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   2003| October-December  | Volume 49 | Issue 4  
 
 
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E-MEDICINE
Open Access to Peer-Reviewed Research through Author/Institution Self-Archiving: Maximizing Research Impact by Maximizing Online Access
S Harnad
October-December 2003, 49(4):337-342
PMID:14699234
  59,293 442 15
REVIEW ARTICLE
Under-Nutrition in Older People: A Serious and Growing Global Problem!
R Visvanathan
October-December 2003, 49(4):352-360
PMID:14699239
Everyone agrees that adequate nutrient intake is important to all living things. Without food or water, life on earth would cease to exist. In the field of medical health, some gains have been made in meeting maternal and child nutritional needs. There is great community awareness regarding the importance of meeting the nutritional needs of the developing foetus and child. Malnutrition secondary to decreased intake in older people and weight loss is also a serious problem with unfortunately, very little notice from the community at large. As one ages, several physiological processes may contribute towards the development of protein energy malnutrition. Under-nutrition in older people is sadly far too common, even in developed countries. It is very likely that the same concerted effort used to address child malnutrition is required to combat under-nutrition in our elders. Protein energy malnutrition in older people comes at a significant cost to the individual, families, communities and the healthcare system. Failure to address this syndrome is not only unethical and unhealthy, but also costly. Vigilance and community awareness is important in ensuring that this important syndrome is detected and managed appropriately. This review mainly attempts to describe the pathophysiology, prevalence and consequences of under-nutrition and aims to highlight the importance of this clinical syndrome and the recent growth in our understanding of the processes behind its development. Some management strategies are also briefly described.
  34,053 785 29
DRUG REVIEW
Reboxetine: A Novel Antidepressant
NG Kadhe, AJ Chillar, YA Deshmukh
October-December 2003, 49(4):373-375
PMID:14699244
  33,563 364 4
CASE REPORT
Olfactory Reference Syndrome: Diagnostic Criteria and Differential Diagnosis
C Lochner, DJ Stein
October-December 2003, 49(4):328-331
PMID:14699232
Olfactory reference syndrome (ORS) has been defined as a psychiatric condition characterized by persistent preoccupation about body odour accompanied by shame, embarrassment, significant distress, avoidance behaviour and social isolation. ORS has however not been included in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV) and, given that its primary symptoms may be found in various other disorders, differential diagnosis can be problematic. Using an illustrative case of ORS, we propose diagnostic criteria for ORS. We also argue that ORS represents a unique cluster of symptoms that can be delineated as a separate diagnostic entity, and that ORS falls on a spectrum of social anxiety disorders that includes social anxiety disorder, taijin kyofusho, and body dysmorphic disorder.
  28,955 443 14
Buried Bumper Syndrome with a Fatal Outcome, Presenting Early as Gastrointestinal Bleeding after Percutaneous Endoscopic Gastrostomy Placement
GK Anagnostopoulos, P Kostopoulos, DM Arvanitidis
October-December 2003, 49(4):325-327
PMID:14699231
Percutaneous Endoscopic Gastrostomy (PEG) has gained wide acceptance among patients who require prolonged tube-feeding support. A rather unusual complication of PEG placement is migration of the internal bumper through or into the abdominal wall. This was first described in 1988 and is called the buried bumper syndrome (BBS). The syndrome is a late complication of PEG tube placement. The manifestations of the syndrome must be recognised and the patient referred for emergency endoscopy and removal of the bumper. Failure to recognise this syndrome may result in serious complications including gastrointestinal bleeding, perforation of the stomach, peritonitis and death. We describe a case where a patient developed the buried bumper syndrome quite early after PEG placement. The syndrome manifested with gastrointestinal bleeding. Although we removed the buried bumper endoscopically, and placed another PEG tube, the patient developed peritonitis and died 16 hours after the removal of the migrated bumper.
  24,313 316 16
REVIEW ARTICLE
Vulnerable Plaques, Inflammation and Newer Imaging Modalities
V Bhatia, R Bhatia, S Dhindsa, A Virk
October-December 2003, 49(4):361-368
PMID:14699240
Currently, inflammation is considered to be the central player in the pathogenesis of atherosclerosis. It leads to the formation of multiple plaques in the arterial beds including coronary vasculature. Recent studies using the latest imaging techniques have shown that in patients with acute coronary syndromes (ACS) multiple plaques are ruptured and have thrombus formation on them. Various factors make these plaques unstable, these include structural components of plaque like thin fibrous cap, high lipid content of the plaque core and inflammation, both localized and generalized. It has been shown that most of the ACS are caused by plaques causing non-critical stenosis as seen on traditional X-ray angiography. Also, the phenomenon of remodelling makes angiography a poor technique for plaque visualization. Hence newer modalities are required to identify these “vulnerable plaques”. Intravascular ultrasound (IVUS), thermography and Magnetic Resonance Imaging (MRI) are a few such promising techniques. Here we review the invasive and non-invasive modalities that can be helpful in the identification of these plaques before they become unstable and cause ACS, and also the available therapies to stabilize these plaques.
  23,964 292 5
EDUCATION FORUM
Digital Photography in Medicine
S Prasad, B Roy
October-December 2003, 49(4):332-336
PMID:14699233
  23,507 297 6
GRAND ROUND CASE
Multiple Pulmonary Infarcts and Reversible Left Ventricular Dysfunction in a Patient with Chronic Heart Disease
A Chockalingam, G Gnanavelu, V Chockalingam, S Dorairajan
October-December 2003, 49(4):343-345
PMID:14699235
  14,536 182 -
TECHNOLOGY REVIEW
Quantitative Stereology: The Use of Camera Lucida for Counting Neurons by Physical Disector Method in Chick Brainstem Auditory Nuclei
S Wadhwa
October-December 2003, 49(4):376-378
PMID:14699245
  13,233 242 1
EDITORIAL
The Glucose Paradox of Cerebral Ischaemia
S Mehta
October-December 2003, 49(4):299-301
PMID:14699225
  13,248 203 2
IMAGES
Double Gibbus Due to Spinal Tuberculosis
SR Ahuja, S Karande, AA Thadhani
October-December 2003, 49(4):346-347
PMID:14699236
  13,050 261 1
ORIGINAL ARTICLE
The Effect of use of Pyridostigmine and Requirement of Vecuronium in Patients with Myasthenia Gravis
M Tripathi, S Kaushik, P Dubey
October-December 2003, 49(4):311-315
PMID:14699228
CONTEXT: Patients with myasthenia gravis receive pyridostigmine, an anticholinesterase agent, as a part of therapy. These patients demonstrate a heightened sensitivity towards non-depolarising muscle relaxants. Continuing pyridostigmine till the day of the surgery or omitting it on the night before surgery could provide variable results with regards to the effect of vecuronium. AIMS: Myographic evaluation of a dose of vecuronium in patients with myasthenia gravis on pyridostigmine therapy. SETTING AND DESIGN: A randomised, double-blind, clinical study conducted in a teaching hospital. SUBJECTS AND METHODS: Medically (oral pyridostigmine) well-controlled adult patients with myasthenia gravis who were posted for thymectomy, were randomly divided into two groups. Patients in Group 1 received their last dose of pyridostigmine on the night before surgery while those in Group 2 received even the morning dose of the drug on the day of surgery. Neostigmine (1-2 mg) intravenously was used as rescue medication. Vecuronium (0.01mg/kg) was used for intubation and muscle relaxation during trans-sternal thymectomy and its effect was reversed using neostigmine and atropine. RESULTS: Fourteen patients (7 in each group) belonging to both sexes were enrolled in the study. The intubating dose of vecuronium showed quicker onset time (155 sec or 2.7min approx.) and peak effect (99% T1 suppression) in patients belonging to Group 1, and 3/7 (43%) complained of respiratory discomfort while waiting for surgery. By giving the morning dose of pyridostigmine (Group 2), an identical intubating dose of vecuronium showed relative resistance (peak effect-97% T1 suppression) and delayed onset time (198 sec approx.). However, the reversal was complete at the end of surgery in both the regimens. CONCLUSIONS: Omission of the pyridostigmine dose on the day of surgery predisposed patients with myasthenia gravis to the possibility of respiratory discomfort and sensitivity to vecuronium. Continued administration significantly prolonged the onset time of vecuronium and the patients required a higher dose of vecuronium.
  12,216 314 6
Postoperative Nausea and Vomiting in Diagnostic Gynaecological Laparoscopic Procedures: Comparison of the Efficacy of the Combination of Dexamethasone and Metoclopramide with that of Dexamethasone and Ondansetron
MM Maddali, J Mathew, J Fahr, AW Zarroug
October-December 2003, 49(4):302-306
PMID:14699226
BACKGROUND AND OBJECTIVE: This study was conducted in a tertiary hospital with the aim of comparing the efficacy of a combination of dexamethasone and metoclopramide with dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting [PONV] after diagnostic gynaecological laparoscopic procedures. SUBJECTS AND METHODS: In this prospective, randomised, double-blind study, 120 women received either saline I.V. [Group I, n=40]; a combination of dexamethasone [8 mg] with metoclopramide [10 mg] [Group II, n=40]; or a combination of dexamethasone [8 mg] with ondansetron [4 mg] [Group III, n=40] prior to induction of general anaesthesia. PONV was evaluated at regular intervals. The results were analysed using one-way ANOVA, post-hoc, Chi-square, Kruskal-Wallace tests and Z test for proportions where appropriate through a SPSS V.9 package. RESULTS: The 3 groups were well matched for demographic characteristics. The incidence of nausea and emesis was significantly lower in Group III {[17.5%, P <0.02] and [10%, P <0.01] respectively}. Nausea scores were also lower in Group III [P <0.02]. Rescue anti-emetic requirements were higher in Group I [P <0.05] as compared to Groups II and III. CONCLUSIONS: A combination of dexamethasone and ondansetron was more efficacious as compared to that of metoclopramide and dexamethasone. The combination of metoclopramide and dexamethasone seems to offer no additional benefit as compared to saline placebo.
  12,078 316 11
The Impact of Diabetes Mellitus on In-hospital Stroke Mortality
BB Hamidon, AA Raymond
October-December 2003, 49(4):307-310
PMID:14699227
BACKGROUND AND PURPOSE: Diabetes mellitus is a strong risk factor for stroke. However, the prognosis in terms of mortality after a stroke is still unclear, especially in diabetic patients. The main purpose of this study was to compare and evaluate the features of stroke in patients having diabetes mellitus with those without diabetes mellitus and to identify factors that influence survival following a stroke. SUBJECTS AND METHODS: In a prospective hospital-based study consecutive patients with acute ischaemic stroke were enrolled. A single observer, using predefined diagnostic criteria recorded the demographics, risk factors and the type of stroke and deaths that occurred during the in-patient period. RESULTS: One hundred and sixty-three patients with acute ischaemic stroke were enrolled in the study. Type 2 diabetes mellitus was present in 90 (55.2%) patients. Diabetes was a significant independent predictor of mortality (OR 4.88; 95%CI 1.25-19.1). Among the diabetic patients middle cerebral artery (MCA) territory infarct (OR 34.8, 95%CI 4.5-269.4) and Glasgow coma score (GCS) less than 9 (OR 12.3, 95%CI 3.7-198.1) were independent predictors of mortality. CONCLUSIONS: MCA infarcts and poor conscious level increase the mortality in diabetic patients with stroke. Mortality is also significantly related to a high level of blood glucose at admission.
  10,698 279 14
IMAGES
Castleman’s Disease of the Parotid
H Mohan, A Bal, A Tahlan
October-December 2003, 49(4):348-349
PMID:14699237
  10,390 172 2
Vein of Galen Aneurysmal Malformation: Antenatal MRI
PR Maheshwari, SA Pungavkar, P Narkhede, DP Patkar
October-December 2003, 49(4):350-351
PMID:14699238
  10,143 260 1
LOOKING BACK
Theodor E. Kocher (1841-1917): Nobel Surgeon of the Last Century
RA Kazi
October-December 2003, 49(4):371-372
PMID:14699243
  10,167 189 3
ORIGINAL ARTICLE
Evaluation of Single Photon Emission Computerised Tomography (SPECT) using Tc99m-Tetrofosmin as a Diagnostic Modality for Recurrent Posterior Fossa Tumours
S Barai, GP Bandopadhayaya, PK Julka, AK Haloi, A Seith, A Malhotra
October-December 2003, 49(4):316-321
PMID:14699229
BACKGROUND: Brain Single Photon Emission Computerised Tomography (SPECT) has been established as a potentially useful tool for the assessment of recurrent brain tumours. Though brain SPECT is exquisitely sensitive in detecting viable tumour tissue in the supratentorial region, its efficacy has not been evaluated till date in case of infratentorial posterior fossa tumours. AIM OF THE STUDY: To evaluate the diagnostic utility of brain SPECT in differentiating recurrence of tumour from post-radiation gliosis in the posterior fossa of the brain. SUBJECTS AND METHODS: Twenty-one patients with primary malignant posterior fossa brain tumour were evaluated by brain SPECT with Tc99m-Tetrofosmin as the tumour-seeking agent. Clinical behaviour of the tumour observed for a minimum period of one year after the SPECT study was taken as the gold standard. STATISTICAL ANALYSIS: The Chi-square test has been used to note the significance of the association between the clinical outcome and the SPECT finding. In addition, the sensitivity and specificity of brain SPECT were also calculated. RESULT: Brain SPECT in 4 patients revealed increased tracer concentration over the primary tumour bed, which was consistent with recurrent tumour. The clinical course was consistent with tumour recurrence in 13 of the 21 patients, which included 3 patients with positive SPECT study and 10 patients with negative SPECT study. Brain SPECT revealed recurrent tumour in 4 patients whereas clinical follow-up suggested recurrence in 13 patients. The clinical course was consistent with radiation necrosis in the remaining 8 patients. In 1 brain SPECT positive patient the clinical course was consistent with post-radiation gliosis. CONCLUSION: This study demonstrates that brain SPECT is not a sensitive diagnostic modality to differentiate recurrent tumour from post-radiation gliosis in the posterior fossa of the brain.
  10,136 182 9
CASE REPORT
Mycetoma Caused by a New Red Grain Mycetoma Agent in Two Members of a Family
PK Maiti, D Bandyopadhyay, JB Dey, M Majumdar
October-December 2003, 49(4):322-324
PMID:14699230
An 18-year-old woman from rural West Bengal was affected with mycetoma involving her neck, back, and chest. After an interval of eight years, her younger brother developed mycetoma on his left arm. No history of trauma or immune deficiency was present in either case. By microscopic examination of sinus-discharged materials from both the cases, identical rusty red, hard grains were demonstrated. Soluble red pigment-producing colonies grew in Sabouraud dextrose-agar medium. Isolates were positive for casein hydrolysis and negative for hydrolysis test of xanthine, hypoxanthine, tyrosine, and nitrate reduction. Thus it differed from the only known red grain mycetoma agent, Actinomadura pelletieri and was provisionally identified as Actinomadura vinacea. Familial affection in mycetoma, that too caused by a new agent, is reported here for its uniqueness.
  8,788 215 1
LETTER TO EDITOR
Congenital Aortic Regurgitation due to Aortic Valvar Fenestration with Associated Aortic Dissection
P Vaideeswar, JR Deshpande
October-December 2003, 49(4):369-369
PMID:14699241
  7,904 141 1
Cryptococcal Lymphadenitis Diagnosed by FNAC in a HIV Positive Individual
BR Shravanakumar, KR Iyengar, Y Parasappa, R Ramprakash
October-December 2003, 49(4):370-370
PMID:14699242
  7,314 178 2
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