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   Table of Contents - Current issue
October-December 2017
Volume 14 | Issue 4
Page Nos. 197-240

Online since Monday, February 5, 2018

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Editorial Highly accessed article p. 197
RN Srivastava
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Neurological benefits of mindfulness meditation p. 198
Pushpendra Nath Renjen, Dinesh Mohan Chaudhari
Meditation can be defined as a form of mental training that aims to improve an individual's core psychological capacities, such as attentional and emotional self-regulation. Research on the biological concomitants of meditation practice is sparse and has mostly focused on changes that occur during meditation compared with a resting control condition in a single experimental session. Over 2000 scientific publications on the term “meditation” have been published till date, mainly in the scientific fields such of psychology and neuroscience. If supported by rigorous research studies, the practice of mindfulness meditation might be promising for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.
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Recurrent aphthous ulcers — Still a challenging clinical entity p. 202
Santosh Kumar Swain, Sanjeev Gupta, Mahesh Chandra Sahu
Recurrent aphthous ulcer (RAU) is a clinical condition characterized by painful ulcer with different size affecting the mucosa of the oral cavity. Its etiology and pathogenesis are not clearly known and the diagnosis is based on the clinical picture. These lesions may be classified into minor, major, and herpetiformis. The aphthous ulcers in the oral cavity affect speech and feeding, leading to poor quality of life. Relevant literature was searched from PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and Scopus last 20 years using the keywords “RAU.” The RAU is a common clinical entity. The diagnosis of RAU is mainly based on clinical ground and must be differentiated from other causes of oral ulceration. The treatment is often unsatisfactory as topical application of corticosteroids and other treatment modalities minimizes the severity of the ulceration but not stop chance of recurrence.
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Factors influencing outcome in head injury patients with glasgow coma scale <8 p. 207
Kodeeswaran Marappan, M Prabhu, Balasubramani K, Sherina Paul Raj
Background: Over the years in the emergency department, it has been generally observed that the overall outcome in severe head injury patients is very poor. Hence, a study was conducted in traumatic brain injury patients with a Glasgow Coma Scale (GCS) <8, in which various factors that affect outcome in severe head injury patients were analyzed. Objective: The objective of the study was to understand the various factors influencing outcome in patients with severe head injury (GCS ≤8). Subjects and Methods: This was a prospective study, conducted on 350 consecutive acute severe head injury patients with a GCS ≤8. Thirteen independent factors expected to affect prognosis of severe head injury patients were analyzed and studied. Multivariate analysis was used to include adjustment for prognostic variables. Positive predictive value and strong association of the data were analyzed using cumulative percentage, Chi-square test, and cross-tabulation. Results: From the study, it was observed that male population, older age group patients, low GCS on arrival, train accidents, increased time interval, poor motor response, sluggish or absent pupillary reaction to light, absence of dolls eye movement, presence of comorbidities and other severe traumatic injury of major organs, poor glycemic status, and altered coagulation profile were associated with poor outcome in patients. Conclusions: A keen evaluation of patient profile before taking definitive management decisions is recommended, so as to improve the outcome in severe head injury patients. This is because, there are certain factors such as glycemic statuses of the patient, hemoglobin level, and coagulation profile that are modifiable, and if identified and corrected early, could improve the prognosis of the patients to a large extent.
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Pediatric humeral fracture fixed by a single retrograde titanium elastic nail p. 212
Kapil Mani K C, Parimal Acharya, Bandhu Ram Pangeni, Suman Babu Marahatta
Introduction: Almost all pediatric humerus fractures are well managed with conservative treatment with higher percentage of union rate. However there are certain conditions where surgical intervention will be inevitable like humerus fracture associated with polytrauma compound fractures, those with head and unacceptable alignment. It is not only the stable fixation but also the alignment which is important and can be maintained even by a single pre-bent elastic or flexible intramedullary nailing. Methods: This was a retrospective study of 28 pediatric humeral fractures fixed with a single retrograde titanium elastic nail from 2012 to 2016. Time to unite the fracture along with other complications was noted. The functional outcomes were assessed according to Broberg and Morrey for elbow function and Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder function. Results: Average age of patients was 8.85 1.84 (range 6 to 12 years). Time to unite the fracture was 8.28 2.43 weeks (range 6 to 12 weeks). There were 1 case of malunion around 10 degrees, 1 case of nail migration, one case of superficial infection at the site of nail entry, one case of transient radial nerve palsy and one case of nail protrusion in our study. There were 24 (85.71%) cases of excellent and 4 (14.29%) cases of good results according to Broberg and Morrey functional scores. Conclusion: Fixation of pediatric humerus fractures with a single flexible nail reduces operative time, radiation exposure, cost of treatment, chances of iatrogenic supracondylar fracture and ulnar nerve injury without compromising the final outcomes.
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Vanishing bone disease of the face: A rare case of massive osteolysis p. 218
Santosh Kumar Swain, Manash Ranjan Baisakh, Chaubarg Nayak, Mahesh Chandra Sahu
Vanishing bone disease (VBD) is an uncommon clinical entity with unknown etiology. This disease affects individual irrespective of age or sex. It can affect any bone of the body including the mandibular region of the face. The osseous tissue is progressively replaced by angiomatic tissue and finally by fibrous tissue. It is usually seen in the second and third decades of the life. It is often difficult to diagnose and the treatment is controversial. Here, we report a case of aggressive VBD in the mandibular region which was treated with radiotherapy and zoledronic acid. Because of its rarity, we described this clinical scenario affecting cosmesis of the patient with pain in face-and-neck area.
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A rare case report of solid pseudopapillary tumor of the pancreas p. 221
Vandana Gite, Maruti Dhakane
A solid pseudopapillary tumor is a low-grade malignant cystic exocrine neoplasm of the pancreas of papillary architecture that typically afflicts young women with excellent postsurgical curative rates and rare metastasis. It may be locally aggressive. Pathological evaluation remains the gold standard in reaching a definitive diagnosis. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed preoperatively on biopsy guiding definitive surgery.
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Primary retroperitoneal yolk sac tumor p. 224
KS Sahana, RM Prakash Saldanha, Guruprasad Bhat
Primary retroperitoneal yolk sac tumour is very rare. 3 year old with rapidly progressing abdominal mass. CT heterogeneously enhancing large lesion with liver metastasis. HPE showed features suggestive of YST. Elevated AFP noted. Patient improved with surgery followed by chemotherapy. Paediatric germ cell tumours are highly curable form of cancer, but their diversity makes it challenging for the clinicians.
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Minimal invasive enucleation of leiomyoma of the esophagus: A fast-track approach p. 227
Priyanka Tiwari, Dinesh Zirpy, Juneed Mohammad Lanker, Prasanna Kumar Reddy
Although benign tumors of esophagus are rare (10%), leiomyoma of esophagus is the most common benign tumor and most commonly situated in the lower and middle-third of esophagus. Most of the tumors produce no symptoms and are found incidentally; however, when symptoms are present, dysphagia and pain predominate. While open surgical technique was the conventional mainstay of therapy for leiomyomas, combined esophagoscopy and video-assisted thoracoscopic surgery or laparoscopic transhiatal resection are being increasingly performed. We describe minimally invasive enucleation of esophageal leiomyoma with a fast-track approach with reduced postoperative pain and hospital stay.
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Laparoscopic management of gastric neuroendocrine tumor with massive hematemesis p. 229
Nadeem Mushtaque Ahmed, Vimalkumar Dhaduk, JK A.Jameel, Prasanna Kumar Reddy
Gastric neuroendocrine tumor (GNET) usually presents with nonspecific symptoms such as dyspepsia, nausea, and epigastric pain. They are usually diagnosed on histological evaluation of gastric polyps. Gastrointestinal bleed may be seen in large ulcerated polyps. However, massive gastrointestinal bleed leading to hematemesis is uncommon in GNETs. We describe a case of 55 years gentleman who was referred for massive hematemesis. On evaluation he was found to have a large ulcerated bleeding GNET. Laparoscopic resection of GNET was done.
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Bulbar myasthenia after 7 years of thymectomy p. 232
Ramesh Babu Mutiki, A Panneer
A small proportion of thymoma patients without myasthenia gravis (MG) have been observed to develop MG after total removal of the thymoma. However, the underlying cause is not yet known due to the rarity of postoperative MG patients. We report a 49-year-old female in who developed MG, 7 years after surgical removal of thymoma. Computed tomography and magnetic resonance imaging showed no features of recurrent or metastatic thymoma. Administration of pyridostigmine bromide resulted in prompt improvement of myasthenic symptoms. Our observations indicate that postoperative follow-up care with monitoring of possible postoperative MG is necessary after thymectomy.
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An intriguing case of rapidly progressive dementia: Creutzfeldt–Jakob Disease p. 234
Dinesh Chaudhari, Pushpendra Nath Renjen, Dhruv Zutshi, Kamal Ahmad, Abhas Kumar
Although no formal definition exists for what constitutes a rapidly progressive dementia (RPD), generally we use the term when dementia occurs in <1–2 years from illness onset, but more commonly over weeks to months. Prion diseases are the prototypical causes of RPD, but reversible causes of RPD might mimic prion disease and should always be considered in a differential diagnosis. We report the case of a 65-year-old male with progressive dementia and typical neurologic symptoms, myoclonic jerks, and magnetic resonance imaging findings of Creutzfeldt–Jakob disease (CJD). This case highlights the need for a high index of suspicion to diagnose CJD.
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Painful knee swelling in a 32-year-old Female p. 238
Raju Vaishya, Vipul Vijay, Amit Kumar Agarwal
We discuss the presentation of an expansile lytic lesion in the distal femur of a young female. We also discuss the radiological findings of the lesion along with the possible differential diagnoses. The presence of such an expansile lytic lesion in a young adult raises multiple diagnostic possibilities, and the final decision depends on incisional biopsy.
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Ollier disease p. 240
Robert U Ashford
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Section Editor's Reply p. 240
Raju Vaishya
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