EFFECT OF CITRAKADI KSARA LĒPA IN THE MANAGEMENT OF SECOND-DEGREE INTERNAL HAEMORRHOIDS

Background and Objectives: Haemorrhoids are dilated veins within the anal canal in the sub-epithelial region formed by radicles of superior, middle, and inferior rectal veins. It hampers the routine life of an affected person. In India about 50% of the population would have haemorrhoids at some point in their life. Achārya Vāgbhata defines Arsas (haemorrhoids) as an abnormal growth which obstructs the anal canal and troubles continuously like an enemy The objective of the study is to assess the efficacy of citrakādi kṣāra lēpa in the management of second- degree internal haemorrhoids. The study also aims to find out an easy, effective and less complicated procedure for second-degree haemorrhoids. The 15 participants with second degree internal haemorrhoids were selected as per inclusion criteria. After doing all the preoperative procedures, the citrakādi kṣāra lēpa was done in a single sitting. The duration of the study was 30 days. The assessment of reduction of size of haemorrhoids, mucosal changes after the procedure and frequency of bleeding were done before the treatment, on 1st, 3rd, 5th, 7th, 15th, and 30th day using the required assessment tools. The symptoms, constipation and mucous discharge were assessed on the 0th and 30th days. The follow up was done on the 60th day. The statistical analysis of the results was done using non- parametric tests. On analysing, it was found that the Citrakādi kṣāra shows 86.11% of the efficacy in the reduction of both subjective and objective parameters. Key words: Haemorrhoids, Arsas, Citrakādi kṣāra

The First Clinical Use of Augmented Reality to Treat Salivary Stones

In this study, we report our first experience of applying the concretion visualization method using augmented reality technology. A clinical case of a new surgical intervention on the parotid salivary gland with the localization of salivary stone in its parenchyma is considered. During additional diagnostics, it was found that the size of the concretion exceeds 5 mm which did not allow us to use the endoscopic technologies. That was the reason for the choice of surgical intervention external access using salivary stone visualization with the help of augmented reality. The preoperative procedures included making the upper jaw cast model, fitting the model and individual mouthguard with an X-ray contrast marker and marker slot. In addition to this, computed tomography of the head and neck using a mouthguard was made. During surgery under general anesthesia with nasal intubation, the mouthguard together with the marker is installed in the patient’s mouth and the surgeon puts on the glasses to visualize the stone image in place of its localization. This method enables to visualize the salivary stone on all surgery stages no matter what type of approach is used or performing hydropreparation. That is why using the augmented reality appears promising and is to be studied further.

The BOAST recommendations for care of the older or frail orthopaedic trauma patient

Safe and effective care for the elderly or physiologically frail patient in cases of trauma requires a multidisciplinary perioperative approach. This article expands upon the British Orthopaedic Association Standards for Trauma and Orthopaedics guidelines for the management of the older or frail orthopaedic trauma patient. Optimisation of the patient is key to a successful surgical outcome, because these patients often have significant comorbidities involving bone health, nutrition, cognitive function and cardiovascular stability. This article discusses the evidence base for tailoring the management of these patients and the importance of doing so in an ageing population. It considers the requisite preoperative procedures and investigations, guidelines for specific cases such as comatose patients or those with complex fractures, and ceiling of care discussions, and then focuses on the postoperative period, including physiotherapy, rehabilitation goals and medical management.

THE EFFECTIVENESS OF INTERSTITIAL SELECTIVE LASER PHOTODESTRUCTION OF FOCAL FORMS OF HEMAGIOMAS IN CHILDREN

Introduction. Hemangiomas in infants at their first weeks of life can quickly progress and lead not only to the disfigurement of appearance, but also to serious complications, like bleeding, ulceration, suppuration and other negative consequences. Purpose. To have good clinical and aesthetic results in children with cavernous hemangiomas using the technique of interstitial selective laser photodestruction. Material and methods. In 2016 - 2018, focal forms of hemangiomas were registered in 140 children aged 1 month-16 years who were consulted in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma. The technique of interstitial selective laser photodestruction was selected for surgical treatment in all patients (RF Patent №2016110843 dated 04.09.2017). Two-wave laser surgical apparatus LSP IRE-Polyus (Russia) with wavelengths 0.97 μm and 1.56 μm was used. All 140 patients had ultrasound examination of their vascular formations and other preoperative procedures . The surgical intervention was performed in the hospital under general anesthesia. 131 of patients had planned operations and 9 of them had urgent operations because of hemangioma bleeding. Results. Long-term outcomes have shown that in 100% of cases we achieved good clinical result with no residual hemangioma elements; in the majority of cases (69%) the optimal aesthetic result was achieved; and in 31% of cases we had satisfactory outcomes by the criteria of aesthetic effectiveness. Conclusions. Interstitial selective laser photodestruction is the best option to radically treat focal forms of hemangiomas in children.

Chest wall metastasis in postoperative thyroid cancer: a case report

Thyroid cancer is common in China. Thyroid adenocarcinoma metastases can be local or distal metastasis. Local metastasis presents as a hard and fixed lymph node in the neck, while distant metastases are found in the lung, skull, vertebrae, and pelvis. However, thyroid follicular carcinomas are mostly observed in hematogenous metastases. The thyroid adenocarcinoma and follicular carcinoma of the thyroid gland are often misdiagnosed. Here, we report the case of a 53-year-old female patient. More than 2 years after her initial diagnosis, her left chest wall was physically examined. The results revealed a progressive enlargement that had a hard quality, poor activity, unclear boundary, pressure pain, and percussion pain. Thyroid follicular cell carcinoma was subsequently diagnosed and treated surgically. The thyroid carcinoma had multiple bone metastases, and the thyroid follicular carcinoma had spread to the chest wall through the blood vessels. Thus, preoperative procedures and follow-up should be strengthened because early pathological thyroid follicular carcinoma and thyroid adenoma can easily be misdiagnosed. Pathologic consultation and follow-ups should be strengthened to prevent misdiagnosis.

Morphological and Morphometric Study of the Supratrochlear Foramen

Introduction The supratrochlear foramen (SF) is located in the distal portion of the humerus, formed in between the coronoid fossa and the olecranon fossa. Is associated with a narrowing of the medullary canal in the distal humerus, in addition to being a phylogenetic characteristic, more common in ancient populations. The objective was to evaluate the incidence of the supratrochlear foramen, it's shape, dimensions and translucency of the septum. Materials and Methods A total of 141 humerus adults, 72 right and 69 left-handed individuals from the collection of the Human Bone of the Academic Center of Vitória-Brazil. The format was classified as oval, round, irregular and cribriform. The vertical (VD) and transversal (TD) diameter were measured and the translucency of the septum was observed. Results Of the 141 humerus, 19.8% (28) had SF 39.3% (11) on the right side and 60.7% (17) on the left side. The oval was the most recurrent, found in 39% of the cases and the translucency was identified in 78% (110) of the bones. The mean VD was 3.653 mm and 3.492 mm on the right and left sides, respectively. The mean of the TD was 4.853 mm on the right side and 5.427 mm on the left. The area averages were 19.633 ± 20.57 mm2 on the right side and 19.919 ± 19.24 mm2 on the left side. Conclusion The knowledge of SF favors the preoperative procedures of patients with fractures in the distal humerus, necessary for the surgeries in the region.

Reliability of an Integrated Ultrasound and Stereophotogrammetric System for Lower Limb Anatomical Characterisation

Background. Lower extremity analysis for preoperative total knee and hip arthroplasty routines can increase surgery success rate and hence reduce associated costs. Current tools are limited by being invasive, limited to supine analysis, or too expensive. This study aimed to propose and validate a device, OrthoPilot®, based on the combined use of a stereophotogrammetric and ultrasound system which can in vivo and noninvasively measure varus/valgus, flexion/extension, femur and tibia torsion, and femur and tibia lengths.Methods. A phantom was measured by four operators to determine the resolution of the system. Interoperator variability was measured on three operators who measured the above six variables on both legs of three subjects in standing and supine positions. Intraoperator variability was assessed on data from three repeats from 9 subjects (18 legs).Results. All 6 variables were reliably detected on a phantom, with a resolution of 1 mm and 0.5°. Inter- and intraoperator consistency was observed for varus/valgus, flexion/extension, and length measurements on the healthy subjects in standing and supine positions (all ICC > 0.93). For torsion measurements, there was a considerable variation.Conclusion. The proposed system, when used on healthy subjects, allowed reliable measurements of key parameters for preoperative procedures in both supine and standing positions. Accuracy testing and further validation on patient populations will be the next step toward its clinical adoption.

Caregivers' reactions to preoperative procedures in outpatient pediatric surgery

ABSTRACT Objective: To identify pediatric caregivers' reactions in outpatient surgery settings. Methods: A quantitative descriptive/exploratory survey-based study involving application of a semi-structured questionnaire to 62 caregivers in two hospitals. Results: Most caregivers (88.7%) were mothers who submitted to preoperative fasting with their children. Nervousness, anxiety and concern were the most common feelings reported by caregivers on the day of the surgery. Conclusion: Medical instructions regarding preoperative procedures had significant positive impacts on patient care, and on patient and caregiver stress levels.

Surgical excision of a residual cyst in a patient with previous history of jaw osteonecrosis associated with oral bisphosphonate: A case report

Residual cyst is an inflammatory odontogenic cyst resultant from pulp necrosis, where the tooth has already been removed. Bisphosphonates are drugs used in the prevention and treatment of bone metabolism diseases with intense resorption activity, and they have been associated with osteonecrosis of the jaws, an important side effect. The aim of this study was to report a successful surgical treatment of a residual cyst in a patient who had previously developed jaw osteonecrosis associated with sodium alendronate use. We emphasize here the importance of safe preoperative procedures when approaching these patients.

An assessment of the preoperative information given to patients in the province of Karaman

<p>The purpose of this research was to determine the status of information provision for patients in the preoperative period. Two hundred fifty patients undergoing surgery in the Karaman Public Hospital. A questionnaire prepared by the authors based on information in the literature and consisting of questions intended to determine patients’ sociodemographic characteristics and the preoperative provision of information was used as a data collection tool. Data were expressed as number, percentage, mean and standard deviation. Mean age of patients was 45±21.08 years. We determined that 47.2% had been given information concerning preoperative procedures and preoperative preparations, and that 7.6% had been given this information by nurses. In the light of the study findings, we conclude that physicians and nurses need to be more proactive in providing patients with preoperative information and that, considering the forgetfulness factor, such information should also be provided in written form.</p>