A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem.</p> <p>Case presentation</p> <p>A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall. Plain radiographs showed an intertrochanteric fracture of the femur, and operative fixation with a dynamic hip screw was planned. His positioning on the table posed a particular problem, and therefore we developed a technique to overcome this problem.</p> <p>Conclusion</p> <p>Positioning of patients for fixation of intertrochanteric fractures of the femur poses a particular problem that can be solved by using our simple technique.</p

Readmissions after day care surgery In ent : A tertiary care experience

BACKGROUND: Re-admission following day care surgery in ENT (Ear, Nose & Throat) results in significant morbidity to patient & massive load to hospital & also raises the question on the safety of day care surgery. Only a small number of published studies emphases on return to hospital within 30 days following day care surgery in otorhinolaryngology especially from our region. This study was carried out to determine the frequency of re-admission after day care surgery in ENT. METHODS: We prospectively studied consecutive patients who underwent ENT procedures [i.e., septoplasty, tympanoplasty type I & functional endoscopic sinus surgery (FESS) for deviated nasal septum (DNS), chronic suppurative otitis media tubotympanic (CSOM TT) variety & ethmoidal nasal polyposis (ENP) respectively] as day care surgery case under general anaesthesia at the Section of Otorhinolaryngology and Head & Neck Surgery, Aga Khan University Hospital & Liaquat National Hospital, Karachi from January 2015 to December 2016. All patients aged 20- 60 years of both genders were included in the study. SPSS software version 20 was used for data compilation and analysis. p-value less than or equal to 0.05 was taken as significant. RESULTS: In the phase of 24 months, total 317 cases met the inclusion criteria & were included in the study. There were 205 males & 112 females in the study population. One hundred & twenty-two patients having DNS, 128 having CSOM TT & 67 suffering from ENP & underwent septoplasty, tympanoplasty type I & FESS respectively. Complications were observed in a total of 7 (2.2%) patients in our study group & required re-admission within 1 month of surgery. Stratification was done between re-admission & all effect modifiers, with all showing insignificant results. CONCLUSIONS: Our results demonstrate that ENT surgeries (septoplasty, tympanoplasty type I & FESS) are safe procedures which can be performed as a day care case with acceptably low readmission rates

An investigation Into the function, accuracy and technology associated with arthroplasty of the hip

Hip arthroplasty is a successful intervention for symptomatic end stage arthritis of the hip. However it remains an imperfect procedure due in many respects to the difficulty in reproducing biomechanics for each individual patient. Reproduction of femoral offset and leg length ensures appropriate muscle balancing which allows for hip biomechanics to be restored. In addition adequate soft tissue balancing reduces the risk of complications such as dislocations and nerve injuries. Post- operative functional performance may also be affected by the implant technology being used as well as surgical accuracy. However little is known as to what functional performance is to be expected following hip arthroplasty, especially when function is measured at fast speeds and walking inclines. This thesis will explore the gait of patients prospectively through pre to post-operative stages, in an attempt to ascertain what gait changes can be expected following hip arthroplasty. Furthermore the gait assessments will focus on higher end function, when walking at fast speeds. Following this, this thesis aims to assess whether gait differences are evident when different implants are used, and judge whether they may be a functional advantage to using different implants in hip reconstruction. Surgical accuracy is paramount, when avoiding complications alluded to earlier. This thesis explores whether rapid prototyping technology can be utilised to aid accurate insertion a femoral stem as part of a pre-clinical test. Finally this thesis will also test the association of implant size and failures that has been alluded to from national joint registries.Open Acces

Thyroid gland neoplasms; histopathological pitfalls as a consequence of FNAC: a tertiary care hospital experience

Fine-needle aspiration cytology (FNAC) is one of the useful procedures for the investigation of thyroid swellings. FNAC is a minimally invasive procedure, is cost effective, and a gold standard for diagnosing thyroid lesions. Haemorrhage, thrombosis, and infarction are known common complications of FNAC. Post FNAC infarction in thyroid gland has been known as a rare phenomenon. Here, we report the case of a young female who underwent FNAC that showed Hurthle cell neoplasm (Bethesda 3). Four weeks later, she underwent right thyroid lobectomy and the final histology showed extensive necrosis and haemorrhage which is a diagnostic dilemma and hampered our diagnosis. Keywords: Hurthle cell neoplasm, FNAC, Thyroidectomy, Thyroid neoplasm

A Synthesis of Spatial Forest Assessment Studies Using Remote Sensing Data and Techniques in Pakistan

This paper synthesizes research studies on spatial forest assessment and mapping using remote sensing data and techniques in Pakistan. The synthesis states that 73 peer-reviewed research articles were published in the past 28 years (1993–2021). Out of all studies, three were conducted in Azad Jammu &amp; Kashmir, one in Balochistan, three in Gilgit-Baltistan, twelve in Islamabad Capital Territory, thirty-one in Khyber Pakhtunkhwa, six in Punjab, ten in Sindh, and the remaining seven studies were conducted on national/regional scales. This review discusses the remote sensing classification methods, algorithms, published papers’ citations, limitations, and challenges of forest mapping in Pakistan. The literature review suggested that the supervised image classification method and maximum likelihood classifier were among the most frequently used image classification and classification algorithms. The review also compared studies before and after the 18th constitutional amendment in Pakistan. Very few studies were conducted before this constitutional amendment, while a steep increase was observed afterward. The image classification accuracies of published papers were also assessed on local, regional, and national scales. The spatial forest assessment and mapping in Pakistan were evaluated only once using active remote sensing data (i.e., SAR). Advanced satellite imageries, the latest tools, and techniques need to be incorporated for forest mapping in Pakistan to facilitate forest stakeholders in managing the forests and undertaking national projects like UN’s REDD+ effectively

Optimized Corrosion Performance of AISI 1345 Steel in Hydrochloric Acid Through Thermo-Mechanical Cyclic Annealing Processes

The thermo-mechanical treatments and cyclic annealing processes have the potential of optimizing the corrosion performance of carbon steels in corrosive environments. Herein, an attempt has been made to optimize the corrosion performance of AISI 1345 steel in hydrochloric acid by thermo-mechanical cyclic annealing treatments. AISI 1345 steel was produced and cast in the laboratory and subjected to three types of thermo-mechanical cyclic annealing treatments (TMCA). The first TMCA treatment comprised hot rolling at 1050 &deg;C followed by oil quenching and single austenitizing at 900 &deg;C followed by furnace cooling (TMSA). The second and the third TMCA treatments involved similar hot rolling processes with double austenitizing and furnace cooling (TMDA) and triple austenitizing and furnace cooling (TMTA) processes. Microstructure analysis showed that dual-phase (retained austenite + pearlite) microstructure was achieved after all TMCA treatments with an exception of secondary phase particles precipitation after TMSA treatment. Maximum fractions of retained austenite and minimum fractions of pearlite were achieved after TMTA treatment. Highly refined microstructure of size 26.7 &micro;m was achieved after TMDA treatment whereas; TMSA treatment offered coarse grained microstructure of size 254 &micro;m. Electrochemical analysis was performed in 5 vol% HCl solution using Tafel scan technique. Results revealed that both TMDA and TMTA treatments caused three-fold reduction in corrosion rates (3.025, 2.771 mpy) compared to non-treated steel sample. After 168 h of immersion corrosion analysis in 5 vol% HCl solution, the surface of TMTA treated sample was observed to be partially covered with a very thin, crack-free oxide layer exhibiting minimum oxygen (8.16%) percentage. These features indicated that the TMTA treated sample underwent a very low-intensity minor corrosion attack of HCl solution and exhibited the best immersion corrosion performance among all samples. Electrochemical and immersion corrosion analysis results were in good agreement

ROLE OF ORAL PANTOPRAZOLE AS PRE OPERATIVE PREANAESTHETIC PREMEDICATION FOR THE PROPHYLAXIS OF ACID ASPIRATION IN ELECTIVE ADULT SURGERY

Background: The effect of drugs affecting gastric pH and volume has been studied extensively but the effect of duodenogastric reflux on gastric pH and volume at the same time has not been evaluated. Patients and Methods: This prospective, triple blind, randomized and placebo controlled clinical trial was conducted on 108 adult inpatients of American Society of Anaesthesiologist physical status I-II, and aged 15-70 years. The patients in Group C (control) received placebo while Group P (Pantoprazole) orally at 9:00 PM, a night before elective surgery. On the next day, gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in oesophagus after tracheal intubation and analysed for pH, volume and the presence of bile salts. Results: Thirty (28.57%) samples out of 105 were contaminated with duodenal contents and 2 with blood. Duodenogastric reflux significantly affected pH and volume of gastric contents in subgroups (C-1 versus C-2: p-value for pH (0.0009) and volume (0.0236) and P-1 versus P-2: p-value for pH (0.0348) and volume (0.0003). Pantoprazole, after excluding samples contaminated with duodenogastric refluxate, increased pH (p 0.0118), decreased volume (p 0.0009) and the proportion of the patients (p 0.0324) considered&quot; at risk&quot; compared with Placebo. Conclusion: Preoperative oral administration of Pantoprazole 40 mg reduced residual gastric content volume ≤25 ml and increased pH ≥2.5, possibly reducing the effects of pulmonary aspiration of gastric contents