SummaryUltrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5 ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95% CI) 0.66 (0.61-0.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).
Background: Acute pancreatitis is inflammation of the pancreas. Severe cases can lead to multi-organ dysfunction. So accurate prediction of severity is of great importance to improve survival. For the prediction of severity, there are several criteria. In this study, we have compared clinical criteria and imaging criteria to detect the severity of acute pancreatitis. In clinical criteria, we have taken Ranson criteria and BISAP(Bedside Index for Severity of Acute Pancreatitis) score. In imaging, we have taken MCTSI(Modified Computed Tomography Severity Index). Method: 50 patients (45 males & 05 females) in the age group of 15-65 years with a diagnosis of acute pancreatitis, admitted to a tertiary government hospital from July 2017 to June 2019 were included. BISAP score, Ranson criteria, and MCTSI were calculated for all the cases. Then Ranson and BISAP criteria were compared with MCTSI, deciding optimum cut-offs for these scorings, by obtaining the area under the curve analysis. Results: As per Atlanta classification, 31 cases were mild, 8 cases categorized as severe and 11 were grouped as moderately severe acute pancreatitis. Out of 50 cases, Pancreatic necrosis was found in 13 cases. Similarly, 15 patients landed in organ failure. The AUC for MCTSI was found to be consistently higher for predicting severe acute pancreatitis (0.958), pancreatic necrosis (0.942), organ failure (0.941) than Ranson criteria and BISAP criteria. The AUC for Ranson and BISAP criteria in predicting severe acute pancreatitis was 0.904 and 0.874, predicting pancreatic necrosis was 0.876 and 0.896 & in predicting organ failure was 0.881 and 0.880 respectively. Conclusion: MCTSI is more effective in detecting severe acute pancreatitis, organ failure, and pancreatic necrosis. So, the CECT scan is a better and simpler tool to detect the severity objectively for acute pancreatitis.
BACKGROUNDDuodenal ulcer perforations are a common surgical emergency. In spite of modern progress in surgical, anaesthetic and management, it is still a life-threatening catastrophe. Due to friable margins and the morbid state of the patient, managing giant duodenal perforation is a challenging task. MATERIALS AND METHODSThe case of 244 patients who underwent emergency laparotomy for duodenal ulcer perforations over a period of two years (2015-2016) were studied and sorted into groups based on the size of the perforations -one group was defined as 'small' perforations (less than 1 cm in diameter), another 'large' (when the perforation was more than 1 cm, but less than 3 cm), and the third, 'giant' (when the perforation exceeded 3 cm). These groups of patients were then compared with each other in regard to the patient particulars, duration of symptoms, surgery performed and the outcome. RESULTSOf the total of 244 patients, there were 178 cases who came under the 'small' perforation. There were 48 patients with large perforation and 18 patients with giant perforations. These patients had a significantly higher incidence of leak, morbidity and mortality when compared to those with small and large perforations. CONCLUSIONThere are three distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first are the 'small' perforations that are easy to manage and have low morbidity and mortality. The second are the 'large' perforations that are also not uncommon and omental patch closure gives the best results even in this subset of patients. The word 'giant' should be reserved for perforations that exceed 3 cm in diameter and these are uncommon.
BACKGROUND Rectal prolapse is a condition affecting the patient's personal and social life making them grossly disabled. From time since the disease was diagnosed, many procedures have been advocated in the past for treating rectal prolapse yet the best method is still debatable. So the purpose of our study is to compare the outcomes of two commonly performed procedures i.e. the modified Thiersch and abdominal rectopexy for complete rectal prolapse among the patients admitted to MKCG Medical College, Berhampur. MATERIALS AND METHODS Fifty patients with complete rectal prolapse were studied among which 25 patients underwent abdominal rectopexy using Prolene mesh and 25 patients underwent modified Thiersch repair using a Prolene mesh. It is a prospective study conducted from June 2015 to June 2017. They were followed up for a mean period of 7 months. All cases were analysed for postoperative complications like haemorrhage, wound infection, constipation, bladder and erectile dysfunction. During the followup period, recurrence rate, bowel frequency changes and restoration or deterioration in continence were taken into consideration. RESULTS The study group included patients from 17 to 88 years, most of them belonged to the age group of 61-70 (28%). Majority of them were male patients 42 (84%) and 8 (16%) were female patients. The patients who underwent abdominal rectopexy had less morbidity, only 1 (4%) patient had constipation and others had improved functional results with a bowel frequency of 1-2/day in 24 (96%) of the patients compared to the modified Thiersch repair where only 11 (44%) patients had an improved bowel frequency, also 8 (32%) had wound infection, 6 (24%) had incontinence, 3 (12%) had constipation, 2 (8%) had bladder dysfunction, 2 (8%) had haemorrhage. CONCLUSION Abdominal rectopexy is a better option than the modified Thiersch repair for complete rectal prolapse in patients who are fit to undergo an abdominal procedure.
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