BackgroundIn order to confer optimal strength and stiffness to the graft in Anterior Cruciate Ligament (ACL) reconstruction, the maintenance of equal strand tension prior to fixation, is desired; positioning of the tensioning device can significantly affect strand tension This study aimed to determine the effect of tensioning device mal-positioning on individual strand tension in simulated cadaveric ACL reconstructions.MethodsTwenty cadaveric specimens, comprising bovine tibia and tendon harvested from sheep, were used to simulate ACL reconstruction with a looped four-strand tendon graft. A proprietary tensioning device was used to tension the graft during tibial component fixation with graft tension recorded using load cells. The effects of the tensioning device at extreme angles, and in various locking states, was evaluated.ResultsStrand tension varied significantly when the tensioning device was held at extreme angles (p < 0.001) or in 'locked' configurations of the tensioning device (p < 0.046). Tendon position also produced significant effects (p < 0.016) on the resultant strand tension.ConclusionAn even distribution of tension among individual graft strands is obtained by maintaining the tensioning device in an unlocked state, aligned with the longitudinal axis of the tibial tunnel. If the maintenance of equal strand tension during tibial fixation of grafts is important, close attention must be paid to positioning of the tensioning device in order to optimize the resultant graft tension and, by implication, the strength and stiffness of the graft and ultimately, surgical outcome.

Introduction: Due to closely related structures like recurrent laryngeal nerve and parathyroid gland, thyroid surgery becomes challenging. Microscope assisted surgery has better visualization for dissection, and decreases the risk of injury to the nerve, parathyroid gland, and its vascular pedicle. Hence it decreases the operative complications. Method: This is a retrospective study of microscope-assisted thyroidectomy at Gandaki Medical College Teaching Hospital, Nepal from January 2017 to December 2019. Ethical approval was obtained from Institutional review committee. Types of surgery, postoperative hypocalcemia and recurrent laryngeal nerve function were analyzed descriptively. Result:  Out of total 48 microscope assisted thyroidectomy, 41 were female, 42(87.5%) benign pathology, 6(12.5.%) malignant. Hemithyroidectomy was done in 40(83.4%), total thyroidectomy 4 (8.2%), total thyroidectomy with neck dissection  3(6.3%), and completion thyroidectomy with neck dissection in 1(2.1%). Among total thyroidectomies, transient hypocalcemia occurred in 2(4.2%) and temporary recurrent laryngeal nerve palsy in 1(2.1%). No complication occurred in hemithyroidectomies. Conclusion: Microscope-assisted thyroidectomy is a safe procedure which leads to reduced complication of hypocalcemia and recurrent never palsy.

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip.  The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles. Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block. Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache. Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.