New Indian Journal of Surgery

Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists, which was postulated to occur due to visuo-proprioceptive dissociation. One therapeutic approach that has the potential to temporarily resolve this visuoproprioceptive dissociation is mirror therapy, during which amputees typically move their intact limb while observing its reflection in a mirror, which in turn evokes the illusory perception of movement of their phantom limb. The objective of this short communication was to update the evidence for efficacy of mirror therapy for phantom limb pain. There were two experimental studies (both were pilot studies) and seven case reports found in our PubMed search.Although most of the studies report positive benefits,the evidence is too low and insufficient to draw definitive conclusions or provide recommendations.

Keywords: Mirror therapy; Phantom limb pain; Postoperative complication; Post-amputation pain; Postsurgical rehabilitation.

Lichen sclerosus (LS) is an acquired, chronic,inflammatory skin disease. Invasive squamous cell carcinoma has been reported with long standing genital LS. Here we report an association of extra genital LS with squamous cell carcinoma in a young lady. Extragenital LS showed decreased expression of the proliferation marker Ki-67 and p53 in comparison to genital LS. The p53 gene may be involved in the pathway of carcinogenesis.

Keywords: Lichen sclerosus; Carcinoma. 

Hydatid disease is common in India and liver is the commonest site of primary hydatid cyst. Various other organs like lung may be involved infrequently.But pancreatic involvement is uncommon and present diagnostic dilemma. Primary pancreatic hydatid cyst is presented with review of literature.

Background: The treatment of chronic anal fissure, in recent years, has seen inclusion of various non surgical modalities to the gold standard i.e. lateral sphincterotomy. It was the attempt of this research to objectively ascertain the roles of various modes of therapy in treatment of chronic anal fissure and alsoto find correlation between decrease in sphincter pressures and decrease in pain with treatment, if any. Methods: A total of 102 patients were included in the study and randomized to receive medical or surgical treatment. 52 patients were managed with Glyceryl trinitrate ointment (0.2%) while 50 patients underwent lateral internal sphincterotomy. Objective assessment of the pain was recorded as per the Visual Analog Score before and after treatment. Mean basal anal sphincter pressures were recorded before and after treatment. All patients were assessed for fissure healing at 4 and 6 weeks after completion of treatmen . Results: The reduction in pain score was significantly higher in the patients treated surgically  (p =0.037). The reduction in sphincter pressure was also significantly higher in the surgical group at 25.10, while in the medical group it was 6.56 (p < 0.001).Fissure healing rates were significantly higher in surgical treatment group at 92 per cent versus 55.76 per cent. The correlation between reduction in pain in anal canal and reduction in the MASP was found to be significant (p=0.00; r=0.488). Conclusion: This is the largest study in Indian patients comparing chemical with surgical phincterotomy using reduction in anal pressures and pain along with fissure healing as outcomes. It showed that the reduction in pain and anal sphincter pressure as well as fissure healing is significantly better in patients undergoing surgery.

Keywords: Anal fissure; Anal sphincter pressure; Sphincterotomy. 

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