Kumar S.,Vydehi Institute of Medical Science |
Palaniappan J.M.,Vydehi Institute of Medical Science |
Kishan A.,Vydehi Institute of Medical Science
Asian Spine Journal | Year: 2017
Study Design: This was a prospective, randomized, controlled trial comprising 60 patients undergoing lumbosacral spine (noninstrumentation/ nonfusion) surgery. Purpose: The purpose of this study was to evaluate the efficacy of 0.2% ropivacaine (20 mL) administered alone as a single, preoperative, caudal epidural block injection versus that of intravenous analgesics in providing effective postoperative analgesia to patients undergoing lumbosacral spine surgery. Overview of Literature: Various studies have shown the effectiveness of a caudal epidural injection (bupivacaine or ropivacaine) in providing postoperative analgesia in combination with steroids or other analgesics. This study uniquely analyzed the efficacy of a single injection of caudal epidural ropivacaine in providing postoperative pain relief. Methods: Sixty patients who were scheduled to undergo surgery for degenerative lumbar spine disease (noninstrumentation/nonfusion) were consecutively divided into two groups, group R (Study) and group I (Control). 30 group R patients received a caudal epidural block with 20 mL of 0.2% ropivacaine after the administration of general anesthesia. 30 group I patients received no preoperative analgesia. Intravenous analgesics were administered during the postoperative period after a complaint of pain. Various parameters indicating analgesic effect were recorded. Results: There was a significant delay in the average time to the first demand for rescue analgesia in the study group, suggesting significantly better postoperative pain relief than that in the control group. In comparison with the control group, the study group also showed earlier ambulation with minimal adverse effects. The requirement for intraoperative fentanyl was higher in the control group than that in the study group. Conclusions: Preemptive analgesia with a single epidural injection of ropivacaine is a safe, simple, and effective approach, providing better postoperative pain relief, facilitating early mobilization, and decreasing the intraoperative requirement for opioid administration. © 2017 by Korean Society of Spine Surgery.
Appaji A.C.,M S Ramaiah Medical College |
Kulkarni R.,M S Ramaiah Medical College |
Kadaba J.S.,Vydehi Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2013
Nonrotation of intestine is a congenital abnormality of the midgut which is due to error in the process of rotation. Errors in the 2nd and 3rd stage of rotation can lead to series of abnormalities in the form of malrotation and reversed rotation. As a consequence, the relative position of other organs likes caecum, intestine, meckel's diverticulum changes. This can lead to missing diagnosis of common clinical conditions such as appendicitis. The incidence of nonrotation is 1:500. The congenital abnormality appears to be rare as this could be an incidental abnormality. The symptoms of nonrotation of intestine could be biliary vomiting, recurrent abdominal pain. This could be due to midgut volvulus and intestinal obstruction which happens as a consequence of nonrotation of the intestine. The investigations used for detection and confirmation are CT Imaging. Other associations of nonrotation of the intestine are peritoneal bands. Here we report a case of nonrotation of intestines. In the cadaver of age around 70 years, the small intestinal loops was situated in the right side of the abdominal cavity and large intestine looped on the left side of the abdominal cavity. This was also associated with aberrant position of the caecum and appendix. There were associated peritoneal bands extending from the ascending colon to the left side the abdominal wall. The bands had been removed to visualize the large intestinal loops.
Hemavathi,Sapthagiri Institute of Medical science |
Sarmah P.,Sapthagiri Institute of Medical science |
Ramesh D.H.,Vydehi Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2012
Introduction: Tuberculosis (TB) is a global health problem. An early diagnosis and an effective treatment are essential to prevent the spread of infection and to reduce the disease burden. Though the causative bacterium for this disease was discovered in the eighteenth century, its diagnosis in the twenty-first century is still a dogma. Objectives: To compare of the rapid slide culture (RSC) method with the growth on Lowenstein Jensen (LJ) media and to know the sensitivity and specificity of the rapid slide culture method and the acid fast smear examination in comparison with the growth on the L J media. Materials and Methods: One early morning sputum sample was collected from 220 clinically suspected pulmonary tuberculosis cases. All the samples were subjected to three tests: 1. Zeihl Neelsen Staining 2. Rapid slide culture and 3. Culture on Lowenstein Jensen media and the results were compared. Results: Of the total 220 sputum samples which were tested by all the three methods, 51 samples (23.18%) were found to be smear positive, 75 (34.09%) were found to be positive by the RSC method, 81 (36.81%) were found to be positive by the LJ culture method and 38(17.27%) samples were found to be positive by all the three methods and 93 (42.27%) samples were found to be positive by any one method. 127 (57.72%) samples were negative by all the three tests The sensitivity of RSC in comparison with the LJ culture was 88.88% with a specificity of 97.8%, whereas the smear showed a sensitivity of 49.4% and a specificity of 92.1%. Discussion: The RSC method is rapid, sensitive and more specific than microscopy. Hence, this method can be adopted by any simple laboratory for the diagnosis of tuberculosis.
Reddy R.G.,Vydehi Institute of Medical science
BMJ case reports | Year: 2013
We are presenting a familial schwannomatosis without the features of neurofibromatosis (NF). We retrospectively reviewed the hospital charts, radiology films, operative notes and pathology slides of the patient. There was a family history of schwannomatosis. The patient had contrast-enhanced MRI, which was negative for vestibular schwannomas. The patient underwent surgical excision of symptomatic lesions. Histopathology confirmed these lesions as schwannomas consisting of areas of Antoni A and B, and immunohistochemical study was positive for S-100 protein. We recommend surgery for symptomatic lesions. Asymptomatic tumours can be monitored. Regular follow-up is essential as they may develop fresh lesions at any time. The relevant literature is discussed.
Jayaprakash S.,Vydehi Institute of Medical science
BMJ case reports | Year: 2011
A primigravida aged 20 years was referred to Vydehi Institute of Medical Sciences with diagnosis of 30 weeks of period of gestation with eclampsia and failure to respond to induction with misoprostol and she was on Pritchard regimen for the treatment of eclampsia and there was no response to induction of labour and emergency ultrasound was taken and it showed an extrauterine gestation of 30 weeks gestation with fetal demise and free fluid in peritoneum. A tentative diagnosis of secondary abdominal pregnancy with eclampsia was made and she was taken for emergency laprotomy. Intra operative findings showed haemoperitoneum, fetus with placenta and membranes in the peritoneal cavity, there was bicornuate uterus and right horn was ruptured from the fundus to about 8 cm down in the posterior aspect and ruptured part was sutured in two layers. After securing perfect haemostasis, abdomen was closed. This paper illustrates a case report of uterine anomaly with 30 weeks period of gestation and eclampsia and rupture following induction with prostaglandins.
Jayaprakash S.,Vydehi Institute of Medical science
BMJ case reports | Year: 2011
A 42-year-old multi para, presented with a mass protruding from vagina since 1 year. The mass was cystic in nature arising from the posterior vaginal wall. It was insidious in growth, gradually increasing in size to 8×8 cm. Surgical excision of the cyst was done by sharp and blunt dissection. The cyst was filled with mucoid material and histopathology confirmed a mullerian cyst. Cystic lesions of vagina are relatively uncommon and they are an incidental finding during gynaecological examination. Mullerian cysts are congenital cysts of vagina, usually reported during childbearing age group. These cysts usually arise at the level of cervix and extend anteriorly in relation to bladder, but very rarely they may also extend posteriorly. This paper illustrates a rare case of large posterior vaginal wall cyst of Mullerian origin.
Shivaprasad C.,Vydehi Institute of Medical science |
Pulikkal A.A.,Vydehi Institute of Medical science |
Prasanna Kumar K.M.,BDH and CDEC
Pancreatology | Year: 2015
Background: Pancreatic exocrine insufficiency has been frequently described in both type 1 and type 2 diabetes. Fecal elastase test has been demonstrated to have good correlation with direct tests for exocrine function, especially in moderate to severe cases. There are no data on the prevalence of pancreatic exocrine insufficiency in Indian patients with diabetes utilizing FEC concentrations. The objective of our study is to evaluate the prevalence of pancreatic exocrine insufficiency (PEI) in type 1 and type 2 diabetes and study the impact of PEI on glycemic control and metabolic parameters in diabetes. Methods and materials: We conducted a cross sectional study on 89 T1D, 95 T2D patients and 90 healthy controls. Biochemical parameters including FBS, HbA1c, serum albumin and serum calcium were estimated. Fecal elastase concentrations (FEC) were estimated by ELISA. Patients with FEC <200 μg/g were considered to have pancreatic exocrine insufficiency. Results: The prevalence of PEI was 31.4% in T1D, 29.4% in T2D and 4.4% in controls (P < 0.01). A significant negative correlation was observed between FEC levels and, both FBS and HbA1c in diabetic patients. There was also a significant positive correlation between BMI and FEC. There was no significant association between low FEC and other biochemical parameters. Conclusion: Nearly one third of patients with both T1D and T2D showed evidence of impaired exocrine function utilizing FEC test. Presence of PEI correlated with lower BMI and higher HbA1c. © 2015 IAP and EPC.
Pujahari A.K.,Vydehi Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2016
Introduction: Laparoscopic Cholecystectomy (LC) has become the gold standard for symptomatic gall stone disease. It is being practiced as a day care procedure in healthy individuals in American Society of Anaesthesialogists (ASA) grade I and II. It is not yet established in presence of co-morbidity and when a second surgery is added. In most of the study, patient’s choice and the psycho-social factors were not considered in deciding the day care procedure. Aim: To find the safety of LC and a second surgery as day care in presence of compensated co-morbidity. To study the choice of the patient whether to stay in hospital or go home after declaring them fit for day care. Materials and Methods: All the patients of symptomatic cholelithiasis with co-morbidity and associations were evaluated and made uncompromising for elective surgery. All the LC were done at 8mmHg CO2 peumo-peritoneal pressure using harmonic scalpel as the energy source for dissection of gall bladder from the liver bed. Cases with conversion and placement of drain were excluded. Results: A total of 1029 out of 1042 patients was included from Jan 2005 to Jan 2015. The age range was 38 to 91years (mean 44.65, SD 14.15). There were 634 females and 395 males. A total of 121(11.7%) of them had co-morbidity and associations. A total of 72(7%) had undergone a second surgery. Only 0.8% had real day care. A total of 95.7% had overnight stay even after fulfilling all the criteria. Only 0.2% needed re-admission in 30 days and one required intervention. Conclusion: Patients like to stay over night in the hospital even if found fit for day care after LC. Overnight stay makes them happy, psycho-socially confident in developing nation and best suited for all patients including co-morbidity. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
Jagadeesh N.,Vydehi Institute of Medical science
Indian journal of medical ethics | Year: 2010
The crime of rape is a major problem in India, evident from the reports in the press as well as official statistics. The accused has often gone free, because the victim did not file a complaint, or because of poor evidence gathering and well as lacunae in the law. This paper presents an overview of the laws applicable to sexual assault cases and amendments in these laws, specifically in terms of the roles and responsibilities of healthcare providers to bridge the gap in providing medical evidence to the courts.
Jayaprakash S.,Vydehi Institute of Medical science |
Lakshmidevi M,Vydehi Institute of Medical science |
Sampath Kumar G.,Vydehi Institute of Medical science
BMJ Case Reports | Year: 2011
A 42-year-old multi para, presented with a mass protruding from vagina since 1 year. The mass was cystic in nature arising from the posterior vaginal wall. It was insidious in growth, gradually increasing in size to 8x8 cm. Surgical excision of the cyst was done by sharp and blunt dissection. The cyst was filled with mucoid material and histopathology confirmed a mullerian cyst. Cystic lesions of vagina are relatively uncommon and they are an incidental finding during gynaecological examination. Mullerian cysts are congenital cysts of vagina, usually reported during childbearing age group. These cysts usually arise at the level of cervix and extend anteriorly in relation to bladder, but very rarely they may also extend posteriorly. This paper illustrates a rare case of large posterior vaginal wall cyst of Mullerian origin. Copyright 2011 BMJ Publishing Group. All rights reserved.