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PURPOSE@#Intramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail.@*METHODS@#Of 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome, and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.@*RESULTS@#The mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 - 122), 144.8 ± 3.6 (range 116 - 208), and 56.6 (range 38 - 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.@*CONCLUSION@#Lateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.
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Humanos , Persona de Mediana Edad , Clavos Ortopédicos , Resultado del Tratamiento , Estudios Retrospectivos , Fracturas de Cadera/cirugía , Tornillos Óseos , Fijación Intramedular de Fracturas/métodosRESUMEN
Background: Thyroid disorders are common in India. Symptoms and signs of thyrotoxicosis are nonspecific. Graves disease is an autoimmune condition and is the most common cause of thyrotoxicosis. Cardiovascular system is frequently affected in thyroid disorders but there is not much data on prevalence of thyrotoxicosis and related cardiovascular morbidities in central India. Objectives of study the clinical profile of patients with thyrotoxicosis and outline the related cardiovascular manifestations in a tertiary care center. Design-over a period of nine months a descriptive cross sectional study was conducted in a tertiary health care center.Methods: A total of 150 patients with thyrotoxicosis were studied. Patients with known diagnosis of thyrotoxicosis and newly diagnosed cases were included. The participants were investigated for thyroid profile, Electrocardiogram, Complete blood count, serum electrolytes and kidney function test.Results: Out of 150 patients of thyrotoxicosis, 87 (58 %) were diagnosed with Graves’s disease. Hypertension was observed in 78 (52 %) of participants. Atrial fibrillation was found in 18 (12%) and sinus tachycardia in 53 (35.33 %) of the participants.Conclusion: Grave’s disease is the commonest cause of thyrotoxicosis. Hypertension, sinus tachycardia and Atrial Fibrillation are the common cardiovascular diseases observed to be associated with thyrotoxicosis.
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Background: Deep vein thrombosis is a disease of potentially serious consequences and is still often unsuspected. The present study was undertaken to look into etiological factors, management approaches and complications in patients presenting primarily with DVT at a tertiary care centre.Methods: This was a descriptive study profiling 75 confirmed DVT cases admitted at a tertiary care government hospital over two years. Detailed assessment included thorough clinical examination, duplex venous ultrasound and basic investigations, along with special investigations and CT angiography in selected few. Appropriate management was provided, and details recorded. Patients were followed up clinically and by ultrasound after 1 week, 2 weeks and 3 months. The complications, if any were also recorded.Results: The mean age of participants was 39.5±14.4 years, with 28% between 30-39 years. Majority (40%) did not have any obvious predisposing factor and most of them presented with pain and swelling. Most (52%) of the cases had involvement of both proximal and distal veins, 45.33% cases had involvement of only proximal veins whereas only 2.67% had restricted involvement of distal veins. Around 60% of cases have complete clinical resolution and approximately 50% cases have complete ultrasonographic resolution at the end of 3 months.Conclusions: Young adults without any obvious risk factors may develop and present with DVT and hence factors leading to thrombosis in them are recommended to be thoroughly evaluated. Duplex venous ultrasound is reliable non-invasive diagnostic modality and is recommended for diagnosis of DVT in clinically suspected cases.
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Introduction: With the increase in the life span of humanbeings and added to that the culture of processed food thereare increase in life style disorders in humans. The commonestorthopedic problem which we see due sedentary life style,lack of healthy wholesome diet are bone related disordersmainly osteoarthritis.Ropivacaine, an alternative to bupivacaine is structurallyclosely related to bupivacaine and supplied as the pureS-enantiomer. We therefore decided to compare the efficacy ofcontinuous infusion of levo bupivacaine against ropivacaine toidentify the differences or superiority of one drug over other.Material and methods: After obtaining the Ethics Committeeapproval, we recruited 110 patients undergoing Total KneeReplacement (TKR) surgery under Combined Spinal Epidural(CSE) Anaesthesia. Sample size of study which was calculatedas 110. All patients underwent a routine pre anaesthetic checkup including the spine examination. Pre-anaesthetic check- upwas done a day prior to surgery. All routine investigationswere advised. The details of our study were explained to thepatients, in the language understood by them. Consent wasobtained for post-operative use of Elastomeric infusion pump.They were explained about the use of VAS.Results: Both groups were comparable with respect todemographic profile. The patients in ropivacaine group showedsignificantly lower pulse rate as compared to levobupivacainegroup. Patients in ropivacaine group recorded significantlylower systolic blood pressure throughout the infusion periodas compared to those in the levobupivacaine group. Thedifference in diastolic blood pressure was not significant. Thetime taken for the sensory block to regress to L1 was longerin ropivacaine group as compared to levobupivacaine group.Conclusion: Patients in both the group had comparable VASpost operatively. Although Patients in the ropivacaine grouphad better VAS score as compared to levobupivacaine, thedifference was not statistically significant. There were noside effects like motor weakness, hypotension, bradycardia orPNOV in any group. Our present study thus concludes thatas far as analgesic properties are concerned Ropivacaine withits more suitable toxicity profile and less motor block is morefavourable for continuous infusion for patients undergoingTKR when used in equipotent doses.
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Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p<0.05). Of the total 22 (14.67%) deaths in the present study, 18 (12%) had associated RVMI and 4 (2.66%) isolated IWMI, the difference being statistically significant.Conclusions: Involvement of right ventricle increases rate of complications as well as the mortality rate in patients with inferior wall myocardial infarction.
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ABSTRACT The aim of this study was to optimize the encapsulation of lycopene using response surface methodology and to determine its stability. The lycopene was extracted from tomato processing industry waste. The extracted pigment was purified by crystallization method. The effect of different process parameters, viz, core to wall ratio, sucrose to gelatin and inlet temperature on encapsulation efficiency (EE) and encapsulation yield (EY) were studied. Structural study of encapsulated material was carried by using scanning electron microscope (SEM). The samples with and without encapsulation were stored under different conditions such as the presence and absence of air, sunlight, at room temperature and under refrigeration. Highest EE (92.6 ± 0.86) and EY (82.2 ± 0.95) were observed when the core to wall ratio was 1:4, sucrose to gelatin ratio was 7:3 and inlet temperature was 1800C. The SEM analysis showed the encapsulated lycopene was of "bee-net" shaped, whereas lycopene without encapsulation was like "saw dust". More than 90% retention was recorded in microencapsulated sample stored in all storage conditions, whereas sample without encapsulation showed less than 5% retention with sample storage conditions after 42 days of storage. The optimization and storage study would be helpful to the lycopene producer to improve storage stability.
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Introduction: Data on the efficacy of hydroxyurea (HU) in Indian children with sickle cell anaemia (SCA) is limited. Hence, we have evaluated the efficacy of fixed low dose HU in Indian children. Methods: The study cohort consisted of 144 children (<18 years of age) with SCA having severe manifestations (≥3 episodes of vasocclusive crisis or blood transfusions, or having ≥1 episode of acute chest syndrome or cerebrovascular stroke or sequestration crisis) who were started on fixed low dose HU (10 mg/kg/day). They were followed up for two years and monitored for the hematological and clinical efficacy and safety. Results: There was significant increase in the fetal hemoglobin level (HbF%), total hemoglobin and mean corpuscular volume. Vasoocclusive crises, blood transfusions, acute chest syndrome, sequestration crises and hospitalizations decreased significantly. Baseline HbF% had significant positive correlation with HbF% at 24 months. There was significant negative correlation between baseline HbF% and change in HbF% from baseline to 24 months. No significant correlation was found between HbF% at baseline and clinical event rates per year after HU. No major adverse events occurred during the study period. Conclusion: Fixed low dose HU is effective and safe in Indian children with SCA.
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Localized growths are commonly seen on the gingiva. Many of these enlargements are considered to be reactive rather than neoplastic in nature. Clinically differentiating one from the other as a specific entity is often not possible. Histopathologic examination is needed in order to positively identify the lesion. The peripheral ossifying fibroma is one such lesion. We report in this study, the clinical report of a 20-yr-old male patient with a peripheral ossifying fibroma in the maxilla exhibiting significant size with the disease duration of 1 year. The signs of recurrence in spite of thorough excision and debridement exposed the need for further study of the causes of recurrence and possible modes to avoid the situation. Clinical, radiographical and histological characteristics are discussed and recommendations regarding treatment and follow-up are provided.
Aumentos de volumen localizados se observan con frecuencia en la encía. Muchos de estos crecimientos se consideran de tipo reaccional más que de naturaleza neoplásica. Clínicamente diferenciar uno del otro como una entidad específica no siempre es posible. El examen histopatológico es necesario con el fin de identificar positivamente a la lesión. El fibroma osificante periférico es una de estas lesiones. Se presenta en este estudio, el informe clínico de un paciente de sexo masculino de 20 años de edad con un fibroma osificante periférico en el maxilar de un tamaño significativo con 1 año de duración de la lesión. Los signos de recurrencia a pesar de la escisión completa y desbridamiento expusieron la necesidad de estudiar más a fondo las causas de la recurrencia y los posibles modos de evitar la situación. Las características clínicas, radiográficas e histológicas son discutidas junto a recomendaciones sobre el tratamiento y seguimiento.
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Humanos , Masculino , Adulto , Fibroma Osificante/patología , Fibroma Osificante , Neoplasias Gingivales/patología , Neoplasias Gingivales , Fibroma Osificante/cirugía , Maxilar , Recurrencia Local de Neoplasia , Neoplasias Gingivales/cirugíaRESUMEN
The study was carried out to compare the postoperative morbidity among patients of conventional and endoscopic septoplasty and to assess the efficacy and use of endoscopic septoplasty with other endoscopic surgeries. The present prospective study was conducted among 100 patients of deviated nasal septum, admitted in the department of Otorhinolaryngology, of Sawai Man Singh Medical College and hospital, Jaipur, Rajasthan. Patients were selected by simple random sampling procedure and were divided into group A and B, with 50 cases in each group. Group A underwent conventional septoplasty and group B underwent endoscopic septoplasty. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (75%) and concha bullosa (26%). Postoperatively, a significant relief from the symptoms of nasal obstruction (96%), nasal discharge (88%), headache (100%) and post nasal drip (67%) was observed in endoscopic septoplasty. Posterior deviations were best corrected by endoscopic septoplasty. Complication rate was higher in conventional septoplasty. The endoscopic approach to septoplasty facilitates accurate identification of the pathology. It facilitates realignment by limited and precise resection of the pathological areas.
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Fifty consecutive patients of cerebral infarction underwent a detailed evaluation for the presence of cardiac disease, by means of a standard questionnaire, clinical examination, a 12 lead electrocardiogram, and a 2-D echo and colour Doppler examination. Only 9 patients had a normal echocardiogram, while as many as 27 (54%) demonstrated potential cardio-embolic abnormalities. Clinical and ECG evidence of pre-existent cardiac disease had been demonstrable in only 13 (26%) patients.