Journal of the Indian Medical Association
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A two-year-old child presented with history recurrent attacks of stridor. Initially he was thought to have laryngomalasia and treated accordingly but the symptoms did not improve with age. The child was symptomatic only during episodes of respiratory tract infection. ⋯ CT angiography showed an incomplete double aortic arch. As the child was symptomatic only during intercurrent infections and there was no feeding difficulty, respiratory distress and growth problems conservative management was opted. Parents were advised to observe the patient and review after six months.
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The aim of present study is to report our experience concerning the effectiveness, quality of analgesia, ease of performance, complications and safety of spinal anaesthesia in children undergoing infra-umbilical surgery. An open, non-comparative study was performed on 40 children aged 5-15 years undergoing elective infra-umbilical surgery. After parents' written consent and premedication, spinal anaesthesia was induced with hyperbaric bupivacaine (5mg/ml), 0.4mg/kg for children up to 15 kg body weight and 0.3mg/kg for >15 kg via L3-L4 or L4-L5 interspace in lateral decubitus position. ⋯ The dose of intrathecal bupivacaine used was 4-9 mg. No evidence of cardiovascular instability, postdural puncture headache, transient neurological symptoms, urinary complication was observed. Spinal anaesthesia with hyperbaric bupivacaine using 26-gauge hypodermic needle provides safe and effective analgesia for paediatric infra-umbilical surgery with high success rate.
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Case Reports
Anaesthetic management of a patient with motor neuron disease posted for microlaryngeal surgery.
Motor neuron disease (MND) typically affects upper and lower motor neurons without any sensory involvement. Regional anaesthesia is preferred in motor neuron disease patients to avoid aspiration and possibility of prolonged postoperative ventilation following general anaesthesia. As microlaryngeal surgery in a motor neuron disease patient needed airway protection, it was decided to perform the surgery under general anaesthesia with awake intubation following airway block and avoiding muscle relaxant agents completely to minimise unnecessary complications. The patient was allowed spontaneous breathing while maintaining anaesthesia and stable haemodynamic condition with combination of anaesthetic and analgesic agents accordingly throughout the operation.
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Breast cancer is second most common cancer in Indian women. It is often curable by various treatment modalities when detected in early stage. Prognosis and selection of therapy in breast cancer depends upon various factors including clinical parameters, histopathological subtype and molecular characteristics of primary tumour. ⋯ Significant patients had breast lump > 4 cm in size. Infiltrating duct carcinoma not otherwise specified (NOS) was the most common histological type showing predominantly microscopic grade II as per Nottingham's Modification of Bloom Richardson grading system. Immunohistochemistry showed 75% ER positivity, 66.66% PR positivity and 25% Her-2/neu positivity.
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A national consultation was organised in January 2012, in order to reconcile between global and national guidelines, to review the evidence base and update the RNTCP guidelines in consensus with Indian Academy of Paediatrics. The consultation had come up with wider recommendations in diagnosing and treating paediatric tuberculosis patients which has been incorporated in the programme.