Trend of human brucellosis over a decade at tertiary care centre in North Karnataka.

BACKGROUND: Brucellosis is an important zoonotic disease. India having a major agrarian population is expected to have a higher prevalence. However, due to lack of laboratory facility or awareness among clinicians, the disease is largely underreported. The aim of this study was to know the prevalence and trend of human brucellosis over a decade, in patients attending a teaching hospital in North Karnataka, and to understand their geographical distribution. MATERIALS AND METHODS: The study was conducted from January 2006 to December 2015 at a tertiary care teaching hospital in North Karnataka. A total of 3610 serum samples were evaluated from suspected cases of brucellosis. All serum samples were initially screened by Rose Bengal plate test, and positive samples were further analysed by Serum agglutination test (SAT) using standard Brucella abortus antigen from Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India. A titre above or equal to 1:80 IU/ml was considered as positive. Demographic data such as age, sex and native place of these patients were also analysed. RESULTS: We observed that human brucellosis is present in North Karnataka. The overall seropositivity of brucellosis in suspected cases was 5.1%. The positive titres ranged from 1:80 to 163,840 IU/ml. The majority of the patients were from Gadag, Koppal and Haveri districts of North Karnataka. CONCLUSION: Our study confirms the presence of human brucellosis in the northern part of Karnataka. Further studies to understand the prevalence of animal brucellosis in these areas will help in implementing prevention measures.

The role of computed tomography in determining delayed intervention for gunshot wounds through the liver.

INTRODUCTION: Gunshot wounds through the liver are highly lethal and are prone to delayed morbidity due to late complications. METHODS: A retrospective study was performed to determine the incidence, morbidity, and need for late interventions in patients shot through the liver, and the role of post-injury CT in making those determinations. RESULTS: 83 patients were shot through the liver. Injury grades were: Grade V-12 (14 %), Grade IV-41 (49 %), Grade III-12 (14 %), Grade II-8 (10 %), Grade I-1 (1 %), and nine were ungraded. Ten (12 %) died in the ED, three (4 %) died in the OR, and two (2 %) died postoperatively. Of the 68 survivors, 52 (76 %) had follow-up CT scans performed a median of 7 days (95 % CI 2-13 days) after injury. Seventeen (33 %) had 25 complications related to the bullet tract: 12 (48 %) abscesses, 6 (24 %) infected hematomas, 3 (12 %) bilomas, 3 (12 %) unclassified fluid collections, and 1 (4 %) hepatic necrosis. Treatment included CT-guided drainage in 15 (60 %), ultrasound-guided drainage in 3 (12 %), surgical drainage and debridement in 2 (8 %), and observation in 5 (20 %). Overall morbidity rate including hepatic and non-hepatic complications was 74 % (50/68). Patients having their CT scan-determined intervention (for all complications) within 7 days of injury (n = 24), compared to those having their CT scan-determined intervention on day 8 or later (n = 28), had a significantly decreased rate of overall complications and morbidity (p = 0.03). This difference was due to early detection and intervention for abscesses, anastomotic breakdown, and missed injuries. Those having a CT scan within 7 days of injury also had a significantly reduced length of stay compared to those scanned on day 8 or later (median 14 days, 95 % CI 4-24 days versus 18 days, 95 % CI 6-30 days, p = 0.05). CONCLUSIONS: Gunshot wounds to the liver have a high morbidity and mortality rate. Survivors should have a follow-up CT scan performed within 7 days to allow detection and intervention for complications, as this dramatically decreases the overall morbidity rate and length of stay.

Association of platelet count and serological markers of dengue infection- importance of NS1 antigen.

INTRODUCTION: Dengue is an acute viral infection with potential fatal complications. Specific antibody detection has been the mainstay of diagnosis which is prone for both false positive and false negative reactions. The newer parameter NS1 appears to be highly specific and reliable for diagnosis of dengue infection from the first day of fever. Platelet count is the only accessory test for diagnosis of dengue infection in the peripheral laboratories. Therefore, we tried to evaluate the association of platelet counts against NS1 and IgM/IgG in dengue infections. MATERIALS AND METHODS: Serum samples from clinically suspected dengue cases were tested for NS1, IgM and IgG by immunochromatography-based test. Platelet counts were obtained for all positive cases and 150 dengue seronegative cases of fever that served as controls. Test results of dengue-specific parameters were compared against platelet counts. The proportions obtained were compared by Standard error of the difference between the proportions (SEP test). RESULTS: Of 2104 samples tested, 320 were positive for one or more dengue parameters. Of the 320, 95 were positive for NS1 only, 161 showed IgM only while 9 showed IgG only. More than one marker was detected in the remaining 55 samples. Thrombocytopenia was more consistently associated whenever NS1 was detected compared to antibody detection (P value <0.001). CONCLUSIONS: Inclusion of NS1 in the diagnosis of dengue increases the detection rate significantly. In cases of fever, thrombocytopenia is more consistently found in dengue positive rather than dengue negative subjects. It correlates well when NS1 and IgM are detected simultaneously.

Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage.

PURPOSE: To evaluate the technical feasibility, efficacy of hemostasis, recurrent bleeding, and ischemia resulting from superselective embolization of acute lower gastrointestinal (GI) hemorrhage. MATERIALS AND METHODS: Fifty-two superselective mesenteric artery catheterization procedures were undertaken in 48 patients with angiographic evidence of lower GI bleeding. Embolization was performed only if the arterial recta leading to the bleed could be successfully catheterized (n = 39). The lesions treated were located in the colon (n = 33) and jejunum (n = 6). In 28 of 39 procedures, embolization was achieved by delivering polyvinyl alcohol (PVA) particles (150-500 microm) through a microcatheter. Microcoils were used as the sole embolic agent in four procedures and a combination of microcoils and PVA particles were used in another four. Gelfoam particles were used in three of our earliest procedures. Of the 35 patients who underwent embolization, 25 were evaluated for objective evidence of ischemia by endoscopy (n = 16) and/or histologic evaluation of the surgical specimen (n = 9); the remaining 10 patients were followed clinically. RESULTS: Embolization was successful in 39 procedures involving 35 patients. Immediate hemostasis was achieved after embolization in all but two patients. Recurrent bleeding occurred in 12 other patients, eight patients underwent surgery, three were managed medically, and one underwent successful repeat embolization. Of the 25 patients evaluated for ischemia, mucosal ischemia was demonstrated in six (24%), but they remained asymptomatic and developed no sequelae as a result of ischemic changes on long-term follow-up. There was no incidence of clinically significant intestinal ischemia. Embolization alone was the definitive treatment in 44% patients (21 of 48). Reasons for unsuccessful superselective catheterization (27%) were small vessel spasm, cessation of bleeding, and vessel tortuosity. CONCLUSION: Superselective embolization is a feasible, safe, and effective technique for treating acute lower GI hemorrhage.

Lung torsion: preoperative diagnosis with angiography and computed tomography.

In a patient with lung torsion, computed tomography demonstrated an occluded right upper lobe bronchus with opacified posterior lung. A pulmonary angiogram demonstrated the right upper lobe artery to be posteriorly and inferiorly displaced into the consolidated lung. In selected cases, computed tomography and angiography can help to confirm a torsed lung.

Outcome of 350 implanted chest ports placed by interventional radiologists.

PURPOSE: To determine the outcome of implanted chest ports placed by interventional radiologists. MATERIALS AND METHODS: Between June 1993 and July 1996, a single institution placed 350 implanted chest ports in 346 patients by means of the subclavian vein approach. The medical records of these patients were reviewed to determine the outcome of the ports. Ports were implanted for chemotherapy (n = 341), blood transfusion (n = 7), or antibiotics (n = 2). RESULTS: Immediate complications were seven (2%) pneumothoraces and one (0.3%) hematoma. Four (1.1%) of the pneumothoraces necessitated hospital admission and treatment with a chest tube. The remaining three were managed on an outpatient basis. One was successfully treated in the interventional suite by catheter suction. Two pneumothoraces were observed and resolved spontaneously. Mean time of patient follow-up was 260 days (range, 22-929 days). Total time of follow-up was 91,000 catheter days. Delayed complications were 10 cases of thrombosis (2.9% or 0.11 per 1,000 catheter days) of the subclavian vein, four infections (1.1% or 0.04 per 1,000 catheter days), four catheter coiling or tip malpositions (1.1% or 0.04 per 1,000 catheter days), three catheter occlusions (0.9% or 0.03 per 1,000 catheter days), and one catheter leak (0.3% or 0.01 per 1,000 catheter days). Six (1.7%) ports had to be removed as a result of a delayed complication. CONCLUSION: Chest port implantation by interventional radiologists within the radiology department is a successful and safe procedure with complication rates equivalent to, or lower than, those reported in surgical placement series.

Emergency department repair of hand lacerations using absorbable vicryl sutures.

The use of absorbable suture material has a number of potential advantages when compared to nonabsorbable suture. We conducted a 5-year retrospective study of 102 patients with hand lacerations and compared the quality of scar formation and healing in these patients. Those patients who did not have tendon, nerve, or bone injury were included in the study. Lacerations were repaired with either 5-0 Vicryl or nylon. There were no reported complications or infections in any study group patient. The quality of scar, when compared visually and by palpation, was the same at the end of 6 months. In addition, there was no difference in the incidence of scar retraction. We conclude that the use of absorbable suture material is an acceptable alternative in the repair of hand lacerations.

Transverse bayonet dislocation of the distal interphalangeal joint--a case report.

Transverse bayonet dislocation of an interphalangeal joint is an unstable injury caused by the disruption of both collateral ligaments. This injury pattern in proximal interphalangeal joint was first described by Patel et al. (Clin Orthop Rel Res. 1978;133:219), who coined the term "bayonet dislocation" to describe this particular type of injury. The case of a distal interphalangeal transverse dislocation is presented. This dislocation was successfully treated by closed reduction and immobilization with an aluminum splint and buddy taping to the adjacent finger.

Utilization pattern and efficacy of nonsurgical techniques to establish drainage for high biliary obstruction.

PURPOSE: To review the frequency and success of percutaneous and endoscopic techniques in the relief of high biliary obstruction. MATERIALS AND METHODS: A search of the radiologic achieves was performed identifying 70 patients with cholangiographic demonstration of high biliary obstruction defined as proximal to the distal third of the extrahepatic bile duct. Record review determined the frequency and success rates of percutaneous and endoscopic techniques in providing biliary decompression for obstructive jaundice. RESULTS: Endoscopic retrograde cholangiopancreatography was performed in 35 of 70 patients, providing initial endoscopic biliary decompression (EBD) in six patients (two subsequently required percutaneous intervention). Percutaneous biliary drainage (PBD) was attempted in 60 of 70 patients, providing initial decompression in 55 patients. PBD provided decompression after failed endoscopic biliary drainage in 18 of 26 patients. Endoscopic drainage was never attempted after failed percutaneous drainage. Overall EBD success was 23% and overall PBD success was 95%. The complication rate attributed to EBD was 26%; that attributed to PBD was 25%. For those patients who underwent attempts at both EBD and PBD, the complication rate was 16%. CONCLUSION: At an institution with well-developed gastrointestinal medical services and interventional radiologic services, PBD was more successful in providing initial biliary decompression than endoscopic techniques for high biliary obstruction.

Surgical complications of transaxillary arteriography: a case-control study.

PURPOSE: The purpose of this study was to review the complications of transaxillary arteriography (TRAX), determine clinical factors associated with their occurrence, and define optimal treatment methods. METHODS: A retrospective review of 842 consecutive TRAX studies performed in a large, urban, tertiary care, academic medical center was undertaken. Patients with complications were compared with a concurrent randomized control group without complications with the use of a multivariate analysis model. Results of operative therapy for nerve injury were compared with those of nonoperative therapy. RESULTS: Nineteen (2.3%) complications were identified including 14 nerve injuries, four expanding hematomas/pseudoaneurysms without neurologic deficit, and one puncture site thrombosis. Several statistically significant or suggestive findings associated with the occurrence of complications were identified: female sex (odds ratio [OR] = 4.7), systolic blood pressure > or = 150 mm Hg at the conclusion of TRAX (OR = 9.5), periprocedural systemic heparin anticoagulation (OR = 7.9), concomitant use of intraarterial thrombolysis or percutaneous angioplasty (OR = 12.0), and duration of procedure > or = 90 minutes (OR = 4.0). Patients who underwent prompt exploration (< or = 4 hours from symptom onset) for nerve injuries were more likely to have complete resolution of their neurologic deficits (five of six patients) than those who were observed or underwent delayed operation (three of eight patients) (OR = 8.3). CONCLUSIONS: Aggressive treatment of post-TRAX hypertension, limitation of TRAX duration, delay of postprocedure anticoagulation, and use of alternative sites for arterial puncture in female patients or patients undergoing catheter-based intervention may reduce the incidence of TRAX-related complications. In patients who have neurologic deficits prompt surgical exploration of the puncture site with decompression of the involved nerve(s) may reduce the incidence of prolonged deficits.

Combined transrectal sonographic and fluoroscopic guidance for deep pelvic abscess drainage.

We attempted to determine the feasibility, safety, and success of transrectal catheter drainage of deep pelvic abscesses using a combination of transrectal sonography and fluoroscopic guidance. In this retrospective review of five cases, transrectal catheters were placed within abscess cavities over a 20 month period. Clinical improvement was prompt, catheters were removed within 7 days, and no complications were detected. No patient required further intervention (follow-up 2 to 20 months). Transrectal sonographically guided catheter drainage proved to be safe and effective in our series. This method is a promising alternative to the posterior (sciatic notch) approach when the anterior transabdominal approach is contraindicated.

Acute lower gastrointestinal hemorrhage: treatment by superselective embolization with polyvinyl alcohol particles.

OBJECTIVE: The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract. SUBJECTS AND METHODS: All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100- to 590-microns polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 11 days) after embolization or by clinical evaluation (n = 1). RESULTS: The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. Two asymptomatic patients were found endoscopically to have small areas of ischemia involving only the mucosa. Only one patient was shown to have severe mucosal ischemia; this involved the colon in a distribution that suggested it was not caused by the embolization. CONCLUSION: Ten superselective embolization procedures that used polyvinyl alcohol particles successfully controlled hemorrhage in the lower gastrointestinal tract in nine patients. In no case was intestinal infarction induced by the procedure, and only two endoscopically proved cases of asymptomatic mucosal ischemia occurred.

Chronic renal failure secondary to post-hysterectomy vaginal prolapse.

The first case of posthysterectomy vaginal prolapse and associated chronic renal failure requiring hemodialysis is presented. A review of the literature on vaginal prolapse and the mechanism and physiology of chronic renal obstruction in this setting is reviewed.

Separation of a ruptured angioplasty balloon with successful percutaneous retrieval--a case report.

A case of ruptured angioplasty balloon with complete separation from the catheter is presented. Successful percutaneous retrieval of the balloon with endoscopic biopsy forceps was performed.

Isolated pulmonary artery stenosis: four-year follow-up: case report.

The authors present a four-year follow-up of a patient with a single isolated right main pulmonary artery stenosis without an associated cardiac anomaly. This is an extremely uncommon lesion thought to be congenital. This case illustrates the stability of isolated lesions of the pulmonary vasculature without associated cardiac defects.

Successful embolization of multiple AV foot lesions--a case history.

A 39-year-old white female with multiple arteriovenous malformations of the left foot had had surgical ligation on her left dorsalis pedis artery at age 12 with no clinical improvement. She was placed into a leotard at age 16 and was able to function but would tire very easily and her left foot was twice the size of her right one. In May 1988, she had four large feeder vessels off the posterior tibial artery and two off the anterior tibial artery embolized by use of 1,000 microns PVA particles, occlusive spring coils, and detachable balloons. Her foot shrunk and is now smaller than her normal right foot; she does not tire, and she now wears a knee length stocking to help prevent other channels from opening.