Journal of the Indian Medical Association最新文献

No effective medical treatment is available for the treatment of ochronotic arthritis which is a manifestation of long standing alkaptonuria. A patient of long standing alkaptonuria progressing to debilitating ochronotic arthritis of both hip and knee jointswith severe deformities has been described. He was successfully treated with bilateral total hip and knee arthroplasty with an excellent four-year follow-up. The occurrence of severe osteoporosis in this condition and the importance of advocating surgery before development of severe deformities of the joints to improve the outcome of surgery has been highlighted in this article.

Current literature has suggested that sentinel lymph node biopsy may replace axillary dissection as the nodal staging procedure of choice in early breast cancer. The aim of this study is to evaluate the effectiveness and accuracy of sentinel lymph node biopsy using methylene blue dye in predicting axillary nodal status in early breast cancer with clinically impalpable axillary lymph nodes. In the period between June 2005 and May 2009, 50 patients with early breast cancer and clinically impalpable axillary lymph nodes, underwent sentinel lymph node biopsy using methylene blue dye followed by completion of axillary dissection in the same setting after taking a written consent from the patients. Of the included 50 patients, sentinel lymph node biopsy was successful in 48 patients (96.0%). Accuracy of sentinel lymph node biopsy was 95.8%, sensitivity was 90.0%, false negative rate was 6.7%, negative predictive value was 93.3%.

A 40-year-old man, resident of a rural area of Rajasthan state of India presented with recurrent biliary colic and fever since last 2 years. Examination was normal and investigations revealed a dilated common bile duct with elevated alkaline phosphatase. Magnetic resonance cholangiopancreatography revealed a dilated biliary system without any evident cause. Patient was subjected to endoscopic retrograde cholangioancreatography and it demonstrated biliary dilatation with a linear filling defect in lower common bile duct, further sphinicterotomy was done and a live Fasciola hepatica was extracted using a biliary basket.

The objective of this study was to evaluate the role of biceps tendon sheath effusion detected on ultrasound as a diagnostic clue to rotator cuff pathology. Despite being the most common cause of shoulder pain in adults early sonographic changes of rotator cuff tendinopathy are easy to miss. A total of 31 patients out of whom 27 had unilateral shoulder pain and 4 had bilateral complaints under- went ultrasonographic examination of shoulder joint using high frequency linear array transducer. Any fluid surrounding the long head of biceps tendon was noted followed by a careful search for any associated sonographic abnormality involving the rotator cuff. Eighteen out of the 35 had presence of fluid in their biceps tendon sheath. Twelve had presence of both biceps tendon sheath effusion and rotator cuff pathologies. Among 17 patients, who had no fluid in their biceps tendon sheath, only 2 had rotator cuff involvement whereas rest 15 had neither biceps tendon sheath fluid nor rotator cuff pathologies. A significant association was found between presence of fluid in long head of biceps tendon sheath and rotator cuff pathologies. Thus the most common finding observed in association with the presence of fluid around the long head of biceps tendon sheath in this study was tendinosis of rotator cuff. On ultrasonography simple presence of fluid around the long head of biceps tendon sheath demands careful examination of rotator cuff.

Air travel has become so common these days that about one billion people travel in one year. A few number of the persons travelling by air have suffered or are suffering from one or more medical conditions which may increase risk to passenger himself. There may be additional risk to copassengers, crew of aircraft or safety of aircraft may be compromised. The present article evaluates different medical conditions from pregnancy to cardiovascular diseases in relation to the air travel.

Hydatid disease is a common parasitic disease of liver. Rupture of aliver hydatid into the peritoneal cavity, either spontaneous or iatrogenic (during surgery) leads to widespread dissemination and is a difficult problem to manage. Surgical management along with long term antihelminthic treatment offers the only hope for such cases. A case of disseminated intra-abdominal hydatid disease and its management has been reported.

Proximal femoral focal deficiency (PFFD) is a rare anomaly with an estimated incidence of < 0.2/ 10,000 births. The aetiology of PFFD is unknown though various agents have been implicated including anoxia, ischaemia, mechanical or thermal injury. Herein is reported a case of a 22-year-old primigravida who delivered a baby with PFFD. This patient had developed high grade fever and had undergone ischiorectal abscess drainage at 7 weeks of gestation; maternal hyperthermia combined with anoxic injury might have been contributory factors in the causation of this disorder. So, it is of prudent importance to do prenatal targeted ultrasonography in patients who develop febrile illness in early pregnancy.