Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

Percutaneous dilatational tracheostomy (PDT) is a frequently performed surgical procedure on critically ill patients. This study was designed to compare its two methods: Griggs guide wire dilating forceps (GWDF) technique and the ULTRA-perc single-stage dilator techniqueMaterials and Methods:Thirty Intensive Care Unit (ICU) patients on prolonged mechanical ventilation and requiring tracheostomy were included in our prospective randomized study. The first group (GP-GWDF) underwent PDT by the GWDF technique and the second group by the ULTRA-perc technique (GP-UP). Time for the procedure and early and late procedural complications were recorded and compared in between the two groups.Results:Time taken for tracheostomy was 11.68 ± 6.48 min for GP-GWDF and 13.93 ± 11.54 min for GP-UP (P-value 0.486). Desaturation was noted in two patients in GP-GWDF versus five in GP-UP (P-value = 0.195). Hypercapnea and rise in peak airway pressure occurred in one patient in GP-GWDF versus two in GP-UP (P-value = 0.543). Loss of airway was recorded in two patients in GP-UP and in none in GP-GWDF (P-value = 0.143). Subcutaneous emphysema, pneumothorax and pneumomediastinum occurred in one patient in GP-UP. No major complications were observed in GP-GWDF (P-value = 0.309). Hoarseness of voice was noted in one patient in each group (P-value = 0.659).Conclusion:Both the techniques seem to be equally reliable for carrying out PDT at bedside in the ICU.

Background: The Study was planned to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT380A in Indian women at Safdarjung Hospital New Delhi, after approval was obtained from Institutional Ethical committee.Methods: Study group consisted of 300 women, divided into two groups: Group A and Group B. The data was analysed by using ‘student “t” test/ non-parametric ‘Wilcoxon Mann Whitney’ for quantitative variables to evaluate the safety, efficacy and acceptability.Results: Mean age was 24.99 years (range: 19-35years), All women were married (off which 64% literate) and Mean parity in group A was 1.97 and 2.06 in group B. Mean pain score during intrauterine contraceptive device (IUCD) insertion on visual analogue scale was 2.93 in group A and 3 in group B and was not statistically different. 84% women completed 12 months follow up in group A and 83.33% women in group B. Strings were visible in 74% women in group A and in 34% women in group B at 1 month of IUCD insertion. Visibility of strings increased in successive follow up visits and was visible in >80% of women at the end of one year in the both groups. String visibility after intra-Caesarean insertion was delayed. Fifty one percent (n=77) subjects in group A and 54% (n=81) in group B experienced amenorrhea up to six months. Menorrhagia was reported in 7.33% in group A and women 8.66% in group B at the end of 1 year of follow up. Pain was complained by 26 out of 150 (17.3%) women in group A as compared to 36 out of 150 (24%) women in group B after 1 month of insertion. There was no case of PID in group A whereas there were 3 cases of PID in group B. There was no perforation/trauma and pregnancy in either group.Conclusions: Overall expulsion rate was 13% and removal rate was 5% in our study. Continuation rate was 83.3% in Cu 375 and 80.6% in CuT380A at 12 months. There was no significant difference between the IUCDs regarding the safety, efficacy and complications such as expulsion, bleeding etc.

Objective: Foreign bodies in the ear are mainly encountered in children. This can often pose a problem especially in an accident and emergency department where a microscope or expert help is not routinely available. This paper presents a simple, safe, and effective way of ear syringing. The ease and simplicity of the procedure along with the equipment are described. Method and result: The equipment consists of a ''disposable'' sterile kit, consisting of a 20 ml syringe, saline at body temperature and 14 or 16 gauge cannula (without the needle). An in vitro experiment was conducted to calculate the pressure generated by the water jet on the eardrum. The pressure was well below the pressure required to burst a tympanic membrane, and hence this technique is safe to use. Conclusions: Ear syringing is an effective and easy way of removing most foreign bodies. A detailed history and an otoscopic examination must precede the procedure. The novel method of syringing described in this paper with the usual safeguards could be a useful adjunct in the management of this common condition. F oreign bodies in the ear are encountered mainly in children, who can push items of jewellery, food, or any small object that comes to hand into the ear.1 Such children need careful management so that they are not frightened or hurt. Most children can be convinced to have their ear cleaned with syringing.The traditional methods of ears syringing use the metal syringe and the electric pulsed water syringe. Both methods have disadvantages, such as availability of syringes and the proved risk of ear damage during manual syringing.2 The metal syringe is filled with water from a receiver and the water stream is directed into the ear canal manually. The electric syringe has an internal pump which sends pulsed jets of water from an attached reservoir through a nozzle into the ear canal.Here we describe a simple assembly for safe syringing. The advantages of the equipment include easy assembly and availability of sterilised equipment, and safe operability. NOVEL SYRINGING TECHNIQUE EquipmentThe disposable kit consists of a 20 ml Luer lock syringe and a 14/16 gauge cannula (without the needle) secured to its tip (box 1). The patient is informed about the procedure and protected by a waterproof cape over their shoulder. The tip of the cannula is introduced into the ear canal at an angle of 45˚in a posterior and superior direction away from the ear drum to direct the saline stream towards the roof of the canal. A receptacle is placed under the affected ear.

Neuroblastoma is the most common solid tumor of infancy presenting clinically in a plethora of different and sometimes unpredictable ways with a wide range of symptoms. Young children can present with bluish skin metastases that may resemble bruising secondary to child abuse. Blueberry muffin baby had been reported to be a manifestation of either dermal erythropoiesis secondary to some congenital viral infections or neoplastic infiltrations. Among the neoplastic diseases, neuroblastoma has been the most common association with these subcutaneous skin metastases. Here, we report 2 months infant with neuroblastoma who presented with abdominal distension and multiple blueberry muffin nodules.