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   2017| January-June  | Volume 15 | Issue 1  
    Online since February 27, 2017

 
 
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CASE REPORTS
Atypical presentations of hiatal hernia in two pediatric patients
Mohemmed Ajij, Shambhavi , Shalu Gupta
January-June 2017, 15(1):10-12
DOI:10.4103/1118-4647.201051  
Hiatal hernia is an uncommon condition in children. Its symptoms can vary markedly from none to life-threatening condition, thereby making its diagnosis challenging. We reported two different cases, first a 15-month-old child presenting with respiratory distress, second a 7-year-old boy presenting with resistant iron deficiency anemia. Surgical management was done in both cases, following which both of them improved. To the best of our knowledge, this is the first case report of hiatus hernia in children in this region, with such contrasting presentation. A stepwise and methodical approach to the patients led to early diagnosis.
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Benign migratory glossitis with scrotal tongue
Karthik Shunmugavelu
January-June 2017, 15(1):13-14
DOI:10.4103/1118-4647.201053  
Benign migratory glossitis (BMG), also known as geographic tongue, consists of migrating, painless white lesions of different sizes on the dorsum of the tongue. These areas are devoid of papillae. BMG may occur in a sole manner or in combination with scrotal tongue. In case of scrotal tongue, also known as fissured tongue, food particles may get accumulated in the deep fissures resulting in irritation of the tongue. This scientific article is a case report regarding a 20-year-old man who presented with a combination of BMG and scrotal tongue.
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Graded epidural anaesthesia for caesarean section in a parturient with severe left ventricular dysfunction from dilated cardiomyopathy: A case report
Olufemi A Ige, Kikelomo T Adesina, Israel K Kolawole, Aminudeen Abdulrahman
January-June 2017, 15(1):7-9
DOI:10.4103/1118-4647.201050  
Dilated cardiomyopathy (DCM) is a primary disorder of heart muscle characterised by left ventricular (LV) or biventricular dilatation and impaired ventricular contractility. During pregnancy, women with DCM have a higher incidence of cardiac events than the non-pregnant patient. When DCM is associated with severe LV dysfunction, anaesthetic management is particularly challenging, because severe LV dysfunction is a predictor of sudden cardiac death and poor quality of life. The goals of anaesthetic management in DCM consist of maintaining normovolaemia, and avoiding myocardial depression and drug overdose during induction (as circulation time is slow). It also includes preventing increases in ventricular afterload and sudden hypotension when regional anaesthesia is a choice. This case report describes the successful anaesthetic management of a parturient with DCM and a severely low LV ejection fraction of 20%, wherein the child was delivered via caesarean section using a graded epidural anaesthesia technique.
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ORIGINAL ARTICLE
Any pattern changes in major lower limb amputations? a 10-year comparative retrospective study in a private orthopedic and trauma center in the south-east region of Nigeria
Thaddeus C Agu, Anselm C Ikwu
January-June 2017, 15(1):1-6
DOI:10.4103/1118-4647.201052  
Background: Major lower limb amputations are performed for various reasons, with many studies showing constantly changing patterns. Amputations are devastating procedures, even when they are done to save lives, and this is because of poor rehabilitation of amputees in our environment. Study Design and Setting: The records of all the patients who had major lower limb amputations in a private orthopedic and trauma center, south-east region of Nigeria from October 2005 to September 2010 (group A) and from October 2010 to September 2015 (group B) were reviewed retrospectively. Results: Traumatic gangrene from traffic accidents was the most common reason for amputation (47.1% in group A and 41.7% in group B) in both groups, followed by diabetic gangrene (17.6% in group A and 27.1% in group B). Traditional bonesetters’ gangrene was 13.7% in group A and 12.5% in group B. These were followed by mangled extremities and malignancies in decreasing order of frequency. Young male adults ranked high at 49.1% in group A and 58.4% in group B, while the more conservative below-knee amputation was 39.2% in group A and 47.9% in group B, compared to above-knee amputation of 52.9% in group A and 39.6% in group B. Conclusion: A greater majority of amputations are still being performed because of traumatic gangrene followed by diabetic gangrene, which had significantly increased comparatively. There is no overall change in the trend concerning the indications for amputation in this study despite the slight reduction in traumatic gangrene. However, the results indicate that the trend is toward being more conservative. The causes of traffic accidents are preventable, and, therefore, there is a need for continued public orientation to reduce the incidence of accidents on our roads and consequently reduce the amputation rate in our subregion.
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