Spontaneous pneumothorax and pneumomediastinum is an uncommon condition and its association with pneumorrhachis (air inside the spinal canal) is even more unusual. An early diagnosis is lifesaving for this potentially fatal condition. We herein present the multidetector computed tomography features of a patient with pneumorrhachis with spontaneous pneumothorax and pneumomediastinum.
There are studies that have demonstrated the role of pregabalin as a pre-emptic analgesic in the multimodal therapy for acute postoperative pain management. However, its use in more painful operative procedures like open cholecystectomy are limited and hence the present study was undertaken to evaluate the effectiveness of a single dose of preoperative oral pregabalin in attenuating the postoperative pain. In this randomized, controlled, prospective and double blind study, 80 patients (ASA I & II, aged 18-55 years and of both sexes) undergoing open cholecystectomy under GA were divided into two equal groups (n=40 each) to receive either oral pregabalin 150mg or placebo 1 hour before the surgery. Intraoperative hemodynamic variables, postoperative VAS scores, sedation scores, analgesic free time intervals, total dose of rescue analgesic, side effects etc. were recorded and compared for the first 24 hours postoperatively. VAS score distribution in the first 24 hours were significantly lower in the pregabalin group than the control group (P<0.05). The analgesia free time interval was longer and the number of rescue analgesic(inj. tramadol 50mg) was lesser in the pregabalin 150mg (P<.05). Preoperative pregabalin 150 mg administered 1 hour prior to surgery attenuates the postoperative pain thereby reducing opioid consumption. KEYWORDS:Pregabalin, open cholecystectomy, pre-emptic analgesia and postoperative pain. INTRODUCTION:Post-operative pain is the most common clinical problem in hospitals among surgical patients and is the main reason for overnight hospital stay in17-41% of surgical day care patients. 1 It has been managed with varieties of drugs and techniques such as combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDS) or paracetamol, small dose ketamine, peri-operative administration of local anesthetics, interventional techniques like epidural and nerve blocks etc. which are associated with potential risks of serious complications. Thus, with the emerging concepts of pre-emptive analgesia, a drug that has analgesic properties, opioid sparing effects, possibly reduces opioid tolerance, relieves anxiety and is not associated with adverse effects typical for the traditional analgesic would be an attractive adjuvant for post-operative pain management. 2 Pregabalin and its developmental predecessor gabalin were originally developed as spasmolytic agents and adjuncts for the management of generalized or partial epileptic seizures resistant to conventional therapies. Pregabalin, like gabapentin is an amino-acid derivative of gamma amino butyric acid. It binds to the α2-δ (type I) receptor in the central nervous system. Binding of pregabalin to the α2-δ (type I) subunit of voltage gated calcium channels alter the kinetic and voltage dependence of calcium current. By reducing calcium influx at the nerve terminal pregabalin reduces the release of several neurotransmitters including glutamate, substance-P, noradrenaline and calcitonin gene related peptide. This accounts for the analgesic activity of pre...
BACKGROUNDAs the number of surgeons performing laparoscopic cholecystectomy, a rigorous evaluation of the safety of laparoscopic cholecystectomy is warranted. It is essential to determine the extent of the difference in morbidity and mortality when compared with open cholecystectomy. Laparoscopic cholecystectomy is now the Gold standard treatment for gallstone disease. All these inventions are invented by trial and error basis, so complete study is needed to know the pros and cons of these new techniques. This study is one such effort.
BACKGROUND Posterior Urethral Valve (PUV) is the most common structural cause of urinary outflow obstruction in paediatric practice. It is also the most common type of obstructive uropathy leading to childhood renal failure. This study was carried out to evaluate the various clinical presentations, investigations, surgical management, complications and outcome of PUV in our region. MATERIALS AND METHODS For the study, a total of 45 patients who had attended the Outpatient Department of Surgery during the period from 2010 to 2016 were included. The selection of the patients was done based on clinical history, clinical examination, laboratory tests and radiological and cystoscopy examinations. Patient above 12 years of age and patient with spinal dysraphism were excluded from the study. RESULTS The commonest age group at the time of presentation is 1-< 5 yrs. comprising about 53.3% and second commonest is the group of 0-< 3 months comprising about 26.7%. In this present study obstructive symptoms, i.e. poor urinary stream and urinary dribbling and a palpable bladder are the most common mode of presentation which occur in 33 cases (73.33%) of posterior urethral valves. In 30 cases (66.67%) of posterior urethral valves blood urea levels were above normal, while serum creatinine levels had significantly raised in 36 cases (80%) at the time of admission. In this study electrolyte abnormality was observed in 30 cases (33.33%) at the time of admission, which returned to within normal range after initial resuscitation. The most common cystoscopic finding during evaluation of children are Type-I urethral valves in the posterior part of urethra with trabeculation of bladder walls. Urinary incontinence is the most common post-operative complication observed in this present study, which persists in 12 cases even at the time of discharge. CONCLUSION The potential of PUV to cause renal failure in infants and children if not treated on time should necessitate for early diagnosis and treatment of this condition. These seemingly simple but with a devastating potential should be dealt timely and properly. The need for a prolonged followup should be emphasised to the parents for a better overall outcome and to minimise long-term complications.
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