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Ghai A.,Pt. B.D. Sharma PGIMS Rohtak | Kumar H.,Pt. B.D. Sharma PGIMS Rohtak | Karwasra R.K.,Pt BDS PGIMS Rohtak | Kad N.,Pt. B.D. Sharma PGIMS Rohtak | And 2 more authors.
Anaesthesia, Pain and Intensive Care | Year: 2015

Objectives: Celiac plexus neurolysis is adjunct modality to relieve intractable pain caused by upper abdominal malignancy. An anterior approach offers advantages including shorter procedure time, less discomfort and less risk of neurological complications. The CT and ultrasound help to improve visualization of the celiac plexus. Their use allow accurate needle placement and reduce the risks. We report our experience with sonographically guided anterior approach to celiac plexus neurolysis in upper abdominal malignancy patients. Methodology: Patients with upper abdominal malignancy with VAS ≥3 not responding to diclofenac and demanding additional opioids or those having adverse effects were included. A prognostic block was performed under deep sedation with sonographic guidance using 22G, 15cm long Chiba needle advanced through biopsy guide to the preaortic zone above takeoff of celiac artery. Thirty to forty ml of 50% alcohol was injected. The VAS scores, analgesic consumption, duration of complete and partial pain relief were assessed at one hour, 24 hours, one week, one month, two month and three month intervals. Results: Fifteen patients were enrolled There was statistically significant decrease in mean VAS score at 1st hour, 24th hour, 1st week, 1st, 2nd and 3rd month respectively (p< 0.05). The analgesic consumption was statistically significant at all time intervals from baseline (p< 0.05). Conclusion: Use of color doppler helps in real time positioning of needle It is successful in terminally ill patients.

Kadian Y.S.,Pt. B.D. Sharma PGIMS Rohtak | Agarwal S.,Pt. B.D. Sharma PGIMS Rohtak | Rattan K.N.,Pt. B.D. Sharma PGIMS Rohtak | Nityasha,Pt. B.D. Sharma PGIMS Rohtak
Journal of Indian Association of Pediatric Surgeons | Year: 2010

An 8-year-old child presented with severe chest pain and respiratory distress after he accidentally bit an automobile tyre tube which burst into his mouth. The chest radiograph revealed left-sided pneumothorax. Both esophagogram and computed tomogram (CT) scan revealed a perforation of the distal third of esophagus with extravasation of contrast on left side. The patient was treated conservatively with gastrostomy feeds and antibiotics for 5 weeks with a good response.

Singla R.,Pt. B.D. Sharma PGIMS Rohtak | Devgan A.,Pt. B.D. Sharma PGIMS Rohtak | Gogna P.,Pt. B.D. Sharma PGIMS Rohtak | Batra A.,Pt. B.D. Sharma PGIMS Rohtak
Journal of orthopaedic surgery (Hong Kong) | Year: 2014

PURPOSE: To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures.METHODS: Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4-14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale.RESULTS: The mean follow-up period was 17 (range, 8-36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82º to 87º (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7-9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade I laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening.CONCLUSION: Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.

Dahiya K.,Pt. B.D. Sharma PGIMS Rohtak | Mann S.,Pt. B.D. Sharma PGIMS Rohtak | Nanda S.,Pt. B.D. Sharma PGIMS Rohtak
Archives of Gynecology and Obstetrics | Year: 2011

Objectives: To assess the efficacy, side effects, and acceptability of medical abortion using oral mifepristone (200 mg) followed 24 h later by oral or sublingual misoprostol (400 μg). Materials and methods: A total of 93 women with pregnancies up to 56 days of gestational age were assigned to two groups according to the different misoprostol regimen (group I 400 μg orally and group II 400 μg sublingually). The principle outcome measure was complete abortion defined as a complete expulsion of intrauterine contents without a need for surgical intervention 7 days after the procedure. Results: Successful abortion occurred in 87.5% of patients in group 1 and 95.5% patients in group 2 (p = 0.166, 95% CI -0.194, 0.033). The patient acceptability and satisfaction rates were similar in both the groups. Conclusion: It is concluded that 400 μg of sublingual misoprostol is as effective as oral misoprostol 24 h after mifepristone for medical abortion of ≤56 days. © 2010 Springer-Verlag.

Magu N.K.,Pt. B.D. Sharma PGIMS Rohtak | Singla R.,Pt. B.D. Sharma PGIMS Rohtak | Rohilla R.,Pt. B.D. Sharma PGIMS Rohtak | Gogna P.,Pt. B.D. Sharma PGIMS Rohtak | And 2 more authors.
Bone and Joint Journal | Year: 2014

We report the outcome of 39 patients who underwent a modified Pauwels' intertrochanteric osteotomy for nonunion of a femoral neck fracture following failed osteosynthesis. There were 31 men and eight women with a mean age of 47.2 years (34 to 59). By Pauwels' classification, there were 11 Type II fractures and 28 Type III fractures. The mean follow-up was 7.9 years (2 to 19). In the 11 patients whose initial treatment had been osteotomy, union was achieved in nine (81.8%). In 28 patients whose initial treatment had been with a lag screw or a dynamic hip screw, union was achieved in 27 (96.4%). Limb lengths were equalised in 14 of 16 patients (87.5%) with pre-operative shortening. The mean neck-shaft angle improved significantly from 100.5° (80° to 120°) to 131.6° (120° to 155°) (p = 0.004). The mean modified Harris hip score was 85.6 points (70 to 97) and the mean modified Merle d'Aubigné score was 14.3 (11 to 18). Good to excellent functional outcomes were achieved in 32 patients (88.8%). A modified Pauwels' intertrochanteric osteotomy is a reliable method of treating ununited fractures of the femoral neck following failed osteosynthesis: Coxa vara and shortening can also simultaneously be addressed. © 2014 The British Editorial Society of Bone & Joint Surgery.

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