Pingle J.,Apollo Health City
Indian Journal of Orthopaedics | Year: 2014
Background: Nonunion and avascular necrosis (AVN) of the femoral head remains one of the major complications following femoral neck fractures. Despite various surgical techniques and internal fixation devices, the incidence of nonunion and AVN has remained unsolved. Neglected nonunion of femoral neck fracture is common in the developing world. Treatment options include rigid internal fixation with or without bone grafting, muscle pedicle bone graft, valgus osteotomy of the proximal femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO). Materials and Methods: Over a period of 35 years (1974-2008), 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008), All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years). Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. Results: Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°). Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore's pins. These were reopened and cancellous screws were inserted in the same tracks. Conclusions: Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.
Subhan I.,Apollo Health City |
Jain A.,University of Rochester
International Journal of Emergency Medicine | Year: 2010
Background: The Republic of India, the world's most populous democracy, has struggled with establishing Emergency Medical Care. However, with the recent recognition of Emergency Medicine as a formal specialty in medical training, there has been renewed vigor in the developments in the field. Method and Results: We outline here the building blocks of the health care system in India, and the contribution each has made and is capable of making to the growth of emergency medical services. We also provide an account of the current situation of emergency medicine education in the country. Conclusions: As we trace the development and status of emergency medicine in India, we offer insight into the current state of the field, what the future holds for the emergency medical community, and how we can get there. © The Author(s) 2010.
Ganesh Y.,Apollo Health City
BMJ case reports | Year: 2011
A 35-year-old Indian working in Dubai had come to India for his annual vacation. He presented with a shortness of breath and mild chest discomfort of 3 months duration. Routine investigations gave normal results, except for his chest x-ray that showed homogenous opacity in the right mid and lower zones. Chest CT scan revealed a huge mass with fat and soft tissue involving the anterior mediastinum predominantly on the right side extending into the pericardiac region. The mass was pushing the right hemidiaphragm inferiorly and was compressing the right lung superiorly with atelectasis. The patient underwent surgical excision of the mass and recovered uneventfully. Gross specimen showed an encapsulated mass weighing 2.585 kg. Histopathological examination revealed lobules of mature adipose tissue interspersed with islands of mature thymic tissue and prominent Hassal's corpuscles suggesting thymolipoma. There was no evidence of malignancy.
Ramana K.V.,Prathima Institute of Medical science |
Rao R.,Apollo Health City
Annals of Tropical Medicine and Public Health | Year: 2013
Human immunodeficiency virus (HIV) is a retrovirus belonging to the family Lentiviruses, which are responsible for chronic and long-lasting infections including the simian immunodeficiency virus (SIV) in monkeys. Since 1981, when the first acquired immunodeficiency syndrome (AIDS) cases were reported, HIV poses a challenge to human beings, and the UNAIDS global estimate reveals that currently more than 33.2 million people are living with HIV infection worldwide. HIV infection leads to variable disease course in different people. The biological basis of this variability in the disease progression is still unknown. Initiation of highly active antiretroviral therapy (HAART) although reduced the mortality, morbidity arising from antiretroviral side effects was a cause of concern. HIV-infected patient care has now shifted from complications arising from opportunistic infections to other causes attributable to HIV pathogenesis and toxic effects of HAART. Monitoring the disease progression and the response to HAART is traditionally carried out using TCD4+ cell counts and HIV/RNA viral load. Many clinical and laboratory markers have been used to estimate disease progression in HIV1 infection. HIV/AIDS after introduction of HAART has taken a different course where people infected with HIV have been considerably living longer due to reduced incidence of opportunistic infections and other AIDS-related conditions. HIV patient care should be multifaceted involving specialist HIV primary care physicians, infectious disease specialists, and emergency physicians considering the ways by which HIV and HAART have changed treatment and management of HIV-infected individuals.
Srivastava A.,Apollo Health City
The Journal of invasive cardiology | Year: 2012
A pseudoaneurysm due to infection after a modified Blalock-Taussig shunt is a rare but potentially fatal complication that can rupture, compress mediastinal structures, produce shunt occlusion, and bacteremia. In these patients, medical management of endocarditis is often incomplete because of the presence of prosthetic material and requires the take down of the shunt, most often by surgery, which can be technically challenging. We outline the use of a covered stent to exclude pseudoaneurysm from circulation.