Quiste cervical del conducto torácico: reporte de un caso y revisión de la literatura

El quiste del conducto torácico en su porción cervical es una patología infrecuente con escasos casos reportados en la literatura mundial. Habitualmente, se presenta como un aumento de volumen blando e indoloro en la fosa supraclavicular izquierda, el cual puede generar sintomatología compresiva variable de las estructuras adyacentes. Presentamos el caso de una mujer de 76 años remitida a la consulta de otorrinolaringología por evidencia de una lesión quística en la fosa supraclavicular izquierda con estudio posterior concordante con quiste cervical del conducto torácico.

The cervical thoracic duct cyst is an infrequent entity, with only a few cases reported in the international literature. It usually presents as a painless swelling on the left supraclavicular fossa, that can generate symptoms due to compression of adjacent structures. We present the case of a 76-year-old women that was referred to otolaryngology due to a supraclavicular cyst, with subsequent diagnosis of cervical thoracic duct cyst.

Hidatidosis subcutánea primaria / Primary subcutaneous hydatid disease: a case report

La hidatidosis o equinococosis quística es una zoonosis parasitaria endémica causada por el estadio larvario del cestode Echinococcus granulosus. El hígado y el pulmón son los órganos con afección más frecuente. Su ubicación subcutánea es una entidad rara, poco descrita, y por ende un reto diagnóstico. Describimos el caso de una mujer, de 18 años de edad, procedente de un área endémica, que presentó un quiste hidatídico primario supraclavicular.

Hydatid disease or cystic echinococcosis is an endemic parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus, the liver and lung being the most frequently affected organs. Its subcutaneous location is a rare entity, little described, and therefore a diagnostic challenge. We describe the case of an 18-year-old woman from an endemic area who presented with a primary supraclavicular hydatid cyst.

Colgajo supraclavicular, revisión de la literatura y serie de casos / Supraclavicular flap, literature review and case series

Los procedimientos reconstructivos en cabeza y cuello son todo un desafío debido a que son áreas expuestas, con gran movimiento, y desempeñan funciones esenciales de la vida como el habla, la alimentación y la respiración. El colgajo supraclavicular es un colgajo locorregional, fasciocutáneo, fino, axial a la arteria supraclavicular, versátil, con baja morbilidad, que se usa ampliamente para cubrir defectos en cuello y sector inferior de la cara ya que proporciona tejido similar al de estas regiones, y técnicamente rápido y sencillo.Se puede usar en asociación con otros colgajos para reconstrucciones complejas. Es un colgajo infrautilizado que es una buena alternativa frente a los colgajos tradicionales musculares regionales y libres. Las principales indicaciones son secuelas de quemaduras como las contracturas esternomentonianas, defectos oncológicos ya sea piel o mucosa oral, faringostomas y fístulas traqueocutáneas. Se mencionan 3 casos clínicos en los cuales se llevó a cabo un colgajo supraclavicular en el Hospital Pasteur, Montevideo, Uruguay.

Reconstructive head and neck procedures are challenging because they are exposed areas, are highly mobile, and perform essential life functions such as speaking, eating, and breathing. The supraclavicular flap is a locoregional, fasciocutaneous, thin flap, axial to the supraclavicular artery, versatile, with low morbidity, which is widely used to cover defects in the neck and lower face since it provides tissue similar to that of these regions, and Technically fast and simple. It can be used in association with other flaps for complex reconstructions. It is an underutilized flap that is a good alternative to traditional regional and free muscle flaps. The main indications are sequelae of burns such as sternomental contractures, oncological defects in the skin or oral mucosa, pharyngostomies and tracheocutaneous fistulas. Three clinical cases are mentioned in which a supraclavicular flap was performed at the Pasteur Hospital, Montevideo, Uruguay

Role of brown adipose tissue in phlegm-dampness metabolic syndrome based on infrared thermal imaging / 中国中药杂志

This study aimed to explore the infrared manifestation and role of brown adipose tissue(BAT) in phlegm-dampness me-tabolic syndrome(MS), and to provide objective basis for clinical diagnosis and treatment of phlegm-dampness MS. Subjects were selected from the department of endocrinology and ward in the South District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences from August 2021 to April 2022, including 20 in healthy control group, 40 in non phlegm-dampness MS group and 40 in phlegm-dampness MS group. General information, height and weight of the subjects were collected and body mass index(BMI) was calculated. Waist circumference(WC), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was measured. Triglyceride(TG), high density lipoprotein cholesterol(HDL-C), fasting blood glucose(FBG), fasting insulin(FINS), leptin(LP), adiponectin(ADP) and fibroblast growth factor-21(FGF-21) were detected. The infrared thermal image of the supraclavicular region(SCR) of the subjects before and after cold stimulation test was collected by infrared thermal imager and the changes of infrared thermal image in the three groups were observed. In addition, the differences in the average body surface temperature of SCR among the three groups were compared, and the changes of BAT in SCR were analyzed. The results showed compared with the conditions in healthy control group, the levels of WC, SBP, DBP, TG and FPG in MS groups were increased(P<0.01), and the HDL-C level was decreased(P<0.01). Compared with non phlegm-dampness MS group, phlegm-dampness MS group had higher conversion score of phlegm dampness physique(P<0.01). According to the infrared heat map, there was no difference in the average body surface temperature of SCR among the three groups before cold stimulation. while after cold stimulation, the average body surface temperature of SCR in MS groups was lower than that in healthy control group(P<0.05). After cold stimulation, the maximum temperature of SCR and its arrival time in the three groups were as follows: healthy control group(3 min)>non phlegm-dampness MS group(4 min)>phlegm-dampness MS group(5 min). The thermal deviation of SCR was increased and the average body surface temperature of left and right sides were higher(P<0.01) in healthy control group and non phlegm-dampness MS group, while the thermal deviation of SCR did not change significantly in the phlegm-dampness MS group. Compared with that in healthy control group, the elevated temperature between left and right sides was lower(P<0.01, P<0.05), and compared with that in non phlegm-dampness MS group, the elevated temperature of left side was lower(P<0.05). The changes of the average body surface temperature of SCR in the three groups were in the order of healthy control group>non phlegm-dampness MS group>phlegm-dampness MS group. Compared with the conditions in healthy control group and non phlegm-dampness MS group, FINS, BMI and FGF-21 levels were increased(P<0.01,P<0.05), while ADP level was decreased(P<0.01, P<0.05) in phlegm-dampness MS group. Moreover, the LP level in phlegm-dampness MS group was higher than that in non phlegm-dampness MS group(P<0.01). It was observed in clinical trials that after cold stimulation, the average body surface temperature of SCR in MS patients was lower than that of the healthy people; the thermal deviation of SCR did not change significantly in the phlegm-dampness MS patients, and the difference in their elevated temperature was lower than that in the other two groups. These characteristics provided objective basis for clinical diagnosis and treatment of phlegm-dampness MS. With abnormal BAT related indicators, it was inferred that the content or activity of BAT in SCR of phlegm-dampness MS patients were reduced. There was a high correlation between BAT and phlegm-dampness MS, and thus BAT might become an important potential target for the intervention in phlegm-dampness MS.

Clinical analysis of diversity of defect repair with supraclavicular island flap after head and neck tumor surgery / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery. Methods:A retrospective analysis was performed on 30 patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2023. The sites and types of defects, intraoperative blood loss, time of flaps preparation, areas of flaps, survival of the flaps and other complications were recorded. Results:A total of 30 patients were enrolled, including 26 males and 4 females, aged 36-82 years. Among them, 22 patients with hypopharyngeal partial defect were repaired （19 patients with ipsilateral defect and 3 patients with contralateral defect）. In addition, 2 patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx, the neck skin defect was repaired in 2 patients, the parotid skin defect was repaired in 2 patients, the temporal bone skin defect was repaired in 1 patient, and the cervical esophageal defect was repaired in 1 patient. The average blood loss during the operation was 8 ml, and the average time was 32 min. The flap areas ranged from 5.0 cm×4.0 cm to 20.0 cm×8.0 cm. 27 of 30 flaps survived（90.0%）, and pharyngeal fistula occurred in 6 patients after operation（4 flaps survived after local dressing）. One patient was complicated with venous thrombosis（the flap necrosis after local dressing）. Shoulder and neck functions（lift, internal rotation and abduction） were not significantly affected in 29 patients, and the function of 1 patient with shoulder infection was not affected after treatment. Conclusion:Supraclavicular island flap is a highly vascularized axial fascial flap. It is easy to make, thin, and soft in texture, and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate. Good results in post-operative repair of head and neck tumors are worth promoting.

Advances in treatment of lymphedema with supraclavicular vascularized lymph node transfer / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of supraclavicular vascularized lymph node transfer (VLNT).@*METHODS@#The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized.@*RESULTS@#The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction.@*CONCLUSION@#There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.

TO STUDY THE EFFECT OF DEXAMETHASONE AS AN ADJUVANT TO LOCAL ANAESTHETICS IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

BackgroundThere is an increase in use of regional anaesthetic techniques in various surgeries.Steroids have anti inflammatory and analgesic properties. Hence , we decided to study the efficacy ofdexamethasone as an adjuvant to local anaesthetic agents in supraclavicular brachial plexus block vialandmark approach for upper limb orthopaedic surgeries.Materials and MethodsAfter ethical clearance, and informed written consent, this prospective randomised controlled clinical studywas carried out in 50 patients, aged 18-50 years, ASA grade I or II, scheduled for elective or emergencyorthopaedic upper limb surgeries.Patients were randomly divided into two groups,Group A- received Inj. Bupivacaine 0.5% 10 ml, Inj. Lignocaine + Adrenaline (1.5%) 20 ml and Inj..Normal saline (0.9%) 2 mlGroup B- received Inj. Bupivacaine 0.5% 10 ml, Inj. Lignocaine + Adrenaline (1.5%) 20 ml and Inj.Dexamethasone (8 mg) 2 mlAfter confirming complete motor and sensory blockade, surgery was commenced.VAS score was recorded for 18 hours postoperatively where 0 equals no pain and 10 as worst possible pain.Results-● The onset of sensory and motor block was significantly faster in patients who receivedcombination of local anaesthetic and dexamethasone.● The duration of motor and sensory block in dexamethasone group was significantly higher thancontrol group.● There was no significant difference in the hemodynamics found between the two groupsperioperatively.● The duration of post operative analgesia was prolonged in dexamethasone group as compared tocontrol group.● Postoperatively, no complications were observed in any group.ConclusionThe addition of dexamethasone to local anaesthetics in supraclavicular approach of brachial plexus blockproduces adequate anaesthesia with following advantage.• Dexamethasone hastens the time of onset of sensory and motor blockade.• It prolongs the duration of sensory and motor blockade.• It prolongs the duration of postoperative analgesia.• Dexamethasone provides stable haemodynamics without any unwanted side effects in perioperative

Comparison Of Magnesium Sulphate With Dexamethasone As Adjuvant To Local Anaesthetics For Supraclavicular Brachial Plexus Block

Background:Background and objectives: Brachial plexus block is routinely performed method of regional nerve block. Different adjuvantshave been used to hasten the onset and prolong the duration of peripheral nerve blocks. In this study we compared dexamethasone and magnesium sulphate as an adjuvant to combination of bupivacaine and lignocaine in supraclavicular brachial plexus block with regards to comparison of time required for onset and duration of sensory and motor block, duration of post-operative analgesia and requirement of rescue analgesics in first 24 hours postoperatively. Material And Methods:This prospective, observational, comparative study was performed on 60 patients of ASA class I, II and III in the age group of 18 to 70 years, weighing 40 to 70 kilogram and undergoing lower arm, elbow, forearm and hand surgeriesdivided in to 2 equal groups D and M. Group D received dexamethasone 8mg and group M received magnesium sulphate 500mg along with bupivacaine(0.5%) and lignocaine(2%).Result:Onest of sensory and motor blockade was significantly faster in group D compared to group M (p-0.001, p<0.001 respectively). Duration of sensory and motor blockade and duration of postoperative analgesia was prolonged in group D compared to group M (p-0.008, p-0.034).Conclusion:Addition of dexamethasone or magnesium sulphate as adjuvant in supraclavicular block prolongs postoperative analgesia. Dexamethasone provided quicker onset and longer duration of analgesia with lesser consumption of rescue analgesic in comparison to magnesium sulphate.

Comparison Between Dexamethasone and Fentanyl as an Adjuvant to Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Objective: To compare the effects of dexamethasone and fentanyl when added to a mixture of bupivacaine and lignocaine in supraclavicular blocks in patients undergoing forearm surgeries. Methods: Sixty-six patients aged between 20 to 60 years old belonging to ASA one or two were recruited prospectively, double-blinded, and randomized way. Supraclavicular block under sonographic guidance was performed in the three groups by using injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection 0.9% normal saline; 2ml (Group S), injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection dexamethasone 8 mg (Group D), and injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection fentanyl 50 µgm (Group F). The onset time of sensory and motor block, duration of sensory and motor block, and hemodynamic variables were recorded. Results: Group D showed a significantly greater sensory and motor block duration than other groups (P = 0.001). Comparison of hemodynamic variables failed to reveal any statistically significant differences between all the groups. Conclusion: Both dexamethasone and fentanyl are good adjuvants in the supraclavicular block, but dexamethasone is better, given faster onset and duration of analgesia.

Construction of a nomogram prediction model for pathological complete response (pCR) of ipsilateral supraclavicular lymph node after neoadjuvant chemotherapy for breast cancer with first diagnosis of ipsilateral supraclavicular lymph node metastasis / 中华肿瘤杂志

Objective: To develop a predictive model for pathologic complete response (pCR) of ipsilateral supraclavicular lymph nodes (ISLN) after neoadjuvant chemotherapy for breast cancer and guide the local treatment. Methods: Two hundred and eleven consecutive breast cancer patients with first diagnosis of ipsilateral supraclavicular lymph node metastasis who underwent ipsilateral supraclavicular lymph node dissection and treated in the Breast Department of Henan Cancer Hospital from September 2012 to May 2019 were included. One hundred and forty two cases were divided into the training set while other 69 cases into the validation set. The factors affecting ipsilateral supraclavicular lymph node pCR (ispCR)of breast cancer after neoadjuvant chemotherapy were analyzed by univariate and multivariate logistic regression analyses, and a nomogram prediction model of ispCR was established. Internal and external validation evaluation of the nomogram prediction model were conducted by receiver operating characteristic (ROC) curve analysis and plotting calibration curves. Results: Univariate logistic regression analysis showed that Ki-67 index, number of axillary lymph node metastases, breast pCR, axillary pCR, and ISLN size after neoadjuvant chemotherapy were associated with ispCR of breast cancerafter neoadjuvant chemotherapy (P<0.05). Multivariate logistic regression analysis showed that the number of axillary lymph node metastases (OR=5.035, 95%CI: 1.722-14.721, P=0.003), breast pCR (OR=4.662, 95%CI: 1.456-14.922, P=0.010) and ISLN size after neoadjuvant chemotherapy (OR=4.231, 95%CI: 1.194-14.985, P=0.025) were independent predictors of ispCR of breast cancer after neoadjuvant chemotherapy. A nomogram prediction model of ispCR of breast cancer after neoadjuvant chemotherapy was constructed using five factors: number of axillary lymph node metastases, Ki-67 index, breast pCR, axillary pCR and size of ISLN after neoadjuvant chemotherapy. The areas under the ROC curve for the nomogram prediction model in the training and validation sets were 0.855 and 0.838, respectively, and the difference was not statistically significant (P=0.755). The 3-year disease-free survival rates of patients in the ispCR and non-ispCR groups after neoadjuvant chemotherapy were 64.3% and 54.8%, respectively, with statistically significant differences (P=0.024), the 3-year overall survival rates were 83.8% and 70.2%, respectively, without statistically significant difference (P=0.087). Conclusions: Disease free survival is significantly improved in breast cancer patients with ispCR after neoadjuvant chemotherapy. The constructed nomogram prediction model of ispCR of breast cancer patients after neoadjuvant chemotherapy is well fitted. Application of this prediction model can assist the development of local management strategies for the ipsilateral supraclavicular region after neoadjuvant chemotherapy and predict the long-term prognosis of breast cancer patients.

Comparison of setup errors in supraclavicular regions of lung and esophageal cancer treated with radiotherapy / 中华放射肿瘤学杂志

Objective:To compare the setup errors in the supraclavicular regions of two different postures (arms placed on each side of the body, namely the body side group; arms crossed and elbows placed above forehead, namely the uplifted group) using the chest and abdomen flat frame fixation device in lung and esophageal cancer.Methods:Clinical data of patients with stage Ⅰ to Ⅳ lung or esophageal cancer who received three-dimensional radiotherapy with chest and abdomen flat frame fixation device in our institution from November 2020 to April 2021 were retrospectively analyzed. The setup errors of two postures were compared.Results:A total of 56 patients were included, including 31 patients (55%) in the body side group and 25 patients (45%) in the uplifted group. A total of 424 CBCTs were performed in the whole group. The overall setup errors in the X, Y and Z directions were similar in both groups ( P>0.05). The setup errors of sternoclavicular joint in the X and RZ directions in the body side group were significantly smaller than those in the uplifted group [(0.163±0.120) cm vs. (0.209 ±0.152) cm, P=0.033; 0.715°±0.628° vs. 0.910°±0.753°, P=0.011]. The setup errors of acromioclavicular joint in the Y, Z and RZ directions in the body side group were significantly smaller than those in the uplifted group [(0.233±0.135) cm vs. (0.284±0.193) cm, P=0.033; (0.202±0.140) cm vs. (0.252±0.173) cm, P=0.005; 0.671°±0.639° vs. 0.885°±0.822°, P=0.023]. The margins of target volume for setup errors were smaller in the X (0.45 cm vs. 0.54 cm) and Y (0.54 cm vs. 0.65 cm) directions of the sternoclavicular joint, as well as in the Y (0.59 cm vs. 0.78 cm) and Z directions (0.53 cm vs. 0.72 cm) of the acromioclavicular joint in the body side group. Conclusions:For lung and esophageal cancer patients requiring supraclavicular irradiation, the body side group yields smaller setup errors and corresponding margins of target volume than the uplifted group. In clinical practice, it is necessary to take comprehensive consideration of the accuracy of radiotherapy and additional radiation of the limbs to select appropriate posture.

Accuracy of sonographic identification of suprascapular nerve at supraclavicular fossa: a cadaveric study / Precisión de la identificación ecográfica del nervio supraescapular en la fosa supraclavicular: un estudio cadavérico

SUMMARY: Sonographic identification of suprascapular nerve (SSN) is essential for diagnosis of suprascapular neuropathy and ultrasound-guided suprascapular nerve block. This study aims to demonstrate the accuracy of identification of SSN at supraclavicular region by ultrasonography in fresh cadavers. Ninety-three posterior cervical triangles were examined. With ultrasonography, SSN emerging from the upper trunk of brachial plexus was identified and followed until it passed underneath the inferior belly of omohyoid muscle. Sonographic visualization of SSN in supraclavicular fossa was recorded. Then, cadaveric dissection was performed to determine the presence or absence of SSN. An agreement between sonographic identification and direct visualization was specified and categorized the following three patterns: "correctly identified" (pattern I), "incorrectly identified" (pattern II), and "unidentified" (pattern III). The identification of SSN using sonography was correct in almost 90 %. The diameter of SSN with pattern I was the largest compared to those of other two patterns. In pattern I, SSN ran laterally from the upper trunk of brachial plexus and passed underneath the inferior belly of omohyoid muscle. Therefore, SSN was easily identified under ultrasonography. In pattern II, nerve identified by ultrasonography was literally the dorsal scapular nerve. In pattern III, SSN was unable to be identified because of its anatomical variation. The accuracy of ultrasonographic identification of SSN at supraclavicular fossa is high and the key sonoanatomical landmarks are the lateral margin of brachial plexus and the inferior belly of omohyoid muscle. The anatomical variants of SSN are reasons of incorrect or unable identification of SSN under ultrasonography.

RESUMEN: La identificación ecográfica del nervio supraescapular (NSE) es esencial para el diagnóstico de neuropatía supraescapular y bloqueo del nervio supraescapular mediante la ecografía. Este estudio tiene como objetivo demostrar la precisión de la identificación de NSE en la región supraclavicular por ecografía en cadáveres frescos. Se examinaron noventa y tres triángulos cervicales posteriores. Se identificó el NSE emergente de la parte superior del tronco del plexo braquial con la ecografía, y se siguió hasta su trayecto por debajo del vientre inferior del músculo omohioideo. Se registró la visualización ecográfica del NSE en la fosa supraclavicular. Luego, se realizó disección cadavérica para determinar la presencia o ausencia de NSE. Se especificó un acuerdo entre la identificación ecográfica y la visualización directa y se categorizaron los siguientes tres patrones: "identificado correctamente" (patrón I), "identificado incorrectamente" (patrón II) y "no identificado" (patrón III). La identificación de NSE mediante ecografía fue correcta en casi el 90 %. El diámetro del NSE con el patrón I fue el más grande en comparación con los de los otros dos patrones. En el patrón I, NSE corría lateralmente desde la parte superior del tronco del plexo braquial y pasaba por debajo del vientre inferior del músculo omohioideo. Por lo tanto, el NSE se identificó fácilmente mediante ecografía. En el patrón II, el nervio identificado por ecografía era literalmente el nervio escapular dorsal; en el patrón III, el NSE no pudo ser identificado debido a su variación anatómica. La precisión de la identificación ecográfica del NSE en la fosa supraclavicular es alta y los puntos de referencia sonoanatómicos clave son el borde lateral del plexo braquial y el vientre inferior del músculo omohioideo. Las variantes anatómicas de NSE son razones de identificación incorrecta o incapaz de NSE bajo ecografía.

Procedure and teaching verses of supraclavicular subclavian catheterization / 中华危重病急救医学

In order to improve the success rate of supraclavicular deep venous catheterization and reduce mechanical complications, we present an auxillary maneuver in regard to supraclavicular subclavian catheterization basing on the relatively fixed anatomy of subclavian vein and its adjacent surroundings, furthermore, we revised the standardized procedure of supraclavicular subclavian catheterization. The maneuver is summarized in the shape of verses (verses: thumb navigation is well designed according to anatomy. Needle penetrated into vein should be parallel to coronal plane. Fine needle in position should be immobilized. Is it difficult for parallel puncture? Pressure determination is required when needle is in place. It is critical to distinguish which vessel has been inserted. Guidewire is advanced smoothly. Check blood return after expansion of skin and catheterization.). For teaching convenience, verses are considered to be more concise and memorable, as well as applicable to clinical practice, in order to provide some help for clinical teaching.

Supraclavicular artery flaps for head and neck reconstruction: a prospective study

Reconstruction of defects of the head and neck remains a challenge to the reconstructive surgeon. This is due to the complex anatomy of the region as well as the age and comorbidities of the patients, which prevent the use of free tissue transfer as the primary tool of reconstruction. The supraclavicular artery (SCA) island flap is a well vascularised tissue and provides a thin and pliable skin for cutaneous and mucosal defects of the head and neck region. Here, we had done this flap for eight patients with no major complications and hence, we concur that it is a safe, reliable and versatile reconstructive option for these defects. The study period was from January 2015 to June 2016 where we operated on 8 patients, 5 for post burn contracture neck and 3 for post oncologic resection. The flap was used as a pedicled fascio-cutaneous and was based on the transverse supraclavicular artery. Eight cases underwent supraclavicular artery flap of which 5 were males and 3 females. Mean defect size was 15×10 cm. All the donor sites were closed with a split skin graft. One patient had distal necrosis which was managed with debridement and secondary suturing. The supraclavicular artery flap is a thin, versatile, reliable and easy to harvest flap for reconstructing head and neck defects, with good cosmetic and functional outcome.

Comparative Study between the Effect of Perineural versus Intravascular Dexmedetomidine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background:Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block.Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20ml) in supraclavicular BPB; group I (Control group): add 1mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μg.kg 1dexmedetomidine perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μg.kg-1 dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min.Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed.Results:Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II.Conclusion:Perineural dexmedetomidine (1 μg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 μg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia

Comparison between Supraclavicular and Infraclavicular Brachial Plexus Block in Patients Undergoing Forearm Surgeries.

Of the various modalities of achieving surgical anaesthesia of the forearm, brachialplexus block by injecting local anaesthetic is considered highly beneficial andpractical. Supraclavicular and infra-clavicular approaches of brachial plexus blocksprovide comprehensive anaesthesia for surgeries of the forearm. The primaryoutcome measured was the comparison of two blocks with respect to sparing of anydermatome, whereas the secondary outcomes measured were block performancetime, duration of analgesia, and complications associated with each technique.METHODSSixty adult patients of either sex belonging to the American Society ofAnesthesiologists (ASA) physical status I and II in the age range of 20–70 yearsscheduled to undergo surgeries of the forearm were divided into two groups:Supraclavicular (SCB group) and Infraclavicular (ICB group) of 30 each. Both theblocks were given by 30 mL of 0.375% injection Bupivacaine using a 22G, 5 cminsulated needle and nerve locator. Both the groups were compared with respect tosparing of dermatomes, block performance time, duration of analgesia andcomplications like Horner’s syndrome, vascular puncture, and pneumothorax.Statistical analysis was performed with Student unpaired t‑test and Chi‑square testand p < 0.05 was considered to be statistically significant.RESULTSBlock performance time was similar in both the groups. Duration of analgesia wascomparable among the two groups. The incidence of incomplete radial block wassignificantly higher in ICB group as compared to SCB group (p= 0.046, S). Incidenceof Horner’s syndrome in SCB group were higher than in ICB group, but they werestatistically insignificant. (p=0.15, NS). One patient in SCB group had subclavian veinpuncture as compared to none in ICB group and was statistically insignificant.CONCLUSIONSSupraclavicular approach for brachial plexus block provides reliable andcomprehensive anaesthesia for forearm surgeries without any significantdermatomal sparing unlike infraclavicular approach. Both groups had similar blockperformance time and duration of analgesia for forearm surgeries. Even though SCBwas associated with complications like Horner’s syndrome and vascular puncture, itwas transient and statistically insignificant. Hence supraclavicular approach isconsidered to be superior to infraclavicular approach.

Efficacy of Potassium Chloride 0.2 mmol as Adjuvant to 0.5% Ropivacaine versus Plain Ropivacaine 0.5% in Supraclavicular Brachial Plexus Block

Background: Brachial plexus block is one of the most common regional anesthetic techniques used for upper limb surgeries.Various adjuvants have been tried for prolonging the duration of post-operative analgesia and also to enhance the quality ofblock. We aimed to study the effects of the addition of potassium chloride to ropivacaine in supraclavicular brachial plexusblock compared to plain ropivacaine.Materials and Methods: This prospective, randomized, double-blind, and controlled study includes 80 adult patients agedbetween 20 and 60 years with ASA Grade I and II scheduled for upper limb surgeries. These patients were randomly allocatedinto two groups of 40 each. The patients in the group I/non-KCL group received 30 ml of 0.5 % ropivacaine along with 1 mlnormal saline (control group). Group II/KCL group received 30 ml of 0.5% ropivacaine along with 0.2 mmol (0.1 ml) of potassiumchloride (prepared by adding 0.1 ml of potassium chloride diluted with normal saline to make a volume of 1 ml) (study group).The onset, duration of sensory and motor blockade, quality of sensory and motor blockade, and the duration of post-operativeanalgesia were compared between both the groups.Results: The onset of sensory and motor blockade was earlier in Group II/ study group when compared to plain ropivacainegroup/Group I and was statistically significant with a P < 0.05. The mean duration of sensory and motor blockade was prolongedin Group II with enhanced quality of analgesia compared to Group I.Conclusion: In our study, it concludes that the addition of potassium chloride as an adjuvant to ropivacaine had a significantclinical advantage over plain ropivacaine on the onset, duration, quality of sensory and motor blockade, and post-operativeanalgesia in supraclavicular brachial plexus block.

A Case of Adenocarcinoma – Primary Versus Secondary

Introduction: Adenocarcinoma is the most common form oflung cancer. It is a type of non small cell carcinoma of lung,most commonly seen in women. Adenocarcinoma occurs inmore peripheral lung location and may be associated with thehistory of smoking.Case report: A 54 year old female caretaker presented withcough with expectoration since 1 month, gradual in onset,non progressive, scanty in amount associated with decreasedappetite since 1 month and breathlessness on exertion since 1week. She had a history of exposure to tuberculosis patient andwas diagnosed with meningioma. There was history of passivesmoking. General examination showed right supraclavicularlymph node enlargement. Respiratory examination showeddecreased chest movements bilaterally along with coarsecrepitation all over lung fields along with decreased intensityof breath sounds bilaterally. Chest x-ray was suggestive ofmetastasis. HRCT chest also suggested metastasis. FNAClymph node and sputum of cytology suggestive of metastaticadenocarcinoma. USG abdomen and pelvis as well as CECTabdomen was done to rule out primary lesionConclusion: As survival rates vary significantly depending onthe type of adenocarcinoma, the survival rate after five yearsdepends on the stage of cancer. So early detection is criticalfor better outcome. The prognosis for different metastaticpattern of intrathoracic metastasis of Lung distinct in EGFRmutant lung adenocarcinoma patient. Early diagnosis andprompt initiation of treatment is key for the prognosis.

The Effect of Single Point and Two Point Technique for Ultrasound Guided Supraclavicular Brachial Plexus Block in Patients Undergoing Elbow, Forearm and Wrist Surgeries- A Prospective Observational Study

Use of ultrasound for brachial plexus block has improved the precision of drug deposition around the plexus and hence the quality of the block. But there has been debate whether single point technique or double point technique is superior. Our aim was to compare the two techniques for the onset, completeness and quality of the block.METHODSA prospective observational study was designed. 140 patients were equally divided into Group A and Group B containing 70 posted for elbow, forearm and wrist surgery. A drug solution of 30 ml was prepared using Ropivacaine 0.75% 15ml + Lignocaine 2% with adrenaline 10 ml + 5ml of normal saline. Group A received 30ml of drug at the lower end of brachial plexus at 7 O’clock position. Group B received 15 ml of drug at site mentioned above and 15 ml was given at the upper part of brachial plexus at 11 O’clock position. Parameters noted were time taken for giving block, onset and completeness of sensory and motor block, encircle time, total duration of block. Unpaired student t test used for comparing quantitative variables and Chi-square test for qualitative variables. p < 0.05 was considered statistically significant.RESULTSThe time required for giving the block was more in Group B (198.57 ±19.56 sec) compared to Group A (151.53 ± 14.37 sec) but the encircle time in Group B (16 ± 3.32 min) was lesser than Group A (19.01 ± 3.6 min). The time of onset and completion of sensory and motor block for musculocutaneous, radial, ulnar and median nerve was faster in Group B compared to Group A. Duration of block in Group A was 367 ± 50.49 minutes, whereas in group B 388 ± 49.98 minutes.CONCLUSIONSIn ultrasound guided brachial plexus block, even though both techniques have satisfactory results, double point technique is superior to single point technique in terms of onset, completeness and duration of the block but in terms of simplicity in technicality single point technique has the upper hand.

A Study of Supraclavicular Brachial Plexus Block by Paresthesia Technique Success Rate and Complications: An Hospital Based Study

Background: The advantage of regional anaesthesia overgeneral anaesthesia are many and well documented. Brachialplexus can be blocked by various methods includingparesthesia technique, nerve stimulation technique and ultrasound guided. The present study was undertaken forassessing time taken to perform block, Successful blockade,complication of supraclavicular brachial plexus block byparesthesia technique.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with aim of assessing success rateand Complications of brachial plexus block. A total of 100patients were enrolled in the present study. Ethical approvalwas obtained from institutional ethical committee and writtenconsent was obtained from all the patients after explaining indetail of the entire research process. Complete demographicdetails of all the patients were obtained. All the results wererecorded in Microsoft excel sheet and were analyzed by SPSSsoftware.Results: Mean time to perform block was 5.35 minutes andsuccesfull blockade in 92% patients, in 6% patient’s partialblockade and in 2% patient’s complete failure of block.Incidence of complications were vessels puncture 8 % patientsand pneumothorax 1% patients.Conclusion: Supraclavicular brachial plexus block byparesthesia technique is an easy and relatively safe procedurefor the upper limb surgeries below mid shaft of humerus withfew complications and provide good post-operative analgesia.