iosr-JDMS   Volume-6 ~ Issue-3

Abstract: 1.1 IntroductionEpidural anaesthesia is preferred in elderly. Amongst all local anaesthetics Ropivacaine is preferred in elderly due to its low cardiac and central nervous system toxicity. 1.2 Aims and objectivesTo compared efficacy of Ropivacaine 0.5% , 15ml with 0.5% Bupivacaine 15ml givenepidurally for lower limb surgery. We compared onset of sensory block, intensity of motor blockade, maximum level of anaesthesia achieved, time required for two segment regression, pulse rate and systolic blood pressure changes in both groups. 1.3 ObservationTime required to achieve T10 sensory level was earlier Bupivacaine group than Ropivacaine group. Motor blockade inBupivacaine group was grade III ( modified Bromage scale) in 29 patients and grade II in one patient. InRopivacaine group 01 patient had grade III, in 17 grade II, in 10 grade I while in 2 patients grade 0 motor blockade. Maximum sensory blockade achieved was T8 in both groups. In group R cardiovascular stability was better than group B. Time of onset of two segment regression was earlier in group R than in group B. 1.4 ConclusionIt was concluded that sensory blockade is comparable in both Ropivacaine and Bupivacaine group. Ropivacaine provides less potent motor block with better cardiac stability when used in a concentration 0.5% .

Key words: Bupivacaine, Elderly, Epidural anaesthesia, Ropivacaine

[1] Shinichi Sakura; Epidural anesthesia and spinal anesthesia in the elderly; Masui; The Japanese journal of anesthesiology 03/2007; 56(2):130-8.
[2] Bajwa SJ, Bajwa S, JasbirKaur. Comparison of epidural ropivacaine and ropivacaine clonidine combination for elective cesarean sections, Saudi J Anaesth 2010;4:47
[3] Mischa J. G. Simon, Bernadette T. Veering, Rudolf Stienstra, Jack W. van Kleef, and Anton G. L. Burm,; The Effects of Age on Neural Blockade and Hemodynamic Changes After Epidural Anesthesia with Ropivacaine, A & A May 2002 vol. 94 no. 5 1325-1330 [4] M. WILLE; Intrathecal use of ropivacaine : a review , ActaAnaesth. Belg; 2004,55,251-259
[5] Z Kanonidou and G Karystianou Anesthesia for the elderly,Hippokratia. , 2007 Oct-Dec; 11(4): 175–177
[6] Anthony Rodgers, Natalie Walker,SSchug, A McKee, H Kehlet, , A van Zundert, D Sage, M Futter, G Saville,T Clark, and S MacMahon; Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials . BMJ. 2000 December 16; 321(7275): 1493.
[7] C Morton, New_ drugs_ Ropivacaine ;pdfwww.mapar,org

[8] K SAITOH, Y HIRABAYASHI, R. SHIMIZU, H. MITSUHATA & H. FUKUDA Extensive extradural spread in elderly may not relate to decresased leakage through intervertebral foramina Br J Anaesth1995;75:688-691

[9] Bernadette Th. Veering, Anton G. L. Burm, Jack W. van Ueef, rim J. Hennis, and Johan Spierdijk, Epidural Anesthesia with Bupivacaine: Effects of Age on Neural Blockade and Pharmacokinetics ; ANESTH ANALG 1987;66; 589-9

[10] Bernadette T Veering ; The role of ageing in local anaesthesia, Pain Reviews,1996, 6,167-173

Abstract: The placental complex formed by the cooperative effort between the extra embryonic tissue of the embryo and the endometrial tissue of the mother represents symbiosis between the two separate organisms without rejection. The formation of placenta is a biological event which is important both embryologically and immunologically. The growth of the foetus depends upon the functional capacity, location and integrity of the placental attachment. The placenta serves the most basic metabolic needs of fetus including respiration, nourishment and excretion by acting as a temporary lung, liver and kidney. It forms an organ for the interchange of material between fetal and maternal blood streams without mixing or physical contact of two blood streams. Here I am presenting morphological findings of 50 placenta at different gestational ages. present study was conducted in the Department of anatomy Sri venkateswara medical college, Tirupati in collaboration with the department of Obstetrics and Gynecology of maternity hospital Tirupati. It was observed that Out of 50 placentae central attachment is observed in 58% of cases, eccentric attachment in 20%, marginal attachments in 20% and velamentous attachment in 2% of cases. The following data was recorded the study. Consistency,Cord attachment, Thickness of placenta, Weight ,diameter, of the placenta observed The Feto placental weight ratio observed in 50 cases ranged between 3.75-7.7. Number of maternal cotyledons observed ranged between 12 to 20 and foetal cotyledons 36 to 84. The ratio of maternal and foetal cotyledons ranged between 2.22 - 4.6 The placental vascular pattern is disperse in type in all cases.In all 50 cases the umbilical cord contains two arteries and 1 vein.

Keywords: placental complex,velamentous attachment,cotylydons,fetoplacentral ratio,vascular pattern

[1]. Aplin, J.D., Jones, C.J.P. 1989, Extracellular matrix in endo metrium and deciduas. In Genbacav A, Klopper A Beaconsfield R (eds) placenta as a model and source. Plenum press : New York : p 115-128.
[2]. Arey, L.B. 1948, Anat Rec.100.636.
[3]. Asha, V.K., Meera, P., 1981, "Study of placental pathology in toxaemias of pregnancy and its foetal importance" India J. Pathol. Microbial, 24: 245:251.
[4]. Asim Kumar Datta, 2000, Human embryology, pp. 57-66
[5]. Batnagar, S.M., Kotari, M.L., Lopa, A. MAHETA., 1983, Essential of human embryology 2nd addition, pp 69-75.
[6]. Benirschke, and Driscoll, S.G., 1967, The Pathology of the Human placenta. Springer, Berlin..
[7]. Benirschke,K.,Kaufmann,P.1995, Pathology of the Human Placenta 2nd ed, pp 1-79. New York, Springer – Verlag,
[8]. Benirschke, K.. 1962, A Review of pathological anatomy of human placenta Am: J. obstet. Gynaecol 84:1595.
[9]. Benirschke, and Driscoll, S.G. 1967, The Pathology of the Human Placenta. Springer Berlin.
[10]. Benirschke, K., and Brown, W.H., 1955, Vascular anomaly of umbilical cord; absence of one umbilical artery in umbilical cords of normal and abnormal fetuses. Obstet. Gynec., 6, 399-404.

Abstract: This study was undertaken to estimate ultrasound measurement of nuchal translucency (NT) thickness in normal fetuses between 11 and 13.6 weeks of gestation.The aim of this study was to establish normative data of nuchal translucency distribution in singleton pregnancies.600 fetuses with known normal outcome were included in this study. The distribution of median values of NT thickness with crown rump length(CRL) in 10 mm intervals and 95th percentile were calculated with linear regression method .False positive rates with increasing gestational age were studied. This study offers a normative data of fetal NT thickness in normal pregnancy, which can be used as a reference for screening chromosomal aberrations or other congenital abnormalities in the first trimester.

Keywords-anomalies,fetus, nuchal,screening, translucency.

[1]. Nicolaides KH, Brizot ML, Snijders RJ. Fetal nuchal transluscency: Ultrasound sreening for fetal trisomy in the first trimester of pregnancy.Br J Obstet Gynaecol.1994;101:782-786
[2]. Pandya PP, Snijders RJ, Johnson SP,DeLourdesBrizotM,NicolaidesKH.Screening for fetal trisomies by maternal age and fetal nuchal transluscency thickness at 10 to 14 weeks of gestation.Br J Obstet Gynaecol.1995;102:957-962.
[3]. Pandya PP, Kondylios A, Hilbert L, SnijdersRJ,NicolaidesKH.Chromosomal defects and outcome in 1015 fetuses with increased nuchal translucency. Ultrasound Obstet Gynecol. 1995;5:`15-19.
[4]. Hyett J, PerduM,Sharland G, Snijders R, NicolaidesKH.Using fetal nuchal translucency to screen for major congenital cardiac defects at 10-14 weeks of gestation: Population based cohort study. Br Med J.1999;318:81-85
[5]. Hafner E, SchuchterK,Liebert E, Phillip K.Results of routine fetal nuchal translucency measurement at weeks 10-13 in 4233 unselected pregnant women. Prenat Diagn.1998;18:29-34
[6]. Thilaganathan B, Khare m, Williams B, Wathan NC. Influence of ethnic origin on nuchal translucency screening for Down's syndrome. Ultrasound Obstet Gynecol.2000;43:998-1001.
[7]. SnijdersRJ,NobleP,Sebire N, Souka A,, Nicolaides KH. UK muticentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation.Lancet 1998; 352:343-346.
[8]. Scott F, Boogert A, Sinosich M, Anderson J. Establishment and application of a normal range for nuchal translucency across the first trimester. Prenat Diagn.1996;16:629-634.
[9]. Taipale P, Hiilesmaa V, Salonen R, Ylostao P. Increasd nuchal translucency as a marker for fetal chromosomal defects. N Enl J Med. 1997;337:1654-1658.
[10]. Schuchter K, Wald N, Hackshaw AK, Hafner E, Leibhart E. The distreibution of nuchal translucency at 10-13 weeks of pregnancy.Prenat Diagn.1998;18:281-286.

Abstract: Intra- articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal method of treatment remains controversial. Study Design & Settings: Observational Randomized uncontrolled Study at a tertiary care hospital from September 2010 to August 2012.

Keywords: DASH & DEMERIT Score, External fixator, Fracture distal radius, Functional assessment, Volar plate.

[1]. Colles A. On the Fracture of the Carpal Extremity of the Radius. Edinb Med Surg J. 1814; 10: 182-6.
[2]. Simic PM, Weiland AJ. Fractures of the Distal Aspect of the Radius: Changes in Treatment over the Past Two Decades. J Bone Joint Surg Am. 2003; 85: 552-64.
[3]. Saito H, Shibata M. Classification of Fracture at the Distal End of the Radius with Reference to Treatment of Comminuted Fractures. In: Boswick JA, Lea and Febiger. Current Concepts in Hand Surgery: 1st ed. Philadelphia: Lea & Febiger ; 1983. p. 129–45.
[4]. Hudak PL, Amadio PC, Bombardier C. Development of an Upper Extremity Outcome measure: The DASH (Disabilities of Arm, Shoulder and hand). http://www.orthopaedicscore.com/scorepages/disabilities_of_arm_shoulder_hand_score_dash.html. Published Jun 1996.
[5]. Nijs S, O‟Broos PL. Fractures of the Distal Radius: A Contemporary Approach. Acta Chir Belg. 2004; 104: 401-12.
[6]. Lafontaine M, Hardy D, Delince P. Stability Assessment of Distal Radius Fractures. Injury. 1989; 20:208-10.
[7]. Wong KK, Chan KW, Kwok TK, Mak KH. Volar Fixation of Dorsally Displaced Distal Radial Fractures Using LCP. J Orthop Surg. 2005; 13(2):153-7.
[8]. Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Pakisma N. Bridging External Fixation and Supplementary Kirschner-wire Fixation versus Volar Locked Plating for Unstable Factures of the Distal Radius. J Bone Joint Surg Br. 2008; 90-B: 1214-21.
[9]. Mehta JA, Bain GI, Heptinstall RJ. Anatomical Reduction of Intra-articular Fractures of the Distal Radius: An Arthroscopically-Assisted Approach. J Bone Joint Surg Br. 2000; 82-B: 79-86.
[10]. Komurcu M, Kamaci L, Ozdemir MT, Atesalp AS, Basbozkurt M. Treatment of AO type C2-C3 Fractures