International Journal of Medical Research & Review (IJMRR)
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Endoscopic exploratory tympanotomy findings in conductive hearing loss: a surgical review
Get PDFBackground: Conductive hearing loss continue to remain undiagnosed in a large number of patients with intact membrane. Endoscope assisted tympanotomy provides an alternative technique for diagnosis and also facilitates treatment.
Methods: A prospective analysis over a 5 year period of 72 exploratory tympanotomies for conductive hearing loss was performed in patients with intact tympanic membrane. Per operative findings were treated in the same sitting. Post-operative follow up of the patient was done up to 6 months.
Results: The most common operative diagnosis was found to be otosclerosis (66%), followed by traumatic ossicular dislocation, tympanosclerotic patch, middle ear adhesions, foreign bodies etc. Small fenestra Stapedotomy with prosthesis insertion was the preferred surgical procedure performed in this study, resulting in perceptible hearing improvement post operatively.
Conclusion: Endoscope assisted tympanotomy and associated middle ear surgeries serves as an effective diagnostic and therapeutic option. This study is of value in assessing the surgical challenges in diagnosis and definitive treatment for conductive hearing loss with an intact tympanic membrane
Delayed anaphylaxis following propofol infusion in unknown egg allergic patient
Get PDFWe report a case of anaphylaxis that occurs more than one hour after propofol administration for colonoscopy. The patient did not reveal his allergy to egg in the preoperative evaluation. Administration of propofol to patient with egg allergy should be avoided
Medial Patellofemoral Ligament Reconstruction
Get PDFRecurrent patellofemoral instability is a common disabling condition especially in young individuals. MPFL is the main stabilizer to lateral patellar displacement and its reconstruction will restore patellofemoral stability. Many techniques had been described to reconstruct MPFL with good results and few complications taking in consideration meticulous surgical technique and careful patient selection. We used hamstring autograft in a double bundle anatomic MPFL reconstruction technique with both ends of the graft fixed to patella through two blind tunnels by anchor and bioabsorbable interference screw fixing the graft through a blind tunnel in the femur at 30 degree flexion
Role of ca 19-9 as a tumor marker in diagnosis and prognosis of pancreatic carcinoma and cholangiocarcinoma (A study of 46 cases)
Get PDFIntroduction: Ca19-9 is currently the single most useful tumor marker for diagnosis and prognosis of pancreatic cancer and cholangiocarcinoma.
Aim: The aim is to elucidate the importance of tumor marker ca 19-9 as a diagnostic and prognostic tool in pancreatic carcinoma and cholangio-carcinoma.
Material and Methods: The time period of the study was from september-2012 to september- 2014. The patients were investigated pre-operatively and post operatively for ca 19-9 levels in their serum with the use of ELISA (enzyme linked immunosorbant assay) test.
Results: Total 28 cases of pancreatic lesions were considered which included 24 cases of pancreatic ductal adenocarcinoma, It was observed that when preoperative serum CA 19-9 level was less than 37 u/ml median survival was 28 months. However when CA 19-9 level was more than 200 u/ml, median survival was 6 months. Out of 18 cases studied in gallbladder tumors, 15 cases were of cholangiocarcinoma. Patients with pre-therapy serum CA 19-9 level was between 37 -200 u/ml median survival was 23.25 months. When CA 19-9 level was more than 200 u/ml, median survival was 10.25 months.
Conclusion: Elevated level of ca 19-9 in pancreatic carcinoma and cholangiocarcinoma are associated with higher age group, male sex, higher histological grade, higher TNM staging and metastasis. Post operative ca 19-9 value has definitive prognostic value to detect any metastasis or recurrence in pancreatic carcinoma and cholangio- carcinoma. Therefore it can be concluded that ca 19-9 is an important tumor marker for pancreatic carcninoma and cholangio-carcinoma
Acute Pancreatitis-A Prospective study of Estimation of Prognosis with MCTSI versus CTSI
Get PDFIntroduction: CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. This study was conducted to assess the correlation of modified CT Severity Index (MCTSI) with patient outcome in cases of acute pancreatitis (AP) and to compare it with the CT Severity Index (CTSI).
Material and methods: A prospective study of 62 cases was carried out in the Department of Radio Diagnosis, with complaint suggestive of acute pancreatitis on the basis of clinical/laboratory/ultrasonography findings/who were referred for a CECT evaluation of the abdomen and pelvis. The severity of the attack was evaluated using both the indices CT and MCTSI. Correlation between the severity of pancreatitis and the outcome parameters was calculated using the chi square test.
Results: When using MCTSI, there was significant correlation between the severity of AP and the outcome parameters such as length of hospital stay (p<0.001), occurrence of infection (p<0.001) and organ failure (p<0.001). CTSI correlated significantly with the occurrence of end organ failure (p = 0.009) and infection (p=0.042) but less so than MCTSI. In case of intervention, the CTSI (p<0.001) fared slightly better than MCTSI (p=0.001). There was no significant correlation between the severity of Acute Pancreatitis as assessed by the CTSI and the duration of hospitalization (p=0. 160).
Conclusion: The MCTSI correlates significantly with the patient outcome parameters than the CTSI and thus can be useful in predicting the prognosis in patients with acute pancreatitis at an early stage
Prognostic value of P53 nuclear overexpression in bladder cancer
Get PDFIntroduction: Urinary bladder cancer is one of the common genitourinary malignancy presenting to the urology department. Prognosis of these patients will depend upon the number of clinicopathological factors. Overexpression of p53 is associated with aggressive behaviour of bladder cancer. The purpose of the present study is to assess the role of p53 tumour suppressor gene as an independent prognostic marker.
Materials & Methods: Thirty-three (33) consecutive cases of urinary bladder cancer attending Department of Urology between August 2006 to December 2008 were studied. In this study P53 protein, nuclear over expression was assessed in Formalin-fixed, paraffin-embedded tissue sections by the immunohistochemical method using monoclonal antibody. This p53 nuclear over expression was correlated with tumour grade and stage. Over all survival rate was assessed in p53 positive and negative patients.
Results: Two patients with T1G1 tumours developed recurrence with initial TURBT and intravesical BCG instillation after 6 months and responded to Re TURBT and intravesical BCG instillation therapy. One patient of T1G3 developed recurrence after 1 year with initial TURBT and intravesical BCG instillation and responded to Re TURBT and intravesical BCG instillation therapy. One patient of T1G3 progressed to muscle invasive disease after 1 year and underwent Radical cystoprostatectomy with ileal conduit received adjuvant chemotherapy and radiotherapy. Two patients developed post-operative urinary leak and underwent bilateral cutaneous ureterostomy. Nine patients died in followup period.
Conclusion: There was a strong positive correlation between the expression of mutant p53 and tumour grade, with none of the low-grade tumours were positive for mutant p53, in contrast to 60% of high-grade tumours. In this study, there was no significant difference in the mortality between p53 positive and negative patients
Interstitial lung diseases - a tertiary care center experience
Get PDFIntroduction: Interstitial lung diseases are a group of diffuse parenchymal lung disorders associated with substantial morbidity and mortality and pose diagnostic and therapeutic challenges to the clinician. Diagnosis of ILD is by multidisciplinary discussion (MDD) between clinician, radiologist and pathologist. The incidence and prevalence of ILDs in India are unknown. Prospective disease registries can provide better estimates of incidence and prevalence as well as insights to etiology, associated risks, natural history, and outcomes of a disease. This was a prospective study undertaken to analyse the spectrum of ILD encountered, demographic profile, clinical and radiological characteristics of the patients with interstitial lung disease in a tertiary care setting.
Materials and Methods: A prospective study over a period of two years conducted at Medical College,Thiruvananthapuram. 164 consecutive patients with multidisciplinary diagnosis of interstitial lung disease were included in the study. Detailed history, spirometry, SPO2, DLCO, HRCT, 6 minute walk test,ECG,2D ECHO were done and recorded in duly filled proforma. ANA profile, serum angiotensin converting enzyme,serum calcium, 24 hour urinary calcium were estimated wherever it was indicated. Diagnosis of IPF was done after excluding the known causes and the HRCT findings suggestive of UIP pattern based on the current guidelines of the American Thoracic Society/European Respiratory Society 2013.
Statitical Analysis: Data were entered in Microsoft Excel and analyzed using Epi Info version 7. For descriptive statistics, quantitative variables were described by mean and standard deviation. Qualitative variables were described by percentage distribution. For inferential statistics between groups, comparison of qualitative variables were analysed by chi-square test and quantitative variables were compared by student t test. P value of less than 0.05 was considered as level of significance.
Result: 164 consecutive ILD patients were included in the study.Of this 26.26% patients were IPF and 73.74% were non-IPF. CTD-ILD was the most common (64%). Mean age of the study population was 54.03 ± 11.08 years. The mean age was higher among IPF patients (61.41±7.7) compared to non-IPF ILD patients (51.4±10.9). 65.8% of study populations were were females. Among IPF patients, 65.1% were males (95%CI: 49.07%, 78.99%) compared to 23.2% (95% CI: 15.96%, 31.68%) males in non- IPF group (p< .001). The proportion of ever smokers was higher among IPF patients (62.7%), 95% CI: 46.7%, 77.02%) compared to non IPF group (15.7%), 95% CI: 9.7%, 23.43%) (p <.001) . IPF patients had lower mean FVC % compared to non- IPF ILDs.(48.1±16.2 vs 51.2±23.8)(p<.001). The mean DLCO was lower among IPF patients (42.6±9.92 vs 53.9±15.22) compared to non-IPF group at presentation (p<.002). The mean 6MWD was lower among IPF patients (209.6±96.30 meters compared to non-IPF (288.6±101.2) meters (P<.001). IPF patients had lower mean SpO2 (90.13±3.5) compared to non-IPF group (93.82±2.86). 100% of IPF patients had UIP pattern in HRCT where as, 9.92%, of patients (95% CI: 5.2%, 16.6%) among non-IPF group had UIP pattern in HRCT (p<.001). In IPF patients, the proportion of patients with pulmonary HTN was higher (53.49%, 95% CI: 37.65%, 68.82%) compared to non-IPF (21.49%, 95% CI: 14.5%, 29.8%). GERD symptoms were more common among IPF patients (74.4%) compared to 67.7% among non IPF,which was not statistically significant. (p 0.41).
Conclusion: Out of 164 ILD patients, 26.2% were IPF. Among non –IPF group, CTD-ILD was the commonest. The mean age was higher among IPF patients, compared to non-IPF ( p value = 0.001.)IPF was more common in males, where as females predominate in Non-IPF group (p<0.001) The proportion of ever smokers was higher among IPF patients (62.7%). FVC%, DLCO%, 6MWD, SPO2 were lower in IPF compared to non –IPF, at the time of presentation(p< 0.001). HRCT showed UIP pattern in 100% of IPF. Proportion of patients with pulmonary HTN was higher in IPF (53.49%,) compared to non-IPF (21.49%,). GERD symptoms were present in 69.5% of study population
MRA evaluation of cerebrovascular stenosis and its association with acute stroke in Indian patients
Get PDFIntroduction: The detection of intracranial atherosclerotic disease has been elusive, possibly because of the dearth of non-invasive methods for diagnosing the condition.
Material and Methods: In this study, we used time-of-flight MRA (TOF-MRA) to identify the presence, nature, and number of stenosis in the intra and extracranial arteries and anterior and posterior circulation systems in 60 Indian patients.
Results: It was found that there is a strong association between the presence of stenosis and hyperlipidemia and hypertension. Intracranial stenosis was more prevalent in the > 60 years age group, and it maximally affected the M1 segment of the middle cerebral artery. Comparatively, significant stenosis and total occlusion were predominant in the intracranial system; single stenosis was associated with the intracranial arteries, whereas multiple stenoses were observed in the extracranial system.
Conclusion: Hemiparesis was the most common symptom of the patients. Thus, TOF-MRA can be used successfully to evaluate the occurrence, prognosis, and treatment options for cerebrovascular stenotic diseases
Lung function tests in different phases of menstrual cycle
Get PDFIntroduction: Menstrual cycle is an integral part of a woman’s life. During these different phases, rhythmic changes occur in the levels of ovarian hormones especially progesterone and estrogen. The goal of this study was to study the effect of the luteal and follicular phases of the menstrual cycle on bronchial reactivity (BR) in a group of women.
Material and Methods: The fifty girl medical students of first year MBBS of 18 – 24 years age were undertaken to study pulmonary function tests in different phases of menstrual cycle. Pulmonary function tests were taken between 8 – 10 th day of menstrual cycle, that is in follicular phase and again were recorded between 20 – 22 nd day of menstrual cycle that is in luteal phase by using spirometric technique. The results were expressed as Mean ± Standard Deviation (Mean+ SD). Statistical analysis was done through Graph pad prism. Comparison of pulmonary function parameters in different phases of menstrual cycle was done by using one way ANOVA (Analysis of Variance) by bonferroni post-hoc test.
Results: Anthropometric measurement of all subjects in which mean age was 19.45 ± 1.80 years, arm span was 157.25± 6.37 cm, chest circumference was 80.58 ± 7.69 cm , height was 149.07 ±4.64 cm , weight was 45.65±6.69 Kgs. Spirometric study found FVC , FEV1, and PEFR increase in luteal phase of menstrual cycle compared to follicular phase, which were statistically significant.
Conclusion: We found better lung functions which were statistically significant in luteal phase as compared to follicular phase of our subjects indicating a possible role of progesterone causing β adrenergic stimulation / sensitization
Fracture Penis – An atypical presentation
Get PDFBlunt penile traumatic injury is usually of concern only with an erect penis, when fracture of the tunica albuginea may result. Here we report a case of fracture penis with an atypical presentation