Editor,
INDIAN JOURNAL OF APPLIED RESEARCH
303, Maharana Pratap Complex, Opp. Kapadia Guest House, B/H V.S.Hospital, Paldi, Ahmedabad-380006, Gujarat (INDIA)
Sr.
No. Title
Page No. 1 Effect of Strategies in Enhancing Social Adjustment Among Middle School Students
- P. Nirmala Devi, Dr. M. Parimala Fathima
1-2
2 The Advantages of Using Self Compacting Concrete for Reinforced Concrete Structures in an Aggressive Marine Environment
- Ciinoiu Marian, Gramescu Ana Maria
3-5
3 Brahamand in Puran and Jinagam - Prof Dr B L Sethi, Abhilasha Jaiman
6-7
4 Treatment of Infected Non Union of Lower Limb Long Bones with Limb Reconstruction System (Lrs). - Dr Mukesh N Shah, Dr Josal S Patel
8-11
5 Deconstructing the Hegemony of History: A Study of Postcolonial Resistance in the Indian and African Perspective
- Dr. Somdev Banik
12-14
6 Incidence of Malignancy in Solitary nodule of Thyroid - Dr. C Ramchandraiah, Dr. R Sadgunachary, Dr. Vijayabhargav
15-19
7 Microinance and Women Empowerment: Evidence from India - Review of Literature - Ms. Madhavi Kodamarty, Ms. Ranjani Srinivasan
20-22
8 Study on Frequency of Metabolic Syndrome Between Literate and Illiterate in Rural Area of Varanasi - Dr Narendra Kumar Sharma, Dr Ajamal Singh Bhayal
23-25
9 Simultaneous Estimation of A Three Component Mixture of Aspirin, Caffeine and Orphenadrine Citrate by Uv Spectrophotometric Method of Absorbance Correction for Interference
- Sanjay Pai PN, Gaude Sameeksha, Anusha Palekar
26-28
10 Antibacterial Activity of Plant Extracts Against Xanthomonas Axonopodis Pv. Punicae Causing Bacterial Blight of Pomegranate (Punica Granatum L.)
- S K Alane, C S Swami
29-30
11 Treatment of Tetanus in Goats and Sheep
- U.UMADEVI, P.MADHU MATHI, K.SARANYA, T.UMAKANTHAN
31
12 Study Regarding Eficiency of Jump Service in Volleyball High Performance - Cojocaru Adin-Marian, Cojocaru Marilena
32-34
13 Excellence in Higher Education: Link with College Principals’ Leadership Styles. - ARPIT SHANKHDHAR
35-36
14 Impediments in Success of CBCS in Colleges of HP - ASHWANI KUMAR SHARMA
37-39
15 Study of Freyer's Prostatectomy in Bph with Special Reference to Modiied Management Plan (Early Removal of Catheter) and Haemorrhage
- Dr Pankaj Singh, Dr Dinesh Pratap
40-42
16 Teacher’s Locus of Control Scale: Development & Validation (TLOCS) - Madhu Gupta, Indu Nain,
43-45
17 One – Room Schoolhouse+Fanatical Teacher + Commited Students = Freedom from a Life of Poverty - Gautam Neeraj, Dr . M.S Khan
46-47
18 Genetic Variability Among Mythical Kinnaura Tribe - Ravi Kiran Sharma
48-50
19 Women Employment in Organized Sector of India: an Empirical Perspective - Navdeep Kaur, Sarbjit Kaur
51-53
20 Micro-Finance – a Tool for Sustainable Livestock Production - Dr. T. Vijaya Nirmala, Dr. K. Ravi, Dr. B. Vamsi Krishna
Sr.
No. Title
Page No. 21 Legal Aid In India-An Overview
- Dr.Prativa Panda
57-58
22 Pattern of Growth Lengths, Circumference Chest and Body Weight of Bali Pig - I P. Sampurna, T. S. Nindhia, I K.Suatha
59-62
23 Changes in The Activity of Enzyme Peroxidase (Ec 1.11.1.7) During Leaf Senescence in Sericultural Crop Morus Alba Linn
- S. K. Khade
63-64
24 Employee Empowerment - G.A.HEMA
65-67
25 Geomorphological Mapping for Identiication of Groundwater Potential Zones in Hard Rock Areas Using Geospatial Information- a Case Study of Nagavati Watershed in Dharmapuri District, Tamil Nadu, India
- R. Kannan, S. Venkateswaran, M.Vijay Prabhu, S.Satheeshkumar
68-70
26 Assessment of Parasitic Protozoan Infestation on Commonly Consumed Raw Vegetables and Their Sources of Contamination
- Sameer Sood, D.K. Kocher
71-73
27 Performance of Madras Export Processing Zones (Mepzs) - DR.SP.MATHIRAJ, R.SAROJA DEVI
Effect of Strategies in Enhancing Social Adjustment
Among Middle School Students
P. Nirmala Devi
Dr. M. Parimala Fathima
Research scholar, Lecturer, DIET, Pudukkotai Research Coordinator, Alagappa University College of Education , Karaikudi.
KEYWORDS
ABSTRACT Emotional Maturity is the key to a happy , fulfilled life. Without which, the individual falls an easy prey to
the dependencies and insecurities. Social Adjustment is one of the components of Emotional Maturity. The behavior of children at school is a crucial element in their overall social adjustment. The present investigation has been undertaken in order to the study the effect of strategies in enhancing social adjustment among middle school students. Simple Experimental Design was used in this study. Social Adjustment scale was developed by investigator. This study reveals that the students under the stage of adolescence (above age 12) lack in social adjustment. Strate-gies were developed by investigator is useful for developing social adjustment among middle school students.
INTRODUCTION
Middle school students are under the stage of adoles-cence seems to be the formative stage. Middle child-hood is a time of dramatic physical, cognitive, emotional, and social change (Cole & Cole, 1993).Children develops on many levels, entering new endeavors and worlds dai-ly. They begin to learn how to establish healthy relation-ships, ind socially acceptable ways to engage in activities that interest them, and make their way through school. However, a number of children experience more trials than their peers .Some are unable to ind solid emotional and social ground as they progress through their develop-mental stages. An inability to “it it” can have behavioral manifestations that cause signiicant dificulty for both chil-dren themselves and those around them. When a child’s behavior violates the accepted norms at home, at school, or in the community can result, such as suspensions or expulsions from school. Lot of opportunities and avenue are there to get them social maladjustment. Hence the researcher selected this problem to enhance Social Ad-justment among middle school students by using new ap-proaches and strategies.
STATEMENT OF THE PROBLEM
The problem selected for the present investigation is “ Effect of Strategies in Enhancing Social Adjustment among Middle School Students”.
OBJECTIVES OF THE STDUDY
• To ind identify the level of social adjustment among middle school students.
• To develop and implement the strategies to enhance social adjustment.
• To assess the level of Social Adjustment after the im-plementation of strategies.
• To ind out and analyses the effect of these strategies.
HYPOTHESIS
• There is no signiicant difference between achievement scores of pre test and post test in social adjustment.
• There is no signiicant difference between Social Ad-justment of the boys and girls in pre test score.
• There is no signiicant difference between Social Ad-justment of the boys and girls in post test score. DELIMITATION OF THE STUDY
The study will be conined only on 8th standard students in PUMS, Kanniapuram, Dindigul District.
Social Adjustment is to be assessed only on the basis of selected tool.
RESEARCH METHOD
Experimental Design (Pre test – Treatment- Post test) has been used.
Sample selection
19 (11 Male + 08 Female) students are studying VIII standard in PUMS, Kanniapuram, Sanarpatti Block in Din-digul District were selected as a sample for present inves-tigation.
Tool Preparation:
The investigator prepared Social Adjustment Question-naire. The question consists of 20 items. All the 20 items were given to educational experts for reining and also given to 5 students in K.R. Higher Secondary School, Odd-anchatram to ind out the understanding level of the stu-dents. After experts‟ opinion and students response, some items were modiied and some items were rearranged and inally 20 items were retained. The tool has three points like Always, Rarely and Never. The score for the items was 2, 1 and 0. The maximum score is 40 and the minimum will be zero. It includes three dimensions. The dimension of the tool is given in the following table.
S.No Dimension of the Tool Positive Item Negative Item 1. Individual Adjustment 1 4,12,14,16 2. Adjustment with Family 11,15,17 6,20 3. Adjustment with School 5,7,9,13 2 4. Adjustment with Society 3,8,18 10,19 Total No. Items : 20
Statistical Technique Percentage analysis and t test
PLANNING OF INTERVENTION
The investigator planned for intervention as follows.
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
VIII in Panchayat Union Middle School , Kanniapuram, Sanarpatti Union in Dindigul district as sample.
• The investigator conducted a pre test by using (Social Adjustment Questionnaire) and found out their level of social adjustment.
• The investigator prepared activities for enhancing their social adjustment among middle school students
• Planned and executed all the activities within the pre-scribed duration of the study.
• Instructions were given to students before executing each activity.
• Introduced content of activity and gave them enough time for learning.
• After completion of the activity, the students were al-lowed to discuss what they have learnt.
• The treatment i.e proposed intervention is to be con-ducted for two weeks.
• At the end, a post test was conducted and ind out their level of social adjustment.
EXECUTION OF INTERVENTION
The Investigator planned 10 different activities to enhance social adjustment of middle school students. She designed the strategies into three different categories as given in the following table.
ACTIVITY: 1 Answer the Following
The question paper consists of 34 items (based on adjust-ment with self, family, friends and society was prepared by investigator and given to each student.
ACTIVITY: 2 Match the following
The sheet consist of 11 items) based on some skills like honesty responsibility, accept the ideas of others, cleanli-ness and obey the rules inside the classroom.
ACTIVITY: 3 Group Discussions
Students were divided three groups according to the strength of the class. The teacher gave different titles relat-ed to the value relat-education like punctuality, cleanliness, hard work, cooperation, faith, adjustment with others etc. ACTIVITY: 4 Story Reading and Discussion
The investigator divided the students into three groups. She gave three different stories cards and students were asked to read the stories and to ind out the values in giv-en stories.
MINOR GAMES
ACTIVITY: 5 making paper ships ACTIVITY: 6 Paper Cutting
ACTIVITY: 7 pour the water into Bottle ACTIVITY: 8 Finding the Leader of the Group ACTIVITY: 9 touching the joints in our body ACTIVITY: 10 making Network by using Rope DATA ANALYSIS
Signiicant Difference between Pre Test and Post Test Scores of Middle School
Students in Social Adjustment
Test Mean SD t value Signiicance
Pre 11.79 3.17
29.43 S
Post 32.63 2.57
The calculated t value is 29.43 is greater than the table value 2.101 at 0.05 level of signiicance, so the investiga-tor rejected the hypothesis “there is no signiicant dif-ference between achievement scores of pre test and post test in Social Adjustment.”It reveals that, there is a signiicant difference between the pre test scores and post test scores in social adjustment of the total sample at 0.05 level of signiicance.
Signiicant Difference between the Social Adjustment of Boys and Girls in Pre Test
Group Mean SD t value Signiicance Boys 12.45 3.36
0.49 NS
Girls 10.88 2.18
The calculated t value is 0.49 is greater than the ta-ble value 2.110 at 0.05 level of signiicance. It reveals that, “there is no signiicant difference between Social Ad-justment of the boys and girls in pre test score.
Signiicant Difference between the Social Adjustment of Boys and Girls in Post test
Group Mean SD t value Signiicance Boys 33.18 2.24
0.53 NS
Girls 31.88 2.41
The calculated t value is 0.53 is greater than the table value 2.101 at 0.05 level of signiicance. It reveals that, “there is no signiicant difference between Social Ad-justment of the boys and girls in post test score.”
FINDINGS OF THE STUDY
The minimum social adjustment score in the pre test was 22.5 % and maxim score was 55%.The minimum social adjustment score in the post test was 72.5 % and maxi-mum score was 90 %.The mean of social adjustment in pre test was 11.79 and post test was 32.63.There is a signii-cant difference between the pre test score and post test score in social adjustment of the total sample at 0.05 level of signiicance. There is no signiicant difference between social adjustment of the boys and girls in pre test score. There is no signiicant difference between social adjust-ment of the boys and girls in post test score. This study also indicates that, there is no gender difference in en-hancing social adjustment. Hence the adopted interven-tional strategies were gender free.
CONCLUSION
The investigator enhanced social adjustment among mid-dle students through applying strategies. Activities were implemented step by step; they focused different dimen-sions of social adjustment among students. During imple-mentation, the students experienced various aspects in en-hancing social adjustment. The students were enjoyed and participated in an active manner. Students were involved in various activities like group discussion, pair study, minor games, drawing, reading and writing
.
“ The Advantages of Using Self Compacting
Concrete for Reinforced Concrete Structures in an
Aggressive Marine Environment”
Ciinoiu Marian
Gramescu Ana Maria
PhD Student Eng. Ovidius University of Constanta PhD Student Constanta Romania
PhD Eng. Ovidius University of Constanta Assoc. Professor Constanta Romania
KEYWORDS
durability, concrete, marine environmentABSTRACT Achieving sustainable constructions, durable, exploited in aggressive chemical environments, in the
marine environment, involves the development of materials capable of having appropriate behavior based on a thorough knowledge. The durability of the utilized concrete in structural elements exploited in the ma-rine environment can be improved by monitoring and influencing variation of strength and also of mass variations of the concrete. In this paper, the authors develop research results through a comparative analysis of samples tested in two different environments, in distilled water and in sea water taken from the Black Sea. The authors monitored the variation of strength and mass concrete in the two environments at different ages.
Based on these results the authors present the advantages of using self-compacting concrete in the reinforced concret structure located in the area of marine aggressiveness.
INTRODUCTION
A decisive role in the design composition of concrete used for construction works operated in areas with natural ag-gressiveness it has the degree of compactness and imper-meability of concrete.The most common method used to compacting traditional concrete is vibrating. The method is based on the balance between viscosity forces, inter-nal friction and inertial forces of all components, concrete compacting it when balance is destroyed by increasing the strength of the vibrating force. Defects that involve improper compaction usually is discovered when the struc-tural element is demoulding. Usually follows repear af-fected concrete, without signiicantly improve the quality and poorly compacted concrete area. All the deiciencies related to compaction and vibration can be eliminated by using self-compacting concrete. Self –compacting concrete has a relatively recent history, the concept was introduced in 1980 in Japan , by Okamura. The main property of this type of concrete is to move under its own weight, illing intricate spaces and achieving full compaction even in thick reinforcement areas. Self compacting concrete has a high workability providing a superior inishing and durabil-ity degree for construction works. The irst self-compacting practical applications were made in the early 1990’s in Ja-pan, and after this, several major companies developing their own recipes for self compacting concrete.
THE OBJECTIVES WORK OF AUTHORS The objectives of the work has been:
To identify the advantages using self –compacting con-crete for structures located in the marine environement, by studying the behavior of fresh self compacting concrete. To identify the mechanism for transport of aggressive sub-stances in concrete through comparative studies on the behavior of normal vibrated concrete and self compacting concrete in aggressive marine environement.
MATERIALS , TEST METHODS
The irst step was the selection of raw materials needed to manufacture specimens and prefabricated elements, select-ing samples of seawater from the Black Sea . It was cre-ated artiicial conditions of the marine environement, by
illing pools with seawater were the concrete cubes were maintained. At the same time , two tanks were illed with distilled water, were the comparative samples were main-tained.
Selected raw materials entered into the composition of the concrete was:
• Crushed aggregates quarry in granitic rocks, from Cerna career, Tulcea, and meeting the conditions of admissibility laid down by SR EN 1260:2003
• The cement used was Portland Cement with ly ash, CEM II/AV42,5R supplied by Lafarge Ciment (Roma-nia), Medgidia Plant, respecting the admissibility crite-ria set out in EN 197-1:2002.
• Limestone iller , whose main component is calcium carbonate obtained by ine grinding of limestone rocks. Sources: Lafarge Aggregates Concrete SA, Hoghiz Plant, Brasov.
• Admixture Glenium 115, supplied by Basf SA.
In the irst stage of research were screened fresh concrete properties and subsequently cured state.Tests were con-ducted in the following test laboratories:
Lafarge Agregates Concrete Laboratory: making and keeping specimens, tests on fresh concrete, compressive strength, depth of carbonation.
ICH Constanta Laboratory: bending tensile strength, per-meability test and gelevity.
Comparisons were made for SCC(self-compacting concrte) and TVC(traditional vibrated concrete), class C30/37 , with the following characteristics:
CONCRETE CLASS C30/37 SCC TVC
Dosage cement [kg] 390 390
Filer limestone [kg] 135 -Admixture Glenium 115 [kg] - 2.09 Admixture Optima 203 [kg] 8.58
Ratio W/C 0.48 0.48
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
In order to evaluate the properties of concrete fresh test the representative was to determine the spread of paction, resulting in a spread of about 700 mm as com-pared with the TVC where for the concrete C30/37 , class consistency S5, sample test was aprox.230mm, were found visible segregation and the appearance of illies.
Fig.01 Slamp-low test
In order to determine the low capacity of the SCC was performed O’Funel test who achieved a low time about 11 sec, between the time of opening the hatch and the total low of the concrete.
Fig .2 O’Funel test
To determine the low and passing ability, to detect visu-al the ability to low of the concrete, the testing method used was LBox. The result was 1,concrete its in PA2, con-crete with good carryieng capacity.
Fig.03 LBox Test
To determine the passing ability were used J-Ring Test. The result obtained it was 800 mm.
Fig.04 J-Ring Test
To determine the mechanical strength of concrete speci-mens and study of behavior of the concrete under the in-luence of sea water were made 17 samplles concrete of TVC and 31 samples of SCC. Interpretation of the results is shown in the charts bellow.
7 zile 28 zile 56 zile 90 zile 1 an BAC 41,99 51,73 52,15 53,05 54,05 BVN 36,52 48,68 49,13 49,02 50,3
0 10 20 30 40 50 60
C
o
m
p
re
s
s
iv
e
s
tr
e
n
g
th
(
M
P
a
)
COMPRESSIVE STRENGTH SCC/TVC: SEA WATER
BAC BVN
Fig.05 Compressive strength SCC/TVC-sea water
7 zile 28 zile 56 zile 90 zile 1 an BAC 42,28 50,9 51,04 52,18 60,13 BVN 37,45 48,55 49,13 51,08 53,22
0 10 20 30 40 50 60 70
C
o
m
p
re
s
s
iv
e
s
tr
e
n
g
th
(
M
P
a
)
COMPRESSIVE STRENGTH SCC/TVC: DISTILLED WATER
BAC BVN
REFERENCE 1. Okamura H., Ouchi M. -Self-compacting concrete. Journal of advanced concrete technology 2. Gaimster R., Gibs J.-Self compacting concrete 3. Goodier C. I-Development of self –compacting concrete, 4. Geert de Schutter,Peter J.M. Bartos, Peter Domone and John Gibs-Self compacting concrete 5. Rilem Technical Committee. Casting of self compacting concrete 6. EFNARC-Speciication and guidelines for self compacting concrete 7. Damtoft J.S.,Lukasik J.,Herfort D., Sorrentino D. and Gartner E.M.-Sustanaible development and climate change initiatives.
28 zile
BAC 5,3
BVN 7,8
5,3
7,8
0 1 2 3 4 5 6 7 8 9
D
e
p
th
(c
m
)
Permeability
BAC BVN
Fig.7 Water Permeability SCC/TVC
28 zile
BAC 3
BVN 5
3
5
0 1 2 3 4 5 6
C
a
rb
o
n
a
ti
o
n
d
e
p
th
(
m
m
)
BAC BVN
Fig.8 Carbonation SCC/TVC
Then it started to manufacture precast element, to study the behavior of self compacting concrete in horizontal and in vertical elements. The precast element obtained were consistent yield expectation, were obtained perfectly smooth faces without being vibrated concrete.
Fig.. 9 SCC Prefabricated elements
CONCLUSIONS
For the fresh concrete test were taken as reference values set out in The Europen Guidelines for self compacting con-crete.
Studied the self-compacting concrete results have allowed its classiication as follows:
Test Unit Result EFNARC class
Slamp low mm 700 SF2
V-funnel sec 6 VS1/VF1
L-Box 1 PA2
J-Ring mm 7
Table 2 Results of fresh SCC
Results research showed that workability, coesion and ho-mogeneity of self compacting concrete are superior com-pared vibrated concrete, for the same strength class. The use of limestone iller in concrete composition gives it a structure denser, more compact.
By using BAC for execution concrete structures shall be eliminated vibrating equipment needed for fresh concrete, leading to a number of advantages: reducing noise pol-lution, particularly in precast industry, reducing electricity consumption, decreasingthe number of workers.
The precast elements, after stripping, had plane suffaces, wich recomanded it to use successfully to achieve the most complex shapes.
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
Brahamand in Puran and Jinagam
Prof Dr B L Sethi
Abhilasha Jaiman
M.Phil, Ph.D, D.Litt Director, Trilok Institutute of higer Sturdies and Research ,Hotel OM Tower, Church Road
M I Road, Jaipur- 302001
Research Scholar, University of Rajasthan
Literature
KEYWORDS
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iq.; vkSj iki] ;s nksuks cU/k rRo gh ds vUrxZr gksus ds dkj.k i`Fkd rRo :i esa ifjxf.kr ugha gSA bUgsa vyx ekuus ls ukS inkFkZ gks tkrs gSA
1- tho % tho rRo psruk y{k.k okyk gSA vkRek esa LoHkkor% ohrjkxrk] psruk] Kku] n'kZu] lq[k] oh;Z vkfn xq.k fo|eku gS ij la;ksx ls jkx] }s"k] r`".kk] nq%[k vkfn fodkj vkRek esas fufgr gSA
vr% vkRek ds ;FkkFkZ Lo:i }kjk gh fodkjh vkSj ij la;ksxh izo`fŸk dks nwj dj mls 'kq) vkSj fueZy cuk;k tk ldrk gSA tho dk oxhZdj.k eqfDr] ;ksX;rk] orZeku fLFkfr] voLFkk fo'ks"k ,oa bfUnz; laosnu ds vk/kkj ij fd;k x;k gSA izFke izdkj dh vis{kk tho ds nks Hksn gS % 1- HkO; & eqfDr izkIr djus dh ;ksX;rk gksA 2- vHkO; & bl izdkj dh ;ksX;rk u gksA
orZeku fLFkfr dh vis{kk Hkh tho ds nks Hksn gS % &
1- lalkjh & deZc)] ,d xfr ls nwljh xfr ls tUe xzg.k djrk gS vkSj ej.k dks izkIr djrk gSA
2- eqDr & deZcU/k ls NwV dj eqDr gks pqdk gSA
voLFkk fo'ks"k %
lalkjh tho pkj izdkj ds gS %
1- ukjdh & i`Foh ds uhps lkr ujd gS muesa tks tho fuokl djrs gS os ukjdh gSA 2- fr;Zap & i'kq] i{kh] dhM+s] edksM+] isM&ikS/ks fr;Zap xfr ds tho gSA
3- euq"; & L=h vkSj iq:"kkfn euq"; xfr gSA 4- nso & Åij ds LoxksZa essa tks fuokl djrs gS os nso gSa
nso] ukjdh rFkk euq"; vkfn esa ikap bfUnz;ka gksrh gS ij fr;Zapks esa bfUnz; laosnu dh vis{kk thoksa ds ikap Hksn gSA
1- tydkf;d 2- i`Fohdkf;d 3- vfXudkf;d 4- ok;qdkf;d 6- ouLifrdkf;d
tSu n'kZu ds vuqlkj isM+&ikS/ks] ty] vfXu] i`Foh vkSj ok;q esa Hkh tho gSA tSu n'kZu esa cgqthookn Lohdkj fd;k x;k gS rFkk izR;sd tho dh Lora= lŸkk Lohdkj dh x;h gSA 2- vtho rRo % vtho vpsruk y{k.k ls ;qDr gSA vtho nzO; ds ikap Hksn gS] iqn~xy] /keZ] v/keZ] vkdk'k vkSj dky tks o.kZ] jl] xU/k vkSj Li'kZ ls ;qDr gS] og iqn~xy gSA
tho vkSj iqn~xy ds leku /keZ vkSj v/keZ nzO; Hkh nks LokrU=~; nzO; gSA tho vkSj iqn~xy Lo;a xfr LoHkko okys gSa] vr% ;fn os xfr djrs gSa] rks Lo;a :dus dk iz'u gh ugha gSA xfr'khy vkSj iqn~xyksa dks xeu djus esa lk/kkj.k dkj.k gksrk gSA ftl izdkj /keZ nzO; tho vkSj iqn~xyksa dh xfr ds fy, lk/kkj.k dkj.k gS] mlh izdkj tho vkSj iqn~xyksa dh fLFkfr ds fy, v/keZnzO; lk/kkj.k dkj.k gSA ;g Hkh yksdkdk'k ds cjkcj gSA :i] jl] xU/k vkSj 'kCn ls jfgr vewfrZd vkSj fuf"Ø; gSA ;s nksuksa nzO; mRikn] O;; vkSj /kzkSO; ;qDr gSA
REFERENCE 1. Aacharya Uma Swami: Tatvarth sutra chapter 3 page 47-48 Bhartiya Gyan Peeth Prakashan, New Delhi 2005 2. Aacharya Aklank: Tatvarth
Rajvarthik chapter 3 Vartik 56 Bhartiya Gyan Peeth Prakashan, New Delhi 2007
Lo;a ifjorZu djrs gq, vU; nzO;ksa ds ifjorZu esa lgdkjh gksrk gSA dky ds nks Hksn gS % fu'p; dky vkSj O;ogkj dkyA
bl izdkj tSu n'kZu esa Ng nzO; vkSj dky nzO; dks NksM+ 'ks"k ik¡p vfLrdk; dgykrs gSA
3-vklzo rRo %
deksZa ds vkxeu ds }kj dks vklzo dgk x;k gSA og }kj ftlds }kjk thou esa loZnk deZiqn~xyksa dk vkxeu gksrk gSA ge eu ds }kjk tks dqN lksprs gSa opu ds }kjk tks dqN cksyrs vkSj 'kjhj ds }kjk tks dqN gyu&pyu djrs gSa] mlls deZoxZ.kk,a vkRek esa lafpr gksrh gSA
ftuds Hkkoksa ls deksZa dk vklzo gksrk gS] mUgsa Hkkoklzo vkSj deZ dk vkuk nzO;klzo dgykrk gSA
'kqHk vklzo & iq.;klzo v'kqHk & vklzo & ikiklzo
4- cU/k % tho vkSj deZ ds izns'kksa dk ijLij vuqizos'k cU/k gSA cU/k nks izdkj dk gS& ,d Hkko cU/k vkSj nwljk nzO; cU/k & ftu jkx }s"k vkSj eksg vkfn fodkjh Hkkoksa ls deksZa dk cU/k gksrk gS] mu Hkkoksa dks Hkko cU/k dgrs gSaA deZ iqn~xyksa dk vkRe izns'kksa ls lEcU/k gksuk nzO; cU/k dgykrk gSA
5- laoj % vklzo dk fujks/k gksuk laoj gSA ftu }kjksa ls deksZa dk vklzo gksrk Fkk] mu }kjksa dk fujks/k djuk laoj gSA
6- futZjk % deksZa dk {k; gksuk futZjk dk y{k.k gSA iwoZc) deksZa dk FkksM+k&FkksM+k] u"V djuk futZjk gSA ;g nks izdkj dh gS % 1- vkSiØfed ;k vfoikd 2- vukSiØfed ;k lfoikd ri vkfn lk/kukvksa ds }kjk deksZa dk Qy >M+rs tkuk lfoikd ¼vukSiØfed½ futZjk gSA
7- eks{k % leLr deksZa dk NwV tkuk eks{k dgykrk gSA tho leLr deZcU/ku ls NwV tkrk gS rks og eqDr tho dgykrk gSA
tho vkSj vtho nks ewy rRo gSA buds la;ksx ls gh lalkj dh l`f"V gksrh gSA lalkj ds ewy dkj.k vklzo vkSj cU/k gSA lalkj ls eqDr gksus ds dkj.k laoj vkSj futZjk gSA
laoj vkSj futZjk ds }kjk tho dks tks in izkIr gksrk gS] og eks{k gSA ;g eks{k gh tho dk pje y{; gSA
czã.Mh; fopkj
yksd ¼czã.M Lo:i½ l`f"V dh jpuk vn`'; o peRdkfjd :i ls ekuh tkrh gSA fgUnw /keZ esa vusd dFkk dgkfu;ka miyC/k gSA fgUnw /kkfeZd ekU;rk esa ekuk x;k gS] izy; ds dqN le; iwoZ l`f"V ds l`tudrkZ fo".kq us euq"; dks LoIu esa n'kZu nsdj ,d ukSdk fuekZ.k dk vkns'k nsdj lHkh iztkfr;ksa ds tksMs j[kus dks dgkA fuf'pr le; ij Hk;adj izy; vkus ij fo".kq Hkxoku us eNyh dk vorkj ysdj euq o mudh ukSdk dks lqjf{kr j[kkA blds i'pkr~ iqu% euq o mudh lUrkuksa us l`f"V dh jpuk esa iap eq[; Hkwfedk fuHkkbZA
l`f"V dh jpuk esa iap rRo ty] Fky] ok;q] vfXu] vkdk'k dh izeq[k Hkwfedk gS vkSj ;gh ikap rRo feydj euq"; ds 'kjhj dk fuekZ.k djrs gSa] ijUrq tSu /keZ esa ;g ekuk x;k gS fd ;g l`f"V "kV~ nzO;ksa ls feydj cuh gSA blfy, tSu /keZ dh l`f"V dh jpuk laca/kh fopkj fHké gSA tSu /keZ ds vUrxZr /keZ ds vuqlkj nzO;] vkdk'k dk ftruk Hkkx ns[kk tk;s og yksd dgykrk gSA
tSu /keZ ds vUrxZr czã.Mh; Lo:i dh dYiuk oSKkfud n`f"Vdks.k ls gSA tSu n`f"Vdks.k Hkh oSKkfud n`f"Vdks.k dh Hkkafr ;g Lohdkj djrk gS fd i`Foh lkSje.My esa fLFkr gSA blds pkjks vkSj ok;qe.My rFkk Åij vkdk'k esa lkSje.My gSA
vkpk;Z mekLokeh us rRokFkZ lw= ds vUrxZr czã.Mh; Lo:i dh O;k[;k djrs gq, i`Foh o vU; yksdksa ds ckjs esa o.kZu fd;k gSA
tSu /keZ o n'kZu ds vuqlkj tks inkFkksZa dks ns[ks o tkus lks yksd gSA tSu n'kZu esa bl czãk.M esa rhu yksd ekus x, gSaA v/kksyksd] e/;yksd vkSj m/oZyksdA
v/kksyksd dk vkdkj os=klu ds leku gSA e/; yksd dk vkdkj [kM+s gq, e`nax ds Å/ oZHkkx tSlk gS rFkk Å/oZyksd dk vkdkj [kM+s gq, e`nax ds leku gSA
yksd dk foLrkj % & vkpk;Z mekLokeh ds vuqlkj leLr yksd jktw uked bZdkbZ ds }kjk ukik tk ldrk gSA muds vuqlkj lEiw.kZ yksd dh Å¡pkbZ pkSng jktw gSA ftlesa v/kksyksd dh Å¡pkbZ lkr jktw gSA e/; yksd dh Å¡pkbZ ,d yk[k ;kstu gSA m/oZyksd dh Å¡pkbZ ,d yk[k ;kstu de lkr jktw gSA
v/kksyksd % v/kksyksd ds vUrxZr lkr i`Foh;ksa dk o.kZu fd;k x;k gS] tks ,d&,d jktw ds vUrj esa fLFkr gSA buds fuEu ukekasa dk mYys[k rRokFkZ lw= esa fd;k x;k gSA 1- jRuizHkk % djHkkx] iad Hkkx] v{k cgqy ;g rhu Hkkx gSA buds fuEu ukeksa dk mYys[k rRofFklw= esa fd;k x;k gSA ftldh Økafr jRuksa ds leku gSA ¼1 yk[k 80 gtkj ;kstu eksVh gS½
2- 'kdZjkizHkk % tks 'kdZjk ds leku izHkk okyh Hkwfe gSA ¼;g Hkwfe 32 gtkj ;kstu eksVh gS½
3- ckyqdkizHkk % ftldh izHkk ckyqdk ds leku gksrh gSA ¼28 gtkj ;kstu eksVh½ 4- iadizHkk % izHkk dkpM+ ds leku gS ¼10 yk[k ujd gSa½ ¼24 gtkj ;kstu eksVh½ 5- /kweizHkk % ftldh izHkk /kqaok ds leku gS] og ?kwe izHkk Hkwfe gSA
6- re% izHkk % ftldh izHkk va/kdkj ds leku gS og Hkwfe re izHkk gSA 7- egkre izHkk % bl Hkwfe esa xgu va/kdkj gSA
bu i``Foh;ksa ds vU; uke Hkh cryk;s x;s gSA /kEek] oa'kk] es/kk] vatuk] vkjs"Vk] e/ kok vkSj ek/kohA
rŸokFkZlw= esa of.kZr czgk.M
rRokFkZlw= esa of.kZr czã.M ds vuqlkj ;g yksd tho vkSj thosrj iqn~xy] /keZ] v/keZ] vkdk'k vkSj dky uked 6 nzO;ksa la lajfpr gSA vkSj blesa rhuksa yksdksa dks Å/oZyksd ] e/;yksd vkSj v/kksyksd ds uke ls tkuk tkrk gSa vkSj budks gh Øe'k% LoxZyksd] Hkwyksd vkSj ujdyksd dgk tkrk gSA
yksd ds vUrxZr Å/oZyksd esa LoxksZa dh fLFkfr ds Åij Øe'k% ukS xzSos;d] ukS vuqfn'k vkSj ikap vuqŸkj foeku gS] ftuds Åij fl)f'kyk fLFkr gS rFkk /kuksnf/k okroy;] /kuokroy; vkSj vkSj ruqokroy; rhuksa yksdksa dks oyf;r vkSj fLFkr fd;s gq, gSA bl yksd dk vkdkj iq:"kkdkj gSaA
i`Fohyksd ;k Hkwyksd esa vusd ioZr] }hi] ufn;ka] ?kkfV;ka vkfn gSA ;gka ij e/; esa tEcw}hi fLFkr gS vkSj bl tEcw }hi vki esa lenqz pkjksa vksj ls [kkjs gSA bl yo.kh; leqnz ds vUrxZr mlls f}xqf.kr foLrkj okyk /kkrdh [k.M gSA tks vius ls nqxqus foLrkj okys dyksnf/k leqnz ls f?kjk gSA dkyksnf/k leqnz ds vuUrj iq"djoj }hi gSA bl izdkj tEcw}hi] /kkrdh [k.M vkSj iq"djk)Z )hi <kbZ }hi uke ls tkuk tkrk gSA bl <kbZ }hi dk gh e/; Hkkx tEcw}hi gSA
bl <kbZ }hi esa ikap es:] iSarhl {ks=] rhl ioZr] lŸkj egkufn;ka vkSj 30 gn gSA tEcw}hi esa pkj vkSj <kbZ }hi esa 20 egkfonsg gSA
rYokFkZ lw= ds o.kZu ds vuqlkj tEcw}hi esa cŸkhl rFkk pkSrhl vk;Z[k.M gS] bUgha vk;Z[k.Mks esa inoh/kj] egkiq:"k] rhFkZadj vkfn mRiUu gksrs gSa blh tEcw}hi esa Js"B f'k[kjksa okys N% dqy/kj ioZr gSA ftuds uke 1- fgeou 2- egkfgeou 3- fu"k/k 4- uhy 5- :fDe rFkk 6 f'k[kjh gSA
Hkjr {ks= %
tEcw }hi dk gh ,d {ks= Hkjr {ks= gSA ftlesa ikap EysPN [k.M vkSj ,d vk;Z [k.M gSA vk;Z[k.M vkSj EysPN [k.Mksa dks iwoZ vkSj if'pe esa Øe'k% flU/kq vkSj xaxk unh i`Fkd djrh gSA rFkk mŸkj fn'kk esa fot;k)Z ioZr gSA bl {ks= esa 14 ufn;ka cgrh gSA ftuesa ls Hkjr {ks= esa xaxk vkSj flU/kq ufn;ka cgrh gSA
fgeor % ;g Hkjr {ks= dh mŸkjh lhek ij fLFkr gSA ;g Li"V :i ls fgeky; gh gSA ufn;ka & Hkkjr dh fLFkfr ds lkFk&lkFk blesa Hkkjresa cgus okyh ufn;ksa dk mYys[k Hkh feyrk gSA tgka lkrksa {ks=ksa ds e/; tkus okyh xaxk] fla/kq] jksfgr] jksfgrkL;k] gfjr] gfjdkark] lhrk] lhrksnk] ukjh] ujdkUrk] lqo.kZ] :I;dwyk] jäk vkSj jäksnk vkfn ufn;ka gSA
m/oZyksd %
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
Treatment of Infected Non Union of Lower Limb
Long Bones with Limb Reconstruction System (Lrs).
Dr Mukesh N Shah
Dr Josal S Patel
Associate Professor of Orthopedic, G C S Medical college,Hospital & Research Centre,Naroda Road,
Ahmedabad.
Junior Consultant, Aditya Hospital, Vasana Road, Ahmedabad. 380007
Medical Science
KEYWORDS
LRS, Infected Non-union, Long Bones, Ilizarov.ABSTRACT Back ground: Infected nonunion of long bones is very big challenge to manage due to the presence of
infection, deformities, shortening and multiple surgeries in the past. Open debridement of the non-union site, appropriate antibiotics and stabilization of fracture are the basic principles of treatment in an infected non-union. Internal fixation of such fracture is fraught with recurrence and or persistence of infection. Infected nonunions are tra-ditionally managed by Ilizarov ring fixator. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. Limb reconstruction system provides single stage, easy to construct and less cumbersome option to the patient. We conducted a study on 21 infected nonunions of lower limb long bones treated by the limb reconstruction system (LRS).
Materials and Methods: Between January 2011 and December 2015, we treated 21cases of infected nonunion of lower limb long bones with the LRS. 19 were male and 2 females. Average shortening was 4.3 cm and 8 cases presented with infected implants. The average age was 33 years (range 21-55 years). All cases had established nonunion for at least 6 months with evidence of infection. The infection was active in 8 patients and non-draining in 5 patients. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 7.6 months. We compressed the fracture site at the rate of 0.5 mm per day for 2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved. Ilizarov study group ASAMI score was used for bone results and functional results. Complications assessed as per Paley classification.
RESULTS: The mean time for union was 5.5 months (4-13 months). The mean follow up after LRS removal was 25.2 months (range 15-44 months). Two cases had angulation of upto 7 degrees (both femur) and remaining cases did not have any angulation. Using ASAMI scoring system functional outcome was excellent in 13(61.9%) patients, good in 6(28.57%) patients & fair & poor result in 1(4.76%) case each. Bone outcome was excellent 14(66.67%) patients, good in 6(28.57%) patients & fair in 1(4.76%) patient. The union occurred in all cases and eradication of infection in 95.35% cases. 3 case required bone grafting out of which 1 case wase initially treated by induced membrane technique. Aver-age lengthening done was 3.6 cm.
CONCLUSION: “Best treatment for infection is Prevention”. Treatment infected non-union is a long battle. It needs an aggressive approach and a lot of patience from the patient. LRS is an attractive alternative to the Ilizarov fixator in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.
INTRODUCTION: Infected non-union has been deined as a state of failure of union and persistent infection at the fracture site for 6-8months6 and union is not likely to oc-cur without active intervention. Infected non-union of long bones poses a great functional and inancial challenge to the patient. The treatment is usually prolonged and in-volves multiple surgeries, disability and social stigma1. With increase in open long bone fractures due to road trafic accidents, the incidence of complex non unions is on a high. In such cases the surgeon faces a formidable challenge11 in planning the treatment, inancial constraints and non-compliance. The issues complicating the trement are devitalisation of bone, soft tissue scarring & at-rophy, deformity, limb length discrepancy, joint stiffness and secondary osteoporosis.2,6,10 The suffering for patient is so severe in some cases that ablation /amputation may be one of the treatment options to save the life of the pa-tient.7-9 Various modalities of treatment for infected non-union of long bones described are extensive debridement, micro vascular soft tissue laps, external ixation with bone graft, Ilizarov ring ixator, bone transport through external ixator over nail and limb reconstruction system(LRS).3 In-ternal ixation of such fracture is fraught with recurrence and or persistence of infection as the implant so placed will act as a foreign body. Colonization of bacteria on the
implant cannot be eliminated as the antibiotics will not reach non vascular areas. The best way to stabilize such a fracture is with an external ixation. External ixation so used should not only stabilize the fracture but should also take the cyclical loading of day to day activities and also weight bearing. Ilizarov ring ixator, LRS and Orthoix are the implants that can serve the above purpose.12,13 Ilizarov ring ixator and limb reconstruction system are popular modalities as they are single staged procedure. It gives correction of deformity and limb length along with excel-lent infection control and facilitates bone union. Weight bearing can also be initiated simultaneously during treat-ment. Ilizarov ixator is cumbersome to the patient, pain-ful and relative dificult to mount.4,14 Limb reconstruction system is less bulky with better compliance, easy to ap-ply and remove with advantage of being dynamic which is most important principle in treatment of non-union.5,15 In this study, we assessed limb reconstruction system in man-agement of infected non-union of long bones of lower limb in terms of union rates, control of infection and as-sociated complications.
unit using limb reconstruction system. There were 19 males and 2 females. The average age was 33 years (range 21-55 years). The causes of infected non-union were open fractures in 17 cases and infection following internal ixation in 4 cases. Of the 17 cases of open fracture, 13 were primarily treated with debridement with external ixation and 4 were treated with debridement with internal ixation. All cases had estab-lished nonunion for at least 6 months with evidence of infec-tion. The infection was active in 8 patients and non-draining in 5 patients. Average limb length discrepancy was 4.3 cm (range 2-6.5 cm). All patients had history of prior 1.7 surgeries (range 1- 4) either debridement or implant removal or ixation with either intramedullary nail or AO external ixator. Duration of non-union prior to LRS surgery was 13.9 months (range 9-34 months). The location of non-union was diaphyseal in 16 cases and metaphyseal in 5 cases. 4 patients were smoker. There were no associated co-morbidities except in 3 patients having diabetes mellitus. Debridement, implant removal, antibiotics according to culture & sensitivity, stabilization of fracture, resto-ration of gunction of limb & adjacent joints are the basic princi-ples to be followed in infected non union management. All pa-tients were operated under all aseptic condition under suitable anesthesia under facility of an image intensiier. First step was to do thorough debridement and sequestractomy (if required) at non-union site; this was followed by corticotomy (ibulec-tomy in cases of tibial non-union). Post operatively antibiotics were given for 6 weeks as per culture sensitivity from intraoper-ative samples. In 7 cases polymethyl methacrylate antibiotic ce-ment beads were implanted. Commonly employed antibiotics were aminoglycosides , cephalosporins and vancomycin. Once there were no clinical signs of infection for 6-8 weeks, cement beads were removed. Patients were counseled regarding com-pression-distraction. Distraction at corticotomy was started after 7 days at the rate of 1 mm/day. We compressed the fracture site at the rate of 0.5 mm/day for 1-2 weeks. Range of mo-tion exercises were started in immediate postoperative period after adequate analgesia. Weight bearing was started as toler-ated. Patients were educated about pin tract dressing, cleaning of ixator and compression–distraction. At each monthly fol-lowup appointment, problems of pin tract infection, loosening of pins, bolts, clamps were addressed. Radiographs were taken on each monthly follow up to check for callus formation. LRS was maintained till radiological sign of union was obtained (at least three out of four cortices united). Infection markers like C - reactive protein and erythrocyte sedimentation rate were also checked regularly. LRS was removed once union was achieved and functional brace given for 4 weeks. All patients were evaluated using ASAMI scoring system18 into bone results and functional results (Table 1). Complications were classiied as per Paley classiication 14 into problems, obstacles and true compli-cations. Problems are dificulties which resolve with conserva-tive management. Obstacles are dificulties which resolve with operative management. True complications are the one persist even after completion of treatment.
Table 1.1 ASAMI scoring system Bone Results
Excellent Union, no infection, deformity<7°,limb length discrepancy<2.5 cm
Good
Union + any two of the following:
no infection, deformity<7°,limb length discrep-ancy<2.5 cm
Fair
Union +only one of the following:
no infection, deformity<7°,limb length discrep-ancy<2.5 cm
Poor Non-union / refracture / union + infection + deformity>7° + limb length discrepancy>2.5 cm
Functional Results
Excellent
Active, no limp, minimum stiffness (loss of <15°knee extension/<15° dorsilexion of ankle), no relex sympathetic dystrophy, insigniicant pain
Good Active with one or two of the following: Limp, stiffness, RSD, signiicant pain. Fair Active with three or all of the following: Limp, stiffness, RSD, signiicant pain
Poor Inactive (unemployment or inability to return to daily activities because of injury) Failure Amputation
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
RESULTS: All cases achieved union. The mean time for un-ion was 5.5 months (4-13 months). Femur took the shortest mean time of 4.6 months to unite and tibia took 9 months. 3 case required bone grafting (2 tibia & 1 femur). In 1 case of infected non union of proximal tibial metaphysis, we used antibiotic cement spacer for 6 weeks & then after in-fection control & membrane induction ibular strut grafting was done. Shortest time taken by femur to unite was thought to be due to better vascularity & better soft tissue envelope. The mean follow-up after LRS removal was 25.2
months (15-44 months). Average lengthening achieved was 4 cm (range 1.5-6 cm). Mean residual limb length discrep-ancy was 1.1 cm (0.5-1.5 cm). Finally there was no limb length discrepancy in 70% of cases, in 16.5% of cases it was 0.1-1 cm and in 13.5% of cases it was 1.1-2 cm. 2 cas-es had angulation about 7 degrecas-es (both femur) and re-maining cases did not have any angulation. Mean time tak-en to control the infection was 3.5 weeks (2-11 weeks). Infection was eradicated in 95.35% cases. There were few problems like pin tract infection in 13 patients which healed with regular dressing. 3 patients had pin loosening which needed the pin to be exchanged. 1 patient had ear-ly consolidation at corticotomy site due to delayed distrac-tion in a non-compliant patient, in this case re-corticotomy was done and distraction was started. 5 patients had knee stiffness which persisted. There were no patients with re-fracture through pin tracts or regenerate. None had neuro-vascular complications or joint subluxations. Functional outcome was excellent in 13 patients and good in 6 pa-tients. Bone outcome was excellent 14 patients and good in 6 patients.
un-ion rates were comparable to various studies with Ilizarov and limb reconstruction system. In this study all cases achieved union. Among them, 24.09% were by primary union, 14.28% cases required bone grafting, 52.38% by bone transport and 9.52% by callus distraction. It is in con-trast of study done by Patil et al. (95%) 16 and Hashmi et al. (90%) 21 where bone grafting was done to achieve un-ion. As LRS is uniplanar, there are chances of malalignment particularly in femur. Few authors have suggested use of intramedullary nail over limb reconstruction system to pre-vent this and shorten treatment duration 3, 16, 22. We believe that in the presence of infection, intramedullary device would exacerbate infection. Also the cost of intramedul-lary nail, cement and antibiotic beads may increase in pre-viously multiply operated patients 3. Therefore we did not use intra-medullary nail with LRS in our study. We did not encounter any issues of signiicant mal-alignment in our study. Precise technique and watchful regular follow up can prevent signiicant mal-alignment. Infection was controlled in 95.35% cases and there were no reactivations at aver-age follow up of 25.2 months (range 15-44 months) after ixator removal. These results were comparable to other studies published in the literature 2. Successful outcome mostly depend on compliance of patient with regular fol-low up, appropriate care of pins & ixator, patient counsel-ling and physiotherapy to prevent joint stiffness and mobi-lization. This is considered as a crucial part of treatment 3.
CONCLUSION: “Best treatment for infection is Preven-tion”. Treatment of infected non-union is a marathon task. It needs an aggressive approach from surgeon and a lot of patience from the patient. Basic treatment protocol for infected non-union is thorough debridement, removal of all infected material including the internal ixation devices & long duration antibiotics according to culture & sensitivity. Fracture stabilized with LRS is equally effective and a good modality of treatment in infected non-union of long bone fractures as compared to traditional ilizarov ring ixator. LRS is safe and effective tool for simultaneous correction of limb length discrepancy; achieve union and infection control in a single stage. It is easy to perform with reliable results and less complications.
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
Deconstructing the Hegemony of History: A Study
of Postcolonial Resistance in the Indian and African
Perspective
Dr. Somdev Banik
Dept. of English, Tripura University, Tripura-799022
English Literature
KEYWORDS
historiography, determinism, storytelling, hegemony.ABSTRACT Rewriting history had been one of the crucial tools in the reconstruction of post-colonial nations.
Hege-lian historical principle was incorporated by colonial ideology in order to justify imperial civilizing missions throughout history. African and India post-colonial intellectuals always emphasized the role of the writer over the politi-cian in reclaiming the nation. Gandhi in the Indian context, formulated an alternative model of historicizing, by deem-phasizing the aggressive, imperialist spirit of history, thereby taking the battle to conquering of the minds. Gandhi privileged myths over history. In the African context, we find Achebe privileging storytelling as an alternative to history proper in Anthills of Savannah. Thus, nationalist excavations of myths, legends and stories emerged as postcolonial al-ternatives to Western hegemony of historical narratives.
The necessity of rewriting history, of foisting the colonised self as the subject of that history, emerged as one of the pre-conditions of anti-colonial and post-colonial move-ments in the nineteenth century. The battle for Independ-ence which broke forth in the ifties and sixties within the colonized countries was preceded by a process of ‘histori-cal excavations’. Amilcar Cabral ‘histori-calls the national liberation of a people the regaining of the historical personality of that people, and their return to history (Boehmer, 2005). Since colonialism was a denial of all cultures, history and value outside the coloniser’s frame, ‘a systematic nega-tion of the other person’, the historical retrieval meant a way of making reparation, a reclamation of oral memory, of presenting the African past as not blank but illed with signiicant human interactions- conlict, tragedy, friendship, ceremony.
In his early essays like ‘The Role of Writer in a New Na-tion’ (1964) and ‘The Novelist as Teacher’ (1965), Chinua Achebe points out the role of the writer as teacher, whose function should be imparting education, ‘to help my soci-ety regain belief in itself and put away the complexes of the years of denigration and self-debasement’. To tell the world that African society had a philosophy of great depth and value and beauty, that they had poetry and above all dignity (Achebe, 1964). Achebe here envisages a writer to be a cultural nationalist engaged in the revival of the past because he believed like Aime Cesaire that short cut to the future is via the past. Achebe’s novel Things Fall Apart had been precisely written with this purpose. Though writ-ten much earlier than Things Fall Apart, Raja Rao’s Kan-thapura, R.K.Narayan’s Swamy and his Friends or The Bachelor of Arts served a similar purpose in case of India too. In the seventies, we see Achebe assigning a second duty to the writers, that of a social critic. The need for rec-reating a past is being surpassed by the more urgent need of dealing with the neo-colonial malaises aflicting the African societies. In the essay ‘The Black Writer’s Burden’ (1964) written before A Man of the People, Achebe says that African writers should be free to criticise their socie-ties, and should focus on the evils within African societies. And he feels the role of a writer should be that of a social transformer, one who is ‘aware of the faintest measures of injustice in human relations’. The post-colonial experiences of African societies had forced Achebe to accord a proac-tive role in the society, not just criticising but re-historicis-ing it also.
In the Indian context, it was Mahatma Gandhi who coun-tered the hegemony of Hegelian progressive determinism of European history by taking the battle to the realm of the minds. Gandhi not only aimed at liberation of Indians, but also the British from the history and psychology of Brit-ish colonialism. His battle was a universal battle to redis-cover the softer side of human nature, the so-called non-masculine self of man, relegated to the forgotten zones by the western enlightenment notion of historical progres-sivism. Gandhi rejected history and afirmed the primacy of myth over historical chronicles. By rejecting history, he rejected the unilateral doctrine of progress, from primitiv-ism to modernity and from political immaturity to political adulthood. In Gandhi, the speciic orientation to myth be-came a major general orientation to public consciousness. Public consciousness was seen not as a causal product of history but as related to history non-causally through memories and anti-memories. If for the West, the present was a special case of unfolding history, for Gandhi history was a special case of an all-embracing permanent present, waiting to be interpreted and reinterpreted. Indian society conceptualises the past as a possible means of reafirming or altering the present. Here, the past is regarded as an authority, but the nature of the authority is seen as shift-ing, amorphous and amenable to intervention. As Marcea Eliade puts it:
While a modern man, though regarding himself as the result of the course of universal history, does not feel obliged to know the whole of it, the man of the archaic societies is not only obliged to remember mythical history but also to re-enact a large part of it periodically. It is here that we ind the greatest difference between the man of the archaic societies and modern man: the irreversibility of events, which is the characteristic trait of history for the lat-ter, is not a fact to the former… (Nandy, 1983: 58)
here-and-the-now. As the core of culture myths widen instead of restricting human choices. They allow one to remember in an anticipatory fashion and to concentrate on undoing as-pects of the present rather than avenging the past. The Western social analysis had regarded history as the re-ality, while the myth a lawed, irrational fairy tale produced by ‘unconscious’ history, meant for savages and children. Thus, cultures living by myths are ahistorical and repre-sentatives of an earlier second-rate social consciousness. Historical societies are the true representatives of mature human self-consciousness and therefore, their construc-tions of the ahistorical societies are more valid scientiically than those of these societies themselves. The societies of the East must act out their ahistorical fates as understood by those who are historians of the world. Gandhi, com-ing in the early part of twentieth century, challenged the hegemony of history over myth, worked out in the para-digm of adult-child relationship by afirming the language of continuity and re-emphasing the language of the self. The language of continuity undervalued the role of revolu-tion, by negating the ideology of modernity, which seek to locate all the creativity, including creative social action, in clear-cut breaks with the past. It privileged reformism over revolution invoking the Indian worldview, which recognised that as the language of revolution hid within it the mes-sage of continuity, the language of continuity too had a la-tent message of disjunction. The language of the self held that greater self-realisation and self-control lead to greater understanding of the ‘objective’ material world, and hence a better scope of changing the world. Through these two languages, Gandhi broke out of the determinism of his-tory, making the common man an agent of cultural change through a realisation of his self. He gave the societies the option of choosing their futures here and now, without he-roes, without high drama and without a constant search for originality, discontinuous changes and inal victories. The present is thus made the historical moment, the per-manent yet shifting point of crisis and the time for choice. This was the concept of permanent revolution introduced by Gandhi to battle out the colonial consciousness. African postcolonial critics have also argued that ‘History’ is a discourse through which the West has asserted its he-gemony over the rest of the world. In the post-colonial world, history can be manipulated to sustain the material interests of the ruling class. If one looks carefully at the archives of history, one inds that it caters to the docu-mentation of the dominant group only and the peasants; the working class and other marginalized groups are sys-tematically kept outside the purview of historiography. This prompts Achebe to reject history proper as the narrative of the masses. He turns to the alternative method of his-toriography- the indigenous technique of storytelling. In his novel, Anthills of Savannah, Achebe privileges story as the more authentic and popular depository of knowledge. In the story there is an instance, where a group of elders assemble in front of the President’s palace, to meet him to apprise about their opinion regarding the President-for-Life referendum.. One elder from the Abazon delegation elab-orates the signiicance of story to the assembled crowd: “The sounding of the battle drum is important; the ierce waging of the war itself is important; and the telling of the story afterwards-each is important in its own way…. But if you ask me which of them takes the eagle-feather I will say boldly: the story” (124). He says:
“The same reason I think that our people sometimes will give the name Nkolika to their daughters -
Recalling-Is-Greatest. Why? Because it is only the story can continue beyond the war and the warrior. It is the story that outlives the sound of war-drums and the exploits of brave ight-ers. It is the story, not the others, that saves our progeny from blundering like blind beggars into the spikes of cac-tus fence. The story is our escort; without it, we are blind. Does the blind man own his escort? No, neither do we the story; rather it is story that owns us and directs us. It is the thing that makes us different from cattle; it is the mark on the face that sets one people apart from their neigh-bours…. The story is everlasting…. Like ire, when it is not blazing it is smouldering under its own ashes or sleeping and resting inside its lint-house.” (123-4)
History can be manipulated but not the storyteller, be-cause Agwu, the god of healers,
…picks his disciple, rings his eye with white chalk and dips his tongue, willing or not, in the brew of prophecy; and right away the man will speak and put head and tail back to the severed trunk of our tale. This miracle-man will amaze us because he may be a fellow of little account, not the bold warrior we all expect nor even the war-drummer. But in his new-found utterance our struggle will stand rein-carnated before us. (125)
To understand the signiicance of story and its advantage over the European novel, one needs to look at Walter Benjamin’s famous essay ‘The Storyteller’ as pointed out by David Caroll. According to him the story is without ex-planation or psychological analysis. That is why the reader is free to interpret the way he understands them. The story does not expend itself. It preserves and concentrates its strength and is capable of releasing it even after a long time. And in the inal paragraph of the essay he writes: “Seen in this way, the storyteller joins the ranks of the teachers and sages. He has counsel- not for a few situ-ations, as the proverb does, but for many, like the sage. For it is granted to him to reach back to a whole lifetime (a life, incidentally, that comprises not only his own expe-rience but no little of the expeexpe-rience of others; what the storyteller knows from hearsay is added to his own). His gift is the ability to relate his life; his distinction, to be able to tell his entire life”.
‘The story continues in the shape of the myth, legend, parables incorporated in the form of a novel. It seeks to transform the random history of contemporary politics into a rite of passage to the future’ (Caroll, 1990: 194).
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
Incidence of Malignancy in Solitary nodule of
Thyroid
Dr. C Ramchandraiah
Dr. R Sadgunachary
Dr. Vijayabhargav
Assistant professor, Osmania general hospital, Hyderabad.
Associate professor, Osmanaia general hospital, Hyderabad.
Assistant professor, Osmania general hospital, Hyderabad.
KEYWORDS
ABSTRACT This study aimed at to detect the incidence of malignancy in solitary nodule thyroid among the patients
who got admitted at Osmania General Hospital at Hyderabad during September 2014 to September 2016.
237 patients were selected with STN. Patients were evaluated clinically and were offered surgery based on suspicious findings from the clinical assessment, diagnostic work up, comprehensive symptoms and eosmoses. All the patients un-derwent hemi thyroidectomy, subtotal thyroidectomy based on the pre-operative and intra operative findings
INTRODUCTION
Solitary thyroid nodule (STN) is a palpably discrete swelling with an otherwise normal thyroid. The most common prob-lems faced by both the surgeons and pathologists is the evaluation of this apparently single thyroid mass. The inci-dence of STN increases throughout life & STN in younger patients are more likely neoplastic.
STN is a common clinical problems, especially in females where it is four times as common as in men. Cancer of the thyroid is also more common among females (females: males, 2:1). Therefore, STN in males carry a two folds in-creased risk of malignancy.
Since cancer is known to occur frequently in STN than mul-tinodular goiter (MNG), STNs are conventionally viewed with suspicion. Clinically detectable thyroid nodules occur in 4.7% of the population.
Clinical examination cannot reliably distinguish between a STN and a dominant nodule in MNG and three fourths of clinically STN actually represent dominant nodules of MNG.
Noninvasive screening tests used in the evaluation of STNs are Thyroid scanning and Ultrasonography, 75-90% of STN are cold and most of these are benign. The reported inci-dence of malignancy in STN varies from 10.4-44.7%. Ultrasonography (USG) can determine whether thyroid nodules are solitary and can categorize them into solid, cystic and mixed (solid- cystic) nodules. Solid nodules have a higher incidence of malignancy (21%) as compared to cystic (7%) and mixed nodules (12%)
However, ultra-sonographic appearances can be mislead-ing and solid lesions may be mistaken for cystic and vice – versa. It appear, therefore that USG which may be used for the follow up of known benign nodules, is not appropriate as a primary investigative modality
For thyroid nodules, thyroid functions tests and thyroid an-tibodies have little or no role in the diagnosis of solitary thyroid nodule (STN).
Thyroid Hormone suppression has been used at times for
diagnostic and therapeutic purposes in thyroid nodules with the rationale that involution is indicative of a benign lesion. However anything less than complete involution does not rule out cancer and conversely lack of involution does not rule out malignancy
The scope of ine needle aspiration Cytology (FNAC) in selecting cases that require surgery and in providing pre-operative morphologic diagnostic has gone a long way in obviating unnecessary surgery as well as in planning surgi-cal and other treatment protocols.
A large body of world literature attests to the accuracy and advantages of the cytological technique for screening of thyroid nodules. In many centers around the world, cytol-ogy is now the primary preoperative investigative modality in clinically suspicious thyroid neoplasms
In search of a screening method for STNs cytology has unquestionably been the answer, being cost effective with the added advantages of accurate morphologic typing of thyroid tumors in a large percentage of cases
This study has been conducted to detect the incidence malignancy in solitary nodule thyroid by comparing the clinical features and histopathological pictures. The impor-tance of solitary thyroid nodule lies in the increased risk of malignancy compared with other thyroid swelling. The inci-dence in solitary nodule varies from 5% to 20% in different surveys, whereas the incidence of malignancy in multinod-ular goiter is only 3-5%.
OBJECTIVE OF STUDY
This study aimed at to detect the incidence if malignancy in solitary nodule thyroid among the patients who got ad-mitted at Osmania General Hospital at Hyderabad during September 2014 to September 2016.
MATERIALS AND METHODS
Volume : 6 | Issue : 2 | FEBRUARY 2016 | ISSN - 2249-555X
RESEARCH PAPER
All 237 patients have undergone the following investiga-tions prior to surgery
General: Complete Blood Picture Complete Urine Examination HB percent
Random Blood Sugar Blood urea
Serum Creatinine
ECG
Chest X-ray Blood grouping
Clotting and bleeding time Speciic: Thyroid function tests
Ultra sonography of the neck ENT examination
X-ray of the neck
FNAC
These patients underwent thyroid hormone assay and most of them had a ine needle aspiration of the thyroid done. The cytological Diagnoses were grouped into Be-nign, malignant and inlammatory thyroiditis. The patients with malignant results were recommended to undergo sur-gery where as those with a benign cytological diagnosis underwent surgery (hemi thyroidectomy) in cases of rap-idly growing nodule, local compression symptoms, and the cosmetic reasons. All the 237 patients the resected speci-men were submitted to the departspeci-ment of Pathology at Osmania General Hospital, Hyderabad.
In the department of pathology the excises biopsy material was processed by the routine procedure to obtain the par-afin section that was later stained with Haematoxylin and Eosin (H & E). Subsequently, histopathological study was done and the results were compared with the cytological diagnosis.
All the patients who were planned for surgery had under-gone ENT examination for the evaluation of vocal cords. The patients were offered surgery based on suspicious inding from the clinical assessment, diagnostic work up, comprehensive symptoms and cosmoses. All the patients underwent hemi thyroidectomy, subtotal thyroidectomy based on the pre-operative and intra operative indings RESULTS
The above patients had undergone thyroid surgery be-tween the years 2005-07. Thirty one (13%) solitary nodule contained a malignant focus.
The mean age of patients with solitary thyroid nodule was found to be 44 years, whereas the mean age for malignant foci is 36 years
Out of 237 patients about 199 (83.9%) were females and the remaining patients i.e. 38 (16%) were males. All the patients were referred to our tertiary hospital for palpable nodules in their thyroid gland. The median of duration of these lumps in thyroid was 96 days.
Ultrasonography of the thyroid was performed for 75 pa-tients for the detection of solitary nodule to exclude multi nodular goiters. The mean size of benign thyroid was 3.3 cm while that of the malignant nodule was 3.0 (S.D., 1.8) cm.
Among all the histopathological reports of 237 patients 6% were colloid goiter, 13% malignant foci, 25% adenomatous
goiter, 5% showed Hashimotos thyroiditis and 8% are folli-cular variant of papillary carcinoma, one case with papillary adeno carcinoma with psamoma bodies and one case with medullary carcinoma thyroid.
Fine needle aspiration cytology was performed for all the 237 patients and 7% solitary thyroid nodule yielded incon-clusive results as the aspirants contained only colloid mate-rial or blood.
Results of FNAC
No of Goiter Percentage
Benign 198 84%
Malignant 21 9%
Inconclusive 18 7%
Total 237 100%
Results of HPE
No of Goiter Percentage
Benign 206 77%
Malignant 31 13%
30 thyroid cancers i.e. 12.7% were papillary carcinoma and 1 case was found be medullary carcinoma.
DISCUSSION
Thyroid cancer is the 1% common cancer of thyroid and there is female dominance. Thyroid nodules are pre-sent in 5% of the population by neck population. The in-cidence increases with the increasing age and 30 to 50% by ultrasonography. It has been believed that fewer than these nodules are malignant and require surgical treat-ment. However, Stoffer ctal reported that 13% of the glands resected to thyroid operation for any reason con-tained carcinoma.
The more sensitive clinical indicator of malignancy is STN is that of a painless hard lump. (57.6% of thyroid cancer pre-sent in this way). It was also noted that 50.5% of solitary nodule felt on population are actually part of multi nodular goiter. This is similar to the pickup rates of thyroid nodules as illustrated by Brander et al. even with experience and careful technique the examiner may fall fail to detect many nodules smaller than 1 cm in diameter.
High frequency real time, ultrasonography is the most sensitive tool in solitary thyroid nodule. It can also detect lymph node metastases, differentiate extra thyroidal tissues and be used to conduct ultrasonography guided biopsy. The important sonographic indings; suggestions of malig-nancy in thyroid nodules are micro calciications; irregular margins of the nodule, complex echogenicity and smaller nodule. The mean size of malignant nodule is 3.0 cm. It is postulated that the thyroid cancers have manifested with more overt signs and symptoms of local invasions or me-tastases by the time they need a signiicant size.
The results of the inal histology showed that 31 patients of solitary nodule of thyroid contain malignant foci i.e. 13%. 30 of these malignant tumors were papillary carcino-ma and 1 case was medullary carcinocarcino-ma.
Among all the histopathological examination reports, 8 cases of the papillary carcinoma are associated with Heshi-motos thyroiditis and 4 cases were Hurthle cell adenomas These igures are in line with the inding of stoffer and Pelizzo ctal. The prevalence of carcinoma in nodule goiter is indeed signiicant. However, Sokul suggested that the incidence of carcinoma in non-toxic thyroid nodule is low and patients can be followed up safety for up to 15 years. The physicians who were concerned about the presenta-tion of nodular goiter had referred these patients to this tertiary centre. Therefore, the incidence of malignancy in Solitary thyroid nodule seen at the tertiary centres would be higher than that in the general h