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2014| September-October | Volume 7 | Issue 5
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September 10, 2014
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ORIGINAL ARTICLES
Role of topical use of insulin in healing of chronic ulcer
Gaurav Goenka, Virendra S Athavale, Dakshayani S Nirhale, Nitin Deshpande, Kunal Agrawal, Murtuza Calcuttawala
September-October 2014, 7(5):579-583
DOI
:10.4103/0975-2870.140400
Background
: Chronic wounds, especially non-healing types, are one of the most common surgical conditions a surgeon comes across. The peculiarity of a chronic wound is that, whatever management you give, they refuse to heal, especially the pressure ulcers or bed sores. Many therapeutic methods are available to effect wound healing such as topical application of insulin, growth factors, negative pressure-assisted wound closure, oxidized regenerated cellulose/collagen, hyaluronic acid conjugated with glycidyl methacrylate or gelatin dressings. A less clinically and economically complicated approach to healing chronic wounds seems necessary.
Objectives:
To study the efficacy of topical use of insulin in wound healing in following terms:-(1) rate of wound healing; (2) safety evaluation; (3) hospital stay.
Materials and Methods:
This was a prospective study carried out in a tertiary health centre from July 2010 to September 2012 in 50 patients after taking an informed and written consent of the patients having chronic ulcer. All the patients who were satisfying inclusion/exclusion criteria patient were randomized into two groups, Group A and Group B. Each group was again sub-divided into 1 and 2 i.e. sub-group A1, A2 and sub-group B1, B2. Patients with diabetes were grouped as A1 and B1 and non-diabetic patients were grouped as A2 and B2. Group A patients were treated with insulin dressings and Group B patient's ulcers were treated with normal saline dressings. Ulcer size and healing was recorded on weekly basis. Strict glycemic control was maintained in all diabetic patients. Results were compared at complete healing or at the end of 12 weeks which ever was earlier.
Results:
Our study included both diabetic and non-diabetic patients. There was no significant change in BSL(R) values after use of insulin on wounds. The number of days required for wound healing in Group A patients in both subgroups (A1 and A2) was significantly less as compared to Group B (B1 and B2). The mean rate of healing of wounds was much faster in Group A as compared to Group B. The hospital stay in Group A patients was significantly less than Group B.
Conclusion:
The use of topical Insulin strongly suggests accelerated wound healing in chronic ulcer. Topical insulin in chronic ulcer is safe and effective without any systemic side effect. Topical insulin significantly reduces the hospital stay of patients with chronic ulcers. Early return to work decreased economical load.
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Deep vein thrombosis of the lower limbs: A retrospective analysis of doppler ultrasound findings
Sanjay M Khaladkar, Dhaval K Thakkar, Kunal Shinde, Dolly K Thakkar, Harshawardhan Shrotri, Vilas M Kulkarni
September-October 2014, 7(5):612-619
DOI
:10.4103/0975-2870.140449
Background:
Deep venous thrombosis (DVT) of lower limbs is one of the most common cause for the majority of deaths caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and sequalae of DVT.
Aim
and
Objectives:
The objectives of the following study were to evaluate the role of Doppler as an imaging modality in diagnosing DVT of lower limbs, to study the spectrum of findings on Doppler ultrasound in patients with DVT.
Materials
and
Methods:
Retrospective descriptive analysis of 78 patients of DVT diagnosed on Doppler.
Results:
Nearly 74% of the patients were males and 26% were females with majority belonging to fifth decade (26%). 75 (96.1%) cases showed unilateral while 3 (3.9%) cases showed bilateral lower limb involvement. In our study, predominant distribution of thrombus was found to be in above knee region with 69/78 (88.5%) patients having thrombus in the superficial femoral vein. Popliteal vein was involved in 54/78 (69.2%) patients. Complete thrombosis was observed in 54/78 (69%) cases, while partial thrombosis was observed in 24/78 (31%) cases. Subacute stage was seen in 42 cases (53.8%), acute stage in 23 cases (29.5%) while chronic stage in 13 cases (16.7%). 71 cases (91%) had multiple contiguous segmental involvement, whereas 7 cases (9%) had isolated vein involvement.
Conclusion:
Color Doppler is useful in diagnosing DVT in symptomatic and at risk patients and provides a non-invasive method of investigation. It is also helpful in evaluating the site, extent and stage of thrombus.
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Reconstruction of soft tissue defects around the ankle and foot
Bharat Bhushan Dogra, Siddhartha Priyadarshi, Ketak Nagare, Raveesh Sunkara, Ashwani Kandari, Karamvir Singh Rana
September-October 2014, 7(5):603-607
DOI
:10.4103/0975-2870.140426
Introduction:
Soft tissue defects over ankle and foot region are encountered quite frequently following road traffic trauma and surgery. Management of such cases is a challenging task for any reconstructive surgeon because of paucity of skin and relative poor vascular status of skin in this region. Hence, invariably such cases require microsurgical free flap coverage, expertise for which may not be available at all the centers, such procedures require long operating hours and suitable recipient vessel may not be available in crush injuries.
Materials and Methods:
Thirty consecutive patients having soft tissue defects around ankle and foot region who underwent various reconstructive procedures in a medical college hospital during last 2 years form the basis of this study. This study was carried out to enlist various etiological factors and reconstructive surgical procedures employed to manage such cases without microsurgery.
Results:
The age of these patients ranged from 9 to 72 years. Twenty-five patients were males while 05 were females, with a mean age of 25 years. Road traffic accidents happened to be the primary cause of such defects in as many as 15 patients, cycle spoke trauma in 02 patients, implant exposure following orthopedic surgery in 6 patients, diabetic angiopathy in 4 patients and chronic osteomyelitis in 3 patients. The site of the defect was lower fourth of tibia in 16 patients, dorsum of foot in 2 patients, sole in 5 patients, medial aspect of ankle in 02 cases, lateral aspect in 02 cases and retro calcaneal region in 03 cases. In 10 cases distally based superficial sural artery flap was used to reconstruct the defect. In step rotation flap was used to provide sensory flap cover in the weight bearing heel in 04 cases. Inferiorly based fasciocutanenous flaps in 09 cases and muscle flaps were used in 07 cases.
Conclusion:
Distally based sural artery based flaps are very handy to provide skin cover around ankle and malleolar regions. Muscle flap can be used when the defect is small but deep to obliterate the cavity and it can be covered with skin graft.
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Comparative evaluation in the measurement of the radial height, radial inclination, and ulnar variance in fracture distal end radius treated conservatively by closed reduction and cast and closed reduction, Kirschner wire and cast
Rahul R Bagul, Ashwin Deshmukh, Anil Salgia, Tushar Agarwal, Deep Rajani, Mithu Sooknundan
September-October 2014, 7(5):590-595
DOI
:10.4103/0975-2870.140416
Background:
Fractures of distal radius continue to be the most common skeletal injury treated by orthopedic surgeons. The treatment of distal end radius fracture has changed over period. The aim of treatment of distal radius fracture is to obtain a good anatomical reduction and fixation and finally a good functional outcome.
Objective:
To study comparative evaluation in the measurement of the radial height, radial inclination and ulnar variance in fracture distal end radius treated conservatively by closed reduction and cast and closed reduction, Kirschner wire and cast.
Materials and Methods:
In the present prospective study, we are reporting our experience in 30 cases where comparative evaluation in the measurement of the radial height, radial inclination, and ulnar variance was done in fractures distal end radius treated conservatively by closed reduction and cast and closed reduction, K- wire, and cast technique.
Results:
As measured by Mayo functional score, we had 14 satisfactory and 1 poor result in the Group 1 (closed reduction and cast) while 8 excellent results and 7 good results in the Group 2 (closed reduction, Kirschner wire and cast). As measured with the modified demerit point system of Saito, in the Group 1 (closed reduction and cast), 11 had average results and 4 had fair results; and in our Group 2 (closed reduction, Kirschner wire and cast), 9 had excellent results and 6 had good results.
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Transfusion transmissible infections in blood donors: A 7-year study in central Gujarat
Pragnesh J Patel
September-October 2014, 7(5):620-624
DOI
:10.4103/0975-2870.140451
Context:
One of the major adverse effects of blood transfusion is transfusion transmissible infections (TTIs). Serological testing can help to reduce, but not eliminate occurrences of TTIs. Study of TTIs in different blood donor groups help to find safe blood for patients.
Aims:
The aim of this study was to determine the prevalence and trends in TTIs in voluntary and replacement blood donors.
Settings and Design:
Voluntary and replacement blood donors were studied for TTIs over the duration of 7 years. TTIs were documented with particulates like gender and type of donation (voluntary or replacement).
Materials and Methods:
Blood donation taken after predonation examination. Tests for TTIs carried out from donated blood and results were documented.
Statistical Analysis Used:
Data entered into Microsoft Excel sheets and studied for prevalence, trend, and odds ratio.
Results:
Total blood units taken during the period from 2007 to 2013 were 15,368. 93.1% were male donors and 6.9% were female donors. Prevalence of TTIs was 0.72%. Human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and syphilis were detected in 0.14%, 0.38%, 0.06%, and 0.14% of donors, respectively. No female donors had TTI. TTIs in voluntary donors (VDs) and replacement donors were 0.64% and 1.15%.
Conclusions:
Outcome of the study shows increasing trend for total blood donation, voluntary donations, and female blood donors. All TTIs were reducing except syphilis. To provide safe blood to patients, blood donation from VDs and female donors should be encouraged.
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Morphometry of mitral valve
Parmatma P Mishra, Manvikar Purushottam Rao, Vaishali Paranjape, Jyoti P Kulkarni
September-October 2014, 7(5):625-630
DOI
:10.4103/0975-2870.140453
Introduction:
Mitral valve lies between the left atrial and left ventricular chambers of the heart guarding unidirectional flow to the left ventricle during ventricular diastole. Dimensions of the valves and circumference of valvular openings play a crucial role in the hemodynamics of heart and in valve replacement procedures.
Materials and Methods:
One hundred and twenty formalin fixed hearts were used in the study. The circumference, cross-sectional area, length of annulus, length and height of cusps of mitral valves were measured tabulated and analyzed.
Result:
On analysis of the data, it was found that 55.83% of mitral valves had a circumference between 7.5 and 10 cm. The cross-sectional area of mitral valve was in the range of 5.1-7.5 cm
2
. The anterior cusp of mitral valve showed a wide range of variation in length from a minimum of 0.73 cm to the maximum of 5.71 cm. Minimum height of anterior cusp was 1.11 cm and maximum height was 3.74 cm. The posterior cusp of mitral valve also showed a wide range in length ranging from 2.15 cm to 9.31 cm. Minimum height of posterior cusp 0.61 cm and maximum height of posterior cusp was 2.55 cm. The length of accessory cusp was 2 cm or less and the height was 0.76-1.02 cm.
Discussion:
Morphometric study will provide base line data with reference to the severity of the reduction in valvular lumen in cases of stenosis, or in stenosis and in evaluating an operative treatment plan." Area of valves thus calculated is essential information for manufacturing prototype of prosthesis valve.
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A comparative study of open technique and Z-plasty in management of pilonidal sinus
Siddhartha Priyadarshi, Bharat Bhushan Dogra, Ketak Nagare, Karan V. S. Rana, Raveesh Sunkara, Ashwani Kandari
September-October 2014, 7(5):574-578
DOI
:10.4103/0975-2870.140398
Introduction:
Pilonidal sinus is one of the common problems encountered in general surgical practices and the management of this disease is variable, contentious and problematic. Principles of treatment require eradication of the sinus tract; complete healing and prevention of recurrence. Although several surgical techniques have been described over the years, the management remains controversial.
Aims and Objectives:
The aim of this study was to compare the two techniques of the open method and Z-plasty in the management of pilonidal sinus, in terms of incidence of post-operative pain, total hospital stay, total recovery time, complications and recurrence rate.
Materials
and
Methods:
This is a prospective comparative study which was conducted in the surgical department of a teaching hospital. A total of 50 cases were included in this study. Of these, 25 cases were operated by the open technique and 25 by excision and Z-plasty.
Observation and Result:
The mean age at presentation was 29.44 years. Male genders followed by age between 20 and 30 years were the most common predisposing factors. The mean body mass index, early and late post-operative complications were comparable between the two groups. Mean hospital stay and total recovery time was significantly more in open technique group compared with Z-plasty group. Visual analog score was also significantly more in open technique group when compared with Z-plasty group.
Conclusion:
Excision with Z-plasty was better technique in terms of lesser hospital stay, lesser recovery time, less post-operative pain.
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CASE REPORTS
Gastroscopic diagnosis of ankylostoma duodenale infestation as a cause of iron-deficiency anemia
Sunita Bamanikar, Arvind Bamanikar, Vinay Sawlani, Dakshayani Pandit
September-October 2014, 7(5):631-633
DOI
:10.4103/0975-2870.140454
Hookworm is one of the most common nematode causing intestinal infestation in the world. Patients with a mild hookworm load are usually asymptomatic, but a moderate or heavy hookworm burden can result in fatigue, recurrent abdominal pain and iron-deficiency anemia. We present here an unusual case of a 35-year-old man with iron deficiency anemia in whom adult hookworm were visualized and recovered on gastroscopy. There was no eosinophilia, and stool examination was negative for occult blood, and parasite ova/cysts. Upper gastroscopy revealed several squirming red worms in the stomach.
Ancylostoma duodenale
infection was confirmed by histopathological examination and eradicated by albendazole successfully. His anemia was corrected after treatment.
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Maggots therapy in facilitating wound debridement: Present status
Nongmaithem Mackson Singh, Simran Kaur Bhatia, Gurjit Singh
September-October 2014, 7(5):639-642
DOI
:10.4103/0975-2870.140476
An ancient remedy, Maggots debridement therapy was reintroduced by William. S. Baer, an orthopedic surgeon who worked at John Hopkins Hospital at Baltimore, Maryland. Maggot debridement therapy is a popular technique for wound debridement. It is considered cheap and safe form of therapy to prepare healthy wound bed. Major constraints are unavailability of sterile/medical grade maggots. A 56-year-old male patient presented with a wound on leg containing maggots. This acted as a trigger to review and search literature about the present status of maggot therapy. Although, this form of therapy is a commonly practiced in Europe and North America, others needed to have a relook at this modality in view of the increasing prevalence of antibiotic resistance to infections.
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Fungal foot abscess caused by
Aureobasidium pullulans
culture diagnosis of fine needle aspiration cytology material in a clinically unsuspected patient
Hilda Fernandes, Amanda Christina Pinto, Meena Dias, Reshma Kini
September-October 2014, 7(5):648-650
DOI
:10.4103/0975-2870.140481
Subcutaneous mycosis includes a large spectrum of infections caused by a heterogeneous group of fungi. Fungal infections of the skin can be identified in scrape preparations of lesions and Fine Needle aspirates of abscesses, with recognition of the specific morphological features such as hyphae and branching. We report a fungal abscess caused by
Aureobasidium pollulans
by smears and culturing the material obtained from Fine Needle Aspiration Cytology.
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Persistent pulmonary hypertension and infantile hypertrophic pyloric stenosis in a neonate: Reduced nitric oxide levels could be a common etiological factor
Sudhir Malwade, Sharad Agarkhedkar, Himanshi Joshi
September-October 2014, 7(5):661-664
DOI
:10.4103/0975-2870.140488
Nitric oxide (NO) is an important mediator of biological functions. It is a potent vasodilator and has an effect on smooth muscle relaxation and proliferation. Absence or shortage of NO plays a role in the pathogenesis of persistent pulmonary hypertension and hypertrophic pyloric stenosis. A 3.2 kg male, full term baby, delivered through vaginal route in hospital settings presented with curdy white and non-bilious vomiting following feeds on 22
nd
day of life. Baby had a history of neonatal intensive care unit admission for 4 days for respiratory distress due to meconium stained liquor. 2D echocardiography revealed pulmonary hypertension. On 22
nd
day of life when vomiting began, baby was vigorous, irritable but examined well. Since, these two conditions occurred simultaneously in the same baby hence postulation that NO might have some role in both diseases.
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Exercise-induced rhabdomyolysis with acute kidney injury: A case report with review of literature
Varsha S Shinde, Sambhaji R Shinde, Manish Mali
September-October 2014, 7(5):679-682
DOI
:10.4103/0975-2870.140498
Exercise-induced rhabdomyolysis is a medical condition that results from muscle injury. Renal failure is the most serious complication of rhabdomyolysis, but is rare. We report a case of acute kidney injury following heavy exercise in a healthy, young adult.
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Disseminated non-Hodgkin's lymphoma presenting as unilateral parotid gland enlargement with facial nerve palsy
Maheswar Samanta, Biswajyoti Ratha, Ashok Kumar Mallik, Manasi Mishra
September-October 2014, 7(5):683-685
DOI
:10.4103/0975-2870.140500
The head and neck is the most common area for the presentation of lymphoproliferative disorders. Primary involvement of salivary glands is uncommon. Non-Hodgkin's lymphoma constitutes a group of malignancies those arises from cellular components of lymphoid or extra nodal tissues. Here we report a case of a 70-year-old male patient who presented with left parotid gland enlargement with left facial nerve palsy and involvement of other nodal sites, which is rarely reported in the literature.
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EDITORIAL
Coping with academic anarchy: An appeal to reviewers, authors and readers to raise the bar
Amitav Banerjee
September-October 2014, 7(5):541-542
DOI
:10.4103/0975-2870.140342
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ORIGINAL ARTICLES
Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients
Shantna Kumari, Inderjeet Banerjee, G Majhi, Suprakash Chaudhury, Amool R Singh, AN Verma
September-October 2014, 7(5):550-557
DOI
:10.4103/0975-2870.140365
Background:
Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem.
Aim:
The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP).
Materials and Methods:
This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively.
Results:
On the modified felt stigma scale, the mean (±standard deviation [SD]) score of psychiatric hospital outpatients (31.89 ± 6.51) was significantly higher than the scores of patients attending COP (29.20 ± 6.80). On Rosenberg self-esteem scale, mean (±SD) scores of patients with psychosis (17.98 ± 1.69) was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60). There was no significant correlation between stigma and self-esteem.
Conclusion:
As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.
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C-reactive protein: A boon in managing acute pancreatitis
Mohit Bhatia, DS Nirhale, VS Athavale, Murtuza Calcuttawala, Anirudha Kale, Vishal Tomar
September-October 2014, 7(5):569-573
DOI
:10.4103/0975-2870.140389
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Comparative analysis of external and internal fixation in lower radial articular fractures
Soumya Ghosh, Soumyadip Dutta, Arunima Chaudhuri, Soma Datta, Debasis Singha Roy, Abhinay Kumar Singh
September-October 2014, 7(5):596-602
DOI
:10.4103/0975-2870.140420
Background:
The treatment of distal radial articular fracture is still controversial despite continue refinement in the treatment.
Objectives:
The study was done to compare the functional as well as radiological outcome of treatment of distal radius by the external fixation frame and internal fixation by plating.
Materials and Methods:
This prospective study was conducted in a tertiary care hospital of eastern India on 40 patients with distal radial articular fractures after taking clearance from the Institutional Ethical committee and informed consent of the patients. All cases of distal radial articular fractures were randomly assigned by computerized methods to two different treatment protocols: a) external fixation application and b) internal fixation application. The fractures were classified with Fernandez and Jupiter classification.
Results:
In the present study excellent results were obtained in all Fernandez type I fractures both in external fixation and internal fixation group. Excellent to good results were obtained in all Fernandez type II fractures both in external fixation and internal fixation group. In external fixation group, out of six type II fracture four (66%) had excellent result and two (33%) had good result. In internal fixation group out of nine type II fracture five (55%) had excellent result and four (45%) had good result. Mixed results were obtained in all Fernandez type III fractures (16) both in external fixation and internal fixation group. In external fixation group, out of eight type III fracture 3(38%) had excellent result, four (50%) had good result and one (12%) had fair result. In internal fixation group out of eight type III fracture six (75%) had excellent result and two (25%) had good result. The results indicate that in type III fractures internal fixation is a better option. Fair to poor results were obtained in Fernandez type V (3) fractures both in external fixation and internal fixation group. Results may be improved by early bone grafting and possible external fixation and internal fixation (combined fixation). Out of thirteen patients with biplanar JESS, eight (61%) had excellent results compared to uniplanar UMAX in which out of seven, patients three (42%), had excellent results.
Conclusions:
External fixation and volar buttress plate produce almost equivalent functional results in distal radial articular fractures, with volar buttress plate having better anatomical results than external fixation in the present study. With careful assessment, good surgical technique and early mobilization, the distal radial articular fractures can be effectively managed with predictably good outcome using either external fixation or volar buttress plate. Volar buttress plate can be more effective in type III Fernandez fractures, while UMAX is a better option for Fernandez type II fractures.
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REVIEW ARTICLE
Serum cholesterol and depression: An update
Satish Kumar Budania, Monika Rathi, Shalini Singh, Suresh Yadav, Purnima Mittra
September-October 2014, 7(5):543-549
DOI
:10.4103/0975-2870.140361
A large number of studies have been performed to establish a correlation between serum cholesterol and depression. Majority of the studies have suggested that depression and suicide are associated with low levels of serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides. However, few researchers have also denied the association between serum cholesterol and depression or suicide. We carried out an extensive literature search for the studies performed on serum cholesterol and depression, and found that a relationship definitely exists between the two.
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CASE REPORTS
Role of high-frequency linear probe in ultrasound diagnosis of biliary atresia
Sanjay Khaladkar, Pallavi J Agrawal, Vilas M Kulkarni, Amarjit Singh
September-October 2014, 7(5):665-668
DOI
:10.4103/0975-2870.140490
Cause of cholestatic jaundice in early infancy continues to be a diagnostic dilemma, with biliary atresia being the most common cause. Increasing age is a negative prognostic factor for biliary atresia. Hence, early diagnosis of the same has immense prognostic significance. Ultrasound (US) plays a major role in the evaluation of infants with cholestatic jaundice and in the differentiation of biliary atresia from neonatal hepatitis, which are the two major causes of conjugated hyperbilirubinemia in neonates and infants. Our study concerns a 2-month-old male infant with signs and symptoms of jaundice, as correlated with liver biochemistry. US revealed features of biliary atresia that later got confirmed on biopsy. The present study summarizes the manifestations of biliary atresia on US, emphasizing the importance of a high-frequency transducer and the clinical diagnostic value of US for biliary atresia, in order to provide evidence for its early diagnosis.
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Bilateral first rib fractures: A case report
Dilip Amonkar, Mervyn Correia, Amey pednekar, Osborne Vaz
September-October 2014, 7(5):669-671
DOI
:10.4103/0975-2870.140493
From the time first rib fractures were first described in 1869, they have been a source of anxiety to attendant trauma surgeons working in the accident and emergency department of major hospitals. First rib fractures are associated with major thoracic trauma and may involve injury to subclavian vessels, brachial plexus, and mediastinal structures. But these complications are more often seen following unilateral first rib fractures. In contrast, bilateral first rib fractures may follow insignificant trauma, suggesting a different mechanism involved. Serious vascular injuries and brachial plexus injuries are rare and angiograms for evaluation of these patients aren't routinely warranted. The case that we report illustrates this very point.
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Dyke-Davidoff-Masson syndrome: A case report
Biswajyoti Rath, Maheswar Samant, Kali P Swain, Ashok K Mallick
September-October 2014, 7(5):672-674
DOI
:10.4103/0975-2870.140494
Dyke-Davidoff-Masson Syndrome (DDMS), also called as cerebral hemiatrophy, is a rare clinical condition characterized by seizures, facial asymmetry, contralateral spastic hemiplegia or hemiparesis, with learning difficulties. It is commonly diagnosed in presence of associated radiologic findings, which include cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses. We present a 21-year female with increased frequency of convulsion and abnormal behavior for the last 2 months. She had a known seizure disorder for 15 years and had mental subnormality. On physical examination, she was disoriented with mild right hemiparesis. On CT scan the brain showed unilateral left cerebral atrophy.
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Endophytic renal cell carcinoma mimicking urothelial neoplasm of the pelvicalyceal system: A prime surgical concern
Bijit Lodh, Kaku Akoijam Singh, Somarendra Khumukcham, Rajendra Singh Sinam
September-October 2014, 7(5):675-678
DOI
:10.4103/0975-2870.140496
Centrally infiltrating renal mass poses great diagnostic and therapeutic challenge for both radiologist and urologist. It is often practically impossible to dedifferentiate on imaging and will render patients to receive unnecessary aggressive surgery. Here we have presented such case for its utmost importance in the clinical settings and reviewed with the available literature. A 70-year-old female was preoperatively diagnosed having right intrarenal transition cell carcinoma, stage T
3
N
0
M
0
. Accordingly, she underwent right nephroureterectomy and the specimen was sent for histopathological examination that revealed an eosinophilic variant of chromophobe renal cell carcinoma (EVCRCC). Biologically it is a tumor of low malignant potential and therefore, in spite of nephroureterectomy, only nephrectomy or a more minimally invasive procedure is the ideal treatment. Henceforth, caution must be exercised while treating such entity and in uncertainty, we may consider a quick pre-operative image-guided percutaneous renal biopsy.
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Dynamics of the dynamic enhancement in a suprasellar lesion: Diagnostic dilemmas and literature review
Sridhara Narayana, Ashish Kumar, Sahu P Barada, Shantiveer Uppin
September-October 2014, 7(5):651-654
DOI
:10.4103/0975-2870.140485
Brain tumors with high vascularity show dynamic enhancement on magnetic resonance contrast imaging owing to their rapid blood flow. This principle is used to differentiate highly vascular lesions in sellar/suprasellar area from the non-vascular or mildly vascular ones. We report a case of suprasellar lesion affecting a 35-year-old female, lesion exhibiting dynamic enhancement on contrast magnetic resonance imaging. The imaging and intra-operative findings have created a diagnostic dilemma about the nature of the lesion and the histopathology revealed it to be a Rathke's cleft cysts (R.C.C). R.C.C have varied imaging manifestations. They can create diagnostic dilemma in a surgeon's mind when they present with such extremes of variations including dynamic contrast enhancement. One should be aware of these atypical imaging findings before approaching these lesions at surgery for an optimal outcome.
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2,448
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Role of advanced magnetic resonance imaging techniques in diagnosis of cerebral toxoplasmosis in immunocompromised patients: A case report
Inderpreet Singh, Abhijit Patil, Rajesh Kuber, Parag Patil, Vilas M Kulkarni
September-October 2014, 7(5):655-660
DOI
:10.4103/0975-2870.140487
Cerebral toxoplasmosis commonly affects patients with advanced HIV infection. Toxoplasmosis can be severe and debilitating in patients with Central Nervous System (CNS) involvement and the condition may be fatal in patients if not suspected and treated early and adequately. Hence, imaging plays an important role in diagnosis and following during treatment in cases of suspected toxoplasmosis. We report a case of a 51-years-old man who was a known sero-positive since 2 years and presented with altered sensorium. Magnetic Resonance Imaging (MRI) scan of the brain showed multiple heterogeneously enhancing lesions in bilateral cerebral as well as cerebellar hemispheres and some of them showed "eccentric target sign." MR spectroscopy showed features of reduced NAA, mildly increased choline, and lipid lactate peak. MR perfusion study showed reduced perfusion favoring diagnosis of cerebellar toxoplasmosis. Patient was started on a combination of pyrimethamine plus sulfadiazine for toxoplasmosis. Follow up MRI after 20 days and 45 days from start of treatment showed significant resolution of the lesions supporting our radiological diagnosis.
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9,710
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Variation of hilar anatomy in an incompletely rotated kidney associated with accessory renal vessels
Smita Singh Banerjee, Vaishali Paranjape, Vasanti Arole, P Vatsalaswamy
September-October 2014, 7(5):645-647
DOI
:10.4103/0975-2870.140479
An incompletely rotated left kidney, with variations in the hilar anatomy associated with accessory renal vessels was seen during routine undergraduate dissection in an adult male cadaver. The left kidney showed three accessory renal vessels. Two renal arteries and one vein entered the lower pole of left kidney. The hilum of the kidney was anteriorly faced and was close to the upper pole, with the ureter running on the anterior surface of the kidney. This was associated with variation in the arrangement of the structures at the hilum. Structures found at the hilum from superficial to deep were: The ureter, one renal vein, and two renal arteries. The ureter was anteroinferior and lateral to the renal vein. The renal arteries were posterosuperior and posteroinferior to the renal vein. The rotational anomaly associated with the presence of accessory renal vessels assumes importance while performing percutaneous procedures in relation to the kidney, screening of donors, and also during interpretation of various radiological diagnostic procedures related to the kidney.
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4,727
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Osteochondritis dissecans of the knee joint: A diagnosis not to miss
Rahul R Bagul, Deep Rajani, Anil Salgia, Amit Kharat
September-October 2014, 7(5):635-637
DOI
:10.4103/0975-2870.140473
Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescent patients. Diagnosis requires a high index of suspicion as clinical findings are often subtle. Limited range of motion may be the only notable clinical sign. The diagnosis is made by thorough clinical examination, radiographic examination and magnetic resonance imaging (MRI). Early diagnosis and treatment can change the prognosis of the disease. If not diagnosed early, OCD can lead to the development of osteoarthritis at an early age. Conservative management is the mainstay of treatment for stable lesions. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management.
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9,649
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COMMENTARY
Osteochondritis dissecans: A diagnosis not to miss
Lars Peterson
September-October 2014, 7(5):638-638
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1,574
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Why is maggot therapy not more commonly practiced in India?
Deboshree Roy, Ronald Sherman
September-October 2014, 7(5):642-644
DOI
:10.4103/0975-2870.140477
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7,274
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Congenital muscular torticollis in children
Bharat Bhushan Dogra, Mahendra Kataria
September-October 2014, 7(5):588-589
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2,231
241
High resolution ultrasound and leprosy
Viroj Wiwanitkit
September-October 2014, 7(5):687-688
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1,416
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Gastroscopic, Ankylostoma duodenale infestation and iron-deficiency anemia
Viroj Wiwanitkit
September-October 2014, 7(5):634-634
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1,663
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LETTERS TO THE EDITOR
An evident mistake
Constantino Ledesma-Montes
September-October 2014, 7(5):688-689
DOI
:10.4103/0975-2870.140504
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Remarks regarding case reports "Molluscum contagiosum: Study of four cases" and "Histoid leprosy in type II reaction with neural abscess: Treated with ulnar nerve decompression and anterior transposition". In vol. 7, issue 3 of Med J Dr. D. Y. Patil University
Yugal Kishore Sharma, Kedar Nath Dash
September-October 2014, 7(5):689-690
DOI
:10.4103/0975-2870.140505
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1,507
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Histoid leprosy in type II reaction with neural abscess: Treated with ulnar nerve decompression and anterior transposition
Milind A Patvekar, Sanjay Dev
September-October 2014, 7(5):690-690
DOI
:10.4103/0975-2870.140506
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1,593
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Role of high-resolution ultrasound in diagnosis and follow-up of leprosy patients
Amit Kharat, Dhaval K Thakkar, Mansi Jantre, Amarjit Singh
September-October 2014, 7(5):686-687
DOI
:10.4103/0975-2870.140501
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4,021
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ORIGINAL ARTICLES
A simple and noninvasive technique using Bohlers stirrup facilitating management of posterior soft tissue injuries of heel
Nikil Jayasheelan, Jagannath Kamath, Premjit Sujir
September-October 2014, 7(5):608-611
DOI
:10.4103/0975-2870.140436
Introduction:
Many techniques have been devised to solve the problems associated with posterior soft tissue injuries. A noninvasive technique with plaster of Paris cast mold has been described by Ravishankar. Plaster casting techniques have been associated with problems such as tight cast and cast damage. Invasive techniques using external fixators as described by Berkowitz and Kim using tubular fixators like "kick back stand" and by Kamath using ring Illizarov fixators. The external fixators have their own problems like maintaining them for weeks and pin tract infection.
Materials and Methods:
We have tried to achieve as noninvasive technique using a Bohler stirrup incorporated with slab for patients with only soft tissue in injury and in a fixator for patients with skeletal injury already on tubular fixators.
Results:
In all the 12 cases where this method was used, the authors achieved the purpose of protecting the split skin graft in four cases and flap in eight cases. We did not encounter any problems related to this method such as skin maceration, sores including loosening of the frame.
Conclusion:
It is a simple and noninvasive method, which can be easily and reliably performed to maintain adequate limb elevation and soft tissue protection, which can be done is any hospital setup.
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A prospective study comparing diathermy and steel scalpel in abdominal incisions
Bhupender Kadyan, Shahaji Chavan, Manisha Mann, Prashant Punia, Sachin Tekade
September-October 2014, 7(5):558-563
DOI
:10.4103/0975-2870.140382
Background:
Diathermy is increasingly used for underlying tissue dissection, cutting, and hemostasis although fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision. Only few surgeons employ diathermy in making a skin incision with fear of producing deep burns and resultant scarring.
Aims and Objectives:
This prospective study was done to compare the outcome of diathermy incisions versus steel scalpel incisions in general surgery with regard to incision time, early postoperative pain, postoperative wound infection rate, and scar assessment.
Materials and Methods:
This study was conducted at Department of General Surgery. A total of 76 patients who underwent steel scalpel incision (group A: 38 patients) or diathermy incision (group B: 38 patients) were analyzed. Variables analyzed were incision time, early postoperative pain, post operative wound infection rate, and scar assessment. All patients aged from 15 years to 60 years who underwent elective surgery (appendectomy and cholecystectomy) were included in the study. The exclusion criteria were (1) emergency surgery, (2) surgically scarred tissues, (3) immune compromised patients, (4) pregnant patients, (5) patients with pacemaker device, (6) lost to follow up. Standard antiseptic protocol was followed for both the groups.
Results:
The results showed significantly less incision time as well as less pain scores associated with diathermy incisions over scalpel incisions. Incision time was significantly lower for patients in the diathermy group (P < 0.001). Early postoperative pain (VAS) was found to be markedly reduced during first 48 hours in group A (P < 0.0001). Postoperative wound infection rate (P > 0.05) was almost the same for both groups and was statistically insignificant.
Conclusion:
Diathermy skin incision in elective surgery has significant advantages over scalpel use as it results in less incision time, less early postoperative pain, and analgesia requirement.
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5,405
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Perforated duodenal ulcer: Emerging pattern
Murtaza Ali Asger Calcuttawala, Daksha S Nirhale, Virendra S Athavale, Mohit Bhatia, Anirudhha Kale, Vinit Singh
September-October 2014, 7(5):564-568
DOI
:10.4103/0975-2870.140385
Background:
A total of 27 patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied.
Materials and Methods:
All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham's omental patch was carried out. This was followed by triple regimen for
Helicobacter pylori
eradication.
Results:
All patients were male, maximum incidence (61.54%) was noted in the age group of 21-30, 'O' +ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between the start of symptoms and surgery was 43 h. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series.
Conclusion:
We conclude that although a number of definitive surgeries have been described for acid peptic disease, but the requirement of such procedures has come down due to increasing use of
H. pylori
eradication therapy and proton pump inhibitors. However, surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence is greater in young males.
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Outcome of bipolar release of the sternocleidomastoid muscle in neglected congenital muscular torticollis
Basant Kumar Bhuyan
September-October 2014, 7(5):584-588
DOI
:10.4103/0975-2870.140407
Purpose:
Neglected congenital muscular torticollis (CMT) is a common presentation in our country, which poses largely a cosmetic disability. Surgical correction is recommended for patients with late reporting cases. The aim of this study is to evaluate the efficacy of surgical release of CMT in neglected cases.
Materials and Methods:
In the present retrospective case series, eleven patients of neglected CMT were treated by a modified Ferkel's release which comprising a bipolar release of the sternocleidomastoid muscle with Z-lengthening. The age at operation ranged from 4 to 18 years (mean 8.3 years). Post-operative protocol included head halter traction for 6 weeks and physiotherapy. Results were evaluated by the scoring system of Lee
et
al
.
Results:
At an average follow-up of 4.4 years (range: 2-8.6 years), excellent results were noted in 8 patients (72.7%) and good in 3 (27.2%). In this study, significant improvement of neck motion, head tilt, chin deviation and cosmesis were observed with surgical treatment. There were no surgery-related complications or recurrences occurred in any of these patients.
Conclusions:
Patients with neglected CMT can benefit from surgical treatment and bipolar release is an effective and complication-free method for such patients.
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