Lenthening of Tibia in CPT by Ilizarov’s Method.

A case of Congenital Pseudarthrosis of Tibia (CPT) with 24 centimetres shortening in a young boy of eighteen years treated by Ilizarov’s method is presented. No features of neurofibromatosis like café-aulait spots or skin nodules were seen. Excision of Pseudarthrosis site, deformity correction and the lengthening was done by Ilizarov’s apparatus, through upper tibial metaphysis. The follow up of two years showed sound union. It gives credence to Ilizarov’s as being one of the best methods for treatment of CPT and large shortening.

Sporotrichosis in Amritsar--a case report.

A case of cutaneous, lymphatic Sporotrichosis, in a farm labourer, is presented. The diagnosis was established by isolating fungus from the lesion. Dimorphic nature of the fungus was established in vitro by demonstrating the mycelial phase at 25-30 degrees C and yeast phase at 37 degrees C. The patient responded well to oral administration of Potassium iodide.

Usefulness of Ilizarov's Procedure in Infected Non-union of Tibia and Femur

A total of 46 patients with infected diaphyseal non-union of tibia (38) and femur (8) were subjected to Ilizarov's ring fixator. Thirty six cases were of infected nonunion with gap requiring bone transport (Group I) while 10 cases did not require bone tranasport (Group II). In majority of group I cases unifocal corticotomies were done through metaphyses of the bone. In two cases, where the gap was large, bifocal corticotomies were done in tibia to shorten the treatment time. Controlled distraction was begun after 7 day's time. Normotrophic regenerate was observed in all cases except one case of tibia and one femur. Both these cases required cancellous bone grafting. In group II, six cases of infected non-union of tibia and four of infected femur required only radical debridement and acute compression at the fracture site. Failure of union was seen only in two cases. Forty four patients showed union clinically and radiologically with a success rate of 95.4%.Equinus contracture (mild) and toe drop were seen in one case of group I. Average follow up is of 67 months. Average distraction at corticotomy site was 60 mm. Average time for fixator removal was 239 days.

Respiratory distress in newborn: treated with ventilation in a level II nursery.

Fifty consecutive neonates with respiratory distress persisting beyond 6 h of age were studied during a 18 month period (total deliveries 2000/y). Twenty two neonates were managed with oxygen hood with increasing oxygen concentration, 28 with continuous positive airway pressure (CPAP) ventilation using a nasal cannula. Of these babies on CPAP, 10 were shifted to intermittent positive pressure ventilation (IPPV) on a pressure limited, time cycled ventilator (Neovent, Vickers). Babies were monitored with continuous hemoglobin oxygen saturation (SaO2), hourly blood pressure and vital charting. Radial arterial blood gas analysis (ABG) was done when feasible and especially on clinical deterioration. Oxygen (FiO2 0.95) from an oxygen concentrator was used as a source of continuous supply of oxygen. Commonest cause of respiratory distress was hyaline membrane disease (18%), followed by wet lung syndromes (14%), meconium aspiration (12%), asphyxia (12%) and septicemia (8%). In 8 babies, a lung biopsy (postmortem) was done to confirm the diagnosis. Nineteen of the 50 babies with respiratory distress died, there was a survival of 50% on CPAP and 30% on IPPV. No case of oxygen toxicity or other major complications was encountered. Even with moderate resources, neonatal ventilation in a Level II nursery is a challenging task. Babies less than 1000g require aggressive measures which is not very economical in a special care baby unit (SCBU).

Multidrug resistant typhoid fever: study of an outbreak in Calcutta.

Of 103 cases of typhoid fever admitted to the Pediatric Wing of our hospital during the months of August 1989 to April 1990, 82.5% were resistant to chloramphenicol, ampicillin and co-trimoxozole. Nearly 87% children were in the age group of 3-10 years. Fever was present in all and splenomegaly in 90.2% cases. Urinary retention during the course of illness was present in 2 cases. The positivity rate of blood culture, bone marrow culture and Widal test was 83.7, 100 and 13.5%, respectively. Majority of the strains were of Phage 51-Type I. For the treatment of multidrug resistant cases gentamicin and furazolidine proved ineffective. Ciprofloxacin was tried in 85 cases and was found to be effective in all cases with no side effects.