iosr-JDMS   Volume-11 ~ Issue-1

Abstract: The increasing use of invasive diagnostic and interventional procedures in cardiovascular diseases makes it important to study the vascular variations of upper limb. Awareness of the possible variations will reduce the risk of complications like bleeding during surgical procedures. .Axillary artery is the continuation of subclavian artery, at the outer border of the first rib and from the lower border of teres major it becomes the brachial artery. During its course it is divided into 3 parts by pectoralis minor muscle. Usually 6 branches arise from different parts of the artery .The present study was carried out in 30 cadavers (10 females and 20males)of the department of anatomy v.s.s medical college, burla and all the branches of axillary artery were studied. There are many reports showing variations in the branching pattern of axillary artery. However, in our study some unusual variations were found.

Keywords: Axillary artery , Clumping, Subscapular artery, Variation

[1] Standring S editor. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed.2008. Churchill-Livingstone: Elsevier. ISBN978-0-443-06684-89.

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[5] Hamilton WJ, Mossman HW. Cardiovascular system. In: Human embryology. 4th ed. Baltimore: Williams and Wilkins, 1972: 271-290.)

[6] Hollinshead, W. H. & Rosse, C. Text Book of Anatomy. 4th Ed. Harper & Row, Philadelphia, 1985. pp.187-189. [7] M. Rodriguez-Niedenfuhr, G. J. Burton, et al.,Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J. Anat. 2001; 199: 407- 41

[8] Ronald A. Bergman, Adel K. Afifi, , Ryosuke Miyauchi. Axillary Artery Opus II: Arteries. Cardiovascular System . Illustrated Encyclopedia of Human Anatomic Variation:2006

[9] Saeed M,Rufai AA,Elsayed SE,Sadiq MS. Variations in the subclavian-axillary arterial system.2002;23(2):206-212. [10] Charitou A,AthanasiouT,Morgan IS,Del Stanbridge R.Use of Cough Lok can predispose to axillary artery thrombosis after a Robicsek procedure.Interact Cardiovasc Thorac Surg 2003; 2(1):68-69

Abstract: DWS is hydrocephalus associated with a posterior fossa cyst and dysgenesis of the cerebellum. In USA the incidence of DWS is thought to be between 1 in 25000 – 35000, live births. This is a case of middle aged male patient with large head since birth, which was asymptomatic till 57 yrs of age. After LOC and CT scan he was diagnosed to have DWS. This case was successfully managed with conservative management plan.

Keywords: Large head, Computerized tomography, Ventricular peritoneal shunt, hydrocephalus

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Abstract: Background: - Many aspects of the management of perforated appendicitis in children remain controversial. PATIENT AND METHOD: -Prospective study 86 cases of appendicular perforation in children were carried out from Jan.2007 to Feb.2012 at I.G.M.C Nagpur. RESULTS: - Total of 86 children, 34 females and 52 males diagnosed as a perforated appendicitis were studied prospectively. 43 patients were included randomly in both the group, group-1(early appendectomy after 24hours of diagnosis) and group-2 (Interval appendectomy after 6 to 8 week from diagnosis). The maximum number of patients 55.81% was found in the age group of 11 to 14 years. Intraoperative position of appendix was retrocaecal in 36(41.86%) patients, followed by pelvic in 40(46.51%) patients. The maximum overall adverse effects was observed in group-2 than group-1 patients. overall postoperative scar was better in all patients of group-1 than group-2 patients. Average total government hospital charges per patient including medicine and operation was Rs.1000/-in group-1 patients and Rs.2500/- was in group-2 patients. Average total government hospital cost per patient was Rs.3500/- in group-1and Rs.6500/- was seen in group-2 patients after discharge. Hospital stay was below 4 days in 34(79.07%) patients of group-1and in 16(37.20%) patients of group-2.Minimal morbidity with no mortality were observed in present series and 4 (4.65%) patients were lost to follow up ingroup-2.

CONCLUSION: - The overall adverse event rate after early appendectomy was significantly lower than that after interval appendectomy. Early appendectomy for perforated appendicitis in children significantly reduced the time away from normal activities, overall adverse event rate, hospital cost and charges.

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[6]. Kuhls TL (1998) Appendicitis and pelvic Abscess T.B. of pediatric, Infectious Disease section eight, 4th edition, By Ralph D.Feifin&Dames D.Cherry.1; 662-667. [7]. Klein Joel (2009) Appendicitis. http://kidshealth.org/parent/misc/reviewers.html
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Abstract: Congenital indirecthyperbilirubinemiaoccurs due to the relative deficiency or absence of the primary conjugating enzyme uridinediphosphate-glucuronyltransferase.The enzyme UDP glucuronyltransferase is responsible for the conjugation of bilirubin in liver. The enzyme is also essential for transport of many other substrates including drugs, hormones, toxins and neurotransmitters. Thus, anaesthetic management of such a case is quite challenging. Avoiding drugs which use this enzyme for its metabolism or excretion during the perioperative period allows safe conduct of anaesthesia for these patients. We report a case of inherited unconjugated hyperbilirubinemiafor an incidental surgery and review the different types of congenital indirect hyperbilirubinemias.

Keywords: Anaesthesia, bilirubin,inheritedunconjugated hyperbilirubinemia, Crigler-Najjar syndrome, Gilbert syndrome

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Abstract: In recent work, FCSA has shown an efficient algorithm for MR image reconstruction by linear combination of least square data fitting, TV and L1 norm regularization algorithms. FCSA based reconstructed MR image had improved results compared to CS methods. In our paper, we are going to propose a reconstruction algorithm which improves the FCSA algorithm in two algorithms. Firstly, MR image will be enhanced by proposed bicubic and bilateral method. Secondly, the enhanced MR image will be resolved by proposed image resolution method. These two algorithms improve the compression technique and image reconstruction. Our performance evaluation results have shown better results comparatively.

Keywords: Bicubic and bilinear method, FCSA, least square data fitting, L1 norm regularization, TV.

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Abstract: Dharti lauha and Navayasa lauha are the two famous ayurvedic preparation that are described in ayurvedic classics for the management in garbhini panduroga (Anemia in pregnancy). A simple random sampling method was followed for the clinical study . The 60 iron deficiency anemia pregnant women age group between 18 to 35 years divided into two group- Group A (n=30) and Group B (n=30) were treated with Dharti lauha and Navayasa lauha respectively. Both drugs provided significant effect on the signs and symptoms of shrama(fatigue), daurbalya(weakness), panduvarna(pallor),hrudrava (palpitation), shwasa (exertional dyspnoea), Bhrama (giddines), anna aruchi (anorexia), Shotha (edema), gatrashool(bodyache). Dhatri Lauha provided significiant result on Hb gm% ,RBC,MCV,PCV serum iron percent transferrin saturation and TIBC where as insignificant changes were found in MCH and MCHC. Navayasa Lauha provided significant result on Hb gm%.RBC,PCV,MCV,MCH,serum iron,percent transterrin saturation and TIBC where a insignificant results found in MCHC. Dhatri Lauha showed significant result in anemia in pregnancy(Garbhini Pandu) Keywords:- Dhatri Lauha, Navayasa lauha,Anemia, Panduroga , Iron deficiency anemia.

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Abstract: Leptospirosis remains one of the most common and most dreaded zoonotic infections worldwide.1 Traditionally related to certain socioeconomic or climatic conditions that favorendemicity in animal vectors and human exposure, it is generally confined to the developing parts of the world, being randomly reported from industrialized countries2 often as an imported disease following international travel to exotic destinations.

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[9]. La Rocque RC, Breiman RF, Ari MD, Morey RE, Janan FA, Hayes JM, et al. Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis. 2005;11:766–769
[10]. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, et al. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Trop Med Hyg.2004;70:670–675

Abstract: Hypertensive disorders complicate 5-10% of pregnancies. They are associated with poor maternal and foetal outcomes. Prompt diagnosis and judicious treatment is essential for a better foetomaternal outcome. We are reporting A case of primigravida with 34weeks of gestation diagnosed with preeclampsia at 26weeksof gestation who was on irregular, inadequate treatment in whom diuretics were used injudiciously ultimately landed with acute renal failure.

Key words: Pre eclampsia, acute renal failure, diuretics.

[1]. Cunningham,Leveno,Bloom,Hauth,Rose,Spong:Williams obstetrics, 23rd edition,chapter34,pg 706
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[4]. Gopalani KR, shah PR,et al: pregnancy related acute renal failure: a single centre experience Indian journal of nephrology 2008;18;1:17-215.
[5]. Drakeley AJ,Le Roux,Anthonoy J,et al:acute renal failure complicating severe preeclampsia requiring admission to obstetric intensive care unit Am J obstet gynecol 186:253,2002
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[7]. FURESEMIDE

Abstract: The Menisci are semi-lunar crescent shaped fibro-cartilages which serve to widen and deepen the tibial articular surfaces. Every knee has a medial and lateral Meniscus that absorbs stress and act as cushions between the bones at the knee. There are many differences in the anatomical features and insertion between the lateral and the medial Menisci also that the contour of the Menisci changes from C – shaped (semicircular) to circular (Discoid) which are important in relation to the injury mechanisms. Discoid lateral meniscus has an incidence of 5% of the population with a bilateral as common presentation. The distinguishing features of a Discoid lateral meniscus are its shape and posterior ligamentous attachments. Here the main aim was to describe the anatomical and pathological features of meniscus and carry out the Morphometric study, and finally conclusions being drawn and discussed.

Keywords: Discoid, Incidence, Menisci, Morphometric Study, Meniscal lesions.

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Abstract: Atopic dermatitis (AD) is a chronic inflammatory skin disease frequently associated with an increased serum level of IgE. lL- 13 is one of the cytokines that are produced by Th2 lymphocytes and it can induce the production of IgE. DNA methylation is known to play an important role in gene transcription and alteration of methylation (eg. hypomethylation) is set to be responsible for the development of certain disorders such as an autoimmune diseases and atopy.

Keywords: Atopic dermatitis, IgE, IL-13 mRNA and DNMT-1 mRNA.

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[9]. Nakamura T, Sekigawa I, Ogasawara H, Mitsuishi K, Hira K, Ikeda S and Ogawa H. Expression of DNMT-1 in patients with atopic dermatitis. Arch Dermatol Res. 2006 Oct;298(5):253-6.
[10]. Sekigawa I, Okada M, Ogasawara H, Kaneko H, Hishikawa T and Hashimoto H. DNA methylation in systemic lupus erythematosus. Lupus. 2003;12(2):79-85.

Abstract: Selection of endotracheal tube size is very crucial in paediatric anaesthesia due to fear of increased airway resistance and subglottic edema. Age related formula is being applied to select appropriate size, some time smaller endotracheal tubes are required due to various reasons, like formula calculated to western standards, reduced weight to the age, poor nourishment. We describe a case where age related formulas to predict endotracheal tube size were fallacious.

Keywords: 5th finger nail width, endotracheal tube size, microcephaly, paediatric anaesthesia.

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Abstract: Introduction: The association between Coronary Artery Disease (CAD) and diabetes is strong and has led to screening strategies in diabetic patients even before they are symptomatic. Diabetic patients often are unaware of myocardial ischemic pain, and so silent myocardial infarction and ischemia are markedly increased in this population. There is a high chance of developing sudden cardiac death in those with diabetes.

Keywords: Coronary Artery Disease , cystatin C ,type 2 diabetes mellitus

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Abstract: To reemphasize LIFT technique for fistula in ano with redefined inclusion and exclusion criteria developed by Thai surgeon Arun Rojanasakul & to standardize the procedure for our setting. Material & Method: A prospective observational study in 32 fistula in ano patients treated by LIFT technique from Sept 2011 to March 2013. Result: Fistula in ano healed primarily in all 32 patients as inclusion and exclusion criteria were strictly observed. Average healing time was around 4-6 weeks. 1 fistula took around 8wks to heal as the patient had immunocompromised status. Conclusion: Results of standardized lift technique are impressive & this technique can be implemented widely for treatment of fistula in ano provided inclusion & exclusion criteria are strictly observed.

Keyword: LIFT TECHNIQUE, FISTULA IN ANO, ARUN ROJANASAKUL.

[1]. Rojanasakul A. LIFT Procedure: a simplified technique for fistula in ano. Tech coloproctol.2009; sep; 13(3):237-40. Epub 2009 Jul. 28.
[2]. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula- in- ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007 mar; 90 (3):581-6.
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[4]. Peter J. Lunniss. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol (2009) 13:241–242.
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Abstract: Tissue bank is an establishment that collects, harvests, stores and delivers human tissue for the purposes of future use in transplant and medical research. For many years, such banks are dispensing tissue to the orthopaedic area, which has been using reconstructive techniques with allografts. The harvesting, preparation, and delivery of musculoskeletal tissue used for transplantation is an intricate process coupled with varying practices among different musculoskeletal tissue banks. Musculoskeletal allografts are used in a wide variety of orthopaedic surgeries ranging from primary bone defects, trauma, and carcinoma to congenital defects. Tissue banking guidelines andpolicies need to be specific and effective in minimizingpotential harms to donors, donor families, as well as to future tissue research and product development.All tissue bank policies and procedures for donor screening, serologic and microbiologic testing should meet current standards and regulations established by the American Association of Tissue Banks (AATB) and the United States Food and Drug Administration (FDA). The musculoskeletal banks should follow the improvement of the patient care, trauma elimination, morbidity associated with secondary surgical procedures, reduction of the prolonged hospital stays etc. This article provides the reader with information on current standards and practices in musculoskeletal banking.

Key words: Tissue bank, Musculoskeletal tissue banks, Musculoskeletal allografts, Orthopaedic surgeries

[1] M.J. Joyce, R.M. Wilkins, S.A. Brubaker, Managing musculoskeletal tissues in the hospital/surgical Center. CTBS, AAOSNow, 2009. http://www.aaos.org/news/aaosnow/dec09/research2.asp

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[5] A. Nather. Tissue banking in the Asia Pacific Region: Current status and future developments. J OrthopSurg 7,1999, 89–93.

Abstract: Background: Rheumatoid arthritis is a systemic autoimmune disease characterized by chronic joint inflammation and subsequent destruction. It also associates with excessive cardiovascular morbidity and mortality similar to metabolic syndrome which reflects a clustering of classical cardiovascular risk factors. This study is designed to investigate the Prevalence of Metabolic syndrome in rheumatoid arthritis patients and possible association to disease related risk factors. Material and Methods: The subjects were 203 patients with rheumatoid arthritis diagnosed according to the American College of Rheumatology criteria while metabolic syndrome was defined according to National Cholesterol Education Program criteria. Results: The overall prevalence of metabolic syndrome in rheumatoid arthritis patients was 51.2 %; being higher in women than men. Women with metabolic syndrome had a higher prevalence of Cardiovascular disease than those without metabolic syndrome (p = 0.004). Significant differences were observed in traditional cardiovascular disease risk factors which are common in rheumatoid arthritis with metabolic syndrome (p < 0.001). Conclusion: The prevalence of metabolic syndrome is high in patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease with metabolic syndrome suggests that the increased prevalence of Cardiovascular disease in patients with rheumatoid arthritis may be attributed to the inflammatory burden of the disease in addition to traditional Cardiovascular disease risks of metabolic syndrome. Keywords: Atherosclerosis, body mass index, cardiovascular disease, hypertension, metabolic syndrome, rheumatoid arthritis, rheumatoid factor.

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Abstract: Potential risk factors for cardiovascular diseases (CVD) tend to cluster in childhood and are strongly associated with obesity. The prevalence of obesity in children has increased dramatically over the last 20 years, leading to higher health risk associated with complications such as type 2 diabetes, high blood pressure and cardiovascular disease. Leptin is a hormone produced by the adipocytes to regulate food intake, its circulating levels directly correlate with the amount of body fat and body mass index (BMI). Previous researchers had provided evidence suggesting that ob gene expression is up regulated by some inflammatory cytokines such as IL-6

Keywords: Obese children exhibited a high prevalence of metabolic syndrome. The children with greater insulin resistance exhibited more risk factors. In the light of these findings intervention measures are necessary in order to prevent excessive weight gain during childhood.

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Abstract: Purpose: Intravitreal Triamcinolone Acetonide (IVTA) is one of the treatment options for Macular Edema (ME). This can cause several complications like transient elevation of intraocular pressure, cataract formation and endopthalmitis. We describe an atypical complication of IVTA. Case: A 60-year-old South Indian male presented with ME secondary to central retinal vein occlusion. We performed intravitreal injection of 4 mg of Triamcinolone acetonide (TA). However, the drug dispersed behind equatorial part of posterior lens capsule and also into the anterior chamber. Conclusion: Although IVTA is an easy and effective treatment for ME, TA may cause inadvertent complications when injected into the eye. Early recognition and appropriate management of such complications is essential.

Keywords: Intravitreal Injection, Pseudophyopyon, Triamcinolone Acetonide.

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[4] A. Jain, M. R. Vishwanath and S. J. Charles, Triamcinolone Pseudo-Cataract. Annals of Ophthalmology, 38(1), 2006, 67-68.

[5] Y. B. Sakalar, K. Unlu, U. Keklikci, et al, Persistent Triamcinolone Acetonide particles on the posterior lens capsule after intravitreal injection, Annals of Ophthalmology, 40(3-4), 2008,190-192.

[6] H. Hosseini, H. R. Anvari-Ardakani, et al, Ultrasonographic pictures of Intravitreal Triamcinolone Acetonide, European Journal of Ophthalmology, 19(2), 2009, 263-267.

[7] Sutter FK, Gillies MC, Pseudo-endophthalmitis after intravitreal injection of triamcinolone, Br J Ophthalmol, 87, 2003, 972–974.

[8] Roth DB, Chieh J, Spirn MJ, et al, Non-infectious endophthalmitis associated with intravitreal triamcinolone injection, Arch Ophthalmol, 121, 2003, 1279–1282.

[9] Nelson ML, Tennant MT, Sivalingam A, et al, Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection, Retina, 23, 2003, 686–691.

[10] Jonas JB, Kreissig I, Degenring RF, Endophthalmitis after intravitreal injection of triamcinolone acetonide, Arch Ophthalmol, 121, 2003, 1663–1664.