Comparative Evaluation of Efficacy of Interscalene Block vs. Interscalene Block and Superficial Cervical Plexus Block for Fixation of Clavicular Fractures

Introduction: Regional anaesthesia is seldom used forclavicle fractures considering the anatomical location of thebone. We aim to compare the efficacy of two techniques ofregional anaesthesia as sole anaesthesia technique for fixationsof clavicular fractures.Material and methods: 60 Adult patients with claviclefractures were divided randomly in two groups (1 and 2) andwere administered interscalene block (ISB) only or interscaleneblock and superficial cervical plexus block(ISB+SCPB) assole anaesthetic, respectively. Patients were monitored forefficacy of block and adequacy of anaesthesia and analgesiaat the surgical site. Side effects and hemodynamic parameterswere also monitored.Results:. ISB+SCPB provides excellent anaesthesia forclavicle fixation. Only 1 patient in group 2 required GeneralAnaesthesia(GA) whereas in Group 1, 8 patients required someform of supplemental anaesthesia. There was no statisticallysignificant difference in side-effects and hemodynamic profilein both the groups.Conclusion: ISB+SCPB is significantly better than ISB onlyfor anaesthesia for fixation of clavicular surgeries.

Consistency and percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings – A prospective study

Background: Exact surface localization of foreign body is vital prior to its surgical removal. Preoperative localization errors lead to excessive soft tissue exploration, prolonged surgery, increased morbidity and post-surgical complications. Sarkar KN, Mandal SK, Kabiraj P, Mallik R, Gupta DK, Sarkar M. Consistency and percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings - A prospective study. IAIM, 2016; 3(6): 32-41. Page 33 Aim: Determination of percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings. Materials and methods: Prospective observational study was conducted on 100 patients over duration of eight months from September 2015 to April 2016 at our institution. Preoperative surface marking of foreign body was done using Ultrasound machine PHILIPS HD7 (2.0.1) with 7 MHz linear transducer, Excel mark premium black stamp ink 2oz, Acco smooth steel wire paper clip, Trade mark 45 cm wooden measuring scale and Apsara glass marking pencil. Percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intraoperative positional findings was studied in 100 patients prospectively. All analysis was done by using IBM SSPS statistics 24 and MS Excel. Results: The color tail artifact technique showed percentage agreement of 93.5% for accurate surface marking of vertical line within ≤ 5 mm of actual location and percentage agreement of 92.5% for surface marking of horizontal line within ≤ 5 mm of actual location. Conclusions: Blind surgical procedures of foreign body removal have been replaced by real time ultrasound guided removal under strict sterile conditions in most of the affluent nations. However in developing nations and semi urban places where there is limited and underrated sterilization and disinfection technique, real time ultrasound procedures for foreign body removal remains a challenging option. This study shall suffice to the needs of developing nations and semi urban places with precise preoperative surface localization, advantages of minimal surgical exploration, minimal local tissue injury, reduced patient’s morbidity and no real time ultrasound associated nosocomial infection. The study shall also be helpful with special emphasis to those underserved villages where surgeons still rely on blind foreign body removal procedures, causing massive tissue exploration, increased hospital stay, increased cost of treatment, failure of removal and increased patients morbidity.

Pediatric carcinoma of rectum--Varanasi experience.

BACKGROUND: Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. AIM: We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. SETTINGS AND DESIGN: Tertiary care Pediatric Surgery centre. Retrospective study. MATERIALS AND METHODS: The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confirmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. RESULTS: There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. CONCLUSION: Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination.