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Sachdeva K.,NSCB Medical College Jabalpur
Indian Journal of Otolaryngology and Head and Neck Surgery

AIM of the study is to evaluate etiopathogenesis role played by predisposing conditions (Diabetes, Immunosupression), precipitating factors (trauma/surgery/ketoacidosis) and possible role of occupational hazard is discussed briefly. Clinical presentation and management of patients presenting with rhinoorbitocerebral mucormycosis is discussed. The prospective study of patient undergoing treatment of mucormycosis] without control Setting was done in ENT Deptt. NSCB Medical College, Jabalpur (tertiary referral centre of mid India). Subject were patients presenting with invasive fungal rhino sinusitis presenting with orbital involvement and cranial nerve palsies undergoing treatment. The detailed history, clinical examination including cranial nerve examination, blood test, CTscan and biopsy. Nasal endoscopy, CWL surgery and medical management with 6 month follow up. All six patients were diabetic when evaluated on presentation. Two patients had ketoacidosis. Four had history of surgery in recent past. Blood stained nasal discharge and dysaesthesia of face are early warning signs. They had necrotic lesion in nose and infraorbital area with 2, 3, 4, 5, 6 and 7 cranial nerve involvement. Skin necrosis/Mucosal necrosis, facial palsy and diplopia signify advanced disease. Altered sensorium, panopthalmitis & diabetes complicated with ketoacidosis signify bad prognosis. In present study two patients with advanced disease, altered sensorium and ketoacidosis succumbed within 72 hours in spite of anti fungal medicine. Of the four surviving patients, all responded well to treatment but had residual sixth and seventh nerve palsy. One patient defaulted in diabetes control & had recurrence after 6 months. Early diagnosis, aggressive surgical debridement and proper management of underlying metabolic abnormality along with amphotericin B can avert the bad prognosis of rhinoorbitocerebral mucormycosis. © 2013 Association of Otolaryngologists of India. Source

Yadav Y.R.,Nscb Medical College And Hospital | Parihar V.,Nscb Medical College And Hospital | Pande S.,NSCB Medical College Jabalpur | Namdev H.,Nscb Medical College And Hospital
Journal of Neurological Surgery, Part A: Central European Neurosurgery

Background Microsurgical resection, stereotactic aspiration, endoscopically assisted microsurgical resection, and ventriculoperitoneal shunt have been the treatment options for colloid cysts of the third ventricle. Recently, an endoscopic approach has been recognized as an effective alternative to open surgery. There is suspicion about the long-term recurrence rate and about obtaining complete removal of cyst. Patients and Methods This is a prospective study of 24 patients with colloid cyst who underwent endoscopic resection. Preoperative computed tomography (CT) scans revealed hydrocephalus in all the patients. Postoperative magnetic resonance imaging (MRI) was done in all cases. Results Age ranged from 16 to 57 years. There were 16 male and 8 female patients. The diameter of the cyst varied from 14 to 24 mm. Operating time ranged from 90 to 156 minutes. Total resection was achieved in 21 patients. All patients with subtotal excision underwent coagulation of residual cyst wall. The follow-up period ranged from 6 to 78 months (mean, 37 months). None of the patients developed any symptoms at 26, 31, and 39 months of follow-up. Preoperative symptoms disappeared in all the patients except for memory disorders and seizures in one patient each. No residual cyst was observed on the postoperative MRIs in 21 patients. Hospital stay was 4 to 10 days (median, 6 days). No endoscopic operation was converted into an open resection. Conclusion Endoscopic excision of a colloid cyst is an effective and safe alternate method. Although the follow-up time was short, residual cyst wall remained asymptomatic without any evidence of growth after subtotal excision and coagulation of wall. © 2014 Georg Thieme Verlag KG Stuttgart New York. Source

Yadav Y.R.,NSCB Medical College Jabalpur | Yadav Y.R.,Nscb Medical College And Hospital | Parihar V.S.,NSCB Medical College Jabalpur | Ratre S.,NSCB Medical College Jabalpur | Kher Y.,NSCB Medical College Jabalpur
Journal of Neurological Surgery, Part A: Central European Neurosurgery

Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But they are also associated with limitations such as the initial learning curve, proximal blind spot, visual obscurity, difficulty in controlling bleeding, disorientation, and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy and microsurgery are similar, endoscopy requires additional skills. A thorough understanding of endoscopic techniques and their limitations is required to get maximal benefit. Knowledge of possible complications and techniques to avoid such complications can improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able to manage complications and have a second strategy such as a cerebrospinal fluid shunt if ETV fails. It is better to abandon the procedure if there is disorientation or a higher risk of complications such as bleeding or a thick and opaque floor without any clear visualization of anatomy. Attending live workshops, practice on models and simulators, simpler case selection in the initial learning curve, and hands-on cadaveric workshops can reduce complications. Proper case selection, good surgical technique, and better postoperative care are essential for a good outcome in ETV. Although it is difficult to make a preoperative diagnosis of complex hydrocephalus (combination of communicating and obstructive), improving methods to detect the exact type of hydrocephalus before surgery could increase the success rate of ETV and avoid an unnecessary ETV procedure in such cases. © 2015 Georg Thieme Verlag KG Stuttgart. Source

Daryani K.K.,NSCB Medical College Jabalpur | Jaiswal M.,NSCB Medical College Jabalpur | Rawat S.,NSCB Medical College Jabalpur | Kuchya S.,NSCB Medical College Jabalpur
International Journal of Pharma and Bio Sciences

ADR related to Anti cancer drugs are important in view of mortality and morbidity. So the current work is targeted to detection, assessment and reporting of Adverse Drug Events (ADEs) in cancer patients undergoing therapy for cancer and treated with Monoclonal Antibodies in a teaching hospital of central india. It was a hospital based prospective observational study with follow up during the study period. Patient Proforma and CDSCO adverse drug event reporting form were used for data collections. ADEs observed with Bevacizumab therapy includes nausea, vomiting, diarrhea, muscular stiffness, fever, chills, anemia and aggravation of burning pain of pre-existing hemorrhoids. ADEs observed with Cetuximab therapy includes dyspepsia & regurgitation, vomiting, acneiform rash, backache, mouth ulcer and anemia. ADEs observed with Nimotuzumab therapy includes vomiting, dysphagia/odynophagia, constipation, taste perversion, decreased appetite, weakness, insomnia, chills, backache, headache and mucositis. ADEs observed with Rituximab therapy includes dyspnoea, headache, weakness, anemia, nausea and vomiting. ADEs observed with Rituximab therapy includes dyspnoea, headache, weakness, anemia, nausea and vomiting. Overall 79.2% ADEs were found to be mild grade and 20.8% ADEs were of moderate grade in severity. No ADEs of severe grade was reported. In conclusion, this study suggests that the use of monoclonal antibody for cancers therapy is well tolerated and associated with less or minor adverse reactions that can be managed easily by supportive treatment. Source

Yadav Y.R.,NSCB Medical College Jabalpur | Parihar V.,NSCB Medical College Jabalpur | Ratre S.,NSCB Medical College Jabalpur | Kher Y.,NSCB Medical College Jabalpur | Iqbal M.,NSCB Medical College Jabalpur
Journal of Neurological Surgery, Part A: Central European Neurosurgery

Microneurosurgical operations differ from other surgery. Longer operative time, narrow and deep-seated operative corridors, hand-eye coordination, fine manipulation, and physiologic tremor present special problems. Proper understanding of visual feedback, control of physiologic tremor, better instrument design, and development of surgical skills with better precision is important for optimal surgical results. Using the pen-type precision grip with well-supported arm, wrist, hand, and fingers avoids fatigue and improves precision. Proper instrument design, patient positioning, hemostasis techniques, tilting operative table, good operative microscope, an adjustable chair, careful use of suction tube, bipolar forceps, and brain retraction play important roles in microneurosurgery. Sufficient clinical case volume or opportunity during routine operative hours may not be available in the beginning for young neurosurgeons; microsurgical training using various models can enable them to gain experience. Training models using deep-seated and narrow operative corridors, drilling, knot-tying technique, and anastomosis using fine sutures under high magnification can be practiced for skill improvement. Training laboratory and simulation modules can be useful for resident training and skill acquisition. Indigenously made inexpensive models and comparatively less expensive microscopes can be used in resource-constrained situations. The maintenance of microsurgical ability should be preserved by staying active in operative practice. The knowledge of ergonomics, proper training, observing hand movements of skillful surgeons, and the use of operative videos can improve skill. Endoscopic assistance, computer-assisted robot hand technique, and microtechnology can provide access to the smallest areas of the body. © 2016 Georg Thieme Verlag KG. Source

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