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  Citation statistics : Table of Contents
   2006| January-March  | Volume 40 | Issue 1  
 
 
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CURRENT CONCEPT REVIEW
Intertrochanteric fractures
GS Kulkarni, Rajiv Limaye, Milind Kulkarni, Sunil Kulkarni
January-March 2006, 40(1):16-23
DOI:10.4103/0019-5413.34069  
  5 27,580 2,317
CASE REPORTS
Calcific tendinitis : An infrequent and misdiagnosed cause of acute wrist pain - A case report
N Hulse, A Kumar
January-March 2006, 40(1):57-57
DOI:10.4103/0019-5413.34437  
  2 12,623 164
SILVER JUBILEE COMMEMORATION LECTURE
Basic science of host immunity in osteoarticular tuberculosis - A clinical study
Anil Arora
January-March 2006, 40(1):1-15
DOI:10.4103/0019-5413.34068  
Background : Osteoarticular tuberculosis is coming back with vengeance. Host immunity plays a major role in either containing the disease or allowing the spread. Number of resistant cases and drug defaulters are on the rise. Immunepotentiation (immunomodulation) has shown beneficial response in pulmonary tuberculosis in various studies. Methods : This study was done to assess immune status of various categories of patients of osteoarticular tuberculosis, to modulate (alter or change) the immune system in non responder patients and to add immunomodulation therapy in some patients from the very beginning of antitubercular chemotherapy and observe their clinical response and objectively assess their immune status. Prospective study was done in two phases involving 103 patients suffering from osteoarticular tuberculosis. In phase one 61 patients (Two Groups - Group 1 called fresh virgin/responder cases given first line antitubercular drugs (ATT) = 41 patients; Group 2 called Non responders immunomodulated with cycles of oral levamisole, BCG and DPT vaccine as an adjuvant to ATT = 20 patients) assessed for their cellular immune profile. In second phase 42 patients (In three Groups - Group 3A who received only ATT = 15 patients; Group 3B who received ATT and immunomodulation from very beginning = 15 patients; Group 4 who were non responders, put on immunomodulation after minimum three months of ATT =12 patients) were assessed for their interleukin profiles at presentation and after three months of therapy in respective groups. The immune parameters of all above mentioned patients (n=103) were correlated with the type of clinical presentation, course of disease, response to therapy and response to immunomodulation. Follow up in all the groups ranges from 24 - 49 months (mean 27.2 months). Results : Group1 (n=41): Thirty nine out of 41 patients showed clinicoradiological response at three months of therapy. The CD4 cell counts in these patients rose to a statistically significant (p=. 000) mean of 1140452.6 cumm indicating that tuberculosis is an important cause of this reversible CD4 T cell lymphopenia. Group 2 (n=20): Thirteen patients showed favorable clinical response to immunomodulation. The CD4 cell counts showed statistically significant (P < .001) improvement after immunomodulation.Group 3 (n=30): After three months of uninterrupted antitubercular chemotherapy in Group 3A some interleukin levels rose ( IL1, IL2, IFN); while other interleukin levels fell (IL10, IL4, IL6, IL12, IL18, TNF). In Group 3B , under the influence of immunomodulation, the rise and fall was quantitatively more than Group 3A. Twenty seven patients responded , by three months, in Group 3. Group 4 (n=12): The initial mean serum IL-1, IL-2 , IFN - r levels were low in these indicating a low beneficial cellular immune status (Th1 cell activity) while initial serum IL-10, IL-4, IL-6, IL-12, IL-18, TNF levels were high in these patients. Under the influence of ATT and immunomodulation, 10 patients showed clinical response and statistically significant improvement in interleukin levels were observed. Overall, out of total 32 nonresponder patients in the present study, 23 responded to immunomodulation regime. No side effect related to immunomodulation was observed. No patient in this study was diabetic or HIV+ve. Conclusions : Correlation of above immune parameters with the clinical presentation, the course of disease and the response to therapy reflected various patterns of host immune responses in osteoarticular tuberculosis. If immunomodulating drugs (Immunotherapy) are given along with ATT from very beginning, these beneficial changes are quantitatively more (more marked) indicating robust host immune response to infection, helping control the disease early. Adjuvant immunomodulation has the potential of shortening the total duration of antitubercular chemotherapy, besides inducing beneficial clinical and host immune responses.
  2 6,486 398
TRAUMATOLOGY
Titanium elastic nailing in pediatric femoral diaphyseal fractures
Roop Singh, SC Sharma, NK Magu, Amit Singla
January-March 2006, 40(1):29-34
DOI:10.4103/0019-5413.34071  
Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4) weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.
  2 6,897 477
CASE REPORTS
Bilateral upper and lower limb ulcers due to gout- A case report
Jiwan Lal Bassi, Pankaj Mahindra, Jaspreet Singh
January-March 2006, 40(1):53-54
DOI:10.4103/0019-5413.34435  
  1 5,119 131
Gorham's Disease - A case report
Deepali Jain, Vijay Kumar, RK Vasishta, Mandeep Singh Virk, Mandeep S Dhillon
January-March 2006, 40(1):55-56
DOI:10.4103/0019-5413.34436  
  - 3,110 199
Meniscal allograft transplantation-A case report
Dinshaw Pardiwala, Gaurav Jindal, Umesh Metkar, Pawan Jadhav, Aniruddha Wargantiwar, Shaligram Purohit
January-March 2006, 40(1):46-49
DOI:10.4103/0019-5413.34075  
  - 5,418 203
Ipsilateral posterior dislocations of the elbow and superior radio-ulnar joint associated with a comminuted radial shaft fracture - A case report
S Vidyadhara, Sharath K Rao
January-March 2006, 40(1):50-51
DOI:10.4103/0019-5413.34433  
  - 2,789 166
Tumoral calcinosis - A case report
Dilip Magarkar, Sulabha Magarkar, Abhijit Deo, Kiran Saoji
January-March 2006, 40(1):52-52
DOI:10.4103/0019-5413.34434  
  - 1,849 118
IOA PRESIDENTIAL LECTURE
IOA Presidential Lecture
KH Sancheti
January-March 2006, 40(1):58-60
DOI:10.4103/0019-5413.34438  
  - 2,414 142
MISCELLANEOUS
Pigmented villo nodular synovitis
S Radha, T Afroz, JVS Vidya Sagar
January-March 2006, 40(1):38-40
Background: Pigmented villonodular synovitis is a rare disorder affecting joints. Methods : We reviewed 19 cases of pigmented villonodular synovitis out of 481 arthroscopic synovial biopsies over a period of ten years. A common presenting symptom was locking. Both diffuse and localized forms were diagnosed. Duration of symptoms varied from 5 months to3 years. We report our experience of patients treated by arthroscopic excision for localized villonodular synovitis and arthroscopic synovectomy for diffuse villonodular synovitis followed by intraarticular Yttrium. Results : In diffuse villonodular synovitis arthroscopic total synovectomy was done a using special angular and straight motorized shaver through different portals to reach all corners of the joint. Localized variety was treated by excising the pedicle attached to the synovium. In our series none of the patients with localized villonodular synovitis showed recurrence till date. Three cases of diffuse variety presented with effusion and swelling three to six months after treatment and were managed by arthoscopic synovial shaving. Two cases who showed recurrence after one year were subjected to intraarticular 90Y isotope injection. Conclusion : Arthroscopic synovectomy helps in reducing morbidity. Radiation and intraarticular Injection of 90 Y are alternative modes of treatment.
  - 4,503 239
Relationship between vitamin D insufficiency in osteoporosis and blood bone biochemistry
Sameer Batra, M Yamin, Sanjeev Sabharwal
January-March 2006, 40(1):41-45
Background: Vitamin D insufficiency is associated with increased PTH secretion, which in turn leads to bone resorption. Method : In the present study primary involution osteoporosis and vitamin D 3 levels were studied in 62 subjects including thirty one controls. The biochemical analysis of serum calcium, phosphorus, ALP, albumin and vitamin D3 [1,25 (OlH) 2 D 3 ] levels was done and 1,25 (OlH) 2 D 3 levels were significantly decreased in osteoporotic patients when compared to non-osteoporotic control group. Results : There was a significant correlation of magnitude of sun exposure and vitamin D intake in the diet with 1,25 (OH) 2 D 3 levels. However, no correlation could be obtained between vitamin D3 levels with increasing age. Our results significantly demonstrated that assays for routinely used bone biochemistry parameters including serum calcium, phosphate, parathormone and alkaline phosphatase are not representative of hypovitaminosis D even in those whose serum PTH is elevated and only reliable way to confirm this is to do vitamin D levels. Conclusion : The diagnosis of hypovitaminosis D should be made on the basis of clinical suspicion, arising from an awareness of risk factors, leading to direct measurements of serum vitamin D.
  - 6,212 346
OBITUARY
Dr. Sharad Shankar Chaudhari
MD Varunjikar
January-March 2006, 40(1):61-61
  - 1,423 114
Dr. P.K. Mullaferoze
MD Varunjikar
January-March 2006, 40(1):61-61
  - 0 0
TRAUMATOLOGY
A clinical study of Ender nails fixation in femoral shaft fractures in children
Laghvendu Shekhar, JC Mayanger
January-March 2006, 40(1):35-37
DOI:10.4103/0019-5413.34072  
Background : Fracture of femoral shaft is fairly common in children and should be considered serious because of blood loss and potential shock that accompany the primary trauma. Surgical procedure allows early mobilization, rapid callus formation and rapid restoration of continuity of bone. Method : We studied 24 children with 24 femoral shaft fractures in age group 6-14 year (average 9.67 years). Eighteen fractures were in middle third, 4 in distal third and 2 in proximal third. Fifteen fractures were transverse, 4 oblique and 5 were spiral. Twenty-three cases were closed and one grade I compound. The injury surgery interval was 6 day. Mean hospital stay was 10.4 days. They were treated by closed reduction and Ender's nail fixation. Result : The minimum follow up was 6 months. The average time to clinical union and full weight bearing was 6.6 week (5 to 12 week); full movement was achieved in 9 weeks (6 to 15 weeks). One case of intraoperative perforation occurred. Two cases of nail protrusion and infection occurred. No cases of deep infection, delayed union, nonunion were seen. Seven cases had no limb length discrepancy. Thirteen cases had lengthening (max 9 mm mean 4.23mm), 4 cases had shorting (max 7mm mean 4.25mm). On the Flynn criteria 20 denoted excellent and 4 had satisfactory results. No poor results were seen. Conclusion : Healing in cases treated with Ender's nail can be with abundant callus attributed to non rigid fixation. This resulted in rapid fracture union and early return to few weight bearing while reducing hospital stay. Advantages that Ender nailing offers over other treatment modalities both consecutive as well as operative convinces us to recommend ender nailing in isolated femoral shaft fracture in children between 6-14 years.
  - 4,841 352
Posterior dislocation of the shoulder joint
Tejas H Thakker, MM Prabhakar, Dinubhai A Patel
January-March 2006, 40(1):24-28
DOI:10.4103/0019-5413.34070  
Background: Posterior dislocation of shoulder is a rather uncommon injury that is often not diagnosed at the initial examination. However certain constant clinical signs may lead the examiner to suspect the presence of this condition. Even the routine antero-posterior roentgenogram may provide a few clues to diagnosis but the axillary view is mandatory to verify diagnosis. Material and methods : We report a series of 15 shoulders (14 patients) with a locked posterior dislocation. Electric shock (7 patients), vehicular accident (4 patients) and epileptic seizure (3 patients) was causes of dislocation in these patients. The diagnosis was missed initially in 10 cases. An axillary radiograph confirmed the diagnosis in all. Treatment consisted of closed reduction, which was successful in 5, Neer's modification of McLaughlin procedure (transfer of subscapularis) in 6, hemireplacement arthroplasty in one shoulder and tuberosity fixation in one patient. Results : Follow-up ranged from 1 year to 4 years. Five patients had excellent, five good, two poor and one had fair result. Conclusion : Key to diagnosis is a high index of suspicion. The prognosis became less favorable and the therapeutic difficulties were found to be increased in direct proportion to the length of time, these lesions remain undiagnosed. With early recognisition of dislocation, prompt reduction is relatively easy. Surgical intervention is necessary for old unreduced posterior dislocations.
  - 6,085 356
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