"Prevalence of chronic pain following resection of pelvic bone tumours: A single centre prospective observational survey".

Background: Hemipelvectomy is a major surgery most often performed for pelvic malignancy. These complex surgeries often involve dissection around major neurovascular bundle and resection of tumour being bone along with involved tissues. This may result in short and long term morbidities. There is very little literature about incidence of chronic pain after pelvic resections. We conducted a prospective study at a tertiary cancer hospital to assess the prevalence of chronic pain post hemipelvectomy. Method: This is a single centre prospective observational study conducted over 30 months. Pain scores were recorded using Brief pain inventory (BPI) and pain detect questionnaire. The quality of life was assessed using musculoskeletal tumour society (MSTS) score. Intra-operative details like extent of surgical resection, nerves spared, details of intra-operative and post-operative analgesia were retrieved from the patient files. Data were analysed using SPSS 21 version. Results: Neuropathic pain post hemipelvectomy was uncommon. The prevalence of mild to moderate somatic pain was around 30%. Functional limitation was minimal as assessed by BPI and MSTS score. A high incidence of numbness was seen to persist in and around the area of surgical incision (50%). Conclusion: This is first study to report the incidence of chronic pain post hemipelvectomy done for pelvic tumour resections. Despite the extensive nature of resection involved, there is a low prevalence of neuropathic pain in this population. However, incidence of persistent somatic pain is high and there is a need for further studies for evaluating the causality.

Pre-induction Ultrasonographic Evaluation of Gastric Residual Volume in Elective Gastrointestinal Cancer Surgeries.

Pulmonary aspiration of gastric contents during elective surgery remains a major cause of airway-related mortality and morbidity. The preoperative fasting times for solids and liquids have been standardized across various anesthesia society guidelines. Enhanced Recovery After Surgery (ERAS) guidelines now advocate liberal clear fluid intake with carbohydrate loading up to 2 h preoperatively. The aim of the study was to assess whether practicing both ASA fasting guidelines and ERAS protocol makes the patients prone to a full stomach. The supine position standard curvilinear ultrasound probe (2-5 MHz) with Sonosite M-Turbo ©system was used to obtain the images. Gastric residual volume (GRV) was derived from the cross-sectional area (CSA) using the Perlas and colleagues model. A total of 102 patients were recruited and analyzed. The mean age and BMI were 50.65 years ± 13.35 years and 22.23 kg/m2 ± 3.7 kg/m2, respectively. A total of four patients (3.92%) had gastric volume > 1.5 ml/kg; out of these four patients, three were female and one was male. We did not observe any case of pulmonary aspiration in any of our patients. In conclusion, even though for elective surgeries, the current fasting guidelines are adequate, these findings cannot be extrapolated to patients with risk factors for high gastric residual volume where further studies need to be performed.

Primary Blast Lung Injury: The UK Military Experience.

INTRODUCTION: Primary blast lung injury occurs when an explosive shock wave passes through the thorax and transits through tissues of varying densities. It requires close proximity to an explosion and presents quick with respiratory distress in survivors. MATERIALS AND METHODS: The Joint Theatre Trauma Registry and the Defence Statistics (Health) Database were interrogated for casualties injured as a result of an explosion during the conflict in Afghanistan. The case notes and imaging of casualties meeting the criteria for diagnosis were reviewed. Demographic and clinical data on casualties with primary blast lung injury were analyzed. RESULTS: 848 blast-exposed casualties survived to discharge from intensive care, and 238 blast-exposed casualties were killed in action. Following exclusions, 111 case notes and all postmortem reports were reviewed in detail. About, 25 casualties had isolated primary blast lung injury (2.9% of casualties surviving to discharge from intensive care) and 31 nonsurvivors (13% of nonsurvivors) had the disease documented at postmortem. Severe cases of primary blast lung injury required an estimated average of 4.5 days of conventional mechanical ventilation. CONCLUSIONS: 8.1% of blast exposed casualties suffered primary blast lung injury. It was a less severe disease than other nontraumatic forms of acute lung injury and did not cause deaths once a casualty had reached a combat support hospital. It was well managed with a relatively brief period of conventional mechanical ventilation.

The Right Ventricle During Selective Lung Ventilation for Thoracic Surgery.

The right ventricle (RV) has been an area of evolving interest after decades of being ignored and considered less important than the left ventricle. Right ventricular dysfunction/failure is an independent predictor of mortality and morbidity in cardiac surgery; however, very little is known about the incidence or impact of RV dysfunction/failure in thoracic surgery. The pathophysiology of RV dysfunction/failure has been studied in the context of acute respiratory distress syndrome (ARDS), cardiac surgery, pulmonary hypertension, and left ventricular failure, but limited data exist in literature addressing the issue of RV dysfunction/failure in the context of thoracic surgery and one-lung ventilation (OLV). Thoracic surgery and OLV present as a unique situation where the RV is faced with sudden changes in afterload, preload, and contractility throughout the perioperative period. The authors discuss the possible pathophysiologic mechanisms that can affect adversely the RV during OLV and introduce the term RV injury to the myocardium that is affected adversely by the various intraoperative factors, which then makes it predisposed to acute dysfunction. The most important of these mechanisms seems to be the role of intraoperative mechanical ventilation, which potentially could cause both ventilator-induced lung injury leading to ARDS and RV injury. Identification of at-risk patients in the perioperative period using focused imaging, particularly echocardiography, is paramount. The authors also discuss the various RV-protective strategies required to prevent RV dysfunction and management of established RV failure.

Holt-Oram syndrome: Anesthetic challenges and safe outcome.

Holt-Oram syndrome (HOS) is an autosomal dominant disease with skeletal and cardiac manifestations. We here are presenting a 31-year-old man and a diagnosed case of HOS, with an ulceroproliferative lesion on lateral border of the tongue, was posted for wide excision of lesion with primary closure and left side radical neck dissection.

Parent-child relations and psychological adjustment among high-achieving Chinese and European American adolescents.

Chinese American students are often perceived as problem-free high achievers. Recent research, however, suggests that high-achieving Chinese American students can experience elevated levels of stress, especially comparing to their peers from other ethnic groups. In this paper, we examine how family dynamics may influence psychological adjustment among a group of high-achieving adolescents. Drawing on survey data collected on 295 Chinese American and 192 European American 9th graders attending a highly selective magnet school, our findings show that Chinese American adolescents reported significantly lower levels of psychological adjustment (d = -.31), and significantly less family cohesion (d = -.34) and more conflict (d = .56) than their European American peers. Further, the ethnic differences on adjustment disappeared after controlling for perceptions of family cohesion and conflict, indicating that such perceptions may be a key factor in understanding the high academic achievement/low psychological adjustment paradoxical pattern of development among Chinese American adolescents.

The experiences of Sudanese unaccompanied minors in foster care.

Sudanese unaccompanied minors were separated from their parents in childhood and lived apart from their families in refugee camps for close to a decade before being resettled in the United States. This phenomenological study examines the refugees' experiences of living in American foster families after living in peer groups in the camps. Interviews with 18 young adults, 7 years after resettlement, revealed that nearly all of the youth struggled with parental authority initially, and nearly half of them changed placements because of relationship difficulties with their foster parents. Misunderstandings based on cultural differences often exacerbated conflicts. However, 15 of 18 youth currently had a positive relationship with at least 1 foster parent, sometimes with a parent from their second or third placement. Changing foster families is often considered a failure in the child welfare system, but several Sudanese youth reported that having supportive relationships helped them during the acculturation process whether those relationships developed during the first or last placement.

The Lost Boys of Sudan: coping with ambiguous loss and separation from parents.

The Lost Boys of Sudan were separated from their families by civil war and subsequently lived in three other countries-Ethiopia, Kenya, and the United States. In-depth interviews were conducted with 10 refugees about their experiences of separation from parents and ambiguous loss, and the coping strategies the youth used when they did not know if other members of their family were dead or alive. All of the youth reported using both emotion-focused and problem-focused coping strategies. The youth also discussed the importance of support from peers and elders while they lived in the refugee camps. In addition, they reflected on the psychological presence of parents who were physically absent, and the important role that hope of being reunited with parents played as they struggled with survival issues and ambiguous loss.

The "model minority" and their discontent: examining peer discrimination and harassment of Chinese American immigrant youth.

Using an ecological framework, the authors explore the reasons for peer discrimination and harassment reported by many Chinese American youth. They draw on longitudinal data collected on 120 first- and second-generation Chinese American students from two studies conducted in Boston and New York. Our analyses suggested that reasons for these experiences of harassment lay with the beliefs about academic ability, the students' immigrant status and language barriers, within-group conflicts, and their physical appearance that made them different from other ethnic minority or majority students. Implications and future research are also discussed.