Mukhopadhaya J.,Paras HMRI Hospital |
Raj M.,UPRIMS and R
Indian Journal of Orthopaedics | Year: 2017
Distraction osteogenesis and bone transport has been used to reconstruct bone loss defect by allowing new bone to form in the gap. Plate-guided bone transport has been successfully described in literature to treat bone loss defect in the femur, tibia, and mandible. This study reports two cases of fracture of femur with segmental bone loss treated with locking plate fixation and bone transport with Ilizarov ring fixator. At the time of docking, when the transport segment is compressed with bone fragment, the bone fragment is fixed with additional locking or nonlocking screws through the plate. The bone defect size was 7 cm in case 1 and 8 cm in case 2 and the external fixation indexes were 12.7 days/cm and 14 days/cm. No shortening was present in either of our cases. The average radiographic consolidation index was 37 days/cm. Both cases achieved infection-free bone segment regeneration and satisfactorily functional outcome. This technique reduces the duration of external fixation during the consolidation phase, allows correction of length and alignment and provides earlier rehabilitation. © 2017 Indian Journal of Orthopaedics Published by Wolters Kluwer - Medknow.
Kumari S.,UPRIMS and R |
Verma R.K.,UPRIMS and R |
Singh D.P.,UPRIMS and R |
Yadav R.,UPRIMS and R
Journal of Clinical and Diagnostic Research | Year: 2016
Introduction: The cases of cryptococcal meningitis and other forms of cryptococcosis have increased in recent time and the present scenario of the condition with significant morbidity and mortality is actually posing a serious threat to the community, so an early and prompt diagnosis is necessary to prevent serious complications and thus improving the overall disease outcome. Aim: Comparison of diagnostic efficacy of nested Polymerase Chain Reaction (PCR) with Latex Agglutination Test (LAT) in the Cerebro Spinal Fluid (CSF) samples of the cases of meningitis in HIV positive and negative cases. Materials and Methods: We have compared the diagnostic efficacy of Latex Agglutination Test (LAT) with nested Polymerase Chain Reaction (PCR) in 200 Cerebrospinal Fluid (CSF) samples, including 14 HIV positive also, in the cases of suspected cryptococcal meningitis. Nested PCR was done in all cases reporting positive by LAT and results were then compared with that of India ink and culture on Sabouraud Dextrose Agar (SD), and the isolates were further identified by urease, nitrate and sugar assimilation tests. Results: Of the 200 cases, including 14 HIV positive, LAT was positive in 46 cases while 154 were negative. Out of these 46 LAT positive cases, nested PCR was positive in 40 cases only, while culture and India ink was positive in 38 and 33 cases respectively. Majority of the cases, 30 (65.2%) were between age group 21-50 years, while 2 (4.3%) in 0-20, and 14 (30.4%) in 51-80 years age group. Conclusion: Although negative staining like India ink and nigrosin are most widely used techniques, but these suffer with subjective error. Rapid method like LAT is available but it always has the scope of false positive and negative results. In such cases nested PCR can help in establishing final diagnosis. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Gill S.P.S.,UPRIMS and R |
Raj M.,UPRIMS and R |
Kumar S.,UPRIMS and R |
Singh P.,UPRIMS and R |
And 3 more authors.
Journal of Clinical and Diagnostic Research | Year: 2016
Introduction: Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. Aim: To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. Materials and Methods: In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Results: Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian's criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Conclusion: Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA/B fractures without increasing the risk of infection. It gives better stability to fracture site and lessen the risk of implant failure. © 2016, Journal of Clinical and Diagnostic Research. All Rights Reserved.
Rupani R.,KGMU |
Verma A.,KGMU |
Rathore S.,UPRIMS and R
Journal of Indian Academy of Forensic Medicine | Year: 2013
The study of pattern of skull fractures is important as head being the most exposed and prominent part of body; it becomes most susceptible to injuries, as a result of criminal violence or accident. The skull fractures, especially by blunt force offer varying diagnostic and medico-legal problems to the medical jurists as well as to the clinicians. 100 cases of intracranial head injury by blunt force for the present study were selected from the dead bodies which were sent to the mortuary, King George's Medical University, Lucknow for medico-legal post-mortem examination. In 100 cases of intracranial lesions, 4 cases sustained fracture of the skull without any injury to the scalp and in 36 cases injuries of both scalp and skull were present. Maximum cases were in the age group of 41-50 yrs while the cause of fracture in maximum number of cases (90%) was direct trauma. Of the various cases with skull fracture, 50% cases were of fissured type, while 30% were depressed and 20% comminuted.
Pandey A.K.,UPRIMS and R |
Gupta S.,Banaras Hindu University
Indian Journal of Psychiatry | Year: 2012
Phenytoin is a commonly used antiepileptic medication because of its easy accessibility as well as affordability. However, scientific literature shows various types of side effects of phenytoin. We report a patient who was showing toxicity symptoms in the form of mood, behavior and cognitive symptoms along with scholastic problems and personality change on long term treatment with phenytoin. The patient's serum phenytoin was found to be quite high (>32.8 ng/ml).The symptoms were attributed to phenytoin toxicity which responded within twelve weeks by reducing the dose of phenytoin (with resultant fall in levels of serum phenytoin) and the addition of folic acid. While the mood and behavior symptoms recovered early, the cognitive symptoms responded slowly showing 80% -90 % improvement over a period of fifteen weeks.