Journal Issue: No 4, Issue 20, OCT-DEC, 2007
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Volume
Number
Issue Date
2007
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Percutaneous extensor tenotomy for chronic tennis elbow using an 18G needle
(Kathmandu University, 2007) S, Lakhey; M, Mansfield; RL, Pradhan; KP, Rijal; BP, Pandey; RR, Manandhar
Abstract
Introduction: Tennis elbow is a common orthopaedic problem presenting in office orthopaedics, but its exact
patho-aetiology has not been identified to date. It is treated operatively when conservative measures including
multiple local steroid injections are not helpful to the patients.
Material and method: This was a retrospective study to assess the outcome of tennis elbow patients on whom
percutaneous release of the common extensor origin was performed using an 18 gauge hypodermic needle. 17
patients with 21 elbows were included in the study. Data was collected by going through the patients’ medical
records, and follow –up by questionnaire mailed to the patient’s home, to assess the outcome and patient satisfaction
with the procedure.
Results: 14 of the 21 (66.7%) elbows became completely pain free. The time taken to achieve a completely pain
free elbow ranged from 1 day to 3 months (average 60.3 days). Those that did not achieve a pain free elbow had a
residual pain of 1.5 to 8.5 on the VAS (average 2.64). 9 elbows (42.9%) had an excellent outcome, 7(33.3%) had
good, 4(19%) had satisfactory and 1(4.8%) had poor outcomes.
Conclusion: Tennis elbow probably results from degenerative tear of common extensor origin and a percutaneous
tenotomy using an 18 gauge hypodermic needle is a simple, safe, patient friendly, effective and easily reproducible
method of treating it in those who require surgery and can be done as an office procedure.
Key words: Tennis elbow, percutaneous tenotomy, 18g hypodermic needle
Oral administration of intravenous solution of midazolam mixed in syrup of paracetamol is an effective way of premedicating children undergoing surgery under general anaesthesia
(Kathmandu University, 2007) S, Shrestha; BR, Shrestha
Abstract
Objective: The purpose of this study was to evaluate the efficacy of injection midazolam administered by oral route
mixed in paracetamol syrup as a premedication in children undergoing surgery.
Methods: 60 children undergoing elective hernia repair under general anaesthesia were randomized into two
groups: the study group (group A) was given oral midazolam 0.5mg/kg (mixed in paracetamol syrup) and the
control group (group B) was given just the paracetamol syrup before bringing them inside the operating theater.
They were evaluated for ease of separation from their parents, ease of i.v. cannulation and induction, and for
recovery time from anaesthesia.
Results: it was found that in group A-96.7% of children showed satisfactory parent child separation while in group
B- only 53.3% of children showed satisfactory separation (P < 0.05). Similarly in group A -73.3 % of children shad
satisfactory induction while in group B only 33.3% of children had satisfactory induction. The recovery time from
general anaesthesia did not differ in the two groups. No significant peri operative complications directly related to
oral midazolam was noted.
Conclusion: It was concluded that injection midazolam mixed in syrup paracetamol administered orally is a
convenient and efficient method of premedicating children undergoing general anaesthesia. Parent-child separation
and induction of anaesthesia was smooth and the recovery uneventful in children premedicated with oral midazolam.
Key words: Anxiety, midazolam, paracetamol, premedication, oral, parent-child separation, induction, recovery.
The role of hysterosalpingography in cases of subfertility
(Kathmandu University, 2007) Poonam
Abstract
Introduction: Subfertility is the inability of a couple to conceive even after one year of regular unprotected coitus.
The desire of woman for children is great, sometimes greater than self-interest in beauty and figure and may be
stronger than the claims of a career. Considering the social stigma attached to subfertility, a sympathetic and a
carefully balanced therapeutic approach to their problem is required.
Aims and objectives: The present work has been undertaken with a view to asses the role of HSG in the evaluation
of subfertility.
Material and method: For the present study, a total of 105 infertile patients were selected from the outpatient
department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Darbhanga. Only those cases
were selected where the couples were in the fertile age group of and were living together for two or more years. The
patients were advised to take 600mg ibuprofen, an hour before the procedure to ease the cramps. A catheter was
inserted through the cervical canal, and radio-opaque dye (urograffin 76%) was passed through it. A radiograph was
taken after injection of two ml. of medium to ensure that there was no filling defect in the uterine cavity which,
otherwise, would be concealed by overdistending the uterus. Further injection outlined the Cornua, isthmus and
ampullary portions of the tube and evaluated the degree of spillage.
Results: Of the total number of cases, abnormal HSG findings were seen in 55 patients. Majority of the patients
were between 26-30years age group with 6-10 years duration of subfertility. The tubes were occluded in 34.28% of
cases in the ratio of 1:8, proximal occlusion being the commonest. 5.71% showed hydrosalpinx. Beaded & wiry
appearances of tubes were seen in 2.85% of cases. Amongst the uterine anomalies, which accounted for 20% of
cases, only five patients had acquired abnormality. In the congenital group maximum number of patients had
hypoplastic uterus (52.38%) followed by bicornuate uterus. Unicornuate and arcuate uterus accounted for 9.52%
each. Intravasation of contrast occurred in two patients.
Conclusion: Hysterosalpingography plays an important role in the initial diagnostic assessment of female
subfertility. Other than being diagnostic, it can prove to be therapeutic also10. An accurate interpretation of the
hysterosalpingogram is necessary for the initial subfertility workup. Knowledge of these entities is important to
avoid the practice of unnecessary and sometimes more aggressive procedures
Key words: Hysterosalpingography, Subfertility