Showing papers by "North Bengal Medical College published in 2010"

Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial

Abstract: Objective: Clonidine has been used as adjuvant to local anesthetics in order to extend the duration of analgesia in various regional and central neuraxial blocks. It is previously reported that clonidine added to bupivacaine increases analgesia duration in brachial plexus block. We evaluated the effect of this combination in supraclavicular brachial plexus block for upper limb orthopedic procedures. Materials and Methods: A randomized double-blind placebo controlled trial was done with 70 patients of American Society of Anesthesiologists Grade I or II status undergoing upper limb orthopedic procedures. Group A (n = 35) patients received 25 ml of 0.5% bupivacaine and 0.2 ml (30 mcg) clonidine, whereas group B (n = 35) received 25 ml of 0.5% bupivacaine and 0.2 ml normal saline through a supraclavicular approach for brachial plexus block. Vital parameters were recorded 10 min prior to block placement and every 3 min thereafter till the end of the procedure. Onset and duration of both sensory and motor blocks and sedation score were recorded. All patients were observed in postanesthesia care unit and received tramadol injection as soon as they complained of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till injection of rescue analgesic. Results: Analgesia duration was 415.4 ± 38.18 min (mean ± standard deviation) in Group A (clonidine) compared to 194.2 ± 28.74 min in Group B (control). No clinically significant difference was observed in heart rate, blood pressure, and oxygen saturation. Sedation score was higher in the clonidine group. Conclusion: Addition of a small dose of clonidine to 0.5% bupivacaine significantly prolonged the duration of analgesia without producing any clinically important adverse reactions other than sedation.

Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair.

Abstract: Background: Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery. Methods: We compared unilateral lumbar PVB with conventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18–65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P (n=30) or S (n=30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intravenous infusion of propofol titrated to light sedation. Results: The time to first post-operative analgesic requirement (primary outcome measure) as 342 ± 73 min in group P and 222 ± 22 min in group S (P<0.0001). Time to ambulation was 234 ± 111 min in group P and 361 ± 32 min in group S (P<0.0001). Urinary retention requiring catheterization were found in zero (0%) patients in group P compared with five (16%) in group S (P=0.024). Conclusion: It can be concluded that unilateral PVB is more efficacious than conventional SA in terms of prolonging post-operative analgesia and reducing morbidities in patients undergoing elective unilateral inguinal hernia repair.

Ovarian tumors in pediatric age group - A clinicopathologic study of 10 years' cases in West Bengal, India

Abstract: Background and objectives: Objective in this retrospective study is to find out the incidence of different ovarian tumors of girls up to 20 years of age observed in last ten years in North Bengal Medical College and to correlate clinical and gross findings with histopathologic findings and to compare the incidence with other studies and follow-up of patients with malignant ovarian tumors. Materials and Methods: Findings were retrieved from records of different pathological reports and clinical reports. Results: Total 151 cases of ovarian tumors were received in pathology department in which 34 cases were malignant (22.6%). Amongst malignant cases, 66% are of germ-cell origin-dysgerminoma being the commonest. Strikingly we got 9 cases of malignant surface epithelial tumor. As per follow-up records most of the dysgerminoma came in stage IA and recovered fully following chemotherapy and radiotherapy. Amongst other malignant tumors, few lost the follow-up management and others expired due to metastasis. Conclusions: Patients from hilly areas of North Bengal and low socio-economic status led to lower detection rate of ovarian tumors in early stage which are absolutely necessary for proper guidelines of management to reduce mortality.

Serum magnesium and stable asthma: Is there a link?

Abstract: Background: Although magnesium is used through intravenous and inhalation route in the management of asthma, actual prevalence of hypomagnesemia in asthma is not known. We conducted this study: 1) to detect the prevalence of hypomagnesemia in stable asthma and 2) to assess the significance of hypomagnesemia in these patients. Design: Prospective clinical study. Setting: Department of Respiratory Medicine, Calcutta National Medical College, Kolkata. Period of Study: Four months from January, 2007, to April, 2007. Materials and Methods: Fifty patients attending outpatients department of respiratory medicine with stable asthma were randomly selected. They were assessed clinically and their serum magnesium levels were measured. This was compared with the serum magnesium values of 45 nonasthmatic healthy controls. Results: Out of 50 patients, 14 had hypomagnesemia. Possible relationship of hypomagnesemia with tachycardia, tachypnoea, severity of asthma, medication use, and previous and future exacerbations were analyzed. Conclusion: There was statistically significant association of hypomagnesemia with tachypnoea, severe asthma, use of long-acting b2 -agonist, inhaled corticosteroids, theophylline, use of ≥ 3 medications, previous and future exacerbations but not with tachycardia or use of short-acting β2 -agonist or montelukast.

Oral manifestations in human immunodeficiency virus infected patients

Abstract: Background: Oral lesions are common among Human Immuno deficiency Virus (HIV)-positive patients. The pattern of oral features in these persons may differ in separate settings. Aims: To find out the spectrum of oral manifestations among a section of seropositive individuals attending the antiretroviral therapy (ART) centre of a referral hospital. Materials and Methods: A total of three hundred and twenty-one newly diagnosed seropositive patients were enrolled in this study. Of these, ninety-four patients who demonstrated lesions related to the oral cavity were examined intra-orally by a clinician. HIV testing was done with ELISA and CD4 counts were measured with the help of fluorescence activated cell sorter (FACS) system. Results: Fifty-four respondents presented exclusively with oral lesions. Candidiasis patients were the largest group (38.30%). Conclusion: HIV disease presents a plethora of oral manifestations, which provide valuable diagnostic and prognostic information.

Evaluation of the prevention of parent to child transmission program in a rural tertiary care hospital of West Bengal, India

Abstract: Background: In India, 67,500 infants acquire HIV infection yearly due to mother to child transmission. Objective: The objective was to assess the operational aspect of the Prevention of Parent to Child Transmission (PPTCT) program in a tertiary care hospital and explore its bottleneck. Materials and Methods: A 5-year (2004-2008) prospective evaluation study was conducted among the pregnant women attending Obstetrics Department of a rural tertiary care hospital, since the year of implementation. Indicators were used according to UNAIDS/WHO guideline. Results: Out of 40,140 registered pregnant women, 23,812 were counseled of which 19,794 were agreed to undergo HIV testing and 111 were found HIV positive with a prevalence of 0.56%. Overall HIV counseling and testing rates were 59.32% and 83.13%, respectively. The nevirapine (NVP) dispensing rate of the mother and newborn were 29.72% and 85.4%, respectively. At 18 months of age, 85% babies were found HIV negative in the mother baby pair who received NVP with absolutely formula feeding but it was 42.8% without such intervention. Conclusion: Majority of the pregnant women who came to the labor room directly were deprived of the program (PPTCT) coverage. Although the HIV testing rate reached the WHO target which was excellent, but the NVP dispensing rate lagged far behind.

Role of pleural biopsy in etiological diagnosis of pleural effusion

Abstract: Background: Pleural effusion remains the most common manifestation of pleural pathology. Sometimes it is difficult to differentiate between tubercular and malignant pleural effusion in spite of routine biochemical and cytological examination of pleural fluid. Aims: This study aims to evaluate the role of pleural biopsy to determine the etiology of pleural effusion and to correlate it with the biochemical and cytological parameters of pleural fluid. Settings and Design: Seventy two consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of Kolkata. It was a prospective and observational study conducted over a period of one year. Materials and Methods: Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy by Abram's needle. Subsequently, the etiology of effusion was determined. Results: Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 72 patients. Pleural tissue was obtained in 62 cases. Malignancy was diagnosed in 24, tuberculosis in 20 and non-specific inflammation in 18, on histopathological examination. Out of 20 histological proven tuberculosis cases adenosine de-aminase (ADA) was more than 70 u/l in 11 cases. Conclusions: In our study, malignancy is more common than tuberculosis, particularly in elderly. When thoracoscope is not available, pleural fluid cytology and pleural biopsy can give definite diagnosis. Pleural fluid ADA ≥ 70 u/l is almost diagnostic of tuberculosis, where pleural biopsy is not recommended.

Tuberculosis of sternoclavicular joint - uncommon manifestation of a common disease

Abstract: 15% of Tuberculosis patients have extra pulmonary lesions of which 1 to 3% have bone and joint lesions. In the musculoskeletal system, tuberculous spondylitis is most typical form of the disease; however, joint changes in extraspinal sites, such as the hip, knee, wrist & elbow, also may occur. Involvement of sternoclavicular joint is very rare. In 2 of the world's largest series of osteoarticular TB, sternoclavicular joint involvement was reported in less than 0.5% of cases with less than 20 cases reported till date. However, with the emergence of drug resistant tuberculosis and large number of immunocompromised patients, the incidence may increase. We report a case of left sternoclavicular joint tuberculosis in an adolescent boy. As this entity is rare, level of suspicion is low and suspicion regarding TB arises only after poor response to antibiotic treatment. Early diagnosis and treatment is mandatory for good result Keywords: Tuberculosis, sternoclavicular joint, extrapulmonary tuberculosis DOI:10.3329/jom.v11i1.4286 J Medicine 2010: 11: 102-104

Calcified pure uterine lipoma mimicking myoma

Abstract: Pure lipoma of the uterus is a rare entity and only a few cases have been reported in the literature. Clinical symptoms and signs are similar to those found in leiomyoma and create preoperative diagnostic confusion. The histogenesis is still unclear. We report the case of a 70 year-old woman with pure lipoma of the uterus with calcification.

Encephalitis Following Wasp Sting

Abstract: Sir, Hymenoptera stings are encountered worldwide; single sting may result in anaphylaxis. Multiple stings cause shock, renal failure, intravascular hemolysis or rhabdomyolysis. Exceptionally, serum sickness, vasculitis, neuritis, encephalitis are also reported. Neurological complications manifest days to weeks after stings. The authors report a girl who developed allergic encephalitis days after being stung by multiple wasps. A 3-yr-old previously healthy girl presented with head ache, vomiting, seizure and drowsiness. History of multiple wasp stings with local reaction was elicited. She was stable by symptomatic management but started having neurological symptoms on day 4. Examination showed; GCS (9/13), spasticity in four limbs, brisk reflexes and bilateral extensor planter. Meningial signs of cranial nerve palsies were absent. Investigations detected; normal hemoglobin and platelets with marked neutrophilic leukocytosis. CSF analysis showed 10 mononuclear cells, protein was 120 mg/dl; sugar was 50 mg/dl (blood sugar of 94 mg/dl). CSF and serum for Japanese encephalitis virus and dengue antibody were negative. Renal function tests, liver function tests, urinalysis and electrocardiography were normal. Hymenoptera induced delayed allergic encephalitis was diagnosed. Intravenous methylprednisolone was administered (30 mg/kg/day, for 5 days) along with symptomatic management. She regained consciousness but motor impairment persisted. Physiotherapy was initiated in continuation to anticonvulsant medication. Follow up revealed further improvement. Hymenoptera induces, acute IgE mediated type I hypersensitivity. Type III reaction with deposition of immune complexes and activation of complement system occur days to weeks after sting. Neurological involvements are uncommon; onset varies from 30 s to 96 h. Reported complications are peripheral or facial neuropathies, myelitis, encephalitis, encephaloradiculoneuritis, optic neuropathy [1] myasthenia gravis, cerebral infarction, acute inflammatory polyradiculopathy, brachial neuropathy, trigeminal neuritis and generalized polyneuropathy [2]. The cerebral lesions consist of edema, hemorrhage, infarction, necrosis and degeneration. Mechanisms include vasoconstriction, platelet aggregation and retrograde stimulation of superior cervical ganglion causing occlusion of terminal internal carotid artery. Means et al. reported a case of bilateral limbs weakness and numbness; following a yellow jacket sting. Necropsy revealed areas of demyelination throughout central and peripheral nervous system with necrosis and inflammatory infiltration in the brain stem and spinal cord [3]. P Likittanasombut et al. reported severe encephalomyeloradiculoneuritis. [4] Pathogenesis of M. Roy :M. Chatterjee Pediatric Medicine, North Bengal Medical College & Hospital, Darjeeling, West Bengal, India

Post-salpingectomy endometriosis: An under-recognized entity.

Abstract: We report a case of a 48-year old lady, who presented with complaints of lower abdominal pain and menorrhagia for the last four months. The patient had undergone bilateral salpingectomy four years back by the Pomeroy technique. Ultrasonography revealed an ovarian cyst on the right side. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and the specimen was sent for histopathological examination. It revealed that the normal mucosa of the tubectomy stump was completely replaced by endometrial tissue. Tubal endometriosis remains an under-recognized entity, due to less extensive routine sampling of the fallopian tubes, and they may be also be associated with other pathologies, as was in the present case.

Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery.

Abstract: Objective Granulomatous mastitis is a benign disorder which closely mimics malignancy clinico-radiologically. A simple and cost effective modality like fine needle aspiration cytology (FNAC) can help in prompt diagnosis and avoid unnecessary surgery.

Nutritional Profile of Children Under 5 Years of Age in a Tribal Community in the District of Maldah, West Bengal:

Abstract: Objectives: To determine the nutritional status of under-5 tribal children. Design: Community-based cross-sectional observational study. Setting: Three tribal villages of the Chanchal II block of the Maldah district in West Bengal. Subjects and Methods: In 3 tribal villages, 188 children under 5 years of age were examined to detect nutritional deficiency disorders. By anthropometric measurement, nutritional grading of them was determined. Interviews of mothers provided breast-feeding and weaning practices. Results: 63.83% of study subjects were suffering from different grades of malnutrition. Prevalence of anaemia and angular stomatitis was 45.74% and 19.12%, respectively, among them.

Morphological predictors of nipple areola involvement in malignant breast tumors

Abstract: Context: Nipple areola (NA) sparing mastectomy has an acceptable complication rate, is oncologically safe and facilitates an improved cosmetic result, aiding greatly in reducing psychological trauma associated with breast loss. Questions regarding preoperative case selection for NA sparing mastectomy are pertinent. Aims: The principle objective was to develop a simple model based on correlation of malignant involvement of NA with morphological factors in breast cancer cases to accurately predict the cancerous involvement of nipple areola preoperatively. Settings and Design: The present cross-sectional study was carried out on 136 patients of breast cancer. The period of study spanned 3 years from 2004 to 2007. Materials and Methods: We evaluated 17 different morphological parameters which had proven prognostic significance in breast cancer cases for their relationship with NA involvement. Data regarding cytological parameters were available in 120 cases out of the total number of 136 cases. Simple and conventional methods appropriate for any under-resourced set-up were employed to enhance the economic viability and acceptability of the project. Statistical Analysis used: Statistical analysis in this study was mostly done using SPSS version: 14 software. P-value < 0.05 was considered significant when assessing correlation between two parameters. Results: The frequency of NA involvement detected in this study was 19.1%. In univariate analysis, 13 of the 17 morphological parameters were found to have strong statistical association (P<0.05) with NA involvement. In multivariate analysis, only four parameters-macroscopic NA changes, tumor-NA distance (<1.5cm), histological lymph node grade and extra capsular extension in lymph node were found to have independent role for NA involvement prediction. This multivariate Cox and Snell Regression model with Cox and Snell Regression Square of 0.551 can predict accurately 98.5% cases of nipple involvement using the 4 parameters as variables. Conclusions: By application of this simple multivariate model, accurate prediction of NA involvement would be possible preoperatively. NA sparing mastectomy may be performed on those cases predicted to have no NA involvement thus substantially reducing the burden of psychological morbidity.

An unusual foreign body in the urinary bladder.

Abstract: A coiled electric cable was removed from the urinary bladder of a 35-year-old male, electrician by profession. Psychiatric evaluation revealed normal childhood and no psychiatric illness. Proper management by both a urologist and a psychiatrist is required in these cases.

Sarcomatoid chromophobe renal cell carcinoma: Cytohistopathological correlation of a case.

Abstract: Sarcomatoid renal cell carcinomas of the kidney are rare neoplasms constituting about 1-5% of all renal malignant neoplasms. These are aggressive tumors and are commonly associated with conventional (clear cell) renal cell carcinomas, but cases associated with chromophobe renal cell carcinomas are sparse. Cytological features of such lesions have rarely been reported. Here, we report a unique case of a 48-year-old male patient who presented with right flank lump and pain. A fine needle aspiration was performed from the lesion under ultrasound guidance and a cytological diagnosis of pleomorphic sarcoma was made. A right-sided radical nephrectomy was carried out and subsequent histopathology revealed a sarcomatoid renal cell carcinoma with wide areas of necrosis coexisting with chromophobe renal cell carcinoma with calcification. Differentiation of pleomorphic sarcoma from a sarcomatoid renal cell carcinoma is, thus, challenging from cytopathology smears and the differential diagnoses should always be borne in mind while giving a cytopathological opinion.

Community Acquired Methicillin Resistant Staphylococcus Aureus: A Rare Presentation

Abstract: Introduction Incidence of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) is increasing. Toxic shock syndrome (TSS), Necrotizing fasciitis (NF), Symmetrical peripheral gangrene (SPG) as a manifestation of CA-MRSA are rare in pediatrics.

An unusual case of hydatid cyst of the ovary and pouch of Douglas

Abstract: A 38 year old third para, presented with gradually enlarging hump in the lower abdomen for the last 2 years associated with a mild pain for the last 1 year. Abdominal examination revealed a cystic nontender mass of 26 week size in the lower abdomen. It had a smooth surface, with slightly restricted mobility. There was no hepatosplenomegaly or ascites. On speculum examination cervix appeared healthy. On vaginal examination, uterus was found to be of normal size, retroverted and deviated to the left side. An ill defined cystic mass encroaching into the posterior fornix was felt separately from the uterus. She was admitted on 19.7.06. J Obstet Gynecol India Vol. 60, No. 4 :July August 2010 pg 345 347

Plesiotherapy for non-melanoma skin cancer: innovating to overcome!

Abstract: Background: The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset of patients. Aims: The application of radiotherapy is subject to availability of proper equipment, non-availability of which precludes appropriate radiotherapy in most centers in third world countries. Materials and Methods: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. Results: In this paper we present successful management of a cohort of non-melanoma skin cancer patients with plesiotherapy using stepping source 192 Ir HDR source. Conclusions: Plesiothrapy is an effective mode of therapy for non-melanoma skin cancer.

Study of pulmonary functions in tea industry workers in North Bengal.

Abstract: This study was intended to compare pulmonary function parameters in tea garden factory workers who are on chronic exposure to tea dust with tea garden plantation workers on the basis of dynamic ventilatory pulmonary function tests. The pulmonary function tests done on 128 subjects included 64 tea garden factory workers and 64 tea garden plantation workers. In tea factory workers the values of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), forced expiratory volume in first 0.75 second (FEV 0.75 ), FEV 1 /FVC%, peak expiratory flow rate (PEFR) were found significantly lower (p<0.001) than those of tea garden plantation workers. It may be concluded that pulmonary functions are more affected in tea factory workers than those of tea plantation workers.

Adenosquamous Carcinoma Of Stomach: A Case Report

Abstract: Adenosquamous carcinomas of stomach are rare entities comprising 0.5% of stomach carcinomas. Here, we report a case of a 50-year-old female, who presented with weakness, pallor, and symptoms of gastric outlet obstruction. A partial gastrectomy was done and histology showed evidence of adenosquamous carcinoma of the antrum with metastasis to the perigastric lymph nodes. The patient condition improved at 6-month follow-up.

Anatomical Factors Influencing the Outcome of Intracerebral Hemorrhage - A Study From North Bengal

Abstract: Today in our tensionful lifestyle cerebrovascular accident is in its escalating rampage. A total of one hundred and forty cases were studied in an attempt to find out the anatomical factors which can influence the outcome of stroke patients due to intracerebral hemorrhage in different age groups in both the sexes. CT scan has been used as a diagnostic tool to detect the site of lesion and the anatomical factors specially the intraventricular extension (IVE) and herniation/midline shift (MLS). Intraventricular extension (IVE), midline shift (MLS) and sensorium of the patient were assessed as important parameters in determining the outcome in patients of intracerebral hemorrhage.

Pneumatosis Cystoides Intestinalis - A Case Report

Abstract: Pneumatosis Cystoides Intestinalis is a rare condition characterised by gas-filled cysts in the wall of the smallgut and sometimes in its mesentry. When the process is limited to the large intestine, the term pneumatosis coli is used . The exact cause of the condition is unknown but it may develop in diseases like peptic ulcer, ulcerative colitis, regional enteritis, chronic bronchitis etc. The condition is usually diagnosed incidentally during abdominal scanning or investigation for the primary disease. Presentation as a case of gastric outlet obstruction (proximal jejunal obstruction) as happened in this case, is rare. A young adult male cultivator presented as a case of gastric outlet obstruction due to suspected chronic duodenal ulcer ( a common complication of Peptic ulcer disease in our country ). Per-operatively, gas filled cysts in proximal jejunum with almost obliteration of the lumen of the intestine was detected and diagnosed as a case of pneumatosis cystoides intestinalis and was treated with resection and anastomosis of the affected portion of gut. The patient is in good health even 5 years after the operation and showed no signs of recurrence of the condition. DOI: 10.3329/jbcps.v27i1.4243 J Bangladesh Coll Phys Surg 2009; 27: 45-48

Dopamine Receptor Gene D1 Reveals No Significant Association with Delusional Disorder on the Basis of SSP Analysis

Abstract: Dysregulation of dopaminergic neurotransmission has been implicated in the etiology of major psychoses. The dopamine D1 receptor (DRD1) plays a role in some brain functions and mechanisms of psychotropic drugs. Therefore, the DRD1 gene makes a good candidate gene for molecular genetic study in delusional disorder. In the present investigation, the association has been studied between DRD1 gene and delusional disorder patients. No association was found between the DRD1 gene and delusional disorder, either in the whole group of patients or in subgroups divided by disease type or predominance of DRD1 positive or negative patients. Moreover, there were no significant differences observed between the delusional disorder patients and normal healthy controls when they were compared for different clinical and demographic variables. These findings suggest that this gene may not be involved in the pathogenesis of delusional disorder.