Background:Congenital talipes equinovarus is a common foot deformity afflicting children with reported incidence varying from 0.9/1000 to 7/1000 in various populations. The success reported with Ponseti method when started at an early age requires an imaging modality to quantitate the deformity. Sonography being a radiation free, easily available non-invasive imaging has been investigated for this purpose. Various studies have described the sonographic anatomy of normal neonatal foot and clubfoot and correlated the degree of severity with trends in sonographic measurements. However, none of these studies have correlated clinical, radiographic and sonographic parameters of all the component deformities in clubfoot. The present study aims to compare the radiographic and sonographic parameters in various grades of clubfoot.Materials and Methods:Thirty-one children with unilateral clubfoot were examined clinically and graded according to the Demeglio system of classification of clubfoot severity. Antero-posterior (AP) and lateral radiographs of both normal and affected feet were obtained in maximum correction and AP talo-calcaneal (T-C), AP talo-first metatarsal (TMT) and lateral T-C angles were measured. Sonographic examination was done in medial, lateral, dorsal and posterior projections of both feet in static neutral position and after Ponseti manouever in the position of maximum correctability in dynamic sonography. Normal foot was taken as control in all cases. The sonographic parameters measured were as follows : Medial malleolar- navicular distance (MMN) and medial soft tissue thickness (STT) on medial projection, calcaneo-cuboid (C-C) distance, calcaneo-cuboid (C-C) angle and maximum length of calcaneus on lateral projection, length of talus on dorsal projection; and tibiocalcaneal (T-C) distance, posterior soft tissue thickness and length of tendoachilles on posterior projection. Also, medial displacement of navicular relative to talus, mobility of talonavicular joint (medial view); reducibility of C-C mal alignment (lateral view); talonavicular relation with respect to dorsal/ ventral displacement of navicular (dorsal view) and reduction of talus within the ankle mortise (posterior view) were subjectively assessed while performing dynamic sonography. Various radiographic and sonographic parameters were correlated with clinical grades.Results:MMN distance and STT measured on medial view, C-C distance and C-C angle measured on lateral view and tibiocalcaneal distance measured on posterior view showed statistically significant difference between cases and controls. A significant correlation was evident between sonographic parameters and clinical grades of relevant components of clubfoot. All radiographic angles except AP T-C angle were significantly different between cases and controls. However, they did not show correlation with clinical degree of severity.Conclusion:All radiographic angles except AP T-C angle and sonographic parameters varied significantly between cases and controls. However, radiographic pa...
A 21-year-old male patient presented with complaints of gradually increasing swelling in the distal aspect of his left thigh posteriorly, just above the popliteal fossa. The swelling increased over a period of 3 years. He developed acute pain with swelling over the entire leg for the past three days. Lateral and frontal radiograph of the left knee joint was performed which revealed bony outgrowth with cortical and medullary continuity, projecting from posterior surface of the lower metaphysis of left femur; suggesting a classical osteochondroma [Table/ Fig-1a&b].Doppler examination was performed which revealed dilatation of the popliteal vein, with intraluminal thrombus and extension of the thrombus into the femoral vein and the peroneal vein [Table/ Fig-2].CT angiography was performed which confirmed the osteochondroma at distal metaphysis of left femur, with cortical and medullary continuity with the parent bone. The left popliteal artery was indented by the lesion and showed an area of focal narrowing with external pressure impression. The popliteal vein showed dilatation in an eccentric saccular configuration, with filling in the delayed phase suggesting true venous aneurysm. There was internal thrombosis which extended both proximally and distally 4].Excision of the osteochondroma was warranted as it was the aetiological factor. The patient was counselled for surgery and put on warfarin. However, the patient was not willing for surgery. The patient was asymptomatic at six months follow up and colour doppler was done at 6 months which showed reduction in size of the aneurysm [Table/ Fig-5]. DisCussionThe most common benign tumour of the skeleton is osteochondroma, which occurs in approximately 1% of the population with a greater male preponderance. They are located in the metaphyses, most commonly in the distal femur and develop from the cortical bone dysplasia at the epiphyseal plate [1]. They are protected by a soft cartilageous cap which undergoes ossification following skeletal maturity. These are most commonly solitary, however, multiple lesions may exist as a part of hereditary multiple exostosis [1]. They are mostly asymptomatic, however most common presentations Osteochondroma is the most common benign skeletal tumour. It frequently causes pain and local symptoms, however, vascular complications are rare. The popliteal artery is more commonly affected and there are isolated case reports of popliteal artery pseudoaneurysm in literature. However, venous complications are extremely rare. We hereby report a case of 21-year-old male patient with distal femoral osteochondroma complicated by a popliteal venous aneurysm and deep vein thrombosis. This association has not been described in the past. The patient was put on anticoagulants as he refused surgery and was asymptomatic at six months follow-up. Awareness of this complication is important for timely diagnosis and surgical management as it is a source of life threatening pulmonary thromboembolism. The popliteal venous aneurysm is seen as a non-opacified...
ECG artefacts are defined as abnormalities in the monitored ECG, which result from measurement of cardiac potentials on the body surface and are not related to the electrical activity of the heart. In the operation theatre, the use of various types of electrical equipment may interfere with ECG interpretation. We describe our experience with artefacts resembling atrial fibrillation when a nerve integrity monitoring device was used on a patient undergoing posterior fossa surgery for epidermoid tumour. These artefacts resemble serious arrhythmias and may result in unwanted interventions. To enable better identification of such artefacts, a 12-lead ECG should be considered as it will display rhythm in all the leads; while artefacts will present in only a few leads, true arrhythmia will be present in all the 12 leads. Our case report aims to increase awareness regarding ECG artefacts and to explain how to distinguish them from actual arrhythmias.
Background:Postoperative pain management by surgical site infiltration has an edge over other methods of analgesia as it is simple and has lesser side effects. This study was designed to compare the analgesic effects provided by bupivacaine, a classical long-acting local anesthetic and ropivacaine, a new amino amide local anesthetic agent.Subjects and Methods:Ninety patients scheduled for elective inguinal herniorrhaphy were randomly allocated to one of the three groups: Group I - R 0.5, group II - R 0.25, and group III - B 0.25. General anesthesia was given. The surgical site was infiltrated before incision with 20 ml of drugs - ropivacaine 0.5% in group I, ropivacaine 0.25% in group II, bupivacaine 0.25% in group III. Intraoperatively hemodynamics were recorded every 15 min until the end of surgery and at the time of skin incision, at the time of cord pulling, and at the time of skin closure. Postoperatively, rest pain, pain on coughing, and pain on movements were assessed using visual analog scale (VAS) score immediately at the end of the surgery and hourly up to 4 h. The time of the first request for rescue analgesia was noted.Results:VAS scores at rest, during coughing and movements were higher in group R 0.25 and the time of rescue analgesia was shorter with group R 0.25 when compared with other groups.Conclusion:Ropivacaine is less potent than bupivacaine at equal concentrations.
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