International Archives of Integrated Medicine

11-15

Authors: T. Chitra, Dorai D., Aarthy G

Background: Solitary nodular goitre is clinically defined as a single nodule in otherwise normal thyroid gland. It can be benign or malignant. Solitary nodule has a higher risk of malignancy (15-20%) when compared to multi-nodular goitre (3-5%). Aim: We conducted a study to evaluate the clinical and radiological factors associated with occurrence of malignancy in Solitary Nodular Goitre (SNG); to find out the incidence of SNG in this part of North Chennai; to analyze the correlation of preoperative cytological and postoperative histopathological results. Materials and methods: It was a prospective study on fifty patients who were clinically diagnosed as SNG. All patients were evaluated with an Ultrasonogram (USG) Thyroid and Fine Needle Aspiration Cytology (FNAC). After surgery, the Histopathological Examination (HPE) reports were compared with the FNAC findings. Results: SNG was more common in the age group of 21-40 years. 86% of SNG patients were females. The incidence of malignancy in SNG this study was 12% which commonly involved males. Among the malignancies, papillary carcinoma was the most common and Hashimoto’s thyroiditis was found to be associated with it. The presence of microcalcifications and paratracheal nodes in USG were more in favour of malignancy. The FNAC report correlated well with the HPE reports, the accuracy of FNAC being 90% in this study. Conclusion: SNG has a high risk of malignancy, especially in males and the most common type being papillary carcinoma. FNAC is the gold standard pre-operative investigation that is well correlated with post operative HPE results.

23-28

Authors: Pandey D, Redkar N

Background: Pregnancy-related acute renal failure (ARF) can be caused by any of the disorders leading to ARF in the general population. We aimed to study the clinical profile of pregnancy related acute renal failure, management and clinical outcomes. Materials and methods: After obtaining ethical committee’s approval, a prospective observational study was carried out on hospitalized patients in our hospital from 1st August 2007 till 30th September 2008, where all pregnant females referred to nephrology unit were enrolled. Results: A total of 41 patients were included in the study in which oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Respiratory system involvement was associated with increased mortality. No correlation between serum creatinine level and mortality was observed. Neonatal deaths were seen in 2.43% of patients while IUFD was seen in 19.51% of patients. Conclusions: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. More than two organ involvement was associated with higher mortality and majority of the patients were treated conservatively. Maternal and fetal mortality were high, 17.07% and 2.43% respectively.

36-44

Authors: Bardhan J, Ghosh SK, Sarkar KN, Sarkar M

Background: An accurate estimation of foetal gestation age is of utmost clinical significance owing to its vast clinical implications principally in management of high risk pregnancies. Aim: To determine correlation and regression coefficient of foetal kidney length as a parameter for gestational age and to do its comparative evaluation with other foetal biometric indices. Materials and methods: A Prospective observational study was conducted on 200 women aged between 18 to 35 years with normal singleton pregnancies, over a duration of six months from December 2015 to May 2016. Gestational age and fetal kidney length was determined using Ultrasound machine PHILIPS HD7 (2.0.1) with 3- 5 MHz curvilinear transducer. Statistical analysis was done using tests of correlation and simple linear regression. All analysis was done by using IBM SSPS statistics 24and MS excel. Results: Pearson’s correlation coefficient value of 0.99 and regression coefficient or slope 1.0 noted between gestational age and fetal kidney length with a significance P< 0.001. Conclusions: Fetal kidney length shows a positive correlation with fetal gestational age, with a linear growth rate throughout pregnancy irrespective of underlying medical condition like intrauterine growth retardation. This study shall prove its worth in cases of engaged fetal head, where it is difficult to measure fetal bi parietal diameter and head circumference as well as in cases of intrauterine growth retardation, macrosomia and malformation where abdominal circumference measurement gives false values.

53-58

Authors: Sreenivasu K, Paul Daniel VK, Subramanian MB, Sajeevan T

Introduction: Frozen shoulder is defined as an idiopathic condition of the shoulder characterized by the spontaneous onset of pain in the shoulder with restriction of movement in every direction. To regain the normal extensibility of the shoulder capsule, passive stretching of the shoulder capsule in all planes of motion by means of mobilization techniques (EMTs) has been recommended. Lack of research has been done to evaluate the combined effects of scapular mobilization and end range mobilization to improve the shoulder range of motion in frozen shoulder. Objectives: To evaluate the effectiveness of end range mobilization with scapular mobilization in improving shoulder range of motion and function in subjects with frozen shoulder and to compare the effectiveness of end range mobilization with scapular mobilization over end range mobilization alone in improving shoulder range of motion and function in subjects with frozen shoulder. Materials and methods: Hospital based comparative study was carried out to compare the effects of two different forms of mobilization techniques on two groups of patients of frozen shoulder among 30 patients attending the OPD of Physiotherapy Department of Oxford College, Bangalore. Assessment of patients included evaluation of Range of motion and disability index (SPADI) both pre and post treatment for both the groups. Data was analyzed by SPPS software ver. 21 using appropriate statistical tests. Results: Shoulder pain and disability index (SPADI) and range of motion of shoulder in all the positions was assessed separately in both the groups, pre and post mobilization treatment therapy. Improvement was observed in both the groups pre and post treatment and these results were statistically significant (p<0.01). Conclusion: End range mobilization with scapular mobilization is more effective in improving range and functioning as compared to end mobilization alone.

66-72

Authors: Abraham Jebakumar, S. Shanmugam, Anbarasan

Background: A fistula-in-ano is an abnormal hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Treatment of fistula-in-ano remains challenging. Surgery is the treatment of choice, with the goals of draining infection, eradicating the fistulous tract, and avoiding persistent or recurrent disease. Aim: This study was intended to investigate the factors determining the course of fistula in ano and its recurrence of patients with fistula in ano came to Govt. Stanley Hospital for 1 year. Materials and methods: 45 patients were selected who were diagnosed as fistula in ano admitted in Govt. Stanley Hospital during June 2015 to May 2016. The anatomy and type of fistula was detected by MRI. Patients underwent definitive treatment. Data regarding the objectives of the study were collected and outcomes of the treatment evaluated by following up the patient for 6 months. Results: Majority of patients (82%) belonged to 31 -60 years of age. Male: Female ratio was 4:1. Most of the fistulas were low anal 41 (91%). About 34 (76%) of external openings were posterior. Fistulectomy was performed in 31 cases, fistulotomy for 10 cases, seton for 4 cases and the operated wound healed in a range of 2 weeks to 8 weeks. Delayed healing was associated with complex fistulas, intersphincteric and transphincteric fistula takes longer time to heal about 4 to 5 weeks (P = 0.007). Fistula of tubercular etiology took minimum 3 weeks to heal (P =0.047). 13 % of cases showed recurrence. Transphincteric fistulas had recurrence rate of 33%. Fistulas with lateral openings had recurrence rate of 67%. Conclusion: Fistulectomy is the commonest and best procedure to get rid of the infective pathology. Fistula in ano has a well recognised incidence of recurrence after surgical treatment.

79-82

Authors: Desai A, Panchal A, Parmar H

Background: Diabetic foot is the commonest complication of Diabetes Mellitus. It is not totally curable or preventable but with positive approach mortality and morbidity due to diabetic foot can be reduced. Aim and objectives: To find out which type of treatment modality is better in terms of cost-effectiveness and number of dressings in patients of diabetic foot, to salvage the limb in diabetic patient with help of various modalities of treatment available to our hospitals, to prevent the recurrence of such lesion by careful follow up, by educating the patient about foot care and prescribing pressure distributing footwear, and rehabilitation of patient once the ulcer has healed. Materials and methods: A total of 60 patients having diabetic foot were included. Clinical assessment was done of all patients after admitting them. History and clinical findings were written as per preformed proforma. All patients were sent to foot wear specialist. All this patients initially underwent debridement or removal of necrotic patch, according to the presenting feature. Depending on the condition of the ulcer (size or slough) they were dressed with newer techniques. Newer techniques used were Vac (Vacuum assisted closure) and Non-Vac (Hydrocolloid, Hydrogel, collagen, Platelet derived growth factor). Results: Majority of diabetic patients were having neuropathic and traumatic type of lesions. 30 patients were dressed with V ac (Vacuum assisted closure) and remaining 30 patients were dressed with Non-V ac. In which 5 patients were dressed with Hydrocolloid, 3 patients were dressed with Hydrogel, 12 patients were dressed with collagen and 10 patients were dressed with platelet derived growth factor. Comparison between V ac and Non-V ac types of dressing in terms of number of dressings, duration of stay, cost effectiveness is done by applying Z-Test. It was significant. Conclusion: Newer techniques for dressing- VAC or NON-VAC decreases the morbidity of the patient and also better in terms of cost-effectiveness and duration of stay as compared to conventional dressings.

93-96

Authors: Keerthi Sunil Kumar, Manga Muralidhar

Background: Mastalgia is defined as pain, dull ache or heaviness in the breast. The most common cause of mastalgia is Aberration of Normal Development and Involution (ANDI) of breast tissue [1]. It can occur during adolescence, pregnancy and perimenopause. Materials and methods: Patients with complaints of breast pain in the age group 15-64 years with clinically no palpable mass attending to the surgical OPD in a tertiary care hospital between August2013- August 2015 (two years) were included in the study. Out of 700 patients who presented with pain in one or both breast, 482 (68%) had fibroadenoma, 78 (11%) were fibroadenosis with nodularity in breast followed by 50 (7%) cases had abscess and 40 (5.7%) had mastalgia without any palpable lesion which are included in this study. Detail history with particular reference to age, duration of symptoms, side of preponderance, menstruation, marital status, parity, lactation, nipple discharge and tenderness are recorded. Pain is recorded by subjective numerical pain intensity scale of 0-10. Clinical findings with particular reference to tenderness, quadrants involved are recorded. Ultrasound of the breast was done for all cases and findings recorded to correlate with clinical features. Results: Regarding age distribution, 18 (45%) patients belong to age group 26-35 years followed by 11 (27.5%) in age group of 36-45 years. 8 (20%) of patients were in the age group of 15-25 years. Remaining 3 (7.5%) were above 46 years. 20 (50%) had symptoms of < 1 month duration, 10 (25%) had duration of 1 - 6 months, 3 (7.5%) had symptoms for more than 6 months.13 (32.5%) had pain on right side, 16 (40%) had pain on left side, 11 (27.5%) had pain both sides. Severity of pain varied from 1 – 10 with an average of 5.4. 36 (90%) are married, 4 (10%) are unmarried. 35 (87.5%) had children, 5 (12.5%) were nulliparous. 32 (80%) women are having regular menstrual cycles and 8 (20%) were not menstruating due to either following hysterectomy or attained menopause apart from 3 (7.5%) patients were lactating mothers. Conclusion: The sonological findings of altered echogenisity and cystic changes can be the baseline while starting the treatment in patients with mastalgia without palpable lesion. These findings will also guide in assessing the response and follow-up of these patients.

111-125

Authors: E. A. Ashok Kumar, P. Jijiya Bai

Various risk factors have been implicated in causation of stroke but hypertension remains the single most important treatable risk factor in all age groups, and it is the one which seems to have a direct relation to incidence. Furthermore antihypertensive therapy has been observed to be effective in reducing the incidence of CVD (cerebrovascular disease). The interaction between hypertension, antihypertensive treatment and stroke is a complex one. Nevertheless the conclusion is that antihypertensive treatment has definite beneficial effects on stroke. Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intra cerebral hemorrhage. In this study, a total of 55 patients who presented with CVD and with hypertension (stage 1 and 2 of JNC 7) were included in this study. Out of 55, 37 (67%) cases are ischemic and 18 (33%) cases were due to cerebral hemorrhage. In ischemic stroke 35 (63.5%) cases are thrombotic, 2 (3.5%) are embolic strokes. All patients were given treatment with oral Nifedipine retard preparation 10-20mg q 8th hourly or Angiotensin converting enzyme inhibitors (which also stabilizes endothelium of the vasculature), along with other conservative treatment and physiotherapy. Patients with intra cerebral haemorrhage were treated with Nimodipine 60 mg q 8th hourly along with antihypertensive treatment. In our study, the reduction of blood pressure improved the outcome, and their Blood Pressure normalized without any complications. Blood pressure reduction in acute stroke, irrespective of the etiology improved the outcome. In our study, we reduced the BP in all acute CVA patients with hypertension to normal within 24-48 hours. This study suggested BP control improves the outcome, when compared to fatalities in other studies, where BP is not reduced acutely.

132-139

Authors: T. Babu Antony, S. Vijayasarathy

Background: Dyspepsia is described as recurrent upper abdominal discomfort and epigastric fullness after meals, often described by the patients as indigestion. The assessment of trending diagnostic patterns in upper GI endoscopy is important to validate the priority of endoscopic evaluation over other modalities of investigation for dyspepsia. The significant patterns may form a platform for new epidemiological studies to re-assess the risk factors and distribution of diseases causing dyspepsia in South Indian population. Aim: A retrospective study was done to assess the trends of diagnosis in upper GI endoscopy in adult dyspeptic patients in South Indian population. Materials and methods: Endoscopy database records of 3271 consecutive patients who underwent upper GI endoscopy between January 2014 and March 2016 were retrospectively analyzed from upper GI endoscopy register. The data was subjected to statistical analysis and compared with that of previous similar studies. Suspected malignant lesions were confirmed with histopathology reports. Results: Positive yield was 80.6%. Gastritis (51%), duodenitis (22%) and hiatus hernia (9%) were the leading endoscopy diagnoses. Esophageal growth was 3 times more common in females (p=0.009). Growth in stomach was reported in 2.3% patients. Carcinoma stomach was significantly higher in age above 40 years (p=0.0009). There was a positive correlation between Ca stomach and increasing age. The cumulative frequencies of gastric cancer by age group were as follows: 7 of 1000 OGDs in patients less than 40 years of age and 40 of 1000 OGDs in patients greater than 40 years of age. Conclusion: The results conclude that gastric malignancy is significantly higher in age>40 years. This recommends a routine upper GI endoscopy for patients>40 years. Esophageal growth is significantly higher in females warranting an epidemiological study on association with possibly dietary pattern and religion in these subjects. Frequent retrospective and prospective studies on yield of upper GI endoscopy are warranted to keep an early check on any alarming trends of significant diseases.

146-152

Authors: G. Ranjani, S. Manikandan, I. Rohini, S. Kalaiselvi

Background: Coronary artery disease is mainly caused by atherosclerosis and its complications. Platelets and their activity have an important role in initiation of atherosclerotic lesions and coronary thrombus formation. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets. Aim: To compare platelet volume indices in acute myocardial infarction, unstable angina, stable angina pectoris and healthy controls and to investigate the importance and role of platelet volume indices in acute coronary syndrome. Materials and methods: This was cross-sectional study of 100 patients includes 25 patients with acute myocardial infarction, 25 patients with unstable angina, 25 patients with stable angina and 25 healthy controls. Venous samples would be drawn at the time of admission before initiation of treatment. Platelet volume indices were assayed within 30 minutes of blood collection, using auto analyser. Results: Platelet volume indices were found to be higher among ACS (acute myocardial infarction and unstable angina) patients as compared to non ACS (stable angina and healthy control). For example mean platelet volume was significantly higher in patients with AMI (9.8±0.86) and unstable angina (9.5±0.84) as compared to stable angina (8.4±0.58) and healthy control (8.2±0.56). Conclusion: Measurement of platelet volume indices may be of benefit in detecting those patients at higher risk for acute coronary syndrome in future.

159-163

Authors: Agnihotri DS, Bhise AR, Patel SM

Background: Athletes are trained for specific games and for specific muscle groups. In all the games respiratory muscles with proper strength are needed so as to provide better outcome. But as the peripheral muscles are trained the Respiratory muscles are not trained specifically in any of the athlete. The less trained Respiratory muscles can directly affect the output of the Athlete by activating Metaboreflex. This reflex is activated when the Respiratory muscles gets fatigued; in which the blood is pulled towards the fatigued Respiratory muscles; due to which the peripheral muscle gets less blood and oxygen to work longer; which results in reduced output. So as to improve overall output, along with specific muscles, the Respiratory muscles should also be trained. Aim: This study was designed to evaluate the effect of Inspiratory Muscle Trainer on Running Performance and Respiratory Muscle strength in Athletes. Materials and methods: An Interventional study was conducted on Athletes studying in a Physical Education college Gujarat. The subjects were selected according to inclusion criteria. The Pre-training outcome of PImax (Inspiratory Mouth Pressure); PEmax (Expiratory Mouth Pressure) and time taken for 30m sprint was taken. And then subjects were divided into two groups’ one training and other control. Group A: Training for Respiratory muscles by Inspiratory Muscle Training Device along with other regular physical activity. Group B: Not getting any additional training for Respiratory muscle other than regular physical activity. The training was given at 50% PImax for 15 min a day for 6 weeks. At the end of 6 weeks postdata of PImax PEmax and speed were collected. Results: Data analysis was done using SPSS20 version. In Experimental group Inspiratory Mouth Pressure, Expiratory Mouth Pressure improved significantly (p<0.05) also time taken for completion of 30msprint reduced significantly. (p<0.05) Conclusion: The Inspiratory Muscle Trainer can be used to improve Inspiratory Mouth Pressure, Expiratory Mouth Pressure and Running Performance in Athletes.

170-178

Authors: K.M. Lakshmana Rajan, D.S. Sudhakar, T. Thirunavukarasu

Background: Orthopedic patients can be particularly challenging for anesthesiologists. Many orthopedic procedures are well suited for regional anesthetic techniques. Epidural analgesia is the one method which can be performed easily, can provide intra-operative and postoperative analgesia better than other methods with better patient comfort. Aim: To study the efficacy of Gabapentin on combined spinal epidural anesthesia for lower limb orthopedic surgeries with respect to postoperative epidural analgesic requirements. Materials and methods: This study involved, using Gabapentin and the effects of it on combined spinal epidural anesthesia in respective of postoperative epidural analgesic requirements. 60 patients of ASA I, II undergoing lower limb surgeries were randomly assigned into two groups Group G, and Group P. Surgery was done under combined spinal epidural anesthesia. The patients’ in-group G received three Gabapentin capsules (1200 mg). In-group P, three placebo capsules were given. Subarachnoid block was performed with 0.5% Bupivacaine 3 ml (Hyper baric). Epidural analgesia was given by 0.125%bupivacaine with Fentanyl 2 µg/ml (8 ml volume). Results: The parameters observed were the mean time to regress by two segments from higher level of blockade (90.7 ± 4.7 minutes (G) VS 85.8 ± 3.5 minutes (P), p <0.05), the time to require first epidural analgesic supplementation (228.5 ± 19.96 minutes (G) VS 195.5 ±13.3minutes (P), p <0.05), the time interval between the epidural analgesic supplementations (8.25 ±1.5 hours (G) VS 4.8± 0.5 hours (P), p <0.05), the total number of epidural requirements in first 24 hours (2 ± 0.2 (G) VS 2.93 ± 0.2(P), p<0.05) , and in the next 24 hours (3 (G) VS 4 (P) , p<0.05). Conclusion: This provides an evidence of the Gabapentin before surgery significantly prolongs two-segment regression time and duration of analgesia in subarachnoid blockade and it significantly reduces the postoperative epidural analgesia requirements.

185-192

Authors: Farah Riyazuddin Munshi, Edrish Saifee Contractor, Muzammil Munshi

Background: Musculoskeletal symptoms or disorders among dentists have been major concern in recent years. The most frequent injuries occur in spine (neck and back), shoulders, elbow and hands. In order to summarize, the study describes mainly about the prevalence of work related musculoskeletal disorders among dentists, percentage of affection and prevalence of psychosocial aspects among dentists. Aim and objectives: The aim of the study was to find prevalence of musculoskeletal disorders and psychosocial aspects among dentist and among male and female dentists, among age groups (years) of dentists, between right handed and left handed dentists, between four categories of body mass index among dentists, dentists working in private practice, in academics and in both Private practice and academics, under‑graduate and post‑graduate level dentists between three categories of clinically experienced dentists between dentists working with assistant and without assistant and to find the prevalence of psychosocial risks among dentists. Materials and methods: To determine prevalence of musculoskeletal disorders by using standardized Nordic questionnaire for analysis of musculoskeletal symptoms and to determine prevalence of psychosocial aspects by using job content questionnaire. Results: Results of the study revealed that there is prevalence of work related musculoskeletal disorders among dentists. Among 463 dentist’s, total percentage of musculoskeletal affection was 90.7%. The percentage of affection in specific body areas are as follows neck pain 73.8%, Low back 70%, shoulder 62.4%, upper back 23%, elbow 16.7%, hips 14%, ankle 11.2%, knee 7.6%. The prevalence of psychosocial risk was 68%. Conclusion: From this survey, it can be concluded that there was high prevalence of musculoskeletal and psychosocial risk factors among dentists. These work related musculoskeletal disorders can be prevented by correcting awkward posture when working and taking appropriate ergonomic measures.

199-205

Authors: N. Guru Raj, G. Ravi Kiran

Background: Risk stratification of patients with acute pulmonary embolism (PE) allows assessment of individual prognosis and guides therapeutic decision making. Several electrocardiographic (ECG) markers measuring the arrhythmogenic substrate(s) in ventricular myocardium are used to identify the high-risk patients with acute PE. However studies on Tp-e/QT ratio in patients with acute PE are lacking therefore the present study is aimed to evaluate the in hospital prognostic significance (death and in hospital adverse clinical events [ACE]) of Tp-e/QT ratio at admission in acute PE patients. Materials and methods: This was a retrospective study that included adult patients who had been diagnosed with acute PE and were treated at our hospital between January 2012 and March 2016. After considering inclusion and exclusion criteria, data was collected from eligible patients. All ECG recordings were digitalized and evaluated by a computer based program. Tp-e and QT intervals were measured from all precordial leads and mean value is calculated. Statistical analysis was performed using SPSS 17.0. Receiver operator characteristic (ROC) curves were computed for the Tp-e/QT ratio to assess the optimal cutoff values for predicting mortality and ACE. Univariate logistic regression analysis for the predictors of in hospital events (death and in hospital ACE) in the study population was done. The statistical significance was considered for a p-value <0.05. Results: A total of 48 patients were included in the study with mean age of 37.95 years (±13.86) and male: female ratio of 1.18:1. Patients with pulmonary embolism have mean Tp-e/QT ratio of 0.25 and the range of Tp-e/QT ratio was 0.18 to 0.29. In regression analysis, a Tp-e/QT ratio ≥0.26 increased the risk of death (P = 0.03) and a Tp-e/QT ratio ≥0.25 increased the risk of ACE (P = 0.01) significantly. Conclusion: In acute Pulmonary Embolism, Tp-e/QT ratio is a simple and useful tool in predicting the patients at high risk of suffering adverse clinical events and death. Hence this ratio may serve as a prognostic marker in these patients.

212-218

Authors: G. Anitha, R. Salma Mahaboob, G. Obulesu

Background: Brain is a rich source of a variety of enzymes and any injury like stroke to brain tissue could similarly result in an increase in activity of these enzymes in cerebrospinal fluid and serum. It was in this context that the present study was done to assess the levels of enzymes like aspartate aminotransferase (AST), creatine kinase (CK) and Isoenzyme of creatine kinase (CK-MB) in serum. Evaluation of enzyme levels in serum has involved keen interest as a simple, economical, reliable and easily available method for the evaluation of severity, course, prognosis, and to some extent in the differential diagnosis of various types of cerebrovascular accidents. Aim: To study the serum enzymes in cerebrovascular accidents. Materials and methods: The present study was done in Fathima Institute of Medical Sciences, Kadapa, by taking 50 of samples and 30 are controls. Creatine Kinase (Total), Creatine Kinase-MB, Aspartate Transaminase, lipid profile, Fasting Blood Sugar were estimated in patients and control group also. Results: The biochemical parameters studied were fasting blood glucose, total cholesterol, triglycerides, LDL, VLDL, HDL, SGOT, CPK and CPK-MB. Serum CPK was grossly elevated in patients with stroke compared to controls which is statistically significant (P Value < 0.001). Conclusion: In the present study, all the parameters were elevated, for better understanding of serum enzymes in cerebrovascular accidents further investigations are needed.

228-235

Authors: S Lakshmi Narayana, M Anil Kumar, V Raj Kumar

Background: Intertrochanteric and subtrochanteric fractures are leading cause of hospital admissions in elderly people. Aim: This study was done to analyze the surgical management of proximal third fractures of femur using Proximal Femoral Nail fixation. Materials and methods: 20 cases there were 15 male and 5 female patients of intertrochanteric and subtrochanteric fractures, which were treated with Proximal Femoral nail. Results: Mean age of 60.4 years. 50% of cases were admitted due to slip and fall and with slight predominance of right side. Out of 20 cases, 10 were trochanteric and 10 were subtrochanteric. In Trochanteric class 60% were Boyd and Griffin type 2, in Subtrochanteric class 40% were Seinsheimer type 3a and 20% were 2b. Mean duration of hospital stay is 19.33 days and mean time of full weight bearing is 12.6 weeks. Out of 20 cases 2 cases expired before first follow up and 1 case lost for follow up. Out of 17 remaining cases 9 were Trochanteric and 8 were Subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 87.5% cases of subtrochanteric fractures. Conclusion: We consider that PFN is an excellent implant for the treatment of proximal third fractures of femur.

241-247

Authors: P. Malathi, Krupa Patalay

Background: In India, 65% of women in the first year of post-partum period have an unmet need for family planning. Hence contraception needs to be practiced in this critical period. Aim: The present study was planned to evaluate the efficacy, safety, and compliance of intra Cesarean IUD insertions. Materials and methods: This was a prospective study for 3 years. Women recruited had CuT-380A insertion immediately after delivery of the placenta during Elective /Emergency Cesarean section. Women having unresolved post-partum hemorrhage (PPH), pre-labor rupture of membranes of (PROM) >18 hrs, fever >38 ˚C, congenital uterine malformation and fibroid uterus distorting the cavity were excluded from the study. The women were followed up with 3 visits at 4- 6 weeks, 3 months and 1 year. Results: Total women counseled were 4141, accepted no was 2850, declined no was 1291, consented but not inserted in 109 as criteria was not met. Lost to follow up 46, followed up 2850, complications (Expulsion 6, IUCD in situ with pregnancy 1, Bleeding 33, String problem 363, Removal 28, Continuation 2745). Conclusion: Immediate post –placental IUCD insertion provides highly effective contraception to the woman at the time of discharge itself. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources.

258-265

Authors: S. Krishnabharath, S. Mathan Sankar

Background: Acute mesenteric ischemia consists of the sudden, partial or complete, interruption of the blood flow in superior or inferior mesenteric vessels that result in intestinal ischemia. The incidence was exponentially increasing with age and no difference has been observed between sexes. Aim: The Aim of this case series was to highlight clinical presentation, the difficulty in diagnosis and importance of early intervention and the prognosis of superior mesentric vessel thrombosis with bowel ischemia. This article presented a case series of intestinal infarction through obstruction of superior mesenteric vessels – three cases of acute mesenteric artery thrombosis, two case of acute mesenteric vein thrombosis. Materials and methods: The materials for this case series was collected from patients diagnosed and admitted as acute superior mesentric vessel thrombosis in various surgical units in Department of General Surgery, Govt. Stanley Medical College, Chennai. All 5 cases have been analyzed for this study during period of 6 months from January 2016 to June 2016. All Cases with superior mesentric vessels thrombosis were included. No exclusion criteria. Results: This case series consisted of 5 cases, three cases of acute mesenteric artery thrombosis and two case of acute mesenteric vein thrombosis. In this case series, superior mesentric artery thrombosis was more common with male preponderance. 4 out of 5 cases were male in which Superior mesenteric artery was more common when compared to vein thrombosis. Out of 5 cases, 2 cases were asymptomatic with mild abdominal discomfort. Most common complaints of 5 cases were sudden onset of abdominal pain with or without vomiting. Abdominal distension/ Constipation were not seen in all cases. Out of 5 cases, 4 patients were on favorable follow up in which 2 cases had been diagnosed very early who had less post-operative stay and no complications after surgery. 2 cases developed post op complications. 1 case had deceased because of late presentation. This case series presentation draws to attention that timely diagnosis and appropriate surgery with resection and immediate postoperative heparinization and proper follow up with anti coagulant the morbidity and mortality is averted. Conclusion: The diagnosis of AMI is difficult and mostly delayed resulting in irreversible bowel ischemia which requires emergency intervention. Mortality and morbidity for AMI remains high, and in patients requiring extensive bowel resection the survival rate was low. As AMI mostly affects the elderly population physicians have to be aware of the possibility of this condition when facing the elderly patient even with mild sudden onset of abdominal pain complaints. An interdisciplinary collaboration is must, since patients are not initially evaluated by surgeons.

270-273

Authors: Choudhary A, Agarwal D, Goyal D, Kalra R, Choudhary A

Breast sarcomas are rare neoplasms accounting for less than 1% of breast malignancy. Phyllodes tumors have biphasic histological features with both epithelial and stromal component. Careful characterization of the stromal component is critical since it is the pathologic features of the stromal cells that determine its malignant potential. We reported a case of 57 years old female with right breast mass who underwent wide excision and on histological examination a diagnosis of malignant phyllodes tumour with heterogonous osseous differentiation was made. The rarity of the lesion was considered for reporting and on follow up the patient was free of metastasis.

278-282

Authors: Saxena S, Saxena N, Jaiswal RM

Sickle beta thalassemia is a disorder which represents the double heterozygous state for the Hb-S and the beta-thalassemia genes. The clinical and hematological manifestations of sickle beta thalassemia are highly variable due to existence of two types of genes, beta0 thalassemia gene and beta+ gene. Beta0 gene leads to complete absence of Hb-A levels, whereas beta+ gene leads to production of Hb-A levels 10-30%. This disorder is diagnosed by levels of HbS, HbA2 and HbF in Hemoglobin Electrophoresis. We are presenting one such young male patient with features of Sickle Beta+ thalassemia who presented with anemia, fatigue and joint pain with characteristic features of avascular necrosis of left hip joint in X-Ray and MRI. For the etiological diagnosis further investigation in the form of capillary haemoglobin electrophoresis and for final confirmation genetic analysis by PCR is done.

286-289

Authors: Kaushal K, Gupta M, Patel B N

Sarcomas comprise only 0.6% of all cancers throughout the body and account for only 1.5% of all salivary gland tumors. The existence of these tumors has been debatable with some investigators stating that such lesions represent extensions of soft tissue sarcomas into the gland. In young patients, these tumors occur more often than the more common parenchymal tumors or the conventional soft tissue sarcomas. We are hereby presenting a case of a 5 year old male child presenting with a large parotid mass which was diagnosed as parotid rhabdomyosarcoma.