasic histological features with both epithelial and stromal component. Careful characterization of the stromal component is critical since it is the pathologic features of the stromal cells that determine its malignant potential. We reported a case of 57 years old female with right breast mass who underwent wide excision and on histological examination a diagnosis of malignant phyllodes tumour with heterogonous osseous differentiation was made. The rarity of the lesion was considered for reporting and on follow up the patient was free of metastasis.

An update on precancerous lesions of oral cavity.

Oral cancer is the most common head and neck cancer, found in 270,000 patients annually worldwide. Some cancers develop from precancerous lesions; however, there is no definitive clinico pathological factor or biomarker that reliably enables malignant transformation to be predicted in an individual patient. Early detection and early treatment of oral cancer are important for improving the survival rate of patients; prevention of oral cancer will clearly contribute most to decreasing its death rate. So correct diagnosis and timely treatment of premalignant lesions with high risk of malignant transformation may help to prevent malignant transformation.

Spotted dermopathy in a diabetic patient due to insulin allergy.

A rare case of diabetic patient who developed multiple cutaneous hyperpigmented spots following bovine isophane (NPH) insulin injection is described here.

Japanese encephalitis with movement disorder and atypical magnetic resonance imaging.

With the advent of magnetic resonance imaging, brain lesions associated with Japanese encephalitis are increasingly being recognized and correlated with movement disorder. Bilateral haemorrhagic thalamic infarcts on MRI, suggested as a characteristic finding in Japanese encephalitis were conspicuous by their absence in this case report of Japanese encephalitis.

Multicentric giant cell tumor of bone--a case report and comprehensive review of literature.

Multicentric giant cell tumor of bone is a very rare occurrence, forming less than 1% of all giant cell tumors. A new case report is presented, along with a comprehensive review of the literature.