Congenital radial club hand is a spectrum of complex pre-axial upper limb defect, Characterized by radial deviation and flexion of the hand, hypoplasia, or aplasia of the radius and thumb, shortened forearm and generalized underdevelopment of the involved extremity. Since first described by (Petit) in 1733, however a huge diversity of techniques ranging conservative stretching, to the complex microsurgical interventions, have been suggested, for treatment, the centralization remains the core idea, despite the recognized relapse rates. Such diversity would reflect the great challenge of management. Here is a prospective assessment of our local exposure, and satisfying results of correction in13 hands with congenital radial club hand deficiency, in 10 patients, using a newly modified technique (Sayre). Where we achieved a mean total hand-forearm angulation correction of 71.5 degrees, left with only 8.4 degrees mean residual angulation after an average 3.8 years follow up.

Obesity is a global health problem and also a strong risk factor for type 2 diabetes mellitus, cardiovascular diseases and obesity genes play a major role in the central regulation of energy balance. Orlistat (Xenical, Alli) is a synthetic anti-obesity drug approved by European Medicines Association (EMA) and Food and drug administration (FDA). But studies shown, orlistat supplementation causes severe liver and kidney injury. Melatonin, an indolamine, produced by the pineal gland plays a major role in circadian rhythm and one of the powerful antioxidant. Literatures shown, it also exerts control over metabolic functions that determine fat accumulation and obesity and it also protects environmental toxicants induced liver and kidney injury. Garlic (Allium sativum L.), has been used as medicinal and alimentary medicine from ancient period and these has been used extensively worldwide especially in countries like India. Studies reported garlic and its constituents have shown the various biological activities especially against cardiovascular disease due to its blood lipid-lowering, antithrombosis, antioxidant effects and inflammatory response. Diallyl trisulphide (DATS), a natural product from garlic have gained attention in many biological activities. Based on literatures and to compensate the orlistat induced side effects, we propose to study the expression levels of obesityrelated genes in high fat diet (HFD) induced experimental animals and also to see the impact of melatonin alone and in combination with DATS supplementation compared to orlistat alone therapy. We studied mRNA and protein expression of KSR2, IRX3, FTO and Neuropeptide Y by real time PCR and western blot method in liver, adipose tissue and brain of experimental animals along with antioxidant and liver function parameters. Histological observations of liver and adipose tissue were also studied. Based on results we found that both the melatonin and DATS alone and its combination with orlistat therapy is efficacy and safety when compared to orlistat alone therapy. This study determined the clinical usefulness of melatonin and DATS as supplemental therapeutic agents in obesity induced liver and kidney dysfunction as well as in orlistat therapy and it may help in providing the therapeutic options to tackle the obesity without causing side effects.

According to a recent estimate approximately 30 % of the population worldwide is engaged in one or other kind of sports and approximately 60 % of them suffer from various kinds of sports injuries and a large percentage of sports men are rendered unfit for further sports life due to the nature of injuries they suffer from. Poor fitness in the form of inadequate flexibility needed for the type of sports, core strength, balance, agility and the psychological factors like anxieties, stress associated with the game not only hamper the performance of the players but also make them prone to injuries. Physiotherapy has its origin in Yoga. Integrated role of Physiotherapy and Yoga can be useful components of comprehensive preventive and treatment programs in athletic injuries. The aim of Yoga is to bring balance into the body physically, mentally and emotionally. The mindbody connection in yoga is essential to helping athletes develop mental acuity and concentration. In addition, yoga helps to relax not just tight muscles, but also anxious and overstressed minds. Various health benefits associated with Yoga and Physiotherapy are improved flexibility, strength endurance, neuromuscular coordination, enhanced control over body movements and hence prevent injuries by conditioning of the athlete. The integration of physiotherapy with yoga offers an evidence based approach not only to enhance the fitness and performance of the sports men but also prevent injuries on field as well as off field.

The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. This drastic change has led to new batch of difficult to treat, musculoskeletal Disorders of the Upper Extremities such as myofascial pain syndrome of neck and upper back and thoracic outlet syndrome. The thoracic outlet anatomy and how the bundle passes through the passageway is complex for even musculoskeletal experts. So for doctors trained in other specialties there can be an inadequate understanding about nature and cause of thoracic outlet syndrome. A syndrome rather than a disease, the Mayo Clinic, Cleveland Clinic and the National Institute of Neurological Disorders And Stroke, plus top 10 ranked hospitals for neurology and neurosurgery agree persistent compression of nerves, arteries and veins traveling through the thoracic outlet is what leads to thoracic outlet syndrome. I will discuss the three models of human movement, the inverted pendulum model, the spring-mass model and the integrated spring-mass model (ISMM). The (ISMM), which integrates the spring suspension systems of the foot and shoulder region as well as the torsion spring of the spine and the mass, the head. I will discuss my clinical findings show compressive disorders like TOS and herniated discs are merely an over control of tension on the human spring mechanism leading to these syndromes. I will give brief review of the symptoms and their patterns, the common orthopedic tests, and diagnostic tests, the 16 different common conservative therapies and the 10 reasons for when surgery is medically necessary. I will discuss an alternative treatment for this disorder based on the integrated spring mass model.

Statement of the problem: Very few publications provide sound scientific data used to determine which components are essential for Infection Prevention and Control (IPC) programs in terms of effectiveness in reducing the risk of infection. As surgical procedures are common in the orthopedics specialty, the difficulty in preventing infections influences the orthopedic treatment outcome. The purpose of this study was to show why patients still catch hospital infections despite IPC programs. A better understanding of a variety of theories could explain the physiopathology of diverse diseases described in the medical past history, as in Traditional Chinese Medicine. A broader view seems to show the necessity of seeing the patient completely; not only focusing on the disease in the prevention of these hospital infections. The methodology used was a review of these theories such as those presented by Hippocrates (“Natural forces within us are the true healers of disease.”), as well as others from oriental medicine, which explain that diseases originate from three factors: external (exposure to cold, heat, humidity, wind and dryness), internal (emotional) and dietary. Findings: Having a broader view of the patient as a whole (Yin, Yang, Qi, Blood energy and Heat retention), we can understand better the formation of hospital infection which is a systemic energy reaction of the body undergoing normal hospital treatment. Conclusion: To understand better why patients are still catching hospital infections, despite IPC programs, we need to broaden our view observing all emotional, environmental and dietary factors, as well as studying the energy imbalance at the moment of admittance, or prior to the orthopedic surgery. Every patient is unique and to achieve a more successful treatment, it is important to individualize them. Therefore, it is possible to identify those who have more risk of hospital infection, studying them in their energy levels.

A giant cell tumor of tendon sheath (GCTTS) is a benign lesion whose presence in Hoffa’s pad has been rarely reported. In this case report we have demonstrated a case of GCTTS in a 37 year old female in Hoffa’s fat pad of knee. The patient had presented with the symptoms of pain and swelling in her left knee and provisionally diagnosed as ganglion cyst. The radiographic findings were inconclusive. The diagnosis was confirmed with excisional biopsy after the tumor was completely removed. This is a unique case report which shows the presence of a large tumor (5×3×2 cm) in Hoffa’s fat pad which was diagnosed as GCTTS and managed with openresection due to its size. Oxford knee score has improved from 34 from the time of presentation to 58, six months post surgery. The patient was pain free, had full range of motion and had returned to previous level of activities and there was no sign of any recurrence. Giant Cell Tumor should be kept as a differential of non-traumatic chronic knee pain in young individuals.

Peter Harris is the Principal at BP Consulting; VP Strategic for Oasis Diagnostics; co-founder, Longevity Surgical Inc. He has worked as an employee for multinationals, but prefers the start-up environment where he has made significant technology contributions in fields as diverse as bariatric surgery, diagnostic cardiology and CO2 laser surgery. Guest Lecturer, Dept Bioengineering, Univ. Washington, Seattle. BS Telecommunications.

Early psychomotor recovery is an essential part of day care surgery which depends on brain integration of motor and sensory co-ordination. Even though dexmedetomidine is commonly used for day care procedures, the recovery profile was not studied. Hence this study was designed to evaluate the psychomotor recovery of sedation with dexmedetomidine during spinal anesthesia and also to compare with propofol .Sixty six patients were included. Group D received dexmedetomidine 0.5 µg /kg (loading dose) followed by 0.2-1 µg/kg/hr .Group P received propofol infusion of 25-100 µg /kg/minute. Psychomotor recovery was assessed by Finger-tapping, Manual dexterity, Visual spatial memory capacity and pen & paper tests. Psychomotor tasks were given to the patients postoperatively at every 30 minutes for 2 hours followed by every hour up to 4 hrs after surgery. The motor recovery using finger tapping test was faster in group D than Group P (73.94±42.13 vs 101.21±37.98min, p value 0.007).Motor recovery using peg board test was faster in Group P than Group D (82.12 ± 40.37 vs 99.39 ± 43.08 minutes, p value 0.098).Visual spatial capacity memory test, pen &paper tests were unaffected. We conclude that patients who received dexmedetomidine showed earlier recovery with finger tapping test. Hence we suggest using dexmedetomidine for complete psychomotor recovery and fast track discharging of the patient after spinal anesthesia.

Conventionally general anaesthesia (GA) is considered gold standard for radical mastectomy however currently regional anaesthesia (RA) techniques are gaining popularity over GA because of the distinct advantages of lesser stress responses, eliminates airway related problems/ complications and facilitates postoperative analgesia. GA poses significant risk in high risk group of patients having hypertention, ischaemic heart diseases and chronic obstructive pulmonary diseases and they are known to be more associated with postoperative nausea vomiting (PONV) and pain following mastectomies. This paper is to present our experience with different RA techniques for radical mastectomy as a sole method of providing surgical anaesthesia over limited field of thoracic segments. Our study comprises of 50 cases of cervical epidural (CE), 25 cases of thoracic epidural (TE) and 50 cases of thoracic paravertebral block (TPVB) for radical mastectomies conducted at our Institution over last 5 years. We observed all the three methods i.e. CE, TE and TPVB are reliable alternative options for radical mastectomies to avoid potential risks and complications with GA and can be administered safely in high risk group of patients. The incidence of PONV and pain was significantly less in patients of regional anaesthesia group so also early ambulation was possible in these patients due to lesser upper limb / shoulder pain. Amongst all TPVB was found to be associated with minimal hemodynamic changes and postoperative complications. TPVB can be considered as a safe and reliable method of providing RA for radical mastectomies even in high risk group of patients.

I love history, and I believe that those who do not learn from their history are condemned to repeat it. Now that I have retired from active surgery, my presentations are mostly based on experiences with surgery and medical education. I have personal experience of more than six decades of practice of surgery and have seen many surgical landmarks in my life time. Surgery has come a long way from the practice of barber surgeons to upcoming practice of robotic surgery. We owe this progress to many stalwarts, some of whom I had the opportunity to work with. It is a challenge for me to condense surgical history of at least five millennia in few minutes allotted to me. I have learnt the history of medicine, covering the period till the middle of last century, through the enormous literature available on the subject. Being a surgeon, historical progress of surgery was of special interest to me. I obtained my basic medical degrees in 1959. Anything after that is contemporary history for me; something I witnessed or was an integral part of it. I have evidence, records and vivid memories of these six decades in which I actively practiced surgery. I started as a general surgeon, and I retired as one. As destiny would have it, circumstances provided me with opportunities where I had to deal with surgical problems of every system of the body, and sometimes, under most handicapped circumstances. These challenges made me rise to the occasion. The result is that I had the experience of journey through the progress of surgery during these sixty years, and my pleasure of keeping the concept of general surgery alive, in the age of specialization and super-specialization. My interests in medical education and my involvement in curriculum development made me to explore newer concepts in medical education, based on the historical developments and the demands of changing times. My presentation will cover this journey through slides and anecdotes, hopefully in 20-30 minutes, depending on the time allotted to me.