Background
The majority of people with hip fracture are treated surgically, requiring anaesthesia

Objectives
To compare different types of anaesthesia for surgical repair of hip fractures (proximal femoral fractures) in adults

Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (November 2003), MEDLINE (1996 to February week 2 2004), EMBASE (1988 to 2004 week 10) and reference lists of relevant articles

Selection criteria
Randomised and quasi-randomised trials comparing different methods of anaesthesia for hip fracture surgery in adults The primary focus of this review was the comparison of regional (spinal or epidural) anaesthesia versus general anaesthesia The use of nerve blocks preoperatively or in conjunction with general anaesthesia is evaluated in another review The primary outcome was mortality

Data collection and analysis
Two reviewers independently assessed trial quality and extracted data

Main results
Twenty two trials, involving 2567 predominantly female and elderly patients, comparing regional anaesthesia with general anaesthesia were included All trials had methodological flaws and many do not reflect current anaesthetic practice Pooled results from eight trials showed regional anaesthesia to be associated with a decreased mortality at one month (56/811 (69%) versus 86/857 (100%)); however, this was of borderline statistical significance (relative risk (RR) 069, 95% confidence interval (CI) 050 to 095) The results from six trials for three month mortality were not statistically significant, although the confidence interval does not exclude the possibility of a clinically relevant reduction (86/726 (118%) versus 98/765 (128%), RR 092, 95% CI 071 to 121) The reduced numbers of trial participants at one year, coming exclusively from two trials, preclude any useful conclusions for long-term mortality (80/354 (226%) versus 78/372 (210%), RR 107, 95% CI 082 to 141)

Regional anaesthesia was associated with a reduced risk of deep venous thrombosis (39/129 (30%) versus 61/130 (47%); RR 064, 95% CI 048 to 086) However, this finding is insecure due to possible selection bias in the subgroups in whom this outcome was measured Regional anaesthesia was also associated with a reduced risk of acute postoperative confusion (11/117 (94%) versus 23/120 (192%), RR 050, 95% CI 026 to 095)

There was insufficient evidence to draw any conclusions from a further four included trials, involving a total of 179 participants, which compared other methods of anaesthesia (a 'light' general with spinal anaesthesia; intravenous ketamine; nerve blocks)

Authors' conclusions
Overall, there was insufficient evidence available from trials comparing regional versus general anaesthesia to rule out clinically important differences Regional anaesthesia may reduce acute postoperative confusion but no conclusions can be drawn for mortality or other outcomes

Anaesthesia for hip fracture surgery in adults

Background: McCune-Albright syndrome (MAS) includes the triad of poly/monostotic fibrous dysplasia, cafe-au-lait spots, and hyperfunctioning endocrinopathies. Acromegaly affects around 20% of MAS patients. Aims: The objective was to review all reported cases of acromegaly associated with MAS. Methods: All studies and case reports of acromegaly in patients with MAS were systematically sought in the world literature up to January 2013. We also included new data (from three unreported cases) and updated data on 23 previously reported patients from our two centers. Results: We reviewed the cases of 112 patients (65 males). Mean age at diagnosis of acromegaly was 24.4 years (range, 3–64). Among the 40 pediatric patients, 23 (57%) had precocious puberty. GH/IGF-1 excess was suggested by accelerated growth in 85% of pediatric cases. Acromegaly was almost always associated with skull base fibrous dysplasia. Modern imaging techniques (computed tomography or magnetic resonance imaging) revealed an adenoma in 54% of...

Acromegaly and McCune-Albright syndrome.

OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of "hemangioma" between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3-65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.

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Surgical treatment of aggressive vertebral hemangiomas

Purpose of reviewInterventional techniques were the mainstay for cancer pain management before the WHO ladder and opioids were freely available The three-step WHO ladder has its limitations, and cancer pain is often under treated Advances in treatment options mean that cancer patients are living l

Interventional management of cancer pain

SUMMARY Chickpea, pigeonpea and lentil constitute the major component of low-input agriculture in the semi-arid tropics (SAT). These pulses play an important role in alleviating malnutrition by way of forming an inseparable component to the dietary proteins for millions of peoples living below poverty line in SAT regions. The production and productivity of these food legumes is severely constrained by Fusarium wilt (FW). It has been reported to cause 100% yield losses, if affects them in the seedling stage. However, recent advances in the identification of races of the pathogen, screening techniques to identify FW resistant genotypes, genetic dissection and mapping and tagging of wilt resistance (WR) genes through molecular markers have resulted in the release of several wilt resistant varieties the world over. This has not only narrowed the gaps between potential and realized yields, but also minimized yearly fluctuations in production and productivity of these SAT pulses. However, the pace of advancements for WR in pigeonpea and lentil has not been comparable to those of chickpea. Even in chickpea, multiple gene pyramiding in a single variety is needed to make it resistant to multiple races of Fusarium. In this review paper, we have attempted to document the progress made along with future outlook towards FW resistance in these three pulses of SAT regions.

Narrowing yield gaps through genetic improvement for fusarium wilt resistance in three pulse crops of the semi-arid tropics

Breeding for short season environments.

Acute hemodynamic instability during alcohol ablation of symptomatic vertebral hemangioma: A prospective study

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequently encountered complication. It can result from a host of agents. Various modalities of treatment have been advocated, of which a novel method is radio frequency ablation. A 63-year-old male, a case of carcinoma prostrate with bone metastases, presented with tingling and numbness in right upper limb. He was given morphine, gabapentin and later switched to pregabalin, but medications provided only minor relief. Initially he was given stellate ganglion block, then radiofrequency ablation of dorsal root ganglion was done, but it failed to provide complete relief. Pulsed radiofrequency ablation (PRF) was then done for 90 seconds; two cycles each in both ulnar and median nerve. After the procedure the patient showed improvement in symptoms within four to five hours and 80% relief in symptoms. We conclude that PRF can be used for the treatment of drug resistant CIPN.

Radio Frequency Ablation in Drug Resistant Chemotherapy-induced Peripheral Neuropathy: A Case Report and Review of Literature

Background and Aims: Medication error can occur due to fault at any level starting from manufacturing until the administration to the patient. It can be difficult to read the drug name and other information from an ampoule, if there is poor contrast between the font color and background of the ampoule. Primary aim of this study was to evaluate the efficacy of the contrast color on the ampoule's label. Material and Methods: The study was conducted in a randomized blinded manner at a tertiary level trauma center. One hundred and eight resident doctors participated in the study. All the participants were divided into two groups after randomization. Group A was given the original drug ampoule while the modified ampoule with contrast was given to Group B. Total time in reading the ampoule and difficulty in reading (DR) scoring were noted for each participant. Another scoring regarding correct reading of ampoule was also noted and compared. Statistical Analysis: Student's t-test and Mann-Whitney test were used accordingly and P Results: It was found that mean time taken in reading the original ampoule was more compared to modified ampoule (11.64 ± 1.48 vs. 9.48 ± 1.62 seconds P Conclusion: The labels on drug ampoules or vials should always have a contrasting background. This may reduce medication error and improve patient safety.

Efficacy of contrasting background on a drug label: A prospective, randomized study.

Traumatic cervical lesions compressing the spinal cord pose a significant risk of exacerbating the existing neurological condition during tracheal intubation and subsequent positioning. Preexisting ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient with traumatic cervical spinal cord. To improve ease and success, and reduce cervical spine movement, awake fibreoptic intubation (FOI) is considered the gold standard technique for airway management in such cases. Attaining appropriate position for intubation was challenge in this case due to rigid curvature of the ankylosed spinal column. To prevent neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and attaining appropriate position was of prime concern. Optimal sedation with self-positioning by the patient in a comfortable posture is quite imperative and assures both airway as well as neurological protection in such expected difficult situations. We report the use of dexmedetomidine for self-positioning and awake FOI in a patient with ankylosing spondylitis having traumatic cervical spine who was otherwise neither able to co-operative nor able to give appropriate position for FOI.

Naveen Yadav

Papers

Breeding for short season environments.

Acute hemodynamic instability during alcohol ablation of symptomatic vertebral hemangioma: A prospective study

Radio Frequency Ablation in Drug Resistant Chemotherapy-induced Peripheral Neuropathy: A Case Report and Review of Literature

Efficacy of contrasting background on a drug label: A prospective, randomized study.

Airway management in a patient of ankylosing spondylitis with traumatic cervical spine injury.