Journal of the Indian Medical Association最新文献

The clavicle fractures managed non-operatively have shown a high prevalence of symptomatic malunion and non-union. We sought to compare patient-oriented outcome and complication rates following non-operative treatment and those after operative treatment of clavicular fractures. In a prospective randomised study, 30 patients with 30 clavicle fractures were randomised by systemic allocation to either operative treatment or non-operative treatment. Fifteen patients were in each group. Outcome analysis included standard clinical follow-up and the disability of the arm, shoulder and hand (DASH) score, and plain radiographs. The mean follow-up of both groups were 12.56 months. DASH scores were significantly improved in the operative fixation group at all time-points. The mean time to radiographic union was 27.46 weeks in the non-operative group compared with 15.73 weeks in the operative group (p = 0.000). There were no non-unions in both groups. Symptomatic malunion developed in seven patients (46.66%) in the non-operative group and in none in the operative group. The complications in the operative group were hardware-irritation (one case) and incisional numbness (one case). At final follow-up, the patients in the operative group were more satisfied with the appearance of the shoulder (p = 0.039) and with the shoulder in general than were those in the non-operative group. There were no differences between the two groups with respect to patient age, sex, side of injury or associated injuries. Operative fixation of AO type B2 clavicular fracture results in improved functional outcome and early union compared with non-operative treatment at one year of follow-up. This study supports primary operative fixation of completely displaced mid shaft clavicular fractures in active adult patients.

The observational study was aimed at assessing the effectiveness and tolerability of Heptral (brand of ademetionine 1,4-butane disulfonate) in Indian patients presenting with intrahepatic cholestasis (IHC) due to chronic Non alcoholic liver disease (NALD). The study also aimed at understanding the prescribing practices of physicians as well as the profile of patients being prescribed Heptral. This Prospective observational study included 250 patients across 23 sites in India. The assessments of health-economic parameters, liver biochemistry, signs and symptoms of IHC (fatigue, jaundice, and pruritus) were performed at two visits, i.e., at baseline and after six weeks of Ademetionine treatment. Ademetionine was prescribed as part of the routine medical treatment as per the local label and not as a study intervention. Full analysis set (FAS) population included 244 patients. The mean age was 43.75 +/- 11.14 years and 75.5% (184/244) patients were males. 30.7% (75/244) of FAS population presented with cirrhosis. Concomitant medications were recommended to 44.4% (108/243) patients. Ademetionine treatment resulted in statistically significant reduction (p < 0.0001) in burden of disease parameters (number of days off work and number of visits to doctor), levels of biochemical markers and signs and symptoms of IHC. Physicians had favourable opinion for effectiveness and tolerability of Ademetionine for majority of the patients. Administration of Heptral in patients with NALD and IHC resulted in significant improvement in burden of disease, laboratory markers, signs and symptoms of cholestasis. The treatment was well tolerated.

Modified Boytchev is one of good operative procedure for recurrent anterior dislocation of shoulder in terms of recurrence and loss of motion of shoulder by rerouting the conjoined tendon deep to subscapularis. To know the possible mechanism of this procedure, electromyographic study showed the significantly greater recruitment pattern in subscapularis as compared to pre-operative subscapularis electromyographic pattern and other rotator cuff muscles.

Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications.

Ambulatory blood pressure monitoring provides a more reliable assessment of actual BP than office BP and is a more sensitive risk predictor of clinical cardiovascular outcomes. Recent international guidelines for hypertension have emphasised the usefulness of ambulatory BP for diagnosis and management of hypertension. We used ambulatory blood pressure monitoring to monitor the effect of the pharmacological treatment in patients with stage 1 or 2 hypertension. This was a multicentric randomised controlled trial having 360 subjects with 180 in each treatment arm. The duration of study was 6 months. The patients were randomly selected to receive atenolol or losartan as initial therapy. The dose of atenolol or losartan was 50 mg once daily at 8 am in the morning. Ambulatory BP assessment was done in a subgroup of subjects using Schiller BR-102 plus machine. One hundred and thirty patients were recruited for the study using ambulatory blood pressure monitoring. There were 66 patients in atenolol arm and 64 patients in the losartan arm. A significant white coat hypertension was noticed in both the arms. Out of 130 subjects in the ambulatory group, 41.53% had a white coat hypertension. Statistically significant reduction of office BP was observed with both atenolol and losartan; however, no significant difference in efficacy of the two drugs was found in reducing office BP. However, when using ambulatory blood pressure monitoring, the reduction with either drug was not significant. The dipper status was better in the atenolol group than the losartan group. Neither of the drugs prevent morning surge of BP when administered once daily in the morning. There was high prevalence of white coat hypertension in patients with stage 1 and stage 2 hypertension. There was similar reduction of systolic blood pressure and diastolic blood pressure by the 2 study drugs. Atenolol scores over losartan in converting non-dipper to dipper but its' impact on clinical outcome is not known. Morning surge of BP was unaffected by either of the study drugs.

Surgical intervention results in a wound. In practice of surgery, wounds and their management is a fundamental job. Various surgical wounds are created by surgeons including abdominal laparotomy wounds. Therefore disruption of a repaired laparotomy wound is an acute wound failure. Burst abdomen, abdominal wound dehiscence, dehiscence of fascial layers is a postoperative complication and the reported mortality rate is about as high as 45%. Incidence of dehiscence as described in literature ranges from 0.4%-3.5%. No specific single cause is one reason for all wound disruption. Abdominal wound dehiscence, which may occur at any age, has been subject to numerous investigations in the past and reviews of many series of cases have been there in the literature. A good knowledge of risk factors is essential for prophylaxis. High risk cases may get benefit from close observation and early intervention.

A prospective randomised controlled study was conducted at RG Kar Medical College and hospital to compare the efficacy and side-effects of two doses of oral misoprostol, with one dose following mifepristone in early abortion. Two randomly allocated groups of seventy-five women each were formed, which were comparable in all respects and also conformed to the inclusion and exclusion criteria laid down in this study. Both groups received 200 mg of mifepristone on day one. After 48 hours, both groups received 400 microg of misoprostol and 3 hours later one group received 3 tablets of 200 microg misoprostol and the other group received 3 tablets of placebo. The women were then followed up to note the time of expulsion, completeness of the process, amount of bleeding encountered, side-effects if any or any other observation. The most important parameter ie, the completeness of the expulsion when compared showed no statistically significant difference between the two groups (p-value = 0.1025).

Pulmonary hypertension is an important cause of dyspnoea in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients. The effect highly active antiretroviral therapy on pulmonary artery pressure has been an area of controversy. The purpose of this study was to evaluate the effect of antiretroviral therapy on pulmonary hypertension in HIV patients. This prospective cohort study was performed in a peripheral medical college of West Bengal with 88 patients from October 2008 to September 2011. By echocardiography, pulmonary artery pressure was recorded before initiation of antiretroviral therapy. After one year of antiretroviral therapy repeat echocardiography was done and pulmonary artery pressure was evaluated. The values were analysed. The present study showed that highly active antiretroviral therapy improves pulmonary artery pressure in HIV/AIDS patients if instituted at early stages (WHO classes I and II). However, at more advanced stages of pulmonary artery hypertension, it does not have any significant effect on reduction of the same. The present study documents that early detection of pulmonary artery hypertension in HIV/AIDS patients is essential and prompt institution of highly active antiretroviral therapy should be considered in them even when those patients do not fulfill the conventional criteria for initiation of this treatment.

The present study was being undertaken in retrospective and prospective basis to investigate the ultimate outcome of the procedure in type IIIA and type IIIB injuries. We have used simple AO type of external fixator and applied uniplanar double tube frame and unilateral biplanar frame. Frames were selected randomly; unilateral uniplanar frame in some patients having type IIIA wound and in some patients having type IIIB wound. Similarly, unilateral biplanar frames were used in some patients with observations have shown that these external fixators are simple, easy to apply, cost-effective and yield acceptably good results. Thus, the 'external fixator' application for the management of open fractures of tibia may give good results even to the poor patients and may be suitable for underdeveloped and developing countries. A study was undertaken by the committee on fracture and traumatic surgery of the American Academy of Orthopedic Surgeons to evaluate the efficacy and practicability of this method of treatment. The study was carried out in the department of orthopaedics, RG Kar Medical College & Hospital, Kolkata in retrospective and prospective basis since June, 2005. Forty-seven patients were selected from the outpatients department and emergency department having open fracture of shaft of the tibia with or without fracture of the fibula and were treated in the orthopaedic indoor department. The patients were followed up for 6 months to 2 years. Out of 47 cases, 2 patients could not be communicated for follow-up. Normal union could be seen in 25 patients followed by delayed union (n = 11) and malunion (n = 11). Joint shiffness was seen in 16 patients.