Showing papers in "Journal of Postgraduate Medicine in 1992"

Hyperbaric oxygen therapy in diabetic foot.

Abstract: To study the effect of hyperbaric oxygen therapy in chronic diabetic foot lesions, a prospective controlled study was undertaken Thirty diabetics with chronic foot lesions were randomised to study group (conventional management and 4 sessions of hyperbaric oxygen therapy) and control group (conventional management) The patients were assessed for average hospital stay, control of infection and wound healing The control of infection spread was quicker Positive cultures decreased from initial 19 to 3 in study group as against from 16 to 12 in the control group (p < 005) This difference was most pronounced for Escherichia coli Also, the need for major amputation was significantly less in the study group (n = 2) as against the control group (n = 7) (p < 005) The average hospital stay was not affected We conclude that hyperbaric oxygen therapy can be safely used and is beneficial as an adjuvant therapy in chronic diabetic foot lesions

Comparative study of hemoglobin estimated by Drabkin's and Sahli's methods.

Abstract: Hemoglobin was estimated by Sahli's and Drabkin's method in samples collected by finger prick and venepuncture. Statistical analysis revealed a significant difference in the hemoglobin values obtained by the two methods (P less than .01 & P less than .05 respectively). Sahli's method carried out by two different groups of workers in samples of blood collected by venepuncture showed statistically significant difference (P less than .001). This could be due to the inbuilt errors of Sahli's method including a subjective bias due to visual comparison. When same samples were subjected to Drabkin's method by the same group of workers no significant difference in the results were obtained (P less than .05). This is due to reliability of the Drabkins method. The aim of this comparative study of hemoglobin estimation by Sahli's and Drabkin's methods is to emphasize the sensitivity and reliability of Drabkin's over Sahli's and utility of Drabkin's method in undergraduate teaching schedule.

Immunotherapeutic modification of Escherichia coli peritonitis and bacteremia by Tinospora cordifolia.

Abstract: We present here the protective effects of an Indian medicinal plant Tinospora cordifolia as compared to gentamicin in E. Coli induced peritonitis. Pretreatment with tinospora cordifolia or gentamicin reduced mortality in mice injected with 1 x 10(8) E. coli intraperitoneally from 100% in controls to 17.8% and 11.1% respectively. This was associated with significantly improved bacterial clearance as well as improved phagocytic and intracellular bactericidal capacities of neutrophils in the Tinospora cordifolia treated group. In the gentamicin treated mice although bacterial clearance was rapid, polymorph phagocytosis was depressed. Tinospora cordifolia did not possess in vitro bactericidal activity. The results demonstrate that a "prohost approach" may be beneficial in the therapy of peritonitis.

Pathological rupture of malarial spleen.

Abstract: Two cases of spontaneous rupture of malarial spleen are reported here. One of them was a male who was on chloroquine for an acute attack of malaria. While on therapy, he complained of pain in left hypochondrium followed by palpitations. The other patient was a female who was admitted for continuous dull aching pain and fever. In both the patients, exploratory laparotomy revealed an enlarged spleen with tear. Splenectomy was performed. Histopathological examination revealed dilated congested sinusoid with follicular atrophy, and RBCs with malarial parasites. The post-operative course was smooth in both patients.

Hyperferritinemia in pregnancy induced hypertension and eclampsia.

Abstract: A study of serum iron and ferritin levels in Indian women with pregnancy induced hypertension (PIH) (mild/severe) and eclampsia compared with controls of similar gestational ages, revealed that mean serum iron was elevated slightly in PIH and significantly in eclampsia as compared to controls Mean ferritin levels were significantly elevated both in PIH and eclampsia as compared to controls indicating that ferritin measurement in PIH and eclampsia would not reflect iron nutritional status Lack of significant changes in liver enzymes and in hemoconcentration in PIH and eclampsia indicate that liver damage and altered hemodynamics only play a partial role in causing hyperferritinemia Possible role of placental ferritin, being released as a result of placental damage in these conditions seems to be an area needing further research

Relevance of plasma fibrinogen estimation in obstetric complications.

Abstract: We present a study of fibrinogen levels in 133 patients who were prone to develop disseminated intravascular coagulation as a result of an underlying complication of pregnancy such as abruptio placentae, pregnancy-induced hypertension, missed abortion, septic abortion, intrauterine fetal death, vesicular mole and amniotic fluid embolism. A high incidence of hypofibrinogenemia was found in cases of abruptio placentae (43.9%) and pregnancy-induced hypertension (25%). Hypofibrinogenemia occurred in 10% cases of intrauterine fetal death within 4 weeks of fetal demise. The use of this simple investigation makes possible the diagnosis of hemostatic failure and also helps to guide replacement therapy during the fibrinopenic state. There were 4 maternal deaths and 12 perinatal losses in this study.

Conjunctival impression cytology--a study of normal conjunctiva.

Abstract: Conjunctival impression cytology was used to study conjunctival ocular surface in 30 normal individuals in the age group of 20 to 60 years. The cytology was graded according to the classification of Nelson. Out of 30 subjects, 26 showed the features of Grade O (average age 28.33 years) and 4 showed grade 1 (average age 56.66 years). The method was very easy to perform, cheap and fast. The relationship of various cells to each other was maintained. This method can be used to study the conditions like trachoma, avitaminosis A and other disorders of conjunctival surface. It can be undertaken by a paramedical worker in an out patient clinic.

MURCS association--a review of 7 cases.

Abstract: MURCS association (Mullerian hypoplasia/aplasia, renal agenesis and cervicothoracic somite dysplasia) is emerging as the second most frequent cause of primary amenorrhoea after Turner syndrome. Seven cases have been described and analysed. All cases had absence of uterus and tubes 85% had cervical spine abnormalities such as vertebral fusion, hypoplasia of vertebrae or butterfly vertebrae and short stature and 28% had renal agenesis or ectopy. The latter finding is in contrast to the reports in world literature where the frequency of renal agenesis is higher. There was no familial incidence in these seven cases lending credence to the belief that the association is essentially sporadic.

Female circumcision: a risk factor in postpartum haemorrhage.

Abstract: A major postpartum haemorrhage occurred in a patient with a previous history of female circumcision. Following assisted vaginal delivery 6 litre blood loss occurred as a result of tears to the vagina and perineum. The tears were sutured, followed by insertion of vaginal packs. Replacement fluid therapy was given. To reduce the incidence of tears and accompanying haemorrhage, it is advisable to perform two episiotomies viz. anterior and midline posterior or mediolateral.

Facial nerve involvement in pseudotumor cerebri.

Abstract: A woman with history of bifrontal headache, vomiting and loss of vision was diagnosed as a case of pseudotumor cerebri based on clinical and MRI findings. Bilateral abducens and facial nerve palsies were detected. Pseudotumor cerebri in this patient was not associated with any other illness or related to drug therapy. Treatment was given to lower the raised intracranial pressure to which the patient responded.

Evaluation of two methods employed for cervical ripening.

Abstract: The study evaluates breast stimulation and oxytocin infusion as methods for cervical ripening in patients where an obstetric indication for induction of labour exists. Forty patients with a Bishop score of 5 or 6 were randomly selected for either breast stimulation or oxytocin infusion. In a similar group of 20 cases, no method was employed. The Bishop score improved in 41.2% of cases where breast stimulation was used as compared to 75% where an oxytocin infusion was given. Three foetal deaths in the breast stimulation group brought the study to a stop after 17 cases. Cervical ripening with an oxytocin infusion drip appears to be a better method since infusion dosage can be precisely controlled making the technique more predictable and reliable. Though breast stimulation is effective in ripening the cervix, it may be used only in cases of intrauterine foetal death as it may otherwise adversely affect foetal outcome.

Experience with the pectoralis major myocutaneous flap for head and neck reconstruction in a general surgical unit.

Abstract: The pectoralis major myocutaneous (PMMC) flap or its modification was used in 19 cases after resectional surgery for malignancy of the oral cavity with minimal morbidity and no mortality. The resection as well as reconstruction was done by the same team consisting only of general surgeons. The final functional and cosmetic results were satisfactory. The pectoralis major myocutaneous flap is a hardy flap and can be performed with relative ease even by those not specialised in plastic surgery. This makes it an important tool for a general surgeon practicing in a country like India with its high incidence of head and neck malignancy.

Temporary intravascular shunts for peripheral vascular trauma.

Abstract: Polyvinylchloride (PVC) disposable endotracheal suction catheters were successfully used as temporary intravascular shunts in 5 patients of popliteal artery trauma. These simple shunts should be used routinely in such conditions to immediately re-establish blood supply to the ischaemic limb particularly in patients of polytrauma where systemic anticoagulation is contraindicated. This avoids the inherent delay prior to vascular repair and reduces the incidence of irreversible ischemia.

Use of nitroglycerin ointment to prevent hypertensive response during electroconvulsive therapy--a study of 50 cases.

Abstract: Fifty patients of either sex, aged between 20 and 60 years undergoing electroconvulsive therapy were included in our study. Each patient was used as his/her own control. We observed the cardiovascular changes without nitroglycerin ointment in the first sitting and in the next sitting with the application of 2 inches of 2% nitroglycerin ointment 45 min before the electroconvulsive therapy. Arterial blood pressure and heart rate increase during electroconvulsive therapy can be effectively attenuated by application of 2 inches of 2% nitroglycerin ointment 45 min before the electroconvulsive therapy (p < 0.001 and p < 0.01 resp.). This may be especially beneficial for patients who are at increased risk of myocardial ischemia and stroke.

Isolated posterior dislocation of the radial head in an adult.

Abstract: Isolated posterior dislocation of the radial head was detected on X-ray in a patient following a vehicular accident. Such a dislocation without an associated fracture is extremely rare in adults. Immobilization of the elbow in full pronation and 90 degrees flexion for 4 weeks normalized the position of the head of the radius.

Changes in thyroid hormones in surgical trauma.

Abstract: A prospective study of 20 patients who underwent elective surgery, is presented reporting the effect of surgical trauma on circulating thyroid hormone levels. Although no increase in the serum T4 levels was observed following surgery, serum T3 values were found to decrease and serum rT3 values were found to increase in the post-operative period, representing activation of an alternate pathway in the peripheral conversion of T4 to T3. Since trauma induces a hypermetabolic state due to hypersecretion of cortisol, alterations in thyroid hormone levels were concluded to represent an appropriate response in trauma to counter the effects of trauma-induced cortisol hypersecretion.

Congenital leukemia--organ involvement in six autopsy cases.

Abstract: Six cases of congenital leukemia were encountered in pediatric autopsies carried out over a period of 7 years. The postmortem findings of these cases were analysed and presented along with antemortem peripheral and bone marrow smear. All the cases were diagnosed as acute myeloid leukemia. Gross changes were observed in lungs, liver, spleen and kidneys. Histological abnormalities were detected in these organs as well as the heart, pancreas and intestine. Lymph node follicles were well preserved in all. The thymus showed a normal lobular pattern with interstitial infiltrate. Bone marrow showed myeloid blast cells with depletion of the erythroid and megakaryocytic cells.

Endodermal sinus tumor of vulva (a case report).

Abstract: An unusual case of endodermal sinus tumor (EST) of the ovary at an extragonadal site-vulva, in an unmarried female of 25 yr is reported. The patient presented only with a vulval swelling on the right side without any other signs or symptoms. The internal genital organs mainly the ovaries were normal.

Persistent facial myokymia: a rare pathognomic physical sign of intrinsic brain-stem lesions: report of 2 cases and review of literature.

Abstract: Characteristically continuous facial myokymia is a pathognomonic, exceedingly rare physical sign of intrinsic brain-stem lesions e.g. multiple sclerosis (where the myokymia lasts only for a few months), pontine glioma (where it is unremitting for years). The physiopathogenesis is unclear. Electromyographic patterns are characteristic. Therapy and prognosis are related to the basic aetio-pathological process. Only two out of 132 cases of intrinsic brain-stem lesions in the department of Neurosurgery, Seth G.s. Medical College, Bombay over a period of 3 decades, exemplify its rarity. These two cases are reported here and the relevant literature is reviewed.

Bilateral pulmonary aneurysm in Behçet's disease (a case report).

Abstract: While investigating a chest opacity in Behcet's disease possibility of pulmonary aneurysm should be considered. Contrast enhanced CT is a safe diagnostic method which is useful in confirming or excluding the presence of an aneurysm in such cases. We report here the first case of bilateral pulmonary aneurysms in Behcet's disease.

An integrated community based approach in undergraduate medical teaching of maternal and child health--an experiment.

Abstract: The batch of 147 undergraduate medical students (Group I) were trained in maternal and child health (MCH) by allotting them families study wherein either pregnant lady or a new born child was present. The students were made to follow up these mothers and their children for three years on periodic basis by paying home visits and motivating the mothers to attend under five clinic in the community. The students educated the mother regarding child rearing with the help of medical teacher. Another batch of 140 undergraduate medical students (Group II) who did not undergo such community based training but only didactic lectures in MCH were studied as control. The knowledge and attitudes of students in both the groups were tested and compared and significantly higher knowledge and favourable attitude were found in Group I. The attendance of patients of Group I in under five clinics was compared with other children who were not adopted by medical students. The comparison was made between their weight gain, immunizational status and episodes of illness. The beneficiaries in students families had better, attendance and immunizational coverage, more weight gain and less episodes of illness. The difference was found to be statistically significant.

Multiple chylous cysts of abdomen causing intestinal obstruction.

Abstract: A case of multiple chylous cysts of the abdomen in a 35 years old female is presented here. The patient presented with signs and symptoms of acute intestinal obstruction. Exploratory laparotomy revealed few intestinal adhesions along with multiple small cysts containing blood stained gelatinous material in the abdominal cavity, some of which were excised alongwith lymph nodes. The abdomen was closed after a saline peritoneal lavage. Chylous nature of the cysts was confirmed on histopathology. The post-operative course was asymptomatic.

Wildervanck syndrome (cervico-oculo-acoustic syndrome).

Abstract: Wildervanck syndrome i.e. cervico (Klippel-Feil anomalad) -oculo (Duane-Stilling-Turk phenomenon with bilateral abducens palsy)-acoustic (deafness) is a rare syndrome. We report here 4 cases diagnosed as Wildervanck syndrome and analyse their findings. One patient had an an atrial septal defect. Such association of congenital heart disease with Wildervanck syndrome has not been reported previously.

Hydatid cyst of the tibia.

Abstract: A case of hydatid cyst of the tibia, which manifested as a pathologic fracture is being reported. Pain and swelling of left lower limb with inability to bear the weight were the main features. Tender swelling was also noted at the upper and middle third of tibia. Open biopsy revealed the hydatid cyst wall and scolices of Echinococcus granulosus. Albendazole treatment was followed by curettage and bone grafting.

Melanocytoma of the optic disc.

Abstract: Melanocytoma of the optic disc is a benign lesion. We report here a patient with melanocytoma who presented with gradual diminution of vision. On examination the left eye fundus showed a mass uniformly dark black in colour, on the optic disc occupying the superotemporal quadrant. The mass completely obscured the fluorescence on fluorescein angiography and was thus differentiated from malignant melanoma.

Benign neonatal pneumoperitoneum--an enigma.

Abstract: A case of neonatal pneumoperitoneum in absence of a bowel perforation or intrathoracic pathology has been reported. The cause of such a rare manifestation remains to be established.