iosr-JDMS   Volume-12 ~ Issue-1

Abstract: Background- Supraclavicular brachial plexus block is a popular and widely employed regional nerve block technique. Aims- To evaluate the effect of dexamethasone added to bupivacaine in supraclavicular brachial plexus block. Materials and Methods- 60 adult patients of either sex, aged 18 – 60 years,ASA physical status I or II ,posted for elective orthopedic surgeries of elbow, forearm and hand under supraclavicular brachial plexus block were enrolled in the study. Patients were randomly allocated to one of the two groups - group A and group B . Group A (n=30) –received 38 mL 0.25% bupivacaine and 2 mL dexamethasone (8 mg). Group B (n=30) –received 38 mL 0.25% bupivacaine and 2 mL 0.9% normal saline. Statistics: Using software package SPSS16 for Windows statistical analysis done. Numerical variables compared by Independent samples t-test. Categorical variables compared between groups by Chi-square test. All analysis has been two tailed and p < 0.05 has been taken to be statistically significant. Results: No statistically significant difference between the groups in respect to patients' age, height, weight, duration of surgery (Independent samples t-test; p >0.05). Onset times of sensory and motor block were similar in the two groups. Duration of sensory(1091.11± 107.42 vs 605.37 ± 58.60 ) and motor blockade (846.67 ± 102.09 vs 544.07 ± 55.40 )were significantly longer in the group A (dexamethasone group) than in the group B (control group). less number of diclofenac sodium injection required in group A. Conclusion: We conclude that addition of 8 mg dexamethasone to bupivacaine 0.25% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade, reduces the requirement of rescue analgesic in postoperative period but has no effect on the onset time of sensory and motor blockade.

Keywords: Dexamethasone, Bupivacaine, Supraclavicular Brachial Plexus Block

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[6]. Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular brachial plexus block with and without dexamethasone - A comparative study. Kathmandu University Medical Journal 2003; 1:158- 60.
[7]. Stan T, Goodman EJ, Bravo-Fernandez C, Holbrook CR. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med 2004; 29(4):380-1.
[8]. Yadav RK, Sah BP, Kumar P, Singh SN. Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study. Kathmandu University Medical Journal 2008; 6(23):302-9.
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Abstract: Tumour lysis syndrome (TLS) is a common problem in patients on treatment for malignancies; Spontaneous tumour lysis syndrome, however is a rare condition and should be suspected in patients with unexplained renal failure having typical biochemical abnormalities of hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia. It may sometimes be the first manifestation of an underling malignancy. Herein we present a case of spontaneous tumour lysis syndrome with Acute kidney injury, requiring hemodialysis, as the initial manifestation of Acute lymphoblastic leukemia (ALL). He responded well to hemodialysis and was able to tolerate the subsequent chemotherapy.

Key words: Spontaneous tumour lysis syndrome, hyperuricemia, hyperphosphatemia, hypocalcemia, Acute kidney injury

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[3]. Scott C. Howard, M.D., Deborah P. Jones, M.D., and Ching-Hon Pui, M.D; The Tumor Lysis Syndrome:N Engl J Med 2011; 364:1844-1854
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[5]. Patrizia Tosi et al, Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Haematology December 1, 2008 vol. 93 no. 12 1877-1885
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[7]. Gemici C, Tumor lysis syndrome in solid tumors. Clin Oncol 2006;18: 773-80.
[8]. Mateusz Opyrchal, Travis Figanbaum, Amit Ghosh, Vincent Rajkumar, and Sean Caples, Spontaneous Tumor Lysis Syndrome in the Setting of B-Cell Lymphoma, Case Reports in Medicine, vol. 2010, Article ID 610969, 3 pages, 2010
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Abstract: Objective: To evaluate the predictive value of roles of gray-scale, color-Doppler ultrasound, and sonoelastography for the assessment of thyroid nodule to determine whether nodule size affects the differential diagnosis of benign and malignant, with fine needle aspiration cytology analysis as the reference standard. Methods: A total of 270 consecutive patients (mean age, 35±55 years; range, 30-50 years; 25males and 245 females) with 300 thyroid nodules were examined by gray-scale, color-Doppler ultrasound, and 100 patients examined by sonoelastography in this prospective study. All patients underwent surgery and the final diagnosis was obtained from fine needle aspiration cytology analysis. Results: Three hundred nodules (206 benign, 94 malignant) were divided into small (SNs, ≤1cm, n=124) and large (LNs, >1Cm, n=178) nodules. Microcalcifications were more frequent in malignant LNs than in malignant SNs, but showed no significant difference between benign LNs and SNs. Poorly-circumscribed margins were not significantly different between malignant SNs and LNs, but were less frequent in benign LNs than in benign SNs. Among all nodules, marked intranodular vascularity was more frequent in LNs than in SNs. By comparison, shape ratio of anteroposterior to transverse dimensions (A/T) ≥1 was less frequent in LNs than in SNs. Otherwise, among all nodules, marked hypoechogenicity and elasticity score of 4-5 showed no significant difference between LNs and SNs. Conclusions: The predictive values of microcalcifications, nodular margins, A/T ratio, and marked intranodular vascularity depend on nodule size, but the predictive values of echogenicity and elastography do not depend on nodule size.

Key words: Elastography; Thyroid nodules; Ultrasound. Malignant. Nodule size.

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[5]. Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer. Thyroid 2009;19:1363–72

[6]. Hong YJ, Son EJ, Kim EK, et al. Positive predictive values of sonographic features of solid thyroid nodule. Cli Imaging 2010;34:127–33

[7]. Moon HJ, Kwak JY, Kim MJ, et al. Can vascularity at power Doppler US help predict thyroid malignancy? Radiology 2010;255:260–69

[8]. Choi YJ, Yun JS, Kim DH. Clinical and ultrasound features of cytology diagnosed follicular neoplasm. Endocr J 2009;56:383–89

[9]. Hagag P, Strauss S, Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid1998;8:989–95
[10]. Luo S, Kim EH, Dighe M, Kim Y. Screening of thyroid nodules by ultrasound elastography using diastolic strain variation. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:4420-3. doi: 10.1109/IEMBS.2009.5332744.

Abstract: Gastroschisis represents herniation of abdominal contents through a paramedian full-thickness abdominal wall fusion defect without involving the umbilical cord. Evisceration, usually, contains only intestinal loops and not covered by membrane unlike in Omphalocele. Gastroschisis with other serious birth defects is unusual. Neonates with Gastroschisis have better prognosis than those with an Omphalocele. Very rarely gastroschisis is associated with herniation of major viscus and their presence makes the prognosis worst. This is a rare case because of Left sided Gastroschisis with evisceration of major viscera and association of Left side upper limb abnormality and a duplicate limb.

Key words: Gastroschisis, Herniation, Left sided, limb abnormality, duplicate limb.

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