Comparison of haemodynamic parameters in two different geriatric age groups undergoing cemented bipolar hemiarthroplasty

Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal  end tidal CO2 (EtCO2) were recorded at the following time points:  baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required

Augmented Repair of Degenerative Tears of Tendo Achilles Using Peroneus Brevis Tendon: Early Results

Reconstruction of degenerated ruptures of the tendoachilles is a challenge. Ruptured tendons and the remaining tendon ends are abnormal. A number of methods have been described in literature reconstruct the tendoachilles, but with variable results. We used peroneus brevis tendon in 20 patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop as described by Teuffer et al. All patients were followed up for atleast 18 months. At the last postoperative visit, 18 out of 20 patients were able to do a toe raise. Eighty-five per cent of patients had excellent or good results and 15% had fair or poor results using modified Rupp scoring. Advantages offered by this procedure are the use of a single incision and mini incision and use of a dispensable tendon such as the peroneus brevis without entirely depending on the damaged tendon for healing

Patients with Blunt Traumatic Spine Injuries with Neurological Deficits Presenting to an Urban Tertiary Care Centre in Mumbai: An Epidemiological Study

INTRODUCTION: Traumatic spine injuries are on the rise. The literature is sparse regarding epidemiology of patients with traumatic spine injuries from this part of the world. OBJECTIVES: To analyse the following in patients with traumatic spine injuries with neurological deficits: demographic and social profile, common modes of injury, pre-hospitalisation practices, region of spine affected, severity of neurological deficit and the lay individuals’ awareness about traumatic spine injuries. METHODS: The study sample comprised 52 adult patients with traumatic spine injuries with neurological deficits. We collected data on demographic and social characteristics, mode of injury, pre-hospitalisation treatment, interval between injury and presentation, spine region affected and severity of neurological deficits and patient's knowledge about such injuries. RESULTS: The average patient age was 31.32y. The male: female ratio was 2.25:1, and the most common modes of injury were fall from height, followed by traffic accident. More than half of the patients suffered cervical spine injuries, followed by dorsolumbar spine injuries. Only 9.61% of patients received pre-hospitalisation treatment. All patients understood there could be complete functional recovery after treatment for traumatic spine injuries. CONCLUSION: There is a growing need to improve railway and roadway safety equipment and to make it accessible and affordable to the susceptible economically weaker population. Attempts should be made to increase awareness regarding traumatic spine injuries

The importance of diagnosis of latent bronchopleural fistula in a child with empyema thoracis for thoracotomy

Empyema thoracis is an accumulation of frank pus in the pleural space. Occurrence of complications such as bronchopleural fistula (BPF) following necrotizing pneumonia is not uncommon in pediatric patients. Failure to diagnose latent BPF is common. High level of suspicion and preventive measures to avoid likely complications is the key to success. This case report underscores the need to diagnose a latent BPF and also highlights the importance of one lung ventilation in an infant in suspected cases of BPF