Journal of the Indian Medical Association最新文献

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.

Microbial keratitis tops the list of the diseases leading to corneal blindness. Corneal transplant, either partial or full thickness, is the most helpful technique for infective keratitis that remains non- responsive, even with the most suitable medical treatment. Aims of this study are to evaluate the success of therapeutic penetrating keratoplasty in non-responsive microbial keratitis in eradication of infection, restoration of anatomical integrity of the globe and prevention of complication that influence the visual prognosis in a positive way. Result of the retrospective study of 60 patients who underwent therapeutic penetrating keratoplasty, following infected keratitis showed restoration of anatomical integrity in 51 cases (85%). Success rate of penetrating keratoplasty was higher in non- perforated (92%) than in perforated group (74.28%) and in non-mycotic than in mycotic group. Penetrating keratoplasty in non-responsive infected keratitis is thus helpful.

Infertility is a distressing condition but extenuating circumstances sometimes make the choice of treatment seem paradoxical. Here is discussed a challenging case of a 30-year-old woman with no living child and secondary infertility who presented with a large abdominal mass and severe abdominal pain, sequelae of previous obstructed labour. There was complex management dilemma. She was young, had no living child, had undergone vesicovaginal fistula (VVF) repair and vaginoplasty yet was wanting fertility; however she was distressed with the abdominal pain and desired a complete cure. Both she and her spouse were counselled about the high possibility of failure if repeat attempt at vaginoplasty was made, and possible damage to the VVF repair. Finally, decision of exploratory laparotomy with total abdominal hysterectomy was taken after counselling the couple about adoption as an option for childbearing.