iosr-JDMS   Volume-14 ~ Issue-8 ~ August-2015

Abstract: Ranula is a benign mucous containing, thin walled swelling which is caused by either rupture or blockage of major or minor salivary gland ducts. We present a case of a healthy 46 year male patient who presented with a 14 days history of swelling under the tongue, accompanied by discomfort while swallowing. He revealed a history of trauma of the maxillofacial region 2 months earlier. Local examination revealed a soft non tender fluctuant mass on the floor of the mouth extending bilaterally with seemingly normal mucosa. A clinical diagnosis of Ranula was arrived at and the lesion was subjected to marsupialization under Local Anesthesia. The aim of this article is to present a case of a giant bilateral Ranula located on the floor of the mouth and to discuss the various diagnostic and treatment modalities.

[1]. Kim PD, Simental Jr A. Treatment of ranulas. Oper. tech. otolaryngol.--head neck surg. 2008; 19 (4): 240-242.
[2]. Shehata EA, Hassam HS. Surgical Treatment of Ranula: Comparison between Marsupialization and Sublingual Sialadenectomy in Pediatric Patients. Ann Paediatr Surg. 2008; 4 (3): 89-93.
[3]. O'Connor R, McGurk M. The plunging ranula: diagnostic difficulties and a less invasive approach to treatment. Int J Oral Maxillofac Surg. 2013 Nov; 42 (11): 1469-74.
[4]. Kim SH, Huh KH, An CH, Park JW, Yi WJ. Giant plunging ranula: a case report. Imaging Sci Dent. 2013 Mar; 43 (1): 55-8.
[5]. Bhaskar SN, Bolden TE, Weinmann JP. Pathogenesis of mucoceles. J Dent Res. 1956; 35: 863-74

Abstract: Diabetes is a major risk factor for number of noncommunicable diseases. Novel factors like lipid profiles have contributed as risk factors for coronary artery disease along with abdominal obesity. So a comparative study is done to know the extent of altered lipid metabolism in NIDDM. Methods: Lipid profiles along with blood sugar levels were done to know the effect of dyslipidemia. Available NIDDM patients with history of diabetes without any complication were taken and equal no. of age & sex matched normal healthy control subjects were recruited in the study.

[1]. Joshi SR. Review diabetes mellitus (Part I). Quarterly Medical Review 2003; 55:1-42.
[2]. Abrams J. J. etal - Metabolism of Cholesterol and Plasma Triglycerides in Non ketotic Diabetes Mellitus - Diabetes 31; 903-910, October 1982.
[3]. Amos A . F etal - The rising global burden of diabetes & its complications estimates & projections to the year 2010. - Diabet Med 1997; 14 Suppl 5 : S 1-85.
[4]. Bagdage J. D. etal - Diabetic lipemia - The New England J of Medicine Feb. 23, 1967, Vol. 276 No.8 Pg. 427-433.
[5]. Banerji M.A. etal - Body composition, Visceral fat, Leptin & Insulin Resistance in Asian Indian Men. - The Journal of Clinical Endocrinology & Metabolism 1999, Vol. 84, No.(1), Pg. 137-144.

Abstract: Malaria is one of the major health problem in India with high mortality and morbidity. Conventional microscopy is the gold standard for the diagnosis of malaria but this approach requires an organized health system, infrastructure with functioning microscopes, trained technicians, regular provision of reagents, supervision, and quality control which is impractical especially in rural areas and in emergency situation. Rapid diagnosis of Malaria by OptiMAL method is an immunochromatographic test which can be done at bedside and does not require expertise personnel to interpret the results.

[1]. Ashok K. K. Malaria in children. IAP Text book of pediatrics, New Delhi: Jaypee bro pub; 1999.231-236.
[2]. Park K. Malaria. Text book of preventive and social medicine, 18th edi. Jabalpur: Banarasidas Bhannot pub; 2002.192-202.
[3]. Panikar CKJ. Malaria parasites. Text book of medical parasitology, 4th edi. Daryaganj: Jaypee bro pub; 1997. 64-93.
[4]. Palmer CJ, Bonilla JA, Bruckner DA et al. Multicentre study to evaluate the Optimal test for rapid diagnosis of malaria in U.S hospitals. Journ of Clin microbial 2003; 41(11): 5178-5182.
[5]. Holding PA, Snow RW. Impact of Plasmodium falciparum on performance and learning. Am.J. Trop. Med 2001; 64(1, 2): 68-75.
[6]. Cooke AH, Doherty T, Moody AH. Comparision of pLDH based immuno chromatographic antigen detection assay with microscopy for the detection of malaria parasites in human blood samples. Am.J.Microbiol.

Abstract: Objective: To access the correlation of Blood Pressure, Serum Lipid Profile, Duration of diabetes in a patient with diabetic cardiomyopathy in Manipur. Material and methods: A total of 100 type2 diabetic patient were selected randomly. Anthropometric parameters were recorded, blood pressure, glucose level and serum lipid profile were determined and echocardiography study were performed in all patient according to standard technique.

[1]. Adeghate E: Molecular and cellular basis of the etiology and management of diabetic cardiomyopathy - A short review. Mol Cell Biochem. 261(1-2): 187-191, 2004.
[2]. Agarwal BD, Sika KK, Srivasta DK and Sukla DK; A study of serum lipid profile in controlled diabetes, uncontrolled diabetes and diabetic with ketosis. Indian Medical Gazette; 422-428, 1980.
[3]. An D and Rodriques B: The role of changes in cardiac metabolism in the development of diabetic cardiomyopathy. American Journal Physiol. Heart Circulation Physiology2003.
[4]. Bernal E, Mizrachi J and Mirachi CB: Diabetic Mellitus and related disorder. Diabetic Care; 26 [suppl 1]; S5, 2003.

Abstract: Aim :To study the etiology, occurrence in relation to age, sex, side and severity & choice of management of Temporomandibular joint Ankylosis and their outcome. Material & Methods:This is a study of the cases, which numbered about 25 cases, had been operated by the Department of Plastic Surgery at Osmania General Hospital between January 2009 to March 2012 in association with department of Radiology & Dentistry.

[1]. Katarzyna Sporniak-Tutak, Joanna Janiszewska-Olszowska, Robert Kowalczyk. Management of temporomandibular ankylosis – compromise or individualization – a literature review. Med Sci Monit. 2011; 17(5): RA111–RA116. [2]. Benaglia MB1, Gaetti-Jardim EC, Oliveira JG, Mendonça JC. Bilateral temporomandibular joint ankylosis as sequel of bilateral fracture of the mandibular condyle and symphysis. Oral Maxillofac Surg. 2014 Mar;18(1):39-42. doi: 10.1007/s10006-012-0384-z. Epub 2013 Jan 10.
[3]. Munro IR, Chen YR, Park BY. Simultaneous total correction of temporomandibular joint ankylosis and facial asymmetry. Plast Reconstr Surg 1986;77:517-27.
[4]. Kreutz RW, Yamada R. Post traumatic extracapsular temporomandibular joint ankylosis between coronoid process and base of skull. Oral Surg 1985;60:577-80.

Abstract: Objectives: To compare the force decay rate of the four brands of elastomeric chain over time and finally establish a gradation of brands in terms of force degradation characteristics. Materials and Methods: In this study total of two hundred and forty elastics were used. It had elastics of the same size from four different manufacturers. The experiment was carried out in vivo. For each patient the interbracket distance is measured for all four quadrants.

[1]. Young J and Sandrik JL "The influence of preloading on stress relaxation of orthodontic Elastic polymers" Angle Orthod 1979; 49(2): 104-109
[2]. Kanchana P and Godfery K. "Calibration of force extension and force degradation characteristics of orthodontic latex elastics" Am J Orthod Dentofacial Orthop 2000; 118:280-7
[3]. Wong AK "Orthodontic elastic materials" Angle Orthodontist 1976; 46(2): 196-205.
[4]. De Genova, DC.McInnes-Ledoux P,Weinberg R,Shaye R."Force degradation of orthodontic elastomeric chains" - a product comparison study. Am J Orthod Dentofacial Orthop 1985; 87(5): 377-384.
[5]. Sonis L, Van der Plas E & Gianelly A: "A comparison of elastomeric auxillaries versus elastic thread on premolar extraction site closure: An in vivo study" Am J Orthod Dentofacial Orthop .89:73-78, 1986.

Abstract: Background: Almost a quarter of the population in developing countries are comprised of adolescent population. Of which 40% of the population is constituted by children under 15 years of age. Menstruation disorder affects 75% of the adolescent population and this abnormal bleeding accounts for 50% of gynaecological visits. Aim : the study was undertaken to identify the incidence of puberty menorrhagia and evaluate morbidity and mortality caused by puberty menorrhagia. Methods: this was a non-randomized study of 65 adolescents (10 -19 years) patients presenting with symptoms of menorrhagia in the outpatient department, emergency department and indoor of the obstetrics and gynecologydepartment .

[1]. Wu T, Mendola P and Buck GM. Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the third national health and nutrition examination survey 1988-1994. Pediatrics 2002 oct;110(4)752-57.
[2]. Flug D, Largo RH and Prader A. Menstrual patterns in adolescent Swiss girls: a longitudinal study. Am Hum Biol 1984;11:495-508.
[3]. Southam AL and Richart RM. The prognosis for adolescents with menstrual abnormalities. Am J ObstGynecol 1966;94(5):637.
[4]. World Health Organisation task Force on adolescent reproductive health. WHO multicenter study on menstrual and ovulatory patterns in adolescent girls. J Adolesc Health care 1986; 7:229-35.
[5]. Widholm and Kantero. A statistical analysis of the menstrual patterns of 8000 Finnish girls and their mothers. ActaObstet et Gynecol Scan 1971;14(14):1-36.
[6]. Rao S, Pawar V, Badhwar VR and Fonseca MN. Medical intervention in puberty menorrhagia. Bombay Hosp Jour 2004 april; 1-6.
[7]. Davey DA. Dysfunctional uterine bleeding; Dewhurst's text book of obstetrics and gynecology for postgraduates. Ed: Keith D, Edmond. 5th ed;4:590-606.

Abstract: Sheroidal degeneration , reported as a rare entity in western literature is a common ocular morbidity in our parts of India. It is commonly seen in persons who are exposed to intense sun light (excess UV radiation) reflected off the surface of the sea, snow and sand. Hence, its prevalence is more in fishermen. Clinically, it is characterised by the presence of amber coloured spherules on the cornea giving rise to intense foreign body sensation, pain, redness, watering, photophobia and decreased visual acuity. Because of the poor ocular surface they are not suitable for certain other ocular procedures like refractive status assessment, cataract surgery etc thus decreasing their quality of life. Superficial keratectomy (manual/laser ,Phototherapeutic keratectomy (with adjuvants) ,Lamellar keratoplasty, Penetrating keratoplasty are the available options for the management of this condition.

[1]. F. T. Fraunfelder, M.D., Calvin Hanna, Ph.D., And J. Parker, M.D.. Spheroid Degeneration Of The Cornea And Conjunctiva 1. Clinical Course And Characteristics.Am J O 1973;76:821-828.

[2]. Alec Garner .Keratinoid Corneal Degeneration.Bjo;1970;54:769-780 [3]. Varsha M Rathi,Sharadini P Vyas,Virender S Sangwan.Phototherapeutic Keratectomy. Ijo 2012;60(1):5-14

[4]. Daljit Singh, Mohindar Singh, Shiv Inder Singh Rudra. Climatic Keratopathy.Ijo 1979;27(4):180-184

[5]. Sridhar Ms, Garg P, Das S, Vemuganti G, Gopinathan U, Rao Gn. Infectious Keratitis In Climatic Droplet Keratopathy. Cornea

[6]. Franufelder, F.T. And Hanna, C., 1973, Amer, J, Ophthal., 76, 41. 2000;19:455-8.

[7]. Tetsuo Hida, Kajuteru Kigasawa, Etsuo Tanaka, Shinobu Akia, Yukio Tashiro ,Yusuhiro Hosoda. Primary Band Shaped Spheroidal Degeneration Of The Cornea : Three Cases From Two Consanguineous Families Families .Bjo 1986 ;70: 347-353.

Abstract: Occlusal splint therapy is chosen for the treatment of dysfunctions in the Orofascial region for several reasons. The aim of this study was to compare the effectiveness of hard and soft occlusal splint in the management of myofascial pain. Thereby subjects seeking treatment for myofascial pain were randomly assigned for the splint group and soft splint group. Modified severely index and objective pain analysis using muscular palpation score. Follow up was done and the patient was examined on baseline, 7, 30, 60 and 90 days. All patients improved over time. The statistical analysis was done using't' and paired 't' test and the results showed that both hard and soft splints are effective but the hard splint is more effective compared to soft splint . Key words: Splints, occlusal splint, splint therapy, hard splint, soft splint, TMD, Myofascial pain, Temporomandibular disorder.

[1]. Okeson JP. Management of temporo mandibular disorders and occlusion. 5th ed. St. Louis: Mosby; P. 260. 2003.
[2]. Tsuga K, Akagawa Y, Sakaguchi R, Tsuru H. A short-term evaluation of the effectiveness of stabilization - type occlusal splint therapy for specific symptoms of temporo mandibular joint dysfunction syndrome, J Prosthet Dent 1989;61:610-3
[3]. Ekberg E, Vallon D, Nilner M. Occlusal appliance therapy in patients with temporo mandibular disorders a double-blind controlled study in a short-term perspective. Acta Odontol Scand. 1998;56: 122–128.
[4]. Ekberg E, Vallon D, Nilner M. The efficacy of appliance in patients with temporo mandibular disorders of mainly myogenous origin. A randomized, controlled, short-term trial. J Orofac Pain. 2003; 17:133–139.
[5]. Ekberg E, Nilner M. Treatment outcome of appliance therapy in temporo mandibular disorder patients with myofascial pain after 6 and 12 months. Acta Odontol Scand.2004; 62:343–349.
[6]. Greene CS, Laskin DM. Splint therapy for the myofascial pain dysfunction (MPD) syndrome: a comparative study. J Am Dent Assoc. 1972; 84:624–628.

Abstract: Objective: To compare recurrence rate between conjunctival autograft and Mitomycin C after primary pterygium excision in primary and recurrent pterygium . Design: Analytical study on patients of primary and recurrent pterygium from 15 december 2012 to 15 february 2013 and June 2013 to March 2014. Setting: Department of Ophthalmology, M.L. B. Medical College, Jhansi/ U.P.

[1]. Wong AK, Rao SK, Leug At, Poon AS, Lam DS. Inferior Limbal – Conjunctival autograft transplantation for recurrent pterygium. Indian J Ophthalmol 2000.
[2]. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis Lei Liu1,2, Jingyang Wu1, Jin Geng1, Zhe Yuan1, Desheng Huang2,3 Department of Ophthalmology, The First Affiliated Hospital, China Medical University,Shenyang, China Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China Department of Mathematics, College of Basic Medical Sciences, China Medical University,Shenyang, China Professor Desheng Huang; haungdsll 2013. [3]. Norn M, Franck C .Long-term changes in the outer part of the eye in welders. Prevelence of spheroid degeneration, pinguecula, pterygium, and corneal cicatrices. Acta Ophthalmol (Copenh) 1990. [4]. Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K (2009) Prevalence and risk factors of pterygium and pinguecula: the Tehran Eye Study. 2008. [5]. Taylor HR, West S, Muñoz B, Rosenthal FS, Bressler SB et al. (1992) The long-term effects of visible light on the eye. Arch Ophthalmol .

Abstract: Bilateral anterior shoulder dislocation is extremely rare. The majorities of simultaneous bilateral dislocations reported in the literature are posterior and typically associated with seizure activity or electrocution accidents. Till date only few cases of bilateral anterior shoulder dislocation has been reported. We report here an unusual case of bilateral anterior shoulder dislocation in 52 year male due to fall on ground while pushing a rickshaw.Careful detailed physical examination and radiological imaging are necessary to rule out any fracture and neurovascular injury.

[1]. Brown RJ. Bilateral dislocation of the shoulders.Injury.1984; 15: 267–273.
[2]. Betz ME, Traub SJ. Bilateral posterior shoulder dislocations following seizure.Internal and Emergency Medicine.2007; 2: 63–65.
[3]. Brackstone M, Patterson SD, Kertesz A. Triple "E" syndrome: Bilateral locked posterior fracture dislocation of the shoulders. Neurology.2001; 56: 1403– 1404.
[4]. Dinnopolous HT, Giannoudis PV, Smith RM, Mathews SJ. Bilateral anterior shoulder fracture-dislocation, A case report and a review of the literature. 1999; 23: 128-130.
[5]. Markel DC, Blasier RB. Bilateral anterior dislocation of the shoulders with greater tuberosity fractures. Orthopedics.1994; 17: 945-949.
[6]. Lin CY, Chen SJ, Yu CT, Chang IL. Simultaneous bilateral anterior fracture dislocation of the shoulder with neurovascular injury: report of a case. Int Surg. 2007; 92: 89-92.

Abstract: Unilateral fracture of radial head and neck are the most commonly seen elbow fractures. These fractures occur due to fall on outstretched hand with a partially flexed elbow. However, bilateral radial neck fractures are extremely rare injury in adults and till the date only few cases has been reported. We report here an unusual case of bilateral radial neck fractures in a patient who presented with complaints of pain and mild swelling in both elbows followingfall on outstretched hands. Careful physical examination and proper radiographs are mandatory for the diagnosis. Early recognition, proper management, and physical therapy are necessary for complete recovery and full functional movement of the elbows.

[1]. Tejwani NC, Mehta H. Fractures of the Radial Head and Neck: Current Concepts in Management. J Am AcadOrthop Surg. 2007; 15 (7): 380-7.
[2]. Hodge JC. Bilateral radial head and neck fractures. J Emerg Med. 1999; 17 (5): 877-81.
[3]. Koval KJ, Zuckerman JD. Handbook of fractures. 2nd Ed. Philadelphia: Lippincott Williams & Wilkins, 2002: 122-5.
[4]. Fekete K, Detre Z, Szepesi A. Bilateral fractures of the proximal end of the radius: MagyTraumatolOrthopHelyreallitoSeb 1990; 33 (4): 307-12.
[5]. Deshmukh NV, Shah MS. Bilateral radial head fractures in a martial arts athlete: Br J Sports Med. 2003; 37 (3): 270-1.
[6]. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954; 42 (172): 123-32.

Abstract: Incidence of diabetes mellitus is increasing worldwide. The role of vitamin D through pancreatic beta cells function is to increase the sensitivity and secretion of insulin. Low vitamin D levels are associated with impaired glucose metabolism. Estrogen hormone activates vitamin D and increase vitamin D receptors (VDR). In menopause, due to decline of estrogen hormone leading to further deficiency of vitamin D (25OH vitamin D).

[1]. Krishna SG, Bubblu T, Amarabalan R; Role of vitamin D in Diabetes. J Endocrinol Metab., 2011; 1(2):47-56.
[2]. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009;32:62–7.
[3]. IDF: One adult in ten will have diabetes by 2030. IDF Press release; 2011 [http://www.idf.org/media-events/press-releases/2011/diabetes-atlas-5th-edition], accessed on 29th August 2014
[4]. William J Marshal ,Clinical biochemistry 2nd edition calcium, phosphorus and magnesium 98-100
[5]. Pittas AG, Harris SS, Stark PC, Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. 2007;30(4):980–6.
[6]. Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose Homeostasis. Int J Endocrinol. 2010;2010:351–85

Abstract: Thoracic outlet syndrome is described as the compression of one or several neurovascular structures that cross the thoracic outlet. The syndrome often appears overlooked and misdiagnosed because objective findings are scarce leading to persistent pain, impaired function and emotional distress. The aim of this study was to identify normal and abnormal anatomy of thoracic outlet using computed tomography scan in symptomatic costoclavicular compression syndrome and to plan them for surgery there after. This was a prospective hospital based study. All the symptomatic cases of costoclavicular compression syndrome admitted in the department of Cardiovascular and thoracic surgery, SKIMS, Srinagar from May 2011 to May 2013 were taken up for the study. A total of 30 cases of symptomatic costoclavicular compression syndrome were reported from May 2011 to May 2013. Mean age of presentation was 26.3 years.

[1]. Peet R M, Henriksen J.D, Anderson T.P, Martin GM.Thoracoc outlet syndrome: Evalvation of a therapeutic exercise programe.Proc Staff Meet Mayo Clin 1956; 31(9):281-287.
[2]. Chirkov A,Zakhariev T,Stankev M,Markov D.The costoclavicular neurovascular compression syndrome.Khirurgiia 1995;48:5-10.
[3]. Peet R.M, Henriksen J.D,Anderson T.P,Martin GM.Thoracic ouetlet syndrome:Evalvation of a therapeutic exercise programe.Proc Staff Meet Mayo Clin 1956;31(9):281-287
[4]. Becker F,Terriat B.Thoracic outlet compression syndrome:the view point of the angiologist.Rev Med Interne 1999;20 suppl 5:4875-935.
[5]. Winkle D,Matthijis O,Pheips V.Diagnosis and treatment of the upper extremities.Non operative orthopedic medicine and manual therapy.Gaithersburg,MD:Aspen Pub.1997;42.
[6]. Astoy E:Thoracic outlet compression syndrome.Orthop ClinNorth Am 1996;27:265-303.

Abstract: spinal giant cell tumors are very uncommon solitary beningn neoplasms with locally aggressive nature. These tumors are most commonly seen in sacrum, rarely present above the sacral part of axial spine. Till now very few cases of giant cell tumors involving lumbar region have been reported in literature. Here in, we are reporting an unusal case of solitary giant cell tumor at [Lumbar]L1 vertebra in a 25 year old man presenting with low backache, paraparesis and urinary disturbances. He underwent near total excision of tumor through posterior approach followed by instrumentation and posterolateral fusion. Postoperatively patient improved neurologically. To the best of our knowledge till now 27 cases of Lumbar giant cell tumors have been documented in literature. Key Words: Giant cell tumor (GCT) , Lumbar region, Metastasis.

[1]. Ben Nsir A, Said IB, Badri M, Boughamoura M, Jemel H. Giant cell tumor of the sixth thoracic vertebra: case report. Turk Neurosurg. 2015;25(3):475-8.
[2]. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G. Giant cell tumor of bone: Treatment and outcome of 214 cases. J Cancer Res Clin Oncol 134(9): 969-978, 2008.
[3]. Munoz-Bendix C(1), Cornelius JF, Bostelmann R, Gierga K, Steiger HJ.
[4]. Giant cell tumor of the lumbar spine with intraperitoneal growth: case report and review of literature. Acta Neurochir (Wien). 2013 Jul;155(7):1223-8.
[5]. Refai D, Dunn GP, Santiago P: Giant cell tumor of the thoracic spine: Case report and review of the literature. Surg Neurol 71(2):228-233, 2009
[6]. Lubicky JP, Patel NS, DeWald RL (1983) Two-stage spondylectomy for giant cell tumor of L4. A case report. Spine (Phila Pa 1976) 8(1):112–115

Abstract: Introduction: Peripheral nerve blocks are gaining wide popularity in anaesthesia clinical practice and can be used in variety of surgical procedures, for surgical anaesthesia and postoperative pain. Supraclavicular approach gives the most effective block for upper extremity and is carried out at the level of trunks of brachial plexus.1the plexus is blocked where it is most compact. i.e. at the middle of brachial plexus, resulting in homogeneous spread of anaesthetic throughout the plexus with a fast onset and complete block. Materials and Methods: This was a prospective, randomised, double-blinded comparative study, which was conducted under the Department of Anaesthesiology and Critical Care, D.Y Patil Medical College and Hospital, Navi Mumbai after obtaining patient's attendant's informed consent. The study was carried out on 100 patients of ASA Grade I and II scheduled for upper limb surgery.............

Key Words: Clonidine, bupivacaine, Peripheral nerve blocks.

[1]. De Mey JC, et al.: The influence of sufentanil and/or clonidine on the duration of analgesia after a caudal block for hypospadias repair surgery in children. Eur J Anaesthesiol 2000; 17: 379-82.
[2]. Constant I, et al.: Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth 1998; 80: 294-8.
[3]. Baris S, et al.: Comparison of fentanyl-bupivacaine or midazolambupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children. Paediatr Anaesth, 2003; 13: 126-3.
[4]. Vercauteren M and Meert TF: Isobolographic analysis of the interaction between epidural sufentanil and bupivacaine in rats. Pharmacol Biochem Behav 1 997; 58: 237-42.
[5]. Palmer CM, et al.: Bupivacaine augments intrathecal fentanyl for labor analgesia. Anesthesiology 1999; 91: 84-9.