V. Singh

POST OPERATIVE PAIN RELIEF IN CAESAREAN SECTION

Eighty female patients in the age group of 20-40 years, weighing 40 ± 15 Kg, in ASA physical status I and II, awaiting either elective or emergency caesarean delivery were selected for this study. Patients with cardiovascular disorders and those with significant systemic ailments were excluded from the study. They were randomly divided into two equal groups of 40 patients each. Group I was subdivided randomly into two equal sub-groups (1A and 1B) of 20 patients each and was selected for administration of epidural narcotics. Patients in sub-group 1A were given epidural morphine in the dose of 3-5 mg and those in subgroup 1B were given buprenorphine in the dose of 0.1-0.15 mg. Group II consisting of 40 patients, were again subdivided randomly into two equal subgroups (2A and 2B) of 20 patients each and were selected for administration of parenteral (intravenous) narcotics. Patients in subgroup 2A were given morphine in the dose of 5-7.5 mg I.V., and those in subgroup 2B were given 0.15-0.3 mg of buprenorphine intravenously. The degree of pain relief was assessed by applying numerical rating scale (NRS) and resulting complications were observed and recorded. It was found that 60-80% of patients with epidural narcotics, with various dosage schedules, experienced good to excellent analgesia as compared to 30-40% of patients with parenteral use of narcotics.

INTRAHEPATIC CHOLANGIOJEJUNOSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: APPROACH TO THE LEFT HEPATIC DUCT

Biliary enteric anastomosis for relief of biliary obstruction caused by malignancy at the confluence of the bile ducts can be difficult due to non availability of an adequate length of duct for anastomosis. This paper describes an approach to the left hepatic duct to decompress the biliary tree and its successful application in 11 of 12 patients who presented with malignant hilar obstruction.

INFANTILE HEMANGIOPERICYTOMA: A Case Report

Hemangiopericytoma is an uncommon tumour of pericyte origin, mostly in adult age group. Hemangiopericytomas which occur in children have a similar histological picture, but a more benign clinical behaviour [1]. A case of infantile hemangiopericytoma is reported to illustrate the clinical and pathologic features of this uncommon tumour. CASE REPORT Four-year-old male child was noticed to have swelling of left forearm at birth, which was gradually progressive. He was born at term after an uneventful pregnancy. Mass was biopsied elsewhere two months prior to reporting to this hospital. Histology was reported as infantile hemangiopericytoma. On evaluation here, he was found to be having a diffuse, bosselated, non-compressible, soft to firm mass, involving entire length of left forearm. Skin over the swelling was free and contained a 4 cm long biopsy scar over the ulnar aspect. Elbow, wrist and radio-ulnar movements and peripheral pulsations were normal. There was no regional lymphadenopathy. Radiograph of left forearm revealed soft tissue mass over medial aspect of forearm with normal underlying bones. At surgery, the tumour was found to be partially circumscribed, infiltrating the flexor compartment muscles and was excised down to periosteum. Cut surface showed cystic, multiloculated lesion filled with hemorrhagic material. Microscopically it showed a tumour comprising of many vascular channels with plump polygonal to elongated cells, as sheets in the walls and as solid groups (Fig. 1, Fig. 2). These had a fair amount of cytoplasm, big vesicular nuclei and infrequent mitosis. Tumour extended in between the skeletal muscle fibres (Fig 3). Open in a separate window Fig. 1 Sheets of round cells surrounding branching blood vessels (H&E × 100).

ANAESTHESIA FOR CONGENITAL LOBAR EMPHYSEMA: A Case Report

A 4-month-old, female child weighing 5 kg was ad› mitted on 12 Apr 94 with acute respiratory distress with history of breathlessness since 6 April 94. Breathlessness used to increase during coughing, crying and feeding. Physical examination revealed signs suggestive of mod› erately severe respiratory obstruction. Her heart rate was 136/min, respiratory rate 40/min, intercostal and sub› costal recession was obvious but their was no cyanosis. Examination of respiratory system revealed shift of tra› chea and apex beat to right, hyper-resonant note with decreased breath sounds over upper left chest. Other systems were normal. Postero-anterior chest radiograph showed a hyperlucent area in left upper and middle zones compressing left lower lobe and also gross medi› astinal shift to right (Fig 1). Routine blood examination and urinalysis did not reveal any abnormality.