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   2007| July-September  | Volume 53 | Issue 3  
 
 
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REVIEW ARTICLE
The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment
V Papadopoulos, K Mimidis
July-September 2007, 53(3):203-206
DOI:10.4103/0022-3859.33868  PMID:17699999
Rumination in adults is considered to be the effortless regurgitation of recently ingested food into the mouth, followed by either rechewing and reswallowing or expulsion of the regurgitate. On the basis of the definition of rumination as a unique category of functional gastroduodenal disorders, according to the newly established Rome III classification, a review of the pathophysiology, diagnosis and treatment of the rumination syndrome in adults is presented after systematic and critical approach of all articles that could be retrieved through PubMed using the term "rumination".
  33,515 657 13
Present status of understanding on the G6PD deficiency and natural selection
V Tripathy, BM Reddy
July-September 2007, 53(3):193-202
DOI:10.4103/0022-3859.33867  PMID:17699998
G6PD deficiency is a common hemolytic genetic disorder, particularly in the areas endemic to malaria. Individuals are generally asymptomatic and hemolytic anemia occurs when some anti-malarial drugs or other oxidizing chemicals are administered. It has been proposed that G6PD deficiency provides protection against malaria. Maintaining of G6PD deficient alleles at polymorphic proportions is complicated because of the X-linked nature of G6PD deficiency. A comprehensive review of the literature on the hypothesis of malarial protection and the nature of the selection is being presented. Most of the epidemiological, in vitro and in vivo studies report selection for G6PD deficiency. Analysis of the G6PD gene also reveals that G6PD-deficient alleles show some signatures of selection. However, the question of how this polymorphism is being maintained remains unresolved because the selection/fitness coefficients for the different genotypes in the two sexes have not been established. Prevalence of G6PD deficiency in Indian caste and tribal populations and the different variants reported has also been reviewed.
  25,631 1,313 34
VIEW POINT
The oxidative hypothesis of senescence
M Gilca, I Stoian, V Atanasiu, B Virgolici
July-September 2007, 53(3):207-213
DOI:10.4103/0022-3859.33869  PMID:17700000
The oxidative hypothesis of senescence, since its origin in 1956, has garnered significant evidence and growing support among scientists for the notion that free radicals play an important role in ageing, either as "damaging" molecules or as signaling molecules. Age-increasing oxidative injuries induced by free radicals, higher susceptibility to oxidative stress in short-lived organisms, genetic manipulations that alter both oxidative resistance and longevity and the anti-ageing effect of caloric restriction and intermittent fasting are a few examples of accepted scientific facts that support the oxidative theory of senescence. Though not completely understood due to the complex "network" of redox regulatory systems, the implication of oxidative stress in the ageing process is now well documented. Moreover, it is compatible with other current ageing theories (e.g., those implicating the mitochondrial damage/mitochondrial-lysosomal axis, stress-induced premature senescence, biological "garbage" accumulation, etc). This review is intended to summarize and critically discuss the redox mechanisms involved during the ageing process: sources of oxidant agents in ageing (mitochondrial -electron transport chain, nitric oxide synthase reaction- and non-mitochondrial- Fenton reaction, microsomal cytochrome P450 enzymes, peroxisomal β -oxidation and respiratory burst of phagocytic cells), antioxidant changes in ageing (enzymatic- superoxide dismutase, glutathione-reductase, glutathion peroxidase, catalase- and non-enzymatic glutathione, ascorbate, urate, bilirubine, melatonin, tocopherols, carotenoids, ubiquinol), alteration of oxidative damage repairing mechanisms and the role of free radicals as signaling molecules in ageing.
  22,285 1,890 51
LETTERS
Does penis radiological shadow indicate the side of hip fracture?
GJ Mouzopoulos, MK Stamatakos, DJ Mouzopoulos
July-September 2007, 53(3):217-218
DOI:10.4103/0022-3859.33873  PMID:17700004
  21,150 329 4
ORIGINAL ARTICLE
Thyroid cancer in toxic and non-toxic multinodular goiter
C Cerci, SS Cerci, E Eroglu, M Dede, N Kapucuoglu, M Yildiz, M Bulbul
July-September 2007, 53(3):157-160
DOI:10.4103/0022-3859.33855  PMID:17699987
Background : Many authors have claimed that hyperthyroidism protects against thyroid cancer and believed that the incidence of malignancy is lower in patients with toxic multinodular goiter (TMG) than in those with non-toxic multinodular goiter. But in recent studies, it was reported that the incidence of malignancy with TMG is not as low as previously thought. Aim : To compare the thyroid cancer incidence in patients with toxic and non-toxic multinodular goiter. Settings and Design : Histology reports of patients treated surgically with a preoperative diagnosis of toxic and non-toxic multinodular goiter were reviewed to identify the thyroid cancer incidence. Patients having a history of neck irradiation or radioactive iodine therapy were excluded from the study. Materials and Methods : We reviewed 294 patients operated between 2001-2005 from toxic and non-toxic multinodular goiter. One hundred and twenty-four of them were toxic and 170 were non-toxic. Hyperthyroidism was diagnosed by elevated tri-iodothyroinine / thyroxine ratios and low thyroid-stimulating hormone with clinical signs and symptoms. All patients were evaluated with ultrasonography and scintigraphy and fine needle aspiration biopsy. Statistical Analysis Used : Significance of the various parameters was calculated by using ANOVA test. Results : The incidence of malignancy was 9% in the toxic and 10.58% in the non-toxic multinodular goiter group. Any significant difference in the incidence of cancer and tumor size between the two groups could not be detected. Conclusions : The incidence of malignancy in toxic multinodular goiter is not very low as thought earlier and is nearly the same in non-toxic multinodular goiter.
  19,636 1,184 32
Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: A retrospective study
E Kamer, HR Unalp, H Derici, T Tansug, MA Onal
July-September 2007, 53(3):176-180
DOI:10.4103/0022-3859.33859  PMID:17699991
Background : Umbilical defects may cause technical problems for general surgeons in patients during laparoscopic cholecystectomy (LC) operations and may increase the incidence of incisional hernia. Aim : The objectives of this study were to determine the optimal repair method for umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during LC. Settings and Design : Medical records of patients who had received simultaneous umbilical hernia repair (UHR) with LC were investigated retrospectively. Materials and Methods : Cholelithiasis was accompanied by umbilical hernia in 64 (8.6%) out of 745 patients who underwent LC and UHR simultaneously in our hospital between 2000 and 2004. Statistical Analysis Used : The Mann-Whitney U, Chi-square, One-Way Anova, Kaplan-Meier survival analysis, the log-rank test and t test were used for statistical analyses. Results : LC was followed by UHR using primary suture (Group 1), Mayo repair (Group 2) and flat mesh-based repair (Group 3) in 32 (50%), 18 (28.1%) and 14 (21.9%) patients, respectively. Mean body mass indexes (BMI) of patients were 26.6 kg/m 2 , 29.2 kg/m 2 and 39.9 kg/m 2 in Groups 1, 2 and 3, respectively. Recurrence rates were 9.4%, 5.6% and none (0%) in Groups 1, 2 and 3, respectively. Recurrence was observed in three (7.0%) out of 43(67.2%) patients with BMI≥30 kg/m 2 while umbilical hernia recurred in one (4.8%) out of 21 (32.8%) patients with BMI<30 kg/m 2 . Overall morbidity and mortality rates were 14.1% and 0%, respectively. Conclusions : The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.
  15,505 459 13
LETTERS
Ultradian pattern bipolar affective disorder and chronic antidepressant use
ST Varghese, A Kumar, R Sagar
July-September 2007, 53(3):214-214
DOI:10.4103/0022-3859.33870  PMID:17700002
  10,330 181 -
CASE REPORTS
Paraphenylene diamine ingestion: An uncommon cause of acute renal failure
R Ram, G Swarnalatha, N Prasad, KV Dakshinamurty
July-September 2007, 53(3):181-182
DOI:10.4103/0022-3859.33860  PMID:17699992
Paraphenylene diamine (PPD) is a major component of hair dyes. The aim is to study the renal manifestations and outcome of PPD consumption. During a four-year period from 2002 to February 2006, 10 persons were admitted to our Institute after consuming a hair dye in a suicidal bid. The percentage of ARF due to PPD at our Institute was 0.95%. Seven patients out of 10 (70%) who consumed PPD developed ARF. All 10 patients, including the patients who had normal renal function had features of rhabdomyolysis. Two patients required ventilator support for respiratory distress and two more required tracheostomy due to upper airway tract edema. One patient has expired after two sessions of dialysis. Renal biopsy in two patients (one, postmortem) showed acute tubular necrosis along with presence of casts in tubules due to myoglobin.
  8,634 297 16
ORIGINAL ARTICLE
Neostigmine does not prolong the duration of analgesia produced by caudal bupivacaine in children undergoing urethroplasty
N Bhardwaj, S Yaddanapudi, B Ghai, J Wig
July-September 2007, 53(3):161-165
DOI:10.4103/0022-3859.33856  PMID:17699988
Context : Neostigmine extends the duration of analgesia produced by caudal bupivacaine in children. Aims : To study the effect of different doses of caudal neostigmine on the duration of postoperative analgesia. Settings and Design : A randomized, double-blind study was conducted in 120 boys aged 1-12 years undergoing urethroplasty under combined general and caudal anesthesia. Materials and Methods : Children were administered 1.875 mg/kg bupivacaine alone (Group B), or with 2, 3 or 4 g/kg of neostigmine (groups BN 2 , BN 3 or BN 4 respectively) as caudal drug (0.75 ml/kg). Children with a pain score of 4 or more (OPS and NRS) postoperatively were administered rescue analgesic. Time to first analgesic and the number of analgesic doses administered in the 24h were recorded. Statistical Analysis : Parametric data were analyzed using ANOVA. Kaplan-Meier survival curves for the time to first analgesic administration were plotted and compared using log rank analysis. Chi-square test was used to analyze the incidence data. Results : The median [IQR] time to first analgesic in Group B (540 [240-1441] min) was similar to that in Groups BN 2 (450 [240-720]), BN 3 (600 [360-1020]) and BN 4 (990 [420-1441]). Significantly more patients in Groups B (9 [34.6%]) and BN 4 (13 [44.8%]) required no supplemental analgesic for 24h than those in Groups BN 2 and BN 3 (4 [13.8%] and 4 [13.3%]). The number of analgesic doses required in 24h in the four groups was similar. Conclusion : Addition of neostigmine to 1.875 mg/kg of caudal bupivacaine did not prolong the analgesia following urethroplasty in children.
  7,586 558 15
Anti-Saccharomyces cerevisiae antibody is not useful to differentiate between Crohn's disease and intestinal tuberculosis in India
UC Ghoshal, U Ghoshal, H Singh, S Tiwari
July-September 2007, 53(3):166-170
DOI:10.4103/0022-3859.33857  PMID:17699989
Context : Clinical, endoscopic, radiological and histological parameters of intestinal tuberculosis (IT) and Crohn's disease (CD) are so similar that differentiation between these two diseases, which require different treatment, is difficult. Anti- Saccharomyces cerevisiae antibody (ASCA), which is often present in the sera of patients with CD, may be potentially useful to differentiate CD from IT. Aim : To evaluate the role of enzyme-linked immunosorbent assay test for ASCA in serum in differentiating CD from intestinal tuberculosis. Settings and Design : Prospective case-control study. Materials and Methods: Sixteen patients with IT, 16 CD, 36 UC diagnosed using standard parameters and 12 controls (11 healthy subjects and one with colonic carcinoma) were tested for IgG ASCA in serum. Statistical Analysis Used : Categorical variables were analyzed using Chi-square test with Yates' correction, as applicable. Continuous variables were analyzed using Mann-Whitney U test. Results : Eight of 16 (50%) patients with IT, 10 of 16 with CD (62%), nine of 35 with UC (26%) and one of 12 controls tested positive for ASCA in serum. Though the frequency of ASCA in serum was comparable among patients with IT and CD (8/16 vs. 10/16, P = ns), IT and UC (8/16 vs. 9/35, P =ns), CD and UC (10/16 vs. 9/35, P =ns), its frequency in CD or IT but not in UC was higher than healthy controls ( P < 0.01). Conclusions : Serum ASCA is unlikely to be useful to differentiate between CD and IT in India.
  7,458 445 18
GUEST EDITORIAL
Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair
BE Wright
July-September 2007, 53(3):156-156
DOI:10.4103/0022-3859.33926  PMID:17699986
  7,373 242 -
ORIGINAL ARTICLE
Sedation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: Comparison of propofol and midazolam infusions
S Yaddanapudi, YK Batra, A Balagopal, NG Nagdeve
July-September 2007, 53(3):171-175
DOI:10.4103/0022-3859.33858  PMID:17699990
Context : Propofol and midazolam are commonly used sedatives during regional anesthesia in adults. Smaller doses of these drugs are required in older age due to altered pharmacokinetics and pharmacodynamics. Aims : To study the sedation, side-effects and the costs involved with smaller doses of propofol and midazolam in patients aged above 60 years during spinal anesthesia. Settings and Design : A randomized single-blind study was conducted in 60 ASA I-II patients aged ≥60 years undergoing urological surgery under spinal anesthesia. Materials and Methods : Sedation was administered after spinal anesthesia using propofol (bolus 0.4 mg/kg-1; infusion 3 mg/kg/hr) or midazolam (bolus 0.02 mg/kg; infusion 0.06 mg.kg-1/h-1 ) and titrated to achieve a sedation score of 3 on the modified Observer's Assessment of Alertness/Sedation Scale. Perioperative sedation, hemodynamics and respiratory events were monitored. Statistical Analysis : The analysis for parametric data was done using Student's unpaired t test and the incidence data using Chi-square test. Results : The onset (13.04.2 vs. 18.84.2 min, P <0.001) and offset (8.92.8 vs. 12.53.5 min, P <0.001) of sedation were faster and the duration of adequate sedation longer (44.712.5 vs. 29.812.9% of total infusion time, P <0.001) with propofol than midazolam. More patients receiving propofol compared to midazolam had hypotension (16 [50%] vs.4 [14.3%], P= 0.003). Airway obstruction occurred frequently in both the groups. Sedation was significantly more expensive with propofol than midazolam (US$ 9.83 2.80 vs. US$ 0.33 0.06, P< 0.001). Conclusions : Propofol provided better titration and adequacy of sedation than midazolam in patients above 60 years of age, but caused hypotension. Lighter sedation is recommended in this age group.
  6,505 469 14
LETTERS
Vitamin D deficiency rickets with Lamellar ichthyosis
T Sathish Kumar, XJ Scott, A Simon, P Raghupathy
July-September 2007, 53(3):215-217
DOI:10.4103/0022-3859.33872  PMID:17700003
  5,893 260 6
IMAGES IN PATHOLOGY
Pseudosarcoma: A diagnostic and treatment dilemma
A Alexander, N Walter, AM Varghese, L Mary
July-September 2007, 53(3):187-188
DOI:10.4103/0022-3859.33864  PMID:17699995
  5,853 246 2
IMAGES IN MEDICINE
Familial hypercholesterolemia with coarctation of aorta
A Aggarwal, A Gupta, M Narang, MMA Faridi
July-September 2007, 53(3):185-186
DOI:10.4103/0022-3859.33863  PMID:17699994
  5,600 395 2
IMAGES IN PATHOLOGY
Calcifying fibrous pseudotumor of peritoneum
A Jain, V Maheshwari, K Alam, V Jain
July-September 2007, 53(3):189-190
DOI:10.4103/0022-3859.33865  PMID:17699996
  5,529 234 6
CASE REPORTS
Central retinal vein occlusion associated with thrombotic thrombocytopenic purpura/ hemolytic uremic syndrome: Complete resolution is possible
SA Issa, Q Qasem
July-September 2007, 53(3):183-184
DOI:10.4103/0022-3859.33862  PMID:17699993
We aim to describe a case of central retinal vein occlusion associated with this is a case report of a 45-year-old patient who was admitted for management of thrombotic thrombocytopenic purpura (TTP). He developed left central retinal vein occlusion three months later. The retinal vein occlusion resolved gradually as his TTP started to respond to medical treatment but significant macular edema persisted. Focal argon laser treatment resulted in complete resolution of the macular edema.
  5,108 268 9
GUEST EDITORIAL
Sedation, spinal anesthesia and older patients
S Mannion
July-September 2007, 53(3):155-155
DOI:10.4103/0022-3859.33854  PMID:17699985
  4,894 301 3
LETTERS
A case of Marfans syndrome with aminoaciduria
N Udayakumar, S Sivapraksh, C Rajendiran
July-September 2007, 53(3):214-215
DOI:10.4103/0022-3859.33871  PMID:17700001
  4,123 153 -
Worsening of tardive dyskinesia due to clozapine therapy
J Raguraman, J Vijaysagar
July-September 2007, 53(3):218-218
DOI:10.4103/0022-3859.33874  PMID:17700005
  4,002 246 6
IMAGES IN RADIOLOGY
Utility of multislice computed tomography in the diagnosis of a right coronary artery fistula to the right atrium
GS Gulati, S Ramamurthy, S Sharma
July-September 2007, 53(3):191-192
DOI:10.4103/0022-3859.33866  PMID:17699997
  3,890 258 1
EDITORIAL
Journal of Postgraduate Medicine: The path ahead
SB Bavdekar, NJ Gogtay, D Muzumdar, P Vaideeswar, V Salvi, M Sarkar
July-September 2007, 53(3):153-153
DOI:10.4103/0022-3859.33852  
  3,241 217 1
FOREWORD
Foreword
ME Yeolekar
July-September 2007, 53(3):154-154
  2,455 145 -
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