Intracranial Magnetic Resonance Venography of Superior Sagittal Sinus, Straight Sinus and Cerebral Venous Channels: Normal Anatomy and Variations in North Indian Population

The intracranial dural venous sinuses can be injured leading to thrombosis with in the dural sinuses causing headache, abnormal vision, weakness of the face and limbs on one side of the body, and seizures.Magne?c Resonance Venography (MRV) is one of the preferred methods of evalua?on of the cerebral venous sinus anatomy, varia?ons and pathology, par?cularly in the diagnosisof venous sinus thrombosis. The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Aim:The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on, which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Materials:The present study was undertaken in the Departments of Anatomy and Radiodiagnosis at a North Indian ter?ary care teaching hospital over a period of two years. Magne?c Resonance Venograms (MRV) of pa?ents a?ending the radiology department were used to study the normal anatomy and varia?ons in the dural venous sinuses. 50 MRV scans of which 26 were of females and 24 of male, were included in the study. Anatomical varia?ons and varia?ons in drainage of the dural venous sinuses were assessed and sta?s?cal analysis was done. Results:For both superior sagi?al sinus drainage and straight sinus drainage, the propor?on of veins draining in right and le? transverse sinuses and confluence of sinuses was significantly different in the two age groups (p<0.001) in both males and females. Par?al spli?ng of superior sagi?al sinus in anterior one third or posterior one third was also seen. Sta?s?cally significant findings were observed regarding the laterality for vein of Labbe & vein of Trolard. Conclusion:MR venography is an excellent diagnos?c technique to visualise anatomy and anatomic varia?ons of venous sinuses as observed in our study. The par?al spli?ng of superior sagi?al sinus in either anterior one third or posterior one third as seen in our study, can cause misdiagnosis of thrombosis. Hence, knowledge of normal anatomy and anatomic varia?ons in the intracranial venous sinuses is very important to diagnose cerebral venous sinus thrombosis accurately.

A Prospective Study to Improve the Yield of Esophagogastroduodenoscopy at a Tertiary Hospital in India

Background: Esophagogastroduodenoscopy (EGD)is an efficient tool for diagnosis, screening and therapy. However, it must be used efficiently, to maximize value for costs and reduce complications. Many centers have adopted an open-access referral policy, resulting in increased costs, waiting times and clinical workload. When EGD is used for screening of common symptoms like dyspepsia by medical and paramedical personnel, the yield is less than 50%.We planned a study to differentiate disease from non-diseased findings and improve the diagnostic yield of EGD. Methods: The clinical history and examination of 150 patients of a tertiary care hospital in north India over 2 years wasrecorded. EGD when indicated by any clinician or desired by a patient was performed by a consultant, using topical anaesthesia.The outcome of the endoscopy was categorized as positive, if there was significant finding. Less severe and equivocal findings such as gastritis, duodenitis were not considered positive for the purpose of this study. Logistic regression (forward LR score) was used; the coefficient of regressionwas used to assign a score for each symptom. Results: Pain was the most common symptom; in 110 patients (77.3%) the endoscopy showed no significant findings. Significant findings were seen in 34 patients giving a diagnostic yield of 22.7%. Clinical features like weight loss, hematemesis, melena, dysphagia, anemia, abdominal distention, ascites, and abdominal lump significantly discriminated and pointed towards a positive endoscopic finding. Pain was not a good discriminating factor; dysphagia, presence of ascites and the presence of abdominal lump independently predict significant endoscopic findings. At a total score of 4 or less endoscopy could be avoided in 75 (50%) of the patients. A score of 5 yielded a sensitivity of 82% and specificity of 71%. For picking up a positive finding. All 11 patients with malignancy had a score >5. Conclusions: Our findings suggest selection of patients for EGD can be improved based on a scoring system. It also provides a basis for prospective studies which can lead to better use of resources in future.

Efficacy and safety of tadalafil in ureteric stent related symptoms: a double blind, prospective, randomised study

Background: Is tadalafil effective and safe in ureteric stent related symptoms? The objective of this trial is to study the efficacy and safety of tadalafil and compare it with tamsulosin in relieving ureteric stent related symptoms by using ureteral stent symptom questionnaire.Methods: Total 144 patients with dj stent symptoms were randomized into two groups with 72 patients in each. Group A patients were given tadalafil 5mg and Group B, tamsulosin 0.4mg for 2 weeks. Ureteral stent symptom questionnaire was filled on 7th day and on 21st day after stent insertion. Statistically significant difference between groups was determined by the t-test, Mann-Whitney U-test, Pearson Chi-square test or Fisher's exact test. Comparison between quantitative time related variables was done by Wilcoxon Signed Rank test. All the statistical tests were two-sided and were performed at a significance level of α=.05.Results: Tamsulosin was found more effective then tadalafil in decreasing mean urinary index (p=0.004). Tadalafil caused significant decrease in body pain (p=0.006) and improvement in general health index score, work performance and sex score (P value= 0.041, <0.001 and <0.015 respectively) as compared to tamsulosin. Additional problems score improvement and analgesic use were found comparable in 2 groups (p value =0.193, 0.070 respectively). Adverse effect with both the drugs were minimal, mild to moderate and self-limiting.Conclusions: Tadalafil found more effective then Tamsulosin in relieving body pain, sexual symptoms and improving general health and work performance but less effective in improvement of urinary symptoms.

Tuberculous dactylitis: A case report.

Tuberculous dactylitis (TD) is an uncommon presentation. It is also known as spina ventosa. Mycobacterium tuberculosis is the causative agent responsible for Tuberculosis. We here present a case of a young adolescent female presenting with complaints of pain and swelling in middle finger region for the last seven month. She was diagnosed as case of tubercular dactylitis and was managed surgically along with anti-tubercular chemotherapy.

Two Staged Surgery for Gap Non-Union of Patella Fracture: A Good Alternative.

Gap Nonunion of patella fractures are rare conditions whose treatment is challenging for surgeons. Strict protocol for such fracture gap nonunion of patella is not well documented in the literature. The decision in treatment of these conditions is based on many factors such as functional demands of the patient, factors leading to nonunion, and presence of an intact extensor mechanism of the knee. We present a case of neglected gap nonunion of a transverse fracture of patella treated at 5 months after injury with a two stage reconstruction procedure.

Post Partum Pubic Diastasis: A Case Report.

Post-partum pubic symphysis diastasis is termed as abnormally wide gap between the two pubic bones following vaginal delivery. It is a rare and under diagnosed condition following acute pelvic pain. We are presenting a case of post partum pubic diastasis, in a 31 year old female with complain of pain, tenderness over pubic area and unable to walk. Patient was diagnosed with x-ray and MRI and treated surgically.

Tuberculosis of Medial Cuneiform: A Case Report.

Isolated tuberculosis of cuneiform is rare in literature. Diagnosis of tuberculosis of cuneiform remains a dilemma because of its rarity in the lower limb. Chance of misdiagnosis and delay in diagnosis may add to morbidity. Presumptive diagnosis can be made on the basis of X-ray, MRI, histopathology of the pathological tissue, which reveals granulomatous inflammation with or without caseation. Here we are reporting a case of 15 year old girl with swelling and pain over a mid foot diagnosed as tuberculosis of cuneiform on subsequent X-ray, MRI and biopsy.

Polycystic ovarian syndrome and insulin resistance: a North Indian study.

Background: Polycystic ovarian syndrome (PCOS) is most common form of chronic anovulation associated with androgen excess. Insulin resistance (IR) is characterized by impaired glucose response to specific amount of insulin. The objective of the study was to find an association between PCOS and IR in North Indian patients. Methods: A total of 50 PCOS cases diagnosed according to Rotterdam criteria, 2003, i.e. at least two of the following three features: oligomenorrhea or amenorrhea, clinical or biochemical hyperandrogenism and polycystic ovaries on ultrasound. Serum glucose levels were measured spectrophotometrically by glucose oxidase-peroxidase method. Insulin levels in serum were estimated by using ELISA based kit procured form Diasorin Ltd, Germany. Homeostatic Model Assessment- Insulin Resistance (HOMA-IR) and Body Mass Index (BMI) were calculated by their formulas. Results: PCOS patients had significantly higher values of BMI, fasting serum glucose, fasting serum insulin and HOMA-IR. Fasting serum glucose was however in the normal range in both cases and control. Conclusion: Our study suggested a strong association of PCOS with insulin resistance in this part of the country.

Cytotherapy for Osteonecrosis of Hip.

Osteonecrosis of hip is a pathological condition that leads to collapse of the femoral head, & the need for total hip replacement (THR). Research has shown that at the cellular level there is decrease in osteoblastic activity & the local mesenchymal stem cells (MSC) population that leads to osteonecrosis of femoral head (ONFH). Cellular therapy could thus be used to improve the local cellular environment. Th is can be achieved by implanting bone marrow, containing osteogenic precursors into the necrotic lesion of the femoral head.

Peritonitis: 10 years' experience in a single surgical unit.

BACKGROUND: Peritonitis secondary to gut perforation is still one of the commonest surgical emergencies in India and is associated with high morbidity and mortality. The present study examines the aetiology and outcome of peritonitis cases operated on in our surgical unit, and compares our findings with those of previous studies performed between 1981 and 1991. METHOD: A retrospective study of 260 peritonitis patients operated on in a single surgical unit from 1995 to 2006 was done and data involving clinical presentation, operative findings and post-operative course were studied and analysed. RESULTS: Causes of peritonitis were small bowel perforation (96 ileal, 17 jejunal), peptic perforation (45 duodenal, 16 gastric), appendicular perforation (36), primary peritonitis (8), and others (42). The incidence of major complications was 25% (burst-11%, leak-5%, intraabdominal abscess-5%, multi-organ failure-6.5%). The overall mortality was 10%. High mortality was observed in jejunal, gall bladder and liver abscess perforation cases (> 20%). Histopathological evaluation (143 specimens) revealed tuberculosis in 42 (mostly small bowel), malignancy in 8, and inflammation in the rest. Comparisons with a similar study carried out in the same unit and published in 1995 revealed similar demographic features and mortality, but a change in the most common cause (peptic ulcer perforation to small bowel perforation), and an increased performance of enterostomy compared with primary repair in small bowel perforation and a decrease in the leak rate (13% to 4%). CONCLUSION: Small bowel perforation is the commonest form of perforation and the mortality rate associated with peritonitis remains unchanged.

Colonic actinomycosis masquerading as perforated colonic carcinoma.

A case of Actinomycosis affecting the transverse colon masquerading as an abdominal neoplasm with perforation to abdominal parietal wall is presented. Abdominal actinomycosis lesions may present as a perforated abdominal neoplasm requiring emergency laparotomy. This case report highlights the diagnostic dilemma and the management algorithm for such infections.

Isolated tubercular splenic abscess in an immunocompetent child.

Splenic abscess is an uncommon entity in children, more so of tubercular etiology in immunocompetent patients. The few cases reported have usually revealed solitary abscesses in the spleen. We present a case of a 12 year-old immunocompetent girl who presented with fever and pain abdomen and was detected to have multiple tubercular abscesses in the spleen in the absence of any other focus of tuberculosis.