Background:Distal end of radius is third most common site for GCT of long bones and 1% of these metastasize mostly to lungs. Reconstruction methods commonly used are fibula (vascularized and nonvascularized), centralization of ulna, translocation of ulna, and endoprosthetic replacement. We report the outcome of series of twenty cases where we did en bloc excision of tumor with translocation of ulna.Materials and Methods:Twenty cases of giant cell tumor (GCT) of lower end of radius were included in this retrospective study. The mean age of patients was 33.15 years (range 21-55 years). We had 14 of Campanacci Grade III and 6 of Grade II. Preoperative radiographs and magnetic resonance imaging of the involved wrist and forearm were done.Results:Of all twenty patients, 14 were males and 6 were females. Mean followup duration was 3.9 years (range 1.5–17 years). Mean grip strength of involved side as a percentage of normal side was 71% (range 42%–86%) and the actual mean value for operated side was 29 kg as compared to 40 kg for normal side. The average range of forearm movement was supination 80.25° (60°–90°) and pronation 77.5° (70°–90°). No patient was dissatisfied as far as cosmesis was concerned.Discussion:In our opinion considering the propensity to recur with more aggressiveness after recurrence, en bloc excision with translocation of ulna has become a standard treatment option for GCT of lower end of radius, with advantages of better functional outcomes, retained vascularity, and elimination of risk of donor site morbidity.
Background: Emergence from general anesthesia and tracheal extubation may be associated with tremendous physiological and metabolic stress in patients which could be major concern for the anesthesiologist in patients especially with neurosurgical patients.
Aims and Objectives: The study was designed to find a novel method to achieving a smooth extubation in neurosurgery by compare the respiratory complications and hemodynamic stress response between conventional awake extubation of an endotracheal tube (ETT) and that following exchange extubation of ETT using a laryngeal mask airway (LMA) in craniotomy surgeries.
Materials and Methods: A total of 60 patients of American Society of Anesthesiologists physical status I and II between ages 18 and 60 years undergoing neurosurgery were evaluated for respiratory events such as bucking, coughing, desaturation, and hemodynamic changes due to sympathetic stimulation such as tachycardia, hypertension, and any other complications that have occurred in any of the two extubation methods.
Results: In Group A, 86.67% patients have shown significant events of bucking and coughing while desaturation events were comparable between two groups. Manipulation events, that is, chin lift and jaw thrust had to perform in 66.67% and 21.67%, respectively, in patients of Group A compared to only 03.33% patients in Group L. (P<0.05). In Group A, 97.33% patients shown tachycardia compared to 30% in Group L where only 30%. Similarly, mean arterial pressure after extubation found to be significantly high in 63.33% of the patients in Group A with 63.33% as compared to13.33% of patients in Group L (P<0.05).
Conclusion: ETT/LMA exchange is the most effective technique for achieving the clinical endpoints of the study, that is, prevention of emergence hypertension and respiratory complications compared to awake extubation methods. The exchange of ETT with LMA in deeper plane of anesthesia significantly reduces emergence related the hemodynamic and respiratory unwonted events.
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