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   2001| July-September  | Volume 47 | Issue 3  
 
 
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ORIGINAL ARTICLE
Oral cancer among patients under the age of 35 years.
EM Iype, M Pandey, A Mathew, G Thomas, P Sebastian, MK Nair
July-September 2001, 47(3):171-6
PMID:11832617
BACKGROUND: Cancer of the oral cavity is one of the commonest cancers among males. AIMS: To assess the aetiological factors, patient characteristics, treatment and the outcome in young patients with oral cancer. SETTINGS AND DESIGN: A retrospective descriptive study of patients under the age of 35 years with cancer of the oral cavity treated between 1982-1996, with the last follow-up till 2001, using the tumour registry data of Regional Cancer Centre (RCC), Trivandrum, Kerala, India. SUBJECT AND METHOD: The detailed clinical, treatment and follow-up data were obtained from the computerised records of RCC and recorded on a preset proforma. This was analysed with emphasis on age, sex, risk factors, site, histology, clinical extent and treatment methods and survival in the study group. STATISTICAL ANALYSIS: The survival analysis was carried by Kaplan-Meier method and the difference in survival was analysed using log-rank test. RESULTS: Out of 264 patients analysed, tongue was the commonest site identified in 136 (52%) patients followed by buccal mucosa in 69 (26%) patients. A male female ratio of 2.3:1 was observed with a significantly higher male preponderance in buccal mucosa (4.3:1). Prior exposure to tobacco or alcohol was noted in 59.4% patients, with more habitués in buccal mucosa cancer. Histological confirmation was present only in 83.7% patients and among them most were squamous cell carcinoma (85.9%). Radiotherapy, surgery or combined modalities of treatment were employed for majority of patients. The 5-year survival was 57.3%. T stage of the tumour was found to be significant in predicting disease free survival (P=0.03). CONCLUSIONS: The importance of early detection for clinical down staging is stressed. There is a need to investigate the aetiology of intra oral cancers in younger patients since a significant proportion (almost 40%) of these patients do not have associated risk factors for cancer.
  48,286 443 23
SPECIAL ARTICLE
Peer review -- process, perspectives and the path ahead.
B Gitanjali
July-September 2001, 47(3):210-4
PMID:11832629
  32,874 412 4
REVIEW ARTICLE
End-tidal carbon dioxide monitoring in pediatrics - clinical applications.
MS Bhende
July-September 2001, 47(3):215-8
PMID:11832630
End-tidal CO2 monitoring is an exciting non-invasive technology that is more commonly used in the emergency department, intensive care unit and in the prehospital setting. Its main use has been in verifying endotracheal tube position, during mechanical ventilation and cardiopulmonary resuscitation, but it is being studied and used for other purposes as well. The new American Heart Association guidelines require secondary confirmation of proper tube placement in all patients by exhaled CO2 immediately after intubation and during transport. This article covers the clinical applications of end-tidal CO2 monitoring with special reference to the paediatric patient.
  20,149 462 8
BRIEF REPORT
Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.
MG Andankar, PN Maheshwari, AL Saple, V Mehta, A Varshney, B Bansal
July-September 2001, 47(3):177-80
PMID:11832618
OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.
  14,096 178 3
IMAGES IN RADIOLOGY
Bilateral congenital capitate-hamate fusion.
HS Hosalkar, BA Shaw, LC Carrie, H Read
July-September 2001, 47(3):208-9
PMID:11832628
  13,506 148 -
IMAGES IN MEDICINE
Cleidocranial dysplasia.
S Gulati, M Kabra
July-September 2001, 47(3):204-5
PMID:11832626
  13,063 247 1
LOOKING BACK
The history of biochemistry in India.
UD Deshmukh, GV Phatarphekar, SP Dandekar
July-September 2001, 47(3):222-5
PMID:11832634
  13,108 144 -
LETTER TO EDITOR
Anaesthesia management for subtotal thyroidectomy in a case of multinodular goitre with retrosternal extension and superior vena caval syndrome.
ST Dave, SK Kamath, AN Shetty, LD Naik
July-September 2001, 47(3):219-219
PMID:11832631
  12,929 155 1
CASE REPORT
Anaesthetic management of splenectomy in Evan's syndrome during pregnancy with pregnancy induced hypertension.
RR Sherke, MS Rao
July-September 2001, 47(3):196-8
PMID:11832624
The management of idiopathic thrombocytopenic purpura (ITP) during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson's syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.
  12,750 210 4
ORIGINAL ARTICLE
Hypertrophic cardiomyopathy: an autopsy analysis of 14 cases.
RS Phadke, P Vaideeswar, B Mittal, J Deshpande
July-September 2001, 47(3):165-70
PMID:11832616
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is one of the less common forms of primary cardiomyopathies. There is little data available on HCM in Indian literature. AIMS: To assess the incidence and analyse the clinicopathological features of HCM. SETTINGS: Analysis of data of 15 years from a tertiary care centre. METHODS AND MATERIAL: The clinical and pathological data in fourteen cases of HCM with respect to their gross and microscopic features and clinical presentation were reviewed. RESULTS: Incidence of HCM amongst the autopsied primary cardiomyopathies (N = 101) was 13.9% (n=14). Males were affected more. Common presenting symptoms were exertional dyspnoea, angina and palpitations. Concentric and asymmetric hypertrophy was equally seen. Obliterative small vessel disease was noted in 50% of the cases. Although significant myofibre disarray (>5%) was seen in all fourteen cases, it could be demonstrated in only 40- 50% of an average of twenty sections studied. Type IA myofibre disarray was the commonest. Six of the fourteen patients died suddenly. Cardiac failure was the commonest cause of death. CONCLUSIONS: Myofibre disarray is a highly sensitive and specific marker for HCM only when considered in a quantitative rather than a qualitative fashion. In this context, the rationale for performing endomyocardial biopsy is to rule out mimics of HCM.
  12,107 230 5
IMAGES IN PATHOLOGY
Clear cell sarcoma of the kidney.
SC Sharma, PA Menon
July-September 2001, 47(3):206-7
PMID:11832627
  10,680 164 -
CASE REPORT
Morgagni hernia with Down syndrome: a rare association -- case report and review of literature.
RC Parmar, MS Tullu, SB Bavdekar, SS Borwankar
July-September 2001, 47(3):188-90
PMID:11832621
Morgagni hernia is a rare diaphragmatic hernia accounting for only 2% of the congenital diaphragmatic defects. A case of Morgagni hernia was diagnosed radiologically in a 12-months-old male with Down syndrome, with recurrent respiratory distress and chest deformity. The 2-dimensional echocardiography was normal. The diagnosis of Morgagni hernia was confirmed by barium studies. The patient underwent a corrective surgery at 18 months of age following which his symptoms subsided. Literature review revealed only 18 cases of Morgagni hernia with Down syndrome reported till date, with age of presentation varying from neonatal age group to 12 years of age. The mode of presentations varied from asymptomatic detection to severe respiratory distress. The possible mechanism of association and its clinical implication has been discussed. The case emphasises a need for diaphragmatic hernia to be looked for as a possible cause of respiratory distress in Down syndrome.
  10,181 186 21
ETHICS FORUM
ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice.

July-September 2001, 47(3):199-203
PMID:11832625
  8,918 222 3
LOOKING BACK
The story of Wilma Rudolph.
AV Deshpande
July-September 2001, 47(3):226-226
PMID:11832635
  8,678 103 -
BRIEF REPORT
Comparative evaluation of intraocular pressure changes subsequent to insertion of laryngeal mask airway and endotracheal tube.
B Ghai, A Sharma, S Akhtar
July-September 2001, 47(3):181-4
PMID:11832619
AIMS: To evaluate the intraocular pressure and haemodynamic changes subsequent to insertion of laryngeal mask airway and endotracheal tube. SUBJECTS AND METHODS: The study was conducted in 50 adult patients. A standard general anaesthesia was administered to all the patients. After 3 minutes of induction of anaesthesia baseline measurements of heart rate, non-invasive blood pressure and intraocular pressure were taken following which patients were divided into two groups: laryngeal mask airway was inserted in group 1 and tracheal tube in group 2. These measurements were repeated at 15-30 second, every minute thereafter up to 5 minutes after airway instrumentation. RESULTS: A statistically significant rise in heart rate, systolic blood pressure, diastolic blood pressure and intraocular pressure was seen in both the groups subsequent to insertion of laryngeal mask airway or endotracheal tube. Mean maximum increase was statistically more after endotracheal intubation than after laryngeal mask airway insertion. The duration of statistically significant pressure responses was also longer after endotracheal intubation. CONCLUSION: Laryngeal mask airway is an acceptable alternative technique for ocular surgeries, offering advantages in terms of intraocular pressure and cardiovascular stability compared to tracheal intubation.
  7,861 176 5
CASE REPORT
Cardiomediastinal tamponade and shock following three-stage transthoracic oesophagectomy.
V Cherian, JV Divatia, A Kulkarni, D Dasgupta
July-September 2001, 47(3):185-7
PMID:11832620
Massive gastric tube dilatation causing cardiomediastinal tamponade is an unusual cause of obstructive shock after transthoracic oesophagectomy. A 55-year-old female was operated for total transthoracic oesophagectomy. Twelve hours after the surgery, she developed hypotension and raised central venous pressure unresponsive to fluid infusion and ionotropes. X-ray chest showed a massively dilated stomach, which was causing intrathoracic tamponade. Suction applied to the nasogastric tube led to aspiration of 150-200 ml of fluid and a large volume of air, which led to resolution of the haemodynamic instability. A simple manoeuvre like nasogastric suction in postoperative case of oesophagectomy can serve as a diagnostic as well as therapeutic tool. It must be performed before resorting to invasive and expensive examination or intervention.
  7,703 136 5
Fallot's tetralogy presenting with variceal bleed.
D Kejariwal, N Sarkar, S Roy, M Bhattacharya
July-September 2001, 47(3):194-5
PMID:11832623
The erythrocytosis of Fallot's tetralogy may lead to spontaneous thrombosis at any site, but splenic vein thrombosis and variceal bleed is rarely a presentation of Fallot's tetralogy. A case of a 48 years old female with undiagnosed Fallot's tetralogy, presenting with variceal bleed due to splenic vein thrombosis, is reported. It is also interesting to note that the patient survived till this age without any medical or surgical treatment.
  7,626 125 -
LETTER TO EDITOR
Tuberculosis associated haemophagocytic syndrome.
HS Subhash, S Sowmya, U Sitaram, AM Cherian
July-September 2001, 47(3):220-220
PMID:11832632
  7,363 149 4
CASE REPORT
Cavernous haemangioma in the interpeduncular cistern: case report and review of literature.
DP Muzumdar, MG Bhatjiwale, A Goel, P Doshi
July-September 2001, 47(3):191-3
PMID:11832622
A rare case of a cavernous haemangioma in the interpeduncular cistern is reported. The patient, forty-five year old male presented with excruciating left sided trigeminal neuralgia and diplopia for the past one year. Examination revealed left third and fifth nerve paresis. Magnetic resonance imaging showed a well-defined, lobulated tumour in the interpeduncular cistern. The tumour was totally excised through a subtemporal route. Histology of the tumour revealed a cavernous haemangioma. Extracerebral location for a cavernous haemangioma is rare. An interpeduncular cavernous haemangioma has never been reported earlier in literature. The clinical and radiological features are discussed and relevant literature is briefly reviewed.
  7,261 163 1
EDITORIAL
Hypertrophic cardiomyopathy: the elusive terrorist?
Y Lokhandwala
July-September 2001, 47(3):163-4
PMID:11832615
  4,419 124 -
LETTER TO EDITOR
Keratinous micro cysts in viral interstitial pneumonitis.
P Vaideeswar
July-September 2001, 47(3):221-221
PMID:11832633
  3,961 98 -
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow