JNMA; journal of the Nepal Medical Association
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JNMA J Nepal Med Assoc · Jul 2006
Fluoroscopy guided chemical lumbar sympathectomy for lower limb ischaemic ulcers.
The purpose of this study was to assess the effectiveness of chemical lumbar sympathectomy in relieving pain and healing ischaemic ulcers in patients with peripheral vascular diseases. Thirty-one consecutive patients with ischaemic/ gangrenous lower limb ulcers, referred to the BPKIHS, Pain Clinic were observed prospectively after chemical lumbar sympathectomy using modified Reid Technique with 3 ml of 70% alcohol each at L2 and L3 level under fluoroscopic guidance. Pain relief and ulcer healing were noted in the follow up. ⋯ By 3 months, 6 patients declined for follow up; 19(76%) of the remaining 25 patients reported pain relief, 18(72%) reported healing or decrease in the size of ulcers and 11(44%) were able to resume at least part of their usual work. Minor complications occurred in 5 patients and amputation was needed in 6 patients. Fluoroscopy- guided chemical lumbar sympathectomy is feasible, safe and effective in relieving pain and promoting ulcer healing in patients with ischaemic lower limb ulcers due both to Buerger's disease and non-Buerger's peripheral vascular diseases.
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JNMA J Nepal Med Assoc · Jul 2006
Case ReportsPractice in anesthesia: intrathecal morphine for off pump coronary artery bypass graft.
Off pump coronary artery bypass grafting is gaining popularity because of its beneficial effects like reduced inflammatory response, early extubation, reduced hospital & ICU stay, less homologous blood transfusion & reduced cost. Here we report a case of left anterior descending artery blockade who had undergone off pump coronary artery bypass grafting. ⋯ It not only provides intense analgesia which helps for early extubation & hemodynamic stability but also provides calm & quiet surgical field with slow beating heart & aids in critical time of vessel anastomosis. We have also discussed the other aspects of anesthetic management with little elaboration in surgical aspect as well.
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Burn injuries constitute a major concern in the pediatric age group with respect to morbidity and mortality particularly in children in developing countries. Burn injuries represent an extremely stressful experience for both the burn victims as well as their families. Burn injuries are least explored areas among other injuries in Nepal. ⋯ Twenty one patients survived after treatment and one patient died due to sepsis. Mortality in this series is about four percent. Burn injury is a leading cause of unintentional injuries mainly seen in children less than 5 years of age with physical as well as psychological consequences.