Showing papers in "Journal of Postgraduate Medicine in 1997"

Surgical physiology of wound healing: a review.

Abstract: The healing of wounds caused by accident, assault, welfare and surgical operations has always been a central consideration in surgical practice because any breach in continuity of skin or mucous membrane exposes the deeper tissues to the danger of infections The understanding of the mechanism of wound healing has increased dramatically during last few years Today wound healing abnormalities are among the greatest causes of disability and deformity "I dressed the wound, God healed it" (Ambroise Pare) wound healing involves multiple complicated events It is the amount and quality of scar tissue and ultimately its remodelling that is of greater importance The understanding of this process of wound healing and factors affecting it forms the basis of any surgical procedure

A prospective study of seroprevalence of Toxoplasmosis in general population, and in HIV/AIDS patients in Bombay, India.

Abstract: Two hundred and seventy nine sera (age group 13-50 years) were tested for antitoxoplasma IgG/IgM antibodies by ELISA techniques; the diagnostic titer for positive test is 10 iu/ml or > 1:100. Sera were obtained from (i) 165 (100 men/65 women) healthy adult voluntary blood donors (HIV, HBsAg, VDRL negative); (ii) 89 consecutive HIV/AIDS patients (82 men/7 women); and (iii) 25 patients (HIV negative: 12 men/13 women) treated for cerebral Tuberculoma or Neurocysticercosis during this study from January 1996-June 1997. The overall seroprevalence was 30.9% (51/165) in the immunocompetent adult (group i) 34% (34/100) men and 26.2% (17/65) in women [range: 10-899 iu/ml; (mean: 376.8)]. In HIV infected hosts the seroprevalence [range: 21-340 iu/ml; (mean; 180)] was 67.8% (56/82 men, 04/07 women). The seroprevalence was 20.5% (8/39), 32.8% (22/67), 34.8% (16/46) and 38.4% (5/13) in the 2nd, 3rd, 4th and 5th decades respectively in healthy adults. In HIV/AIDS patients, 69% (29/42) in the 3rd and 70.6% (24/34) in 4th decade were seropositive. The risk of cerebral Toxoplasmosis (encephalitis-02, granuloma-24) was 43.3% (26/60, mean 250 iu/ml). The seroprevalence was 28% in group iii (range 12-80 iu/ml, mean 21 iu/ml). Anti-toxo IgM was negative in all. Primary Toxoplasma infection appears to be subclinical and prevalent throughout life. T. gondii has emerged as an important opportunistic infection in HIV/AIDS patients in Bombay. Recrudescence of cerebral toxoplasmosis (CTOX) is observed with low IgG response during mid-late stage of the disease, as seen in our patients (mean IgG 250 iu/ml, CD4+ = 283/cmm (range 43-504 in 5 patients). Primary prophylaxis for CTOX seems rationale and can be targeted to asymptomatic HIV/AIDS population at risk who are seropositive for T. gondii (mean IgG 111.5 iu/ml in our study). The very high predictive value of a negative test for TOX remains the best serological parameter for excluding acute episode of TOX.

Effect of oral administration of Terminalia chebula on gastric emptying: an experimental study.

Abstract: Terminalia chebula is a commonly advocated agent in Ayurveda for improving gastrointestinal motility. Charles Foster rats (150-200 gms of either sex) were divided into four groups as follows--Group 1 (n = 15) normal animals; Group II (n = 6) rats administered metoclopramide (1.35 mg/kg); Group III (n = 8) rats given atropine (0.45 mg/kg). These agents were injected intramuscularly, 30 mins before the experiment. Rats from Group IV (n = 8) were administered Terminalia chebula (100 mg/kg/day for 15 days orally). Metoclopramide and atropine have established prokinetic and antikinetic activities respectively and are therefore included for comparison. All rats were then given a test meal of methyl cellulose (1.5%) mixed with phenol red (50 mg/100 ml) orally and gastric emptying was measured 20 mins later. Gastric emptying of normal rats (Group I) was found to be 51.6 +/- 7.79%. Metoclopramide significantly increased the gastric emptying (76.33 +/- 12.37%; p < 0.01) and atropine inhibited the motility (% gastric emptying being 7.26 +/- 19.76%; p < 0.01). Terminalia chebula was found to increase the percent gastric emptying (86.57 +/- 6.65%; p < 0.01). Thus from this study it appears that Terminalia chebula can serve as an useful alternative to prokinetic drugs available today.

Gastric volvulus in childhood.

Abstract: Gastric volvulus is an uncommon condition more so in the paediatric age group. The cause of gastric volvulus may be idiopathic or secondary to various congenital or acquired conditions. In this short series of three patients, one had volvulus which was due to ligamentous laxity and mobile spleen, second had congenital postero-lateral diaphragmatic defect and the third had hiatus hernia.

Methaemoglobinemia in nitrobenzene poisoning.

Abstract: A young girl with nitrobenzene induced methaemoglobinaemia was saved by the timely use of mechanical ventilator, administration of oral methylene blue and parenteral ascorbic acid Though parenteral methylene blue is the antidote of choice, due to its non-availability, the laboratory preparation of methylene blue have been utilized orally The rare occurrence of such cases, and the efficacy of oral methylene blue and other supportive measures in evading death due to Nitrobenzene poisoning have been highlighted

Duplication cyst of the pylorus--a rare cause of gastric outlet obstruction in the newborn.

Abstract: Duplication cysts of the pylorus are the rarest of alimentary tract duplications with very few reported cases. We present such a cyst in a neonate presenting with gastric outlet obstruction. We have also reviewed the literature and outlined the theories of origin, modes of presentation, diagnosis and the surgical procedures. Even though several modes of surgery have been described, it is best to individualize the surgical option in each case. The results depend on the nature and site of duplication, complications and the associated anomalies.

Intraparotid facial nerve schwannoma.

Abstract: Intraparotid facial nerve schwannoma are uncommon. Preoperative diagnosis of parotid tumour as schwannoma is difficult when facial nerve function is normal. A rare case of solitary schwannoma involving the upper branch of the facial nerve is described and the literature on the subject is reviewed.

Effect of Y virilin on male infertility.

Abstract: A prospective placebo controlled double blind study was conducted in patients attending male infertility clinics of our hospital to evaluate effects of a herbal formulation for male infertility--'Y-virilin'. In phase 1 forty patients with oligospermia with or without asthenospermia were randomly allocated to 2 treatment groups--Treatment Group A i.e. formulation under test and treatment Group B (Placebo). Therapy with these agents was given twice a day for 6 months. In phase 2, 12 patients with azospermia were administered either 'Y virilin' or the placebo (n = 6/Gp). In all patients along with semen analysis (sperm count, percentage of motile sperms and grade of motility) was done monthly for 6 months. Serum FSH levels were estimated before and at the end of therapy. A significant increase in sperm count was observed from 2-3 months in oligospermics receiving Y virilin as compared to basal values (p < 0.05). In Group B the follow-up sperm counts were either comparable to basal values or were lesser. However, the percentage and grade of motility did not differ in two groups at the end of respective treatment. No change was found in mean FSH value. During the therapy period incidence of conception was 20% in treatment Group A and 5% in Group B. Of the azospermic receiving 'Y-virilin' 50% showed a count of 10-20 millions/cmm while none from the placebo group. This study highlights the therapeutic potential of the tested formulation in the patients with infertility.

Irreducible lateral dislocation of the elbow.

Abstract: A rare case of an irreducible post-traumatic lateral dislocation of elbow is presented. The mechanism of injury was fall on a flexed elbow with trauma on its medial aspect resulting in pronation of the forearm. At open reduction, the brachialis muscle was in the form of a tight band which prevented reduction. The ulnar nerve was entrapped in the joint.

Two stage reconstruction for the Shepherd's crook deformity in a case of polyostotic fibrous dysplasia.

Abstract: Polyostotic fibrous dysplasia leads to progressive and disabling deformity involving the proximal femur Conventional methods of treatment have been ineffective in controlling this problem Two stage reconstruction was carried out in a case of polyostotic fibrous dysplasia with bilateral shepherd's crook deformity Bilateral subtrochanteric osteotomies with intramedullary fixation in the first stage and intertrochanteric osteotomies in the second stage with nail plate fixation was done to provide definitive control of the deformity Bone graft was not used

Seminal profiles of lysosomal enzymes in normal and infertile men.

Abstract: Human seminal plasma is known to possess considerable proteolytic activity, much of which is associated with lysosomes. The activities of lysosomal hydrolases like alkaline proteinase, cathepsin-D, aryl-sulfatase and N-acetyl-beta-D-glucosaminidase in seminal plasma from randomly chosen infertile and vasectomised men have been compared. These enzymes have been implicated in the coagulation and liquefaction processes. The role of fructose and proteins in these processes has also been studied. The results indicate that cathepsin-D and aryl-sulfatase activity in infertile men were significantly lower than normo-spermic subjects. N-acetyl-beta-D-glucosaminidase was lowest in azoospermia suggesting that it could be used as a biochemical marker for azoospermia. Conversely, alkaline proteinase showed increased levels in all the infertile cases.

Atlantoaxial dislocation associated with stenosis of canal at atlas.

Abstract: Three rare cases of stenosis of spinal canal at the level of atlas associated with atlantoaxial dislocation are presented. An atlantoaxial lateral mass fixation with plate and screws after posterior midline bony decompression was successfully performed in these cases.

Lipoprotein lipase deficiency.

Abstract: A rare case of a 3 month old child with lipoprotein lipase deficiency who presented with bronchopneumonia is reported. After noticing lipaemic serum and lipaemia retinalis, a diagnosis of hyperlipoproteinaemia was considered. Lipoprotein lipase deficiency was confirmed with post heparin lipoprotein lipase enzyme activity estimation.

Single unilateral ectopic bifid ureter with contralateral orthotopic quadrufid ureter--a rare combination.

Abstract: This is a report a case with a unilateral single ectopic ureter associated with ipsilateral incomplete duplication of upper third of the ureter, contralateral quadrufid ureter and L3 hemivertebra. These findings provide further evidence of a generalised mesenchymal or epithelial defect, which would explain a defective ureteral bud and metanephric development, besides associated anomalies.

Multiple dermoid cysts of omentum.

Abstract: Dermoid cyst of the omentum is an extremely rare condition. We report a case of multiple dermoid cysts of omentum in a 50 years old woman. The aetiopathogenesis, clinical presentation and relevant literature is briefly reviewed.

Persistent frontal fistula.

Abstract: The frontal sinus is prone to various complications--usually secondary to blockage of the fronto-nasal duct and stagnation of frontal sinus secretions. These pent-up secretions may result in pressure necrosis of the inferior or posterior sinus wall. Involvement of anterior wall is uncommon. We present a case of an anterior wall frontal sinus fistula and discuss its management.

Bone imaging in sports medicine.

Abstract: Increased participation in sports by the general public leads to increase in sports induced injuries including stress fractures, shin splints, arthritis and host of musculotendenous maladies. We have studied twenty patients referred from sports clinic for bone scanning to evaluate clinically difficult problems. It showed stress fracture in twelve patients, bilateral shin splint in five patients and normal bone scan in three patients. Present study highlights the utility of bone imaging for the diagnosis of various sports injuries in sports medicine.

Ebstein's anomaly--an autopsy study of 28 cases.

Abstract: Twenty eight autopsy specimens of Ebstein's anomaly were studied in order to evaluate the morphologic features of the abnormal tricuspid valve. All cases showed marked dilatation of the original tricuspid annulus, a normally positioned anterior leaflet and variable downward displacement of the posterior and septal leaflets. Sixteen cases showed a very large anterior leaflet. All three leaflets showed dysplastic features and a wide range of anatomic abnormalities in the valve and valve apparatus. A thin walled atrialised right ventricle was present in nine cases. Associated cardiac anomalies were seen in 21 cases, the commonest being an atrial septal defect (17 cases).

Tricortical cervical inter-body screw fixation.

Abstract: A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.

Effect of closed mitral valvotomy on spirometric pulmonary function tests in mitral stenosis.

Abstract: The effect of closed mitral valvotomy on the spirometric pulmonary functions was studied in 25 patients with mitral stenosis. The tests were performed before and after operation, the latter at varying intervals (4 to 6 weeks and 8 to 12 months). The preoperative values were considerably low. After 4 to 6 weeks following surgery, further significant reduction in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) was observed. This was ascribed to the residual healing process and thoracotomy pain. However, Forced expiratory flow rate during mid segment of FVC (FEF25-75%), which reflects obstruction in small airways, did not show any variation. There was improvement in all the above parameters, 8-12 months after surgery. This suggests definite reversibility in the pulmonary functions following valvotomy.

Sphenoid wing meningioma--an unusual cause of duro-optic calcification.

Abstract: Sphenoid ridge is the third commonest site of intracranial meningiomas. Although sphenoid ridge meningiomas often involve the optic canal, calcification along the optic nerve has not been reported with these tumors. We describe CT features of a calcified optic nerve in a patient with a calcified sphenoid ridge meningioma.

A giant vascular hamartoma of the breast in a child.

Abstract: Vascular tumors of the breast are uncommon. Perilobular hemangiomas, the commonest histologic subtype of breast hemangiomas, constitute majority of microscopic, vascular mammary tumors. Macroscopic hemangiomas and vascular hamartomas of the breast are distinctly rare. We describe a giant, vascular hamartoma of the right breast in a five year old girl and discuss pertinent literature.

Sacral chordoma--a case report.

Abstract: Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life.

Benign osteoblastoma mimicking malignancy of the spine.

Abstract: A case of osteoblastoma of the spine in a sixty year old female is presented. These lesions usually get misdiagnosed as tuberculosis or malignancy of the spine. Salient diagnostic features have been discussed.

Qualtum cosmics-and-chaotics--the ultimate tortoise in physics and modern medicine.

Abstract: Qualtum cosmics is the qualitative opposite of quantum mechanics. The flip-side of qualtum cosmics is qualtum chaotics, the two governing much of what is seen as inscrutable in medicine. The Ultimate (Last) Tortoise is close to Einsteinean idea of a Unified Theory, a single concept that can explain whatsoever there is in physics, (and in medicine, or what have you).

Nasolacrimal duct foreign body--endoscopic removal.

Abstract: Foreign body in the nasolacrimal duct is extremely rare. We present a case of foreign body of nasolacrimal duct responsible for recurrent dacryocystitis which was removed with the help of an endoscope.

Polygraphic recordings of respiration in neonates: a pointer to SIDS?

Abstract: Polygraphic respiratory recordings of 60 neonates were obtained from the infants in paediatric intensive care unit of a large public hospital. Thirty infants were pre-term and thirty infants were in the term (control) group. The recordings were analysed for periodic breathing and apnoeic episodes. Results were also determined for apnoeic density in pre-term and term Infants. Apnoeic episodes were found to be statistically significant in the pre-term infants over term Infants.