ABSTRACT
BACKGROUND: Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit. MATERIALS AND METHODS: A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof. RESULTS: Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy. CONCLUSION: One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.
ABSTRACT
OBJECTIVES: To study the epidemiological factors in children with syndromic hearing loss. STUDY DESIGN: Interview based prospective study. SETTINGS: Govt. ENT Hospital, AYJNIHH, NIMH-SEC, and Schools for the Deaf-in Hyderabad and SecunderabadPatients: Children aged below 14 years, with hearing loss, their parents/guardians. INTERVENTION(S): The study revealed type and degree of hearing impairment. In high risk groups genetic counseling was offered. RESULTS: Epidemiological studies were carried out in 743 children below 14 years with hearing impairment and 138 (18.57%) were found to have syndromic deafness. Majority of the children with hearing loss have an association of ocular abnormality (22.46%, n=31) followed by skeletal anomalies 14.49% (n=20) and dental anomalies (10.86%). We observed 24 cases (3.21%) with genetically well recognized syndromes. CONCLUSION: Data is generated on epidemiological and etiology of Hearing Impairment. Hearing Impairment is due to both environmental and genetic causes. Environmental factors in 17 (13.77%), genetically inherited 21 cases (15.22%) and the cause is not known in the remaining cases. Such a data is required in order to offer genetic counseling to reduce the genetic burden.
ABSTRACT
A case of Obsessive Compulsive Disorder with no contributory or past history who developed delusional mania while on clomipramine is presented. The manic symptoms resolved after discontinuation of drug. The link between serotonin and mania is speculated upon. The need to look for manic symptoms in patients on clomipramine is stressed.
