Journal of the Indian Medical Association最新文献

Bronchiectasis is an abnormal permanent dilatation distortion and destruction of the airways with both pulmonary and extrapulmonary side-effects. The aim of the study was to find out the presenting features, aetiologies and socioeconomic factors in patients of bronchiectasis. It is a prospective observational study comprising 53 patients over aperiod of two years. Aetiologies were determined using Kuppuswamy's socioeconomic scale. Number of exacerbations and mortality were noted. The age ranged from 14 to 80 years (mean: 43.33 ± 16.37 years). There were 35 males (66%) and 18 females (34%). Clubbing was seen in 58% cases (n = 31); 11% patients (n = 6) had haemoptysis. Bilateral involvement was seen in 64% cases (n = 34). Allergic bronchopulmonary aspergillosis and post-tuberculous sequelae were the commonest causes (n = 12, 23% each). The range of household medical expenditure in these patients varied from 6% to 47%. Lower the Kuppuswamy scale poorer the follow-up (p-value < 0.05). Multiple exacerbations were seen in all classes of patients (p-value 0.09). Death occurred in 4 patients. It is concluded that bronchiectasis is a chronic illness with significant morbidity and socioeconomic implications. Lower the socio-economic scale, poorer the compliance of therapy.

The aim of this study is to compare the effectiveness of 100 mg versus 200 mg mifepristone along with misoprostol for medical abortion in gestation upto 56 days. This is a prospective controlled study. Eighty women seeking medical abortion with a gestation up to 56 days were included in the study. The women were randomly allotted into two groups. They received 100 mg/200 mg mifepristone on day 1 followed by 800 mcg misoprostol two days later. Women who had not aborted completely by day 14, received a repeat dose of 400 mcg misoprostol and were evaluated on day 21 for completeness of the procedure. Five women in both the groups had incomplete abortion by day 14 (12.5%), while one woman in the test group had to undergo dilatation and evacuation on day 3 due to excessive bleeding. By repeating a second dose of misoprostol, all of them aborted completely and the complete abortion rates were markedly improved from 85% and 87.5% in the test and the control group, respectively to 97.5% and 100%, respectively. It may be concluded that 100 mg mifepristone is as effective as 200 mg and appears to be the lowest effective dose for medical abortion.

Denial to a girl child of her right to live is one of the heinous violations of the right to life committed by the society. Gender bias and deep rooted prejudice and discrimination against girl child and preference of male child have led to large scale female foeticide in the last decade. The declining sex ratio is a major concern for all. The census 2001 data indicates that female ratio is declining at an alarming rate and needs immediate action. In order to check the female foeticide, the Prenatal Diagnostic Techniques (regulation and prevention of misuse) Act 1994 was enacted and became operational from January, 1996. This article is an attempt to throw light on the successful implementatuion of PC and PNDT Act in the Gulbarga region and active participation of various organisations and people in proper implementation of the act.

A meningomyelocele is herniation of meninges along with neural elements through a congenital defect in the cranium or vertebral column. Reported incidence of occipital meningomyelocele is 1 in 5000 live births. Children with meningomyelocele may have varying degrees of sensory and motor deficits and other important associated congenital defects with clinical features of brain stem compression. The major anaesthetic challenges associated with myelomeningocoele repair includes difficulty in securing airway, intra-operative prone positioning, accurate assessment of blood loss and prevention of hypothermia.

Small cell carcinoma of the urinary bladder is extremely rare. In this report, a case of non-metastatic small cell carcinoma of the urinary bladder treated by systemic chemotherapy followed by adjuvant external radiotherapy, with a brief review of the epidemiology, clinical features, diagnosis, pathological features, staging, treatment and prognosis about this neoplasm is reported. A 53 years old man attended with sign and symptoms suggestive of a bladder cancer. Computed tomography of the whole abdomen showed a large tumour at right lateral wall of the bladder. Transurethral resection and histopathological study of the bladder tumour established the diagnosis of a small cell carcinoma. The patient received six cycles of platinum based chemotherapy with adjuvant locoregional external radiotherapy. He had an invasive bladder recurrence thirteen months later and died shortly afterwards.

Prevalence of lower urinary tract symptoms (LUTS) and groin hernia increase with rising age. Straining in itself is an important aetiology of inguinal hernia. Posthernioplasty retention of urine is one of the most significant complications. The aims of this study are to know the prevalence of signifi- cant LUTS in men > 50 years (n = 200) undergoing inguinal hernia surgery, to identify the high-risk patients for posthernioplasty urinary retention and to assess the role of peri-operative use of alpha- blocker in reducing the incidence of postoperative urinary retention in these patients. This study was performed at RKMSP Hospital, Kolkata from August 2005 to January 2008. All findings were docu- mented. Prevalence of significant LUTS above 50 years undergoing inguinal hernioplasty was found to be 48% (96 out of 200). Out of 96 patients who had International Prostate Symptoms Score>7, 48 patients had maximal urine flow (Qmax) < 10 ml/second and postvoid residual urine > 100 ml, 48 patients belonged to high risk group for postoperative retention of urine. Incidence of postoperative retention of urine among high risk group among tamsulosin users was only 3(12.5%) out of 24 patients and among tamsulosin non-users was 10(41.6%) out of another 24 patients. Therefore, we concluded that among male patients > 50 years of age (undergoing groin hernia surgery) prevalence of significant LUTS increases per decade. We also concluded that tamsulosin is important for alleviation of LUTS and is quite effective for prevention of postoperative retention of urine and helpful for early discharge of patients.

Migraine is a common neurological problem, which accounts for large morbidity and disability. Non-steroidal anti-inflammatory agents and triptans are mainly used to terminate the attack of moderate to severe migraine. This study compared the safety, efficacy and pharmaco-economics of rizatriptan (5HT(IB/ID) agonist) versus conventional therapy (paracetamol 500 mg + metoclopramide 10 mg + flunarizine 10 mg + alprazolam 0.5 mg). In this study, drug combinations used in conventional therapy was indigenously designed by the neurologist. Rizatriptan was found more efficacious than conventional therapy in terminating an attack of migraine and its' associated symptoms but looking into the contra-indications, side-effects and cost of the former there has been limitation in its prescription as well as the use.

Tuberculosis is very much prevalent in developing countries like India. Genito-urinary tuberculosis usually occurs after 5 to 15 years of the primary lung infection. After lymph node involvement,it is the second common form of extrapulmonary tuberculosis. In this retrospective study, case records of 67 patients diagnosed with genito-urinary tuberculosis in our institute were thoroughly reviewed regarding age, sex, the urogenital organ involved by tuberculosis,mode of diagnosis,and treatment given to the patients. Median age of the patients was 38.5 years, males were more commonly involved than females, kidney was the most common organ involved by tuberculosis followed by ureter and urinary bladder.HIV infection was present in a single patient who had developed tuberculous perinephric abscess. Most common mode of diagnosis was by histopathological examination of the organ involved. Hydronephrosis of the involved kidney with echogenic debris in the dilated pelvicalyceal system on ultrasonography and non-visualised kidney on intravenous urogram was the most common findings on imaging studies who underwent nephrectomy. One patient was seen with tuberculosis of the glans penis which is not much common. Surgical intervention was ablative in nature in most of the cases in the form of nephrectomy. Early diagnosis is important and can prevent the anatomical defor- mity and loss of function of the involved organ.

Conjunctival melanoma is a rare ocular malignancy occurring most frequently in aged patients. It is a potentially life-threatening condition. This article presents history and management of a case of malignant melanoma of conjunctiva resembling a horn.

The first clinically available antiprogestin, mifepristone has generated immense interest in the research community since its' discovery in 1980. Mifepristone is a synthetic orally active steroid with potent antiglucocorticoid, antiprogestogen and a weak anti-androgen activity, used primarily for termination of pregnancy. It acts as a competitive receptor antagonist at the progesterone receptor in the presence of progesterone, and acts as a partial agonist in the absence of progesterone. Extensive research has been carried out regarding its' antiprogestogen activity for use in medical abortion. Lately other medical uses of mifepristone are being explored like for induction of labour in late preg- nancy, as oestrogen free oral contraceptive and for treatment of endometriosis, uterine fibroids, ovarian cancer, prostate cancer, meningiomas, Cushing's syndrome and major psychotic depression.