ABSTRACT
A50-year-old known diabetic female presented to us with gradually progressive dyspnea and swelling over both lower limbs since 15 days. She was a known case of ischemic heart disease since 3 years on medical management. On examination she was afebrile, heart rate was 128 beats/min, BP-98/52mm of Hg, JVP was raised at 11 cm of water. The respiratory rate was 30/min. Oxygen saturation was 92% while breathing in ambient air. Air entry was decreased on right inter and infra scapular areas with bi basal late inspiratory crepitations.
ABSTRACT
Background: Displaced proximal humerus fractures generally result in long-term functional disability. Recently, the advances in treatment for proximal humerus fracture have involved minimally invasive plating which offer minimal soft tissue damage and rapid and improved healing of the fracture. In recent literature, there has been a shift towards the deltoid splitting approach for the fixation of proximal humeral fractures due to the increased visualization of the posterior fragments as well as the less amount of soft tissue stripping. We used the deltoid splitting approach to evaluate the feasibility and outcomes as regards to axillary nerve injury, complications and functional deficits. Methods: Out of a total of 35 patients included in this study, 28 were male and 7 were female; with a mean age of 44 (range26 - 62yrs.). Results: In patients, the fracture of the proximal humerus was classified as type III; while 30 % (n=6) had type II fracture, according to Neer’s classification. Depending upon the fracture anatomy and the need for exposure, the skin incision was a continuous long incision in 7cases, with complete exploration of axillary nerve in the substance of deltoid; while in 13 cases, fixation was done using two separate skin windows. The mean follow up period was 26weeks (range 18-32 weeks). The average time to radiological union was14 weeks (range12-2 0 weeks). At final follow up, there were no cases of nonunion. There were 2 cases (10%) with varus malunion of the head fragment, and 1 case (5%) of acromial impingement. Axillary nerve palsy or deltoid dysfunction was not seen in any of the patients. The mean Constant- Murley score of shoulder function, at final follow up, was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, by calculating the difference of score between the involved shoulder and the uninvolved shoulder, 60% patients(n=12) had excellent, 35% (n=7) had good and 5% (n=1) had fair functional results. Conclusion: Thus deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits.
ABSTRACT
Type II Diabetes Mellitus (DM) is a major risk factor for Coronary Artery Disease (CAD). Patients remain mostly asymptomatic and thus diagnosed at an advance stage of the disease. Our aim of study was to detect the CAD at an early stage in asymptomatic diabetic patients. Methods: 136 asymptomatic type II diabetes mellitus patients were enrolled prospectively for treadmill test (TMT) and subsequent coronary angiography (CAG) was performed on 96 (70.87%) TMT positive patients. Diabetic status, clinical parameters including risk factors, TMT and angiographic findings were analyzed. Results: The patients were divided into two groups, high rich group A (risk factor >2) and low risk group B (risk factor >1). 34 patients of group A (36.95%) were CAD positive out of 92 patients of high risk group and 4 patients group B (9.09%) out of 44 patients of low rich group. Duration of diabetes mellitus and multiple risk factors were correlated with coronary artery disease (CAD) as well as multiple coronary artery involvement. Conclusions: A routine TMT of all long standing asymptomatic type 2 diabetic patients (>10 years) with family history of CAD and subsequent CAG should be done on all TMT positive patients for early detection of CAD to take early appropriate revascularization measure.