Chander P Puri

Kyrle’s Disease: A Rare Presentation in Diabetic and Hypertensive Patients

Two rare cases of Kyrle’s disease in diabetic patients who presented with papules on legs, back and abdomen, are reported. Pathology of this disease and management are described in detail. Importance of treating the underlying condition associated with this disease is highlighted.

Early Results of Total Condylar Knee Arthroplasty using Indian-designed Prostheses

The present study was undertaken to evaluate the results of 50 total knee replacements performed at Military Hospital Kirkee, Pune, India, using Indian-manufactured prostheses, from November 2001 to November 2005. The study group consisted of 18 males and 28 females in the mean age of 63 years for osteoarthritis and 48 years for rheumatoid arthritis (RA): 41 knees of osteoarthritis and RA in 9 knees. The followup period was 6 months to 2 years, with a mean of 14 months. Good correction of deformities was achieved for all the knees. Postoperatively, there was improvement in Knee Society Score by 69 points for osteoarthritic knees and 65 points for rheumatoid knees. Excellent results were achieved in 88% of the cases. Average postoperative range of movements achieved was 90°. The results are comparable with those following use of far costlier imported prostheses.

A Case of Progressive Supranuclear Palsy/Steele–Richardson–Olszewski Syndrome

Progressive supranuclear palsy (PSP) is an uncommon neurological disorder, the hallmark of which is supranuclear ophthalmoplegia involving vertical gaze. Other clinical features include pseudobulbar palsy (dysphagia and dysarthria), neck dystonia (retrocollis), bradykinesia, postural instability, and repeated falls occurring early in the course of the disease, personality changes, a staring unblinking facies, mild dementia, and cerebellar and corticospinal tract signs. Magnetic resonance imaging (MRI) of the brain on midsagittal images may reveal a characteristic atrophy of the midbrain in a shape that suggests a bird, particularly a humming bird. The PSP may resemble Parkinson’s disease (PD), but the pathophysiology is distinct from PD. Here, we report a rare case of a 72-year-old man who came with difficulty in naming objects and persons, dysphagia, dysarthria, difficulty in vertical gaze, and history of recurrent fall even while in sitting down position. He was diagnosed as PSP based on clinical examination and neuroimaging. The PSP has poor prognosis.

A Case of Fournier's Gangrene of Penis leading to Complete Loss of Penile Urethra

Fournier’s gangrene (FG) of penis is a rare but fulminant condition often associated with significant morbidity and mortality. Fournier’s gangrene typically spares testis, urethra, and deep penile components in view of their deeper blood supply, which is independent of compromised fascial and subcutaneous circulation. An unusual case of a 55-year-old nondiabetic male who presented to the emergency department of MGM Medical College, Navi Mumbai, India, with acute urinary retention due to impacted urethral calculus is reported. Patient developed FG of penis with isolated involvement of corpus spongiosum, leading to loss of penile urethra. Emergency penile exploration and debridement was done followed by elective perineal urethrostomy at a later date.

Pediatric Catatonia in Early-onset Schizophrenia and Treatment Implications

A 13-year-old girl presented with symptoms of catatonia during second episode of early-onset schizophrenia. Catatonic features seen were motoric immobility, extreme negativism, mutism, ambitendency, and refusal to take food. She was initially treated with antipsychotic drugs but developed side effects. In view of life-threatening situation and absence of improvement, she was treated with electroconvulsive therapies (ECTs). Nine adequately spaced ECTs were given using propofol as the anesthetic agent. She showed significant response to ECTs with respect to her symptoms of catatonia and activities of daily living.

Asymptomatic Patient with Unrecordable Blood Pressure: Could It be Takayasu?

Takayasu’s arteritis is a rare, systemic inflammatory vasculitis of large vessels that usually affects women of childbearing age. Also known as pulseless disease or occlusive thromboaortopathy, the disease is named after the Japanese ophthalmologist who in 1905 described a form of retinal arteriovenous anastomoses due to retinal ischemia caused by large vessel vasculitis. We present here a case of a young female who presented with stroke. The patient had stroke which eventually recovered but now was referred for evaluation of her unrecordable blood pressure.

Effect of Sahaja Yoga Meditation on Heart Rate Variability.

Introduction: Nowadays, people are showing a keen interest in yoga and meditation as an alternative therapy to manage psychological stress and stress-related diseases. Yoga is a spiritual discipline with many proven health benefits. There are different types of yoga techniques practiced worldwide for their known health enhancement effects and for reduction of stress and its related disorders. One of the meditation techniques is Sahaja Yoga. It is a unique technique of meditation that involves mental state of internalized attention characterized by mental silence and emotionally positive experience of bliss. The present study has been undertaken to find out the heart rate variability (HRV) in Sahaja Yoga meditators during rest and meditation. Objectives: To study the HRV in Sahaja Yoga meditators during rest and meditation. Materials and methods: A total of 20 volunteers aged 25 to 40 years were considered for the study. The volunteers were practicing Sahaja Yoga meditation (SYM) regularly for 5 years or more. The HRV was recorded during rest with eyes closed and 15 minutes of SYM in a quiet room. Results: Statistical analysis was done using student paired t test. Results are given as mean ± standard deviation (SD). The mean R–R interval, total power (TP), low frequency (LF), high frequency (HF), and LF/HF ratio were studied during rest and during meditation. The HF (during rest 16.2383 ± 11.1896 and during meditation 28.4875 ± 14.5112) was high and LF/HF ratio (during rest 2.262211 ± 1.346382 and during meditation 1.30545 ± 1.200041) was low during meditation compared with that during rest, which was statistically significant. Conclusion: Increase in HF and decrease in LF/HF ratio during meditation signifies that meditation shifts sympathovagal balance toward the parasympathetic side, hence signifying a relaxed state of body and mind in Sahaja Yoga meditators.

Vascular Leiomyosarcoma of the Thigh: A Rare Presentation

High-grade mesenchymal soft tissue tumors are rare neoplastic lesions that occur uncommonly in the extremities and in other sites of the body. Herein, we report a case of high-grade vascular leiomyosarcoma of the thigh. The patient was a 72-year-old male with a 4-day history of swelling in his right thigh. Excision biopsy of the tumor showed highly pleomorphic tumor cells arranged typically in perivascular fashion with large areas of hemorrhage and necrosis. Immunohistochemistry was positive for vimentin, smooth muscle actin, and showed a 90% proliferation index on ki-67 labeling. Vascular leiomyosarcomas comprise a group of very infrequent tumors with varied presentation and can occur at unusual sites.

Epidermal Cyst of the Breast: A Rare Case Presentation

Epidermal inclusion cyst (EIC) arising from the breast is an interesting, rare, benign, and diagnostically challenging condition, since these may be misdiagnosed as malignant breast neoplasm, both on clinical and radiological examination, thereby creating undue anxiety and apprehension until the definitive diagnosis is formulated. To substantiate it, two cases of epidermal cyst of breast have been described.

Anesthetic Management of a Patient with Dilated Cardiomyopathy for Inguinal Hernia Repair

Anesthetic management of a patient with dilated cardiomyopathy (DCM) undergoing noncardiac surgery poses a challenge to the anesthesiologist as there is risk of precipitating congestive heart failure or malignant arrhythmias. The anesthesiologist must have the knowledge of its pathophysiology, clinical presentation, diagnostic evaluations, and more so regarding various drugs used during anesthesia. We report a case of DCM with severe left ventricular (LV) dysfunction posted for right inguinal hernia repair managed successfully with epidural anesthesia using ropivacaine.