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Dutta S.,Shri Guru Ram Rai Institute of Medical and Health science | Mukerjee B.,Vinayak Mission
Jornal Vascular Brasileiro | Year: 2010

Background: Anatomic variations of the hepatic arteries are common. Preoperative identification of these variations is important to prevent inadvertent injury and potentially lethal complications during open and endovascular procedures. Objective: To evaluate the incidence, extra-hepatic course, and presence of side branches of accessory hepatic arteries, defined as an additional arterial supply to the liver in the presence of normal hepatic artery. Methods: Eighty-four human male cadavers were dissected using a transperitoneal midline laparotomy. The supra-celiac aorta, celiac axis, and hepatic arteries were dissected, and their trajectories were identified to describe arterial branching patterns. Results: Normal hepatic arterial anatomy was identified in 95% of the cadavers and six (5%) had accessory hepatic arteries. In five cadavers the accessory hepatic artery followed its course through the fissure for ligamentum venosum, and in one it coursed adjacent to the hepatic artery through the margin of the lesser omentum. One cadaver had a single side branch, which provided arterial blood supply to the left adrenal gland in the absence of any left inferior phrenic artery. Conclusion: Accessory hepatic artery most often follows the course of the hepatic fissure for ligamentum venosum. Albeit uncommonly found in 5% of cases, this finding should be identified during open and endovascular procedures to prevent inadvertent injury. © 2010 by Sociedade Brasileira de Angiologia e de Cirurgia Vascular.


PubMed | Muzaffarnagar Medical College, Dr. Ram Manohar Lohia Avadh University and Shri Guru Ram Rai Institute of Medical and Health science
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2016

Inguinal hernia repair is the most common surgery done by both young and experienced surgeons. The hernia in the inguinal region usually contains the omentum and small intestine but rarely can contain unusual contents like the appendix, ovary with fallopian tubes, urinary bladder, sigmoid colon, and cecum. The aim of this study is to present our experience of uncommon contents in the inguinal hernia sac and their surgical management. A retrospective study of 330 patients who underwent inguinal hernia repair was carried out over a period of 3years from January 2008 to December 2011. Only five patients presented with unusual contents in the inguinal hernia sac; an incidence of 1.5%. Two of them had vermiform appendix, with acute appendicitis (Amyands hernia) noted in one of them. The patient with acute appendicitis underwent appendicectomy with herniorrhaphy, while in the other, hernioplasty with mesh was done as the patient was with normal appendix. In one case, the urinary bladder was the content of the inguinal hernia sac and there were two cases with the ovary and fallopian tubes as its content. In all these cases, contents were replaced back and hernia repair was done. Unusual contents of the hernial sac may create a surgical dilemma (whether to save or sacrifice the organ) during hernia repair even to an experienced surgeon.


Masood T.,Shri Guru Ram Rai Institute of Medical and Health science | Kushwaha R.S.,Shri Guru Ram Rai Institute of Medical and Health science | Singh R.,University of Lucknow | Sailwal S.,Shri Guru Ram Rai Institute of Medical and Health science | And 4 more authors.
Drug Discoveries and Therapeutics | Year: 2015

The circadian time structure of serum 25 (OH) vitamin D (25-OHD), calcium (Ca) and phosphorus (P) may prove to be helpful in prevention, efficacy and management of diabetes mellitus. Ten newly diagnosed patients with type-2 diabetes mellitus (6 men and 4 women), 30-65 years of age, and 10 age-matched clinically healthy volunteers (7 men and 3 women) were synchronized for one week with diurnal activity from about 06:00 to about 22:00 and nocturnal rest. Breakfast was served around 08:00, lunch around 13:30 and dinner around 20:00. Drugs/nutraceuticals known to affect the vitamin D-calcium metabolism and status were not taken. Blood samples were collected at 6-h intervals for 24 h under standardized, 24-h synchronized conditions. Serum 25-OHD, Ca, P, Ca-P product and Ca-P ratio were determined. A marked circadian variation was demonstrated for 25-OHD in healthy volunteers (p = 0.030) and of borderline statistical significance in the diabetic patients (p = 0.083) by population-mean cosinor analysis. Similarly, healthy volunteers showed borderline significance for serum Ca, P and Ca-P ratio. The circadian acrophase of Ca occurred later in the patients as compared to healthy controls. Mapping the circadian rhythm (an important component of the broader time structure or chronome, which includes a.o., trends with age and extra-circadian components) of vitamin D and calcium is needed for exploring their role as markers in the treatment and management of diabetic patients.


Banga P.K.,Shri Guru Ram Rai Institute of Medical and Health science | Singh D.K.,Shri Guru Ram Rai Institute of Medical and Health science | Dadu S.,Shri Guru Ram Rai Institute of Medical and Health science | Singh M.,Shri Guru Ram Rai Institute of Medical and Health science
Saudi Journal of Anaesthesia | Year: 2015

Background: In patients with penetrating eye injury and a full stomach, suxamethonium is still used for rapid sequence induction of anesthesia. But its use is associated with the rise in intraocular pressure (IOP) and this can result in permanent vision loss in these patients. Dexmedetomidine and clonidine are two alpha-2 adrenergic agonist drugs which prevent the rise in IOP. The aim of this study is to compare the efficacy of intravenous (i.v.) dexmedetomidine and clonidine in preventing an increase in IOP after administration of suxamethonium and tracheal intubation. Materials and Methods: Sixty patients undergoing elective nonophthalmic surgery under general anesthesia were included in this clinical study. Patients were randomly assigned into three groups to receive 0.5 mcg/kg dexmedetomidine (Group D), 2 mcg/kg clonidine (Group C) or normal saline (Group S) as premedication i.v. over a period of 10 min before induction. IOP, heart rate, and mean arterial pressure were recorded before and after premedication, after suxamethonium, after intubation and then after 5 min. Results: Following administration of dexmedetomidine and clonidine IOP decreased in both groups. After suxamethonium IOP increased in all three groups but it never crossed the baseline in Group D and C. After laryngoscopy and intubation IOP again increased in all three groups but in dexmedetomidine group it never crossed the baseline whereas in clonidine group it was significantly higher than the baseline. Conclusion: Single i.v. dose of dexmedetomidine premedication (0.5 mcg/kg) blunt the IOP and hemodynamic response to suxamethonium injection and tracheal intubation more effectively than single i.v. dose of clonidine premedication (2 mcg/kg).


Mathur A.,Shri Guru Ram Rai Institute of Medical and Health science | Manish A.,Shri Guru Ram Rai Institute of Medical and Health science | Maletha M.,Shri Guru Ram Rai Institute of Medical and Health science | Luthra N.B.,Shri Guru Ram Rai Institute of Medical and Health science
Indian Journal of Urology | Year: 2011

Emphysematous epididymo-orchitis is a rare cause of an acute scrotum and is a surgical emergency. Diagnosis is clinically difficult, and sonography with a high-frequency probe is useful to pick up gas shadows in the scrotal wall or testicular substance. A diabetic patient presented with fever, urinary tract infection, and an acute scrotal swelling. The patient needed orchidectomy and scrotal debridement. As in emphysematous pyelonephritis, this condition occurs in diabetics, and patients may need surgery. There is a need to perform sonography in all diabetic patients with an acutely inflamed scrotum, because detection of gas shadows makes surgical intervention more likely.


Dutta S.,Shri Guru Ram Rai Institute of Medical and Health science
Romanian Journal of Morphology and Embryology | Year: 2010

Variation arterial anatomy of suprarenal gland is significant for radiological and surgical interventions. Knowledge of anomalous suprarenal artery is required to avoid complications in surgical procedure. Arterial architecture of human suprarenal gland was studied in sixty-eight cadavers of adult male and female. In all cases, superior suprarenal artery on right side was normal in origin but on left side, 24% showed anomalous origin. The incidence of anomalous origin of middle suprarenal artery on right side was 47% and on left side 6%. Anomalous origin of inferior suprarenal artery on the right side was 29% and left side 35%. The superior suprarenal artery was present in all subjects. However, there was absence of right middle suprarenal artery in 29% and left inferior suprarenal artery in 35% subjects. The most variable group was inferior suprarenal artery. The study result is being described to report anomalous origin of suprarenal arteries in the light of surgical, radiological and embryological significances. Present study findings suggest, thorough knowledge of anomalous arterial anatomy of suprarenal gland is required for surgical and radiological interventions of retroperitoneal organs of upper abdomen to avoid complications.


Mathur A.V.,Shri Guru Ram Rai Institute of Medical and Health science
Indian Journal of Surgical Oncology | Year: 2015

One of the criteria for recommending cholecystectomy for silent gall stones, is gall stones in regions with high incidence of gall bladder cancer. Both gall stones and gall bladder cancer are common in North India. All tertiary care centres in India report high rates of gall bladder cancer (GBC) incidence and poor treatment outcomes in the majority of cases due to advanced stage of presentation. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia and advocated prophylactic cholecystectomy in asymptomatic patients. Incidence rate of gall bladder cancer in Indian males is equal to that of Chile, whereas in females, the rates are almost double the rates of Chile. Indians have also been found to have high concentrations of heavy metals in gall bladder wall, and antibodies to tumor suppressor genes. In India, gall bladder cancer is the commonest GI cancer in women and fourth commonest cancer overall in the female population. In view of the epidemiology and clinical scenario of gall bladder cancer and proven safety of laparoscopic cholecystectomy, there is a need to act before it is too late in the current rates of gall bladder cancer. This study looks at the evidence correlating gall stones and gall bladder cancer, in relation to India. There is pressing evidence today to justify a strategy of prophylactic cholecystectomy in silent gall stones in North India. Data for this study was selected through an internet based search for literature concerning gall stones and gall bladder cancer in India, and for prophylactic cholecystectomy. © 2015, Indian Association of Surgical Oncology.


Dasgupta S.,Shri Guru Ram Rai Institute of Medical and Health science | Gupta R.,Shri Guru Ram Rai Institute of Medical and Health science
International Eye Science | Year: 2016

AIM: To evaluate and compare subjective and objectively, the course of surgically induced dry eye following both phacoemulsification (PKE) and manual-small incision cataract surgery (SICS) procedure, and to analyze the result in terms of causative factors. METHODS: This single centre prospective study included 100 eyes of 100 patients randomly divided into two groups (Group 1, SICS-50 patients; Group 2, PKE-50 patients), who underwent cataract surgery with intraocular lens (IOL)-implantation from Jun. 2013 to Dec. 2014 for a period of one and half year by single surgeon. In all patients post operative course of dry eye were tabulated and assessed at 1, 4, 12wk, subjectively and objectively, and thereafter analyzed in terms of possible causative factors. Statistical data were calculated using SPSS 23.0 Windows software. RESULTS: There was no significant preoperative intergroup difference in subjective and objective dry eye test (DET) values (P>0.05). Both the groups showed similar trend of persistently declining objective DET-values till at the end 12wk, as compared to their respective preoperative values (P<0.05), although there were no significant intergroup changes seen throughout the postoperative period (P>0.05). PKE seems to have better subjective DET-value at the end of 12wk. CONCLUSION: Dry eye disease is inevitable following cataract surgery. Both PKE and SICS, can affect the dry eye test values in almost similar manner post operatively till up to 12wk. Randomized multicentre trial with larger cohort and longer follow-up is warranted to substantiate our findings. Copyright 2016 by the IJO Press.


PubMed | Shri Guru Ram Rai Institute of Medical and Health science
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2017

Amblyopia is one of the common causes of childhood visual impairment. The prevalence of amblyopia usually varies according to the age group of the studied population and the factors prevailing in that region. The upper limit of the critical time when amblyopia can develop is around eight years of age and it can be permanent if corrective measures are not taken in time.The purpose of study was to know the profile and pattern of amblyopia in children aged 5-15 years with refractive error in Uttarakhand and to compare it with national and regional (South Asian) studies.In the present retrospective cross-sectional study, 360 children from 5-15 yrs of age who attended the OPD during the period between September 2014 to February 2015, had undergone detailed Ophthalmic examination. The children having vision < 6/12 with out organic lesion were included in the study. The children with strabismus, previous ocular surgery and ocular diseases were excluded. Chi-Square test was done for statistical analysis (IBM SPSS Version 23).The percentage of amblyopia was 8.6% (n=31) with insignificant gender variation (p-value>0.05). Amblyopia due to astigmatism (combined) was in 41.93% (n=13) followed by Hypermetropia [32.25% (n=10)] and least in myopia [25.8% (n=8)]. In 51.61% cases age of presentation was 5-10 years while rest belonged to > 10 years of age. Binocular amblyopia was more (58.06%) then unilateral amblyopia (41.93%).Refractory errors are second most common cause of paediatrc amblyopia. Amblyopia and associated strabismus can have devastating psychosocial and economical fall outs. Our study emphasizes the need of visual screening of school children and prescribing them correct spectacles at appropriate time.


PubMed | Shri Guru Ram Rai Institute of Medical and Health science
Type: Journal Article | Journal: Kathmandu University medical journal (KUMJ) | Year: 2016

Acute subperiosteal hematoma of orbit is a rare condition and its presentation with rapid severe diminution of vision is even rarest. Urgent intervention is required for these patients presenting with visual compromise. Needle aspiration is safe and simple procedure for management of such hematoma provided the patient presents early and does not have any associated complications. We present one such rare case highlighting the importance of timely diagnosis and urgent management to overcome functional complications in acute subperiosteal hematoma. To best of our knowledge this is the first pediatric case presenting with acute subperiosteal hematoma accompanied by severely diminished vision within few hours of trauma.

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