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Introduction: Decision making regarding the surgicalapproach for ACOM artery is based on A1 dominancy,projection and how is the plane of the both A2 vessels. Thepresent study was conducted with the aim to analyze theprognosis of superiorly projecting anterior communicatingartery aneurysm with respect to position of A2 anteriorcerebral artery.Material and methods: The present retrospective analysisconsisted of 543 cases of all cerebral aneurysms operatedfrom Jan 2012 to December 2015 at Sree Chitra TirunalInstitute for Medical Sciences and Technology (SCTIMST),Trivandrum. The open A2 plane was defined as when the A2of the pterional approach side was present more posteriorlythan the contralateral A2. All patients were evaluated throughGlasgow outcome scale at the time of discharge. All the dataobtained was arranged in a tabulated form and analyzed usingSPSS software.Results: The mean age of the subjects was 54.2 years.There were 63 males and 32 females. Among 95 patients,A1dominant was present in 83 patients and co-dominance waspresent in 12 cases. Out of 54 superiorly projecting aneurysms.Intraoperative rupture was present in the 18 patients (33.3%),Gyrus rectus aspiration was done in the 35 patients (64.9%), 1patient had the perforator injury.Conclusion: Surgical approach from the A2 posteriordisplacement side (the open A2 plane) in patients with superiorprojecting aneurysms allows neurosurgeon to secure aneurysmnecks safely and prevent postoperative complications.
ABSTRACT
Backround: The patho-physiology of anal fissure is thought to be related to trauma to the anoderm from any cause. A tear in the anoderm causes acute pain, which results in spasm of the internal anal sphincter and decreased blood supply to the anoderm. Aim: To comparative evaluation of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in anal fissure and to evaluate the role of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in healing of anal fissure as compared to prevalent conservative treatment i.e. topical anaesthetics Material and methods: The study was conducted on the patients of anal fissure reported in outpatient department of General Surgery at Guru Gobind Singh Medical College and Hospital, Faridkot including 60 patients which randomized in 3 groups, group A, group B and group C. the data was statistically analyzed using the SPSS version 16. Results: Improvement in constipation after 8 weeks of treatment were 85%, 85% and 80% in Group A, B and C respectively and p value was non-significant (0.887). Improvement in bleeding after 8 weeks of treatment were 90%, 90% and 85% in Group A, B and C respectively and p value was non- significant (0.851). Healing was 78.57%, 92.31% and 46.15% in Group A, B and C respectively Conclusion: Topical 2% Diltiazem and 0.2% Glyceryl trinitrate ointment are equally effective in healing of chronic anal fissure. However, early pain improvement and fewer side effect profile of Topical 2% Diltiazem ointment; this study suggests it as first line treatment of chronic anal fissure.
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Background: Penetrating keratoplasty is the surgical removal of diseased cornea with replacement by full thickness corneal donor tissue. The aim of the study was to know the visual outcome in patients undergoing penetrating keratoplasty. Methods: Thirty patients were selected from department of ophthalmology, Guru Gobind Singh medical college & hospital, Faridkot for penetrating keratoplasty. Results: Visual acuity of 6/12 was seen in 1 case, 6/18 in 4 cases, 6/36 in 5 cases, 6/60 in 5 cases, 3/60 in 4 cases, hand movements in 4 cases, PL+PR+ in 2 cases and no perception of light in 2 cases. Final vision at 6 months of follow up was >6/60 in 10 cases (33.33%). 5 cases (16.67%) had vision between 6/60-4/60. 13 cases (43.33%) had vision of 3/60 or less. While in 2 cases (6.67%) there was no vision at the end of follow up. Conclusion: Penetrating keratoplasty helps patients in regaining vision which makes them able to move independently. Although in our study visual outcome of more than 3/60 was present in only 50% cases.
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The authors describe a 14-yr-old boy who presented with non-ketotic hyperglycemia, elevated serum creatinine levels and deranged liver function. There was no microalbuminuria or proteinuria. He also had mild mental retardation with learning difficulties. Ultrasonography of the abdomen revealed multiple renal cysts of varying sizes in both the kidneys. Dosage analysis of the hepatocyte nuclear factor (HNF)-1β gene by multiplex ligation-dependent probe amplification (MLPA) detected a heterozygous whole gene deletion (p.Met1_Trp557del). This finding is consistent with the diagnosis of renal cysts and diabetes (RCAD) syndrome. This is the first case of the RCAD syndrome reported in an Indian patient. Pediatricians need to be aware of this entity whenever renal disease is seen in a diabetic child in the absence of microalbuminuria or proteinuria.
ABSTRACT
Congenital self-healing Langerhans cell histiocytosis (CSHLCH) is a rare type of Langerhans Cell Histiocytosis, presenting at birth or during the neonatal period with eruption of multiple, discrete red-brown papules or nodules that undergo spontaneous regression. Systemic signs are generally absent. We describe a 4-month-old infant presenting with reddish brown nodular cutaneous lesions since birth with a past history suggestive of pulmonary involvement. Skin biopsy showed a dermal infiltrate of pleomorphic histiocytes; which were CD1a and S-100 positive, consistent with the diagnosis of CSHLCH. Both pulmonary and cutaneous lesions showed spontaneous resolution.