Evaluation of central neuropathy in type 2 diabetes mellitus: a case control study

Background: Diabetes mellitus (DM) is a global pandemic affecting almost every organ in the body. Peripheral nervous system involvement in diabetes is well known but there are not many studies on central nervous system involvement. Visual evoked potential (VEP) is a sensitive, non-invasive test to detect central demyelination of optic nerve. The objective was to compare the visual evoked potentials in type-2 DM patients with that of healthy controls and to find out if any correlation is there with the duration and glycaemic control of the disease and to compare incidence of peripheral and central neuropathy in DM patients.Methods: Author included 50 DM patients and 50 age and sex matched controls. Patients with previous stroke, demyelination, diabetic retinopathy and other ophthalmological disorders were excluded. VEP was recorded using pattern reversal stimulation with EMG RMS MARK II machine and p100 latency was measured.Results: P100 latencies (ms) was significantly prolonged in diabetics with mean±SD of (111.24±5.28 ms) as compared to controls (101.30±1.66 ms) with p value <0.003. Also, there was significant correlation between duration of DM and P100 latency prolongation, but no significant correlation was present when compared with glycaemic control.Conclusions: Central neuropathy is very common in DM. It is related to duration of DM and not HbA1c unlike PNP which is related to both. Central neuropathy occurs even prior to development of retinopathy or PNP. Hence, VEP is a non-invasive and sensitive screening tool for early neurological involvement in DM.

Leiomyoma of the nasal septum.

Leiomyoma of nasal cavity is an extremely rare and unusual benign mass that uncommonly arises from the nasal septum. These are vascular or nonvascular masses of myogenic origin. We present a rare case of leiomyoma arising from the nasal septum and discuss its management using KTP 532 laser.

Delirium in the elderly: a review

Delirium is a common disorder, often under diagnosed and mismanaged. It is becoming more prevalent, because of the ageing population. In this clinical review, we summarise the definition, diagnosis and management of delirium

Ectopic Thyroid Tissue With a Rare Vascular Variation / Tejido Tiroideo Ectópico con una Rara Variación Vascular

Awareness of the variations and anomalous existence of some structures serve as useful guide for both in studies of human anatomy and in clinical practice today. Identification of ectopic thyroid tissue and variations in origin, number and course of the branches of the superior thyroid artery are of significant practical importance for the general, vascular surgeons and radiologist. Angiographic images with such vascular patterns may lead to confusion in interpretation. The relations of these vessels with the other structures are important for accurate diagnostic and invasive techniques and to prevent further complications during surgical interventions. In our routine dissections with the purpose of preparation of the teaching and museum specimens, it was observed that in one of the elderly male cadaver showed median thyroid tissue at a site other than in its usual pretracheal region. It was situated in the median plane extending from the hyoid bone to the front of cricoid cartilage. Normal thyroid gland in the pretracheal region was absent. Added to this rare anomaly a vascular anomaly was found in the same ectopic thyroid tissue. Solely the superior thyroid arteries supplied this median thyroid tissue. The inferior thyroid arteries were found to be absent on both sides supplying this median thyroid tissue.

Conocer la existencia de variaciones y anomalías de algunas estructuras, sirve usualmente como guía para estudios de anatomía humana y práctica clínica. La identificación de tejido tiroideo ectópico y variaciones en origen, número y curso de ramas de la arteria tiroidea superior son, por lo general, de importancia práctica significativa para cirujanos vasculares y radiólogos. Imágenes angiográficas con tales patrones vasculares pueden llevar a confusión en su interpretación. La relación de estos vasos con otras estructuras son importantes en un diagnóstico acucioso, en técnicas invasivas y para prevenir complicaciones durante intervenciones quirúrgicas. En una disección de rutina, con el propósito de preparar piezas anatómicas de museo para la enseñanza, se observó en un cadáver de sexo masculino, tejido tiroideo mediano en un sitio diferente a la región pretraqueal. Estaba situado en el plano mediano extendiéndose desde el hueso hiodes a la parte anterior del cartflago cricoides. La glándula tiroides normal en la región pretraqueal estuvo ausente. Agregada a estainusual variación, una rara anomalía vascular fue encontrada en el mismo tejido tiroideo ectópico, sólo las arterias tiroideas superiores irrigaban este tejido tiroideo mediano. No se encontraron arterias tiroideas inferiores irrigando este tejido.

Hyperhomocysteinemia presenting as superior mesenteric artery thrombosis.

We report a 23-year-old man who presented with acute abdomen. At laparotomy, he was diagnosed to have superior mesenteric artery thrombosis, with consequent extensive intestinal gangrene extending from the proximal jejunum till the mid transverse colon. He subsequently developed dry gangrene of the digits. Further evaluation showed that he had marked hyperhomocysteinemia. The gangrenous bowel was resected, and the homocysteine level normalized with folic acid supplementation. He is well at 1-year follow up. His brother, who was asymptomatic, was also detected to have hyperhomocysteinemia, which responded to folic acid.

Upper gastro-intestinal tract foreign body (denture) retrieval by gastrotomy.

A case of foreign body (denture) in upper gastro-intestinal tract in an adult male is reported because of its uncommon occurrence, and failure to remove it by laryngoscopy or oesophagogastroscopy. The peculiar nature of the denture and the accessories necessitated laparotomy-gastrotomy.