Introduction: The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications. Methods: Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available. Results: In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks. Conclusions: The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures. Keywords: distal tibia fracture; limited open reduction; percutaneous plate osteosynthesis.
Background: Since the introduction of laparoscopic cholecystectomy in 1987 by Philips Mouret its popularity has increased tremendously and very rapidly because of its several advantages. But reports of randomized large control seriesare not yet available so we plan to report our experience of 5000 cases of single incision laparoscopic cholecystectomies and their anesthetic management. Objective: The purpose of this retrospective study was to evaluate the general anesthetic technique for laparoscopic cholecystectomy keeping in mind the pathophysiological effect of laparoscopy, head up position and pneumoperitoneum. Methods: A retrospective study of 5000 cases of symptomatic gall bladder disease that underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Nepal from Jan 2010-Dec 2015 was done. Detail pre-anesthetic check up, investigation, preparation and anesthetic techniques were carried out as per hospital protocol. Strict vigil was made to maintain the vital parameters within normal limit particularly ETCO2 below 35 mmHg. All efforts were made to keep ETCO2 below 35mHg. At the end of surgery residual neuromuscular blockade was reversed with neostigmine and glycopyrrolate, before they were transferred to PACU. Results: The mean age of the patients was 48 years with a male:female of 1:2.26. 28.64 % of patients belonged to ASA III. More than 95 % patients maintained SPO2 between 98-100% and 91% maintained their ETCO2 below or around 35 mmHg. Intra-operative surgical and anesthetic complications were controlled with proper therapies. There was no intra-operative death. Conclusion: Single incision laparoscopic Cholecystectomy (SILC) is a safe, cost effective ideal for day care surgery and general anesthesia with controlled mechanical ventilation with oxygen, air, fentanyl, isoflurane, midazolam and vecuronium/atracurium is good choice.
Background Percutaneous Nephrolithotomy, widely used procedure by urologists for removing renal stones nowadays. Generally, it is preferred in general anesthesia but here in our study we have compared it with spinal anesthesia to know its safety and efficacy.Material and Methods Sixty patients of either sex, aged between 20-60 years, ASA – Grade I and II, with stones size larger than 15 mm posted for Percutaneous Nephrolithotomy were randomly selected. Patient was divided in two groups 30 each, Spinal Anesthesia (S) and General Anesthesia (G). Patient’s stones sizes, numbers & location, Anesthesia duration, Surgical duration, Recovery duration, Blood loss and Blood transfusion, Analgesic demand, post-operative Nausea & Vomiting, Patient satisfaction, Hospital stays and Heart Rate and Mean arterial pressure between two groups were compared.Results There was no significant difference in terms of mean age, weight, stones sizes, and numbers and its location. The p value for Anesthesia duration and surgical duration were 0.144 and 0.22 which was insignificant. Recovery duration (p-value 0.007), Blood loss (p-value 0.004) were significantly lesser in spinal anesthesia group. There was no significant difference in nausea and vomiting, patient satisfaction when compared between two groups. But Analgesic demand, Blood Transfusion and Hospital stays significantly found to be decreased in spinal anesthesia groups (p<0.05). The mean of MAP showed no significant difference except in 10 and 20 minutes.Conclusion Spinal anesthesia tends to be as effective as general anesthesia for PCNL and beneficial in terms of recovery duration, blood loss, analgesic demands, hospital stays, hence decrease the cost of patient. Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, Page: 37-42
Orthopaedic surgeons and the surgical team not only face health hazards faced by most of the physicians in any medical field but also hazards specific to the practice of orthopaedic surgery. Common health hazards are related to radiation, infections, surgical smoke, noise, chemicals, physical and it may be psychological. The aim of this article is to review the hazards and raise the awareness for the safety of orthopaedic surgeon and the surgical team as well as patient and newly introduced surgical team member in Operation Theater.
Results: PostCA19-9 were measured within 3 months after surgery (20-88 days, median; 43 days). Group C patients showed significantly poorer survival (group A/B/C; 3-year OS 61.9% /53.4% /12.4%; median survival time 44.2m /37.3m/ 13.6m; p< 0.001). The early recurrence rate within 6 month (p< 0.001) and the frequency of liver metastasis (p=0.009) were significantly higher in Group C. Multivariate analysis revealed that without adjuvant chemotherapy (HR=3.29; p< 0.001), preoperative-CT tumor size>20mm (HR=2.76; p< 0.001) and sustained elevation of postCA19-9 (HR=2.49; p=0.0017) were the independent significant prognostic factors for poor survival. The ROC curve analysis revealed that the optimal cut-off value of preCA19-9 which predict postCA19-9 normalization was 116 U/ml. Conclusion: Sustained elevation of postCA19-9 is a strong prognostic factor for R-PDAC. Patients with preCA19-9>120 could be considered the existence of potential distant metastasis (especially liver metastasis).
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