Raj Bahadur

Tuberculosis of the sternoclavicular joints

From May 1991 to December 1997, we treated 9 patients with tubercular arthritis in 10 sternoclavicular joints. The patients presented with a painful swelling (7 joints), painless swelling (2 joints) and a painless (?) discharging sinus (1 joint) having a mean duration of symptoms of 13 (6-32) months. The diagnosis was made with fine-needle aspiration or open biopsy. In 1 patient debridement of the joint was combined with open biopsy. All patients were initially put on a 4-drug regimen of antitubercular therapy (ATT). 2 joints not responding to closed treatment were surgically debrided after 2-3 months of ATT. Total duration of ATT was 14-18 months. At final follow-up after average 4.5 (1.5-7.5) years, all lesions had healed. 3 patients had mild limitation of shoulder motion, with no pain, and 2 patients had a cosmetically ugly scar at the site of the sinus or biopsy

Steffee variable screw placement system in the management of unstable thoracolumbar fractures: a third world experience

Twenty consecutive patients with unstable thoracolumbar fractures were taken up for posterior spinal stabilization using the Steffee VSP system at the earliest opportunity. Patients were followed up from 20 to 38 months. 70% patients were operated within 3 weeks of sustaining injury (group 1) while injury-operation interval exceeded 3 weeks in 30% (group II). The average preoperative kyphotic angle was 19.35 degrees which improved to 8.70 degrees, the correction being much more in group I (17.60 degrees to 5.3 degrees) compared to group II (22.90 degrees to 14.40 degrees). The average preoperative vertebral body height was 57.75% which improved to 79.75%, the correction being much more in group I (61.20 to 88.40%) compared to group II (51.40 to 63.70%). No patients deteriorated neurologically while 7 out of 16 patients with neurological deficit showed improvement by one or more Frankel Grade (43.75%). It is concluded that reasonable correction of deformity, fair chance of neurological recovery and significant reduction of recumbency associated complications can be expected even when surgery is delayed.

Glidescope(®) for predicted difficult airway in Klippel-Feil Syndrome.

532 Journal of Anaesthesiology Clinical Pharmacology | October-December 2012 | Vol 29 | Issue 4 An anaphylactic reaction was suspected and the patient was immediately placed in Trendelenburg position. 500ml of normal saline was rapidly infused and 100% oxygen administered. Adrenaline 100 mcg, hydrocortisone 100 mg, pheneramine maleate 45.5 mg and ranitidine 50 mg were administered IV. Nebulization with levosalbutamol and ipratropium bromide was done, through an attachment to the endotracheal tube connector.