1.Cannulated Screw Fixation For Femoral Neck Fractures: A 5-year Experience In A Single Institution
Khoo CCH ; Amber Haseeb ; Vivek Ajit Singh
Malaysian Orthopaedic Journal 2014;8(2):14-21
Cannulated screw fixation is a widely accepted surgical
method for management of fractures of the neck of femur
especially in patients with poor premorbid conditions,
minimally displaced fractures and those from a younger
age group. A five year retrospective study was carried
out in 53 consecutive patients between 2006 to 2010 to
determine the pattern of injuries, management, outcomes
and the associated predictive factors.All the patients
underwent cannulated screw fixation, with 37 (69.8%)
having had surgery within 24 hours and the remaining
16 (30.2%) 24 hours after the initial injury. All patients
were followed up to union of fractures and complications
thereafter if any. Good outcome was observed in 43
(81.1%) patients leaving only 10 (18.9%) patients with a
poor outcome, of whom nine developed avascular necrosis
(90%) and one non-union (10%). We found no significant
relationship between the incidence of avascular necrosis
and age of patient, fracture displacement, numbers of
cannulated screws used, fracture reduction acceptability
and anatomical location of the fracture. The time interval
from injury to surgery and the presence of posterior
comminution did seem to influence the rate of avascular
necrosis but due to the small number of patients, was not
statistically significant.We conclude that cannulated screw
fixation is a viable option of treatment for fractures of the
neck of femur.
Femoral Neck Fractures
2.Bilateral Mirror Image Cervical Neurofibroma in an Adult with Neurofibromatosis Type 1
Sharad Pandey ; Kulwant Singh ; Vivek Sharma ; Mohammed Tabish Khan
Malaysian Journal of Medical Sciences 2017;24(1):117-120
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by
various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal
abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal
Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving
the spinal roots at every level being even rarer. We reported an interesting case of bilateral
symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror
image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male.
3.Early Transneuronal Degeneration in Dyke-Davidoff-Masson Syndrome.
Anu GUPTA ; Manoj Kumar GOYAL ; Parampreet SINGH ; Vivek LAL
Journal of Clinical Neurology 2016;12(1):117-118
No abstract available.
4.Malignant Melanoma of the Foot in Patients with Diabetes Mellitus – A Trap for the Unwary
Paisal Hussin ; Seng Cheong Loke ; Fatimah Mohd Noor ; Maliza Mawardi ; Vivek Ajit Singh
The Medical Journal of Malaysia 2012;67(4):422-423
Melanomas on the foot are difficult to differentiate from
diabetic foot ulcers (DFU). In particular, acral lentiginous and amelanotic melanomas have a high chance of being misdiagnosed. We present two patients with diabetes
mellitus and malignant melanomas of the foot initially
diagnosed as DFU. Both cases were treated with wide
excision amputation and local dissection, without adjuvant
chemotherapy or radiotherapy. Both patients remain
disease-free up to the last follow-up visit. It is important to maintain a high index of suspicion and a skin biopsy should be done in any DFU with atypical features.
5.Outcome of application of primary versus secondary Illizarov's fixator in open tibial shaft fractures
Joshi ANIL ; Singh SAURABH ; Jain SUDEEP ; Rohilla NARENDER ; Trikha VIVEK ; Yadav CHANDRA
World Journal of Emergency Medicine 2016;7(3):221-226
BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov''s fi xator application as a treatment method for type Ⅲ open tibial fractures in terms of non-union and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type Ⅲ tibial fractures were treated with Illizarov''s apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov''s application, primary (n=28) and secondary (n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov''s fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov''s fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.
7.Endovascular management of intracranial pseudoaneurysm: an institutional experience
Vivek PHOGAT ; Ashok GANDHI ; Trilochan SRIVASTAVA ; Keshav MISHVA
Journal of Cerebrovascular and Endovascular Neurosurgery 2020;22(4):211-215
Objective:
Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs.
Methods:
The study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed.
Results:
Total 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit.
Conclusions
Endovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.
9.Incidence and outcome of bone metastatic disease at University Malaya Medical Centre.
Vivek Ajit SINGH ; Amber HASEEB ; Alla Allden H Ali ALKUBAISI
Singapore medical journal 2014;55(10):539-546
INTRODUCTIONMorbidity and mortality from malignant diseases are usually the result of metastasis. The bone is the third most common site of metastasis.
METHODSThis is a retrospective study of patients with metastatic bone disease who were referred to the Orthopaedic Department of University Malaya Medical Centre, Malaysia, between January 2004 and October 2009.
RESULTSA total of 151 patients (51.0% men, 49.0% women) had metastatic bone disease, with the highest incidence at the age range of 50-59 years. The commonest primary cancer was breast (23.3%), followed by lung (21.2%), prostate (9.3%), thyroid (7.3%) and renal cell carcinoma (5.3%); unknown primary cancer was 6.6%. There was long bone involvement in 52.7% of cases, axial bone in 44.5%, and both long and axial bones in 2.8%. The majority (90.1%) were symptomatic, with pain as the commonest symptom. 106 (70.2%) patients had pathological fractures. Neurological deficit was reported in 90.7% of patients, with 41.1% having extraskeletal metastases. 67.8% of the lesions were osteolytic, 24.3% were sclerotic, and 7.9%, mixed. Palliative and therapeutic interventions were undertaken for 62.0% of patients. The mean survival times were: breast 21.0; thyroid 20.7; prostate 20.3; lung 16.0; and unknown primary cancer 32.6 months.
CONCLUSIONIn our study, breast and lung cancers were the commonest primary cancers in metastatic bone disease. Most patients had more than one site of involvement, pain at presentation and pathological fractures. Surgery is beneficial to relieve pain and improve function and neurology. Duration of survival depends on the type of primary cancer and whether systemic metastasis is present.
Academic Medical Centers ; statistics & numerical data ; Adult ; Age Distribution ; Aged ; Bone Neoplasms ; epidemiology ; secondary ; Breast Neoplasms ; pathology ; Female ; Humans ; Incidence ; Lung Neoplasms ; pathology ; Malaysia ; epidemiology ; Male ; Middle Aged ; Retrospective Studies
10.Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease.
Arun KARYAMPUDI ; Uday C GHOSHAL ; Rajan SINGH ; Abhai VERMA ; Asha MISRA ; Vivek A SARASWAT
Journal of Neurogastroenterology and Motility 2017;23(2):208-217
BACKGROUND/AIMS: Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. METHODS: Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH < 4 for > one hour during night, and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded. RESULTS: Of the 58 patients (age 35.5 [inter-quartile range 26.5–46.0] years, 38 [65.5%], 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9–4.1] vs 5.7 [4.6–6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.360 and 0.0 [0.0–1.0] vs 0.0 [0.0–0.3] minutes, P = 0.260, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.750). Though ilaprazole was associated with less NABs (1 [range 1–2, n = 19] vs 1 [range 1–3, n = 23], P = 0.010) than omeprazole, the frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.560; 117 [0–315] vs 159 [69–287] minutes, P = 0.500; 1.02 [0.7–1.4] vs 1.04 [0.44–1.3], P = 0.620, respectively). CONCLUSIONS: Though NAB was common while patients were on a proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole, except for the lesser number of NABs with ilaprazole.
Chest Pain
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Electric Impedance
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Gastroesophageal Reflux*
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Heartburn
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Humans
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Hydrogen-Ion Concentration
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Omeprazole*
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Prospective Studies
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Proton Pump Inhibitors
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Proton Pumps
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Thorax