Sandeep Shrivastava

Role of Decompression in Late Presentation of Cervical Spinal Cord Disorders

Study Design Prospective study conducted at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India. Purpose To show the efficacy of decompression in the late presentation of cervical spinal cord disorders. Overview of Literature Studies by various authors have shown that early spinal decompression results in better neurological outcomes. Methods From January 2003 to January 2005, 11 of the 41 patients with cervical spinal cord compression, meeting the inclusion criteria, underwent anterior decompression; interbody graft placement and stabilization by anterior cervical locking plate. The neurologic and functional outcomes were recorded. Results Five patients had spinal cord injury and 6 patients had compressive cervical myelopathy. Complications included 1 death and 1 plate loosening. No patient lost their preoperative neurological status. One patient had no improvement, 2 patients showed full recovery. The mean follow-up is 28.3 month. At the of rehabilitation, 6 were able to walk without support), 2 could walk with support, and 1 needed a wheelchair. The average American Spinal Injury Association motor score on admission to the hospital, 32.8 (standard deviation [SD], 30.5); admission to rehabilitation, 38.6 (SD, 32.4); discharge from rehabilitation, 46.2 (SD, 33.7). The most recent follow-up was 64.0 (SD, 35.3). Conclusions The anterior approach for cervical decompression allows for adequate decompression. This decompression is the best chance offered in even late reported cases, including posttraumatic cases where there is no evidence of cord transactions. The use of anterior cervical plates reduces the chances of graft loosening, extruding, or collapsing.

Dorsal Herniation of Cauda Equina Due to Sequestrated Intradural Disc

Intradural lumbar disc herniation (ILDH) is uncommon pathology. In present report, authors present a case of ILDH associated with dorsal herniation of the cauda equina rootlets in a 30-year-old male laborer who had chronic backache since last two years. To the best of our knowledge we are reporting this for first time. Report demonstrates the natural course of ILDH.

Closed total (pan-talar) dislocation of the talus with delayed presentation: a rare case report and review of the literature

Major fractures and dislocation of the talus and peritalar joint are uncommon. We present here a very rare case of injury with delayed presentation of closed total talus dislocation with fractured medial malleolus and posterior talar tubercle fracture. This report analyzes previous reports in the literature and the proposed treatment.

A rare variant of tibial hemimelia and its treatment.

Tibial hemimelia is a rare condition. We present a variant of tibial hemimelia not reported in literature before. In this variant, we were able to successfully salvage the limb with excellent function to carry on with life.

Giant cell tumour in the diaphysis of radius – a report

BackgroundWe present a case of a 35 yrs old female who presented with swelling over her forearm. This is a rare case of a giant cell tumour in a nonepiphyseal region.MethodsCase report and presentation of clinical, radiological and histological data on single case of giant cell tumour of diaphysis of radius.ResultsAlthough age, clinical features and radiological features are helpful, it is still the histology that helps to clinch the diagnosis.ConclusionA thorough literature search and an exhaustive online search using various search engines revealed seven reported cases of giant cell tumours in the diaphysis of long bones. We reiterate the fact that irrespective of the location, a giant cell tumour should be diagnosed based on its histology.

Bio Technological Intervention with Platelet Rich Plasma for Assisted Regeneration of Sole

With the advent of Regenerative medicine products in medicine, newer solutions are getting evolved for complex conditions. The Cellular therapies offer a new ray of hope by inducing regeneration of tissue at the site of damage. The cellular therapy led by platelet rich plasma (PRP) is one such key regenerative product. But there is a huge variability in its usage, particularly for wounds. The standardisation for clinical usage is not yet evolved, hence limiting the clinical application of the same. The authors have developed a standard protocol “STARS” therapy, which utilises PRP as biotechnological tool, re-engineering the damaged tissue and gradually assisting the regeneration. In this study we report 8 cases of wounds / ulcers over the sole being treated by it. The results are excellent and offer a milestone solution to non-healing wounds/ ulcers over soles. These wounds are otherwise, very difficult to treat particularly as they are associated with high risks factors such as infection, Diabetes and old age. They are under constant pressure due to weight bearing and give way easily and do not heal. The bioenginreeing of the sole tissues through PRP led STARS intervention is safe, effective and easily reproducible.

Bio-Engineering of Wounds by PRP Led Regeneration

Platelet rich plasma (PRP) therapy is one of the biological interventions in regenerative medicine with a sure success in clinical translations of wound healing. Platelet rich plasma is an autologous plasma fraction of peripheral blood and it’s the simplest intervention of regenerative medicine. It is rapidly extending to multiple clinical fields because of its easy use and biosafety which facilitates translation in humans. The biggest advantage over other therapies is it’s being autologous, no adverse events or reactions are encountered. The economic as well as social burden caused due to chronic and degenerative disease is well cared by this autologous therapy. The clinical applications have proven its efficacy and efficiency in healing all types of wounds. The microscopic and histopathological changes in the tissues after PRP therapy are described in this article. The changes in the tissues have evoked the transformation from fibrosis led healing to collagen led healing; a bioengineered mechanism of PRP led regeneration of wounds.

Platelet Rich Plasma as a Mono Therapy for Diabetic Ulcer

Diabetic non-healing Ulcers are very difficult to treat. Many of such Patients undergo Amputations to lessen the morbidity. There is no defined management for them. Current management requires multiple surgical interventions, drugs and intense local dressing and care. The authors have developed an innovative therapy called as STARS (Sandeep’s technique for assisted regeneration of skin) for wound management. It is basically based on principle of regenerative medicine with autologous platelet rich Plasma (PRP) being the source of regenerative growth factors leading to complete healing of wounds. This case is a young female, a Juvenile Diabetic with non-healing infected ulcers on both heels since 3 years. She received STARS therapy and her one ulcer healed completely and second ulcer healed 40%. A complete healing of non healing diabetic ulcer without surgery, drugs and intense dressing, in an uncontrolled diabetic patient, is a milestone in such wound management. STARS therapy led by Platelet regeneration, is an innovative protocol for such cases.

Treatment of femoral shaft fractures in young children by Ender’s nail: indications & complications

Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.