Association of Thrombophilic Factors in Pathogenesis of Osteonecrosis of Femoral Head in Indian Population.

PURPOSE: Role of heritable blood clotting disorders, both thrombophilias and hypofibrinolysis in causing avascular necrosis (AVN) of femoral head have been studied in regions like Europe and U.S.A. This study was done to investigate the role of heritable thrombophilias in ethnic Indian population. MATERIALS AND METHODS: A case control study of 150 patients (100 cases and 50 age and sex matched controls) of Indian Ethnicity with clinico-radiographically documented idiopathic AVN of femoral head was done after ethics committee approval. DNA was extracted from the blood and PCR analysis was used to study heritable thrombophilic gene mutation (G1691A Factor V Leiden). Enzyme-linked immunosorbent assay (ELISA)-based assays, were utilized to measure antigen levels of protein C, antithrombin III levels and protein S. RESULTS: Nine cases out of 100 showed deficiency of Protein C (9%) while no control showed deficiency of Protein C (p value: 0.028-significant, Odds ratio: 9.791) Ten cases showed deficiency of Protein S (10%) in study population as compared to one case (2%) in control population (p value: 0.038-significant, Odds ratio: 5.44). ATIII deficiency was more prevalent in control group i.e. 22% compared to 11% in study group. Factor V mutation was present in 3% cases as compared to one (2%) in control group. (p value is 0.393-not significant). CONCLUSION: Difference in thrombophilic mutations in various populations indicates possible effect of ethnicity on genetic profile in the development of AVN. This risk stratification will enable in near future early diagnosis and possible role of antithrombotics in disease prevention.

Caeco-colic intussusception in an adult: a rare case report.

Intussusception is common in children but rare in adults. Caeco-colic intussusception is an uncommon cause of intestinal obstruction in adults. Very limited information is available about the role of colonoscopy in diagnosis of intussusception in the literature. We present a case of caeco-colic intussusception in a 50-year-old male who presented with the complaints of pain in abdomen and a lump in the right hypochondrium. Colonoscopy and contrast studies revealed the diagnosis of intussusception. Abdominal computed tomography (CT scan) is considered as the most sensitive investigation to diagnose intussusception at present, whereas colonoscopy is sparingly used to diagnose intussusception. In this patient, colonoscopy not only established the diagnosis and malignant nature of the lead point, but also guided the definitive extent of surgical resection. CT scan offers a presumptive diagnosis as compared to the definitive diagnosis of intussusception by colonoscopy. In adult intussusception, colonoscopy can be considered as a complimentary investigation to other diagnostic modalities. Hence regular use of colonoscopy in adult intussusception should be encouraged where presentation is either subacute or chronic.

Surgical response to the 2008 Mumbai terror attack.

BACKGROUND: Mumbai, the financial capital of India, was attacked by terrorists at various famous, densely populated places on 26 November 2008. The attack lasted for 60 h, resulting in multiple civilian casualties from bullet and blast injuries. The aim was to review the disaster management plan and analyse the injury patterns and surgical response. METHODS: The disaster management plan was activated in the Sir Jamshetjee Jejeebhoy Group of Hospitals as soon as the earliest casualties were reported. The casualty receiving area was converted into a triage zone; patients were accordingly sent to different stations for further management. There was rotation of the duties of the medical personnel every 8 h for increased efficiency. RESULTS: A total of 271 casualties were encountered, of which 108 were dead at admission. Some 163 patients were triaged, 23 of whom received primary care as outpatients. The remaining 140 patients needed admission to hospital; 194 operations were performed in 127 patients. There were six postoperative deaths. CONCLUSION: This was a unique terrorist attack targeted on civilians and continuing for more than 2 days. The casualties consisted of military injuries due to combined firearm and blast trauma. Primary triage, or onsite triage once the site is safe, optimizes management.