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Kaushik D.,Sawai Man Singh Medical College and Hospital
Chinese journal of traumatology = Zhonghua chuang shang za zhi | Year: 2014

Open fractures with bone loss are a common occurrence following high energy trauma. But usually the bone fragments are lost on the roadside and are not usable. We report a patient who was involved in a head-on collision between two wheelers and presented with a bone fragment embedded in his thigh. Radiological survey revealed no bony injury in that patient. Another patient, who presented at the same time, sustained a segmental fracture of shaft femur and was found to have lost a bone fragment that was similar to the one found in previous patient. CT scan with 3D reconstruction revealed this missing fragment to be the same as that found in previous patient. Both patients had a history of head-on collision while travelling on a two-wheeler. Present case report throws some highlights on the probable mechanism of injury.

Jindal N.,Government Medical College and Hospital | Banshiwal R.C.,Sawai Man Singh Medical College and Hospital | Lamoria R.,Sawai Man Singh Medical College and Hospital | Bachhal V.,Post Graduate Institute of Medical Education and Research
Journal of Orthopaedic Surgery and Research | Year: 2013

Background: It has been recently reported that local injection of autologous blood in tennis elbow offers a significant benefit by virtue of various growth factors contained therein. The objective of our study was assessment of efficacy of autologous blood injection versus local corticosteroid injection in the treatment of tennis elbow.Methods and trial design: A single blinded, prospective parallel group trial was undertaken. 50 consecutive patients of untreated lateral epicondylitis were enrolled. Randomisation was done on alternate basis and two groups were constituted, first one receiving steroid injection and second one injection of autologous blood. Both groups were evaluated at 2 and 6 weeks for pain relief and stage of disease.Results: Baseline evaluation showed no difference between the two groups (chi square test, P > 0.05). Between group analysis at 2 weeks showed no difference in pain relief and Nirschl stage (unpaired t test, P > 0.05). Evaluation at 6 weeks demonstrated a significant decrease in pain levels and stage of disease in blood group (unpaired t test, p < 0.05).Conclusions: Autologous blood injection was more effective than steroid injection in the short term follow up in tennis elbow. © 2013 Jindal et al.; licensee BioMed Central Ltd.

Saigal R.,Sawai Man Singh Medical College and Hospital
The Journal of the Association of Physicians of India | Year: 2010

A case of pachydermoperiostosis presented to us in rheumatology clinic with complaints of pain and swelling in knee joints unresponsive to treatment, characteristic facial features, grade four clubbing of nails and broadening of distal parts of extremities. He also complained of fatiguability which was due to anemia. The natural history of the disease was reviewed and investigated.

Jindal N.,Sawai Man Singh Medical College and Hospital | Jindal N.,Government Medical College and Hospital | Sankhala S.S.,Sawai Man Singh Medical College and Hospital | Bachhal V.,Sawai Man Singh Medical College and Hospital | Bachhal V.,Post Graduate Institute of Medical Education and Research
Journal of Bone and Joint Surgery - Series B | Year: 2012

The purpose of this study was to determine whether patients with a burst fracture of the thoracolumbar spine treated by short segment pedicle screw fixation fared better clinically and radiologically if the affected segment was fused at the same time. A total of 50 patients were enrolled in a prospective study and assigned to one of two groups. After the exclusion of three patients, there were 23 patients in the fusion group and 24 in the non-fusion group. Follow-up was at a mean of 23.9 months (18 to 30). Functional outcome was evaluated using the Greenough Low Back Outcome Score. Neurological function was graded using the American Spinal Injury Association Impairment Scale. Radiological outcome was assessed on the basis of the angle of kyphosis. Peri-operative blood transfusion requirements and duration of surgery were significantly higher in the fusion group (p = 0.029 and p < 0.001, respectively). There were no clinical or radiological differences in outcome between the groups (all outcomes p > 0.05). The results of this study suggest that adjunctive fusion is unnecessary when managing patients with a burst fracture of the thoracolumbar spine with short segment pedicle screw fixation. ©2012 British Editorial Society of Bone and Joint Surgery.

Agrawal M.,Sawai Man Singh Medical College and Hospital | Joshi M.,Sawai Man Singh Medical College and Hospital
Journal of Spinal Cord Medicine | Year: 2015

Objectives: To study the correlation between neurological level of spinal injury and bladder functions as detected by urodynamic study. Study design: Analytical study. Setting and participants: Seventy individuals with traumatic spinal cord injury (SCI) admitted to the Department of Physical Medicine and Rehabilitation, S.M.S. Medical College and Hospital, Jaipur. Detailed clinical, neurological evaluation as per American Spinal Injury Association Classification and radiological assessment were done along with clinical examination of bladder and urodynamic study. Results: Out of 65 patients with suprasacral injuries, 53 (81.5%) demonstrated hyperreflexia with or without detrusor sphincter dyssynergia, 6 (9.2%) detrusor areflexia, and 6 (9.2%) had normal bladders, 41 (59.4%) low compliance (<20 ml/cmH2O), and 47 (72.30%) had high detrusor leak pint pressures (>40 cmH2O). Of the five patients with sacral injuries, one (20%) showed detrusor hyperreflexia, four (80%) detrusor areflexia, and one (20%) had low bladder compliance; all five (100%) had high detrusor leak point pressures. Conclusions: The correlation between somatic neurologic findings, spinal imaging studies, and urodynamic findings in patients with SCI is not exact. Therefore, bladder management should not completely rely only on clinical bladder evaluation or neurological examination alone, but should always include urodynamic studies. © The Academy of Spinal Cord Injury Professionals, Inc. 2015.

Saigal R.,Sawai Man Singh Medical College and Hospital | Singh Y.,Sawai Man Singh Medical College and Hospital | Mittal M.,Sawai Man Singh Medical College and Hospital | Maharia H.R.,Sawai Man Singh Medical College and Hospital
Journal of Association of Physicians of India | Year: 2010

Pyoderma gangrenosum (PG) is an idiopathic, ulcerative, noninfective chronic inflammatory skin disorder of unknown etiology. It is associated with systemic medical illness in 50% of cases like inflammatory bowel disease, systemic arthritis, haematological diseases and malignancies. Characteristic lesions begin as pustule or vesiculopustule and progresses to an ulcer or deep erosion with violaceous overhanging or undermined borders. Diagnosis of pyoderma gangrenosum is clinical and depends on exclusion of other causes of cutaneous ulceration. The management of PG is treatment of underlying systemic medical illness and judicious use of immunosuppressants. Association of PG with these medical illnesses and treatment with immunosuppressants make the clinical utility for internists, gastroenterologists, haematologists and rheumatologists. © JAPI.

Bachhal V.,Sawai Man Singh Medical College and Hospital | Bachhal V.,Jawaharlal Institute of Postgraduate Medical Education & Research | Sankhala S.S.,Sawai Man Singh Medical College and Hospital | Sankhala S.S.,Jawaharlal Institute of Postgraduate Medical Education & Research | And 4 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011

We report the outcome of 32 patients (37 knees) who underwent hemicallostasis with a dynamic external fixator for osteoarthritis of the medial compartment of the knee. There were 16 men (19 knees) and 16 women (18 knees) with a mean age at operation of 54.6 years (27 to 72). The aim was to achieve a valgus overcorrection of 2° to 8° or mechanical axis at 62.5% (± 12.5%). At a mean follow-up of 62.8 months (51 to 81) there was no change in the mean range of movement, and no statistically significant difference in the Insall-Salvati index or tibial slope (p = 0.11 and p = 0.15, respectively). The mean hip-knee-ankle angle changed from 190.6 (183° to 197°) to 176.0° (171° to 181°), with a mean final position of the mechanical axis of 58.5% (35.1% to 71.2%). The desired alignment was attained in 31 of 37 (84%) knees. There were 21 excellent, 13 good, two fair and one poor result according to the Oxford knee score with no correlation between age and final score. This score was at its best at one year with a statistically significant deterioration at two years (p = 0.001) followed by a small but not statistically significant deterioration until the final follow-up (p = 0.17). All the knees with Ahlback grade 1 osteoarthritis had excellent or good results. Complications included pin tract infections involving 16.4% of all pins used, delayed union in two, knee stiffness in four, fracture of the lateral cortex in one and ring sequestrum in one. In conclusion, hemicallostasis provides precision in attaining the desired alignment without interfering with tibial slope or patellar height, and is relatively free of serious complications. ©2011 British Editorial Society of Bone and Joint Surgery.

Sharma K.,Sawai Man Singh Medical College and Hospital | Yadav A.,Sawai Man Singh Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2015

Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. Dengue fever (DF) with its severe manifestations such as dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) has emerged as a major public health problem of international concern. Thrombocytopenia and bleeding are common complications of dengue fever, hence besides platelet counts, there is a need to assess the role of mean platelet volume. Aims: Studying association of mean platelet volume (MPV) with severity, serology & treatment outcome to assess its prognostic utility, which can be of great help in limiting morbidity & mortality associated with dengue fever. Materials and Methods: The present study was conducted in Central Pathology Lab of SMS Medical College & Hospital, Jaipur, Rajasthan from the period of March 2013 till October 2013. Blood samples were collected from 200 patients with NS 1 Antigen positivity experiencing febrile illness, clinically consistent with dengue infection. Evaluation of platelet counts, MPV, IgM and IgG antibodies was done in all these cases. Statistical Analysis: Categorical data were presented as numbers (percent) and were compared among groups using Chi-square test. Groups compared for demographic data were presented as mean and standard deviation and were compared using student t-test, ANOVA and Post-Hoc Test, Tukey Test using SPSS, version 20 for Windows. Results: A total of 200 Dengue fever cases were studied. Out of which, 68% cases were of DF, 23% DHF & 9% DSS i.e. classical dengue fever was most common presentation. Maximum (44%) cases were in age group of 15-24 years. Fever was the presenting complaint in all cases (100%). 98% cases of dengue had thrombocytopenia. MPV showed no significant correlation with severity, serology & treatment outcome, thus excluding its role in dengue cases. Conclusion: Mean platelet volume is not important as prognostic parameter in dengue fever. © 2015 Journal of Clinical and Diagnostic Research. All Rights Reserved.

Saini P.,All India Institute of Medical Sciences | Kumar R.,All India Institute of Medical Sciences | Shekhawat V.,Sawai Man Singh Medical College and Hospital | Joshi N.,Sawai Man Singh Medical College and Hospital | And 2 more authors.
Injury | Year: 2013

Introduction: Subtrochanteric fractures are difficult fractures associated with high incidence of complications and various implants, both intramedullary and extramedullary, are available for their fixation. Traditional extramedullary implants are associated with higher rate of implant failure and varus collapse while the biomechanically better intramedullary nails are technically demanding and are associated with higher re-operation rates. This study was done to evaluate the outcome following biological (indirect) fixation of unstable comminuted subtrochanteric fractures with proximal femur-locking compression plate (PF-LCP). Methods: Thirty-five consecutive patients with comminuted subtrochanteric fractures were operated upon with PF-LCP by using an indirect reduction technique. Seinsheimer types 3-5 fractures were included in the study. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications. The Harris Hip Score was used to document hip function at final follow-up. Results: Thirty-two patients with average age of 44.7 years were available for final evaluation. The mean operating time was 79.5 min and total blood loss averaged 233.13 ml. Union was achieved in all cases with an average time of 15.62 weeks. Complications included two cases of delayed union and two cases of infection. Two cases had a shortening of 1 cm and one case had malunion with external rotation. No instances of implant failure or nonunion were recorded. Conclusion: Biological fixation of comminuted subtrochanteric fractures with PF-LCP provides stable fixation with high union rate and fewer complications. © 2012 Elsevier Ltd. All rights reserved.

Study design:Randomized longitudinal comparative study.Objectives:To compare the efficacy of lamotrigine and amitriptyline in the management of traumatic spinal cord injury (SCI)-induced neuropathic pain (NP).Setting:Sawai Man Singh Medical College and Hospital, Jaipur, India.Methods:A total of 147 individuals with NP were randomized for a 3-week trial of either amitriptyline or lamotrigine. Amitriptyline was administered orally at doses of 25, 50 and 100 mg once daily at night time, and lamotrigine was administered orally at doses of 25, 50 and 100 mg twice daily, both for 1 week by means of optional titration. Assessment of NP was done at baseline and thereafter at 1, 2 and 3 weeks using Short–form MC Gill Pain Questionnaire-2 (SFMPQ2) scores.Results:There was a significant difference between the mean values of the SFMPQ2 score at baseline and those at each follow-up for amitriptyline. Similar results were seen in the lamotrigine group. When the differences in mean SFMPQ2 scores at different time frames from baseline were compared with those of the other group, values were found to be nonsignificant as seen on the Mann–Whitney U-test.Conclusions:These findings support the use of both amitriptyline and lamotrigine in the management of NP after traumatic SCI.Spinal Cord advance online publication, 16 August 2016; doi:10.1038/sc.2016.123. © 2016 International Spinal Cord Society

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