Shibban K Kaul

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 Postoperative Hypotension in a Patient of Sheehan's Syndrome

Sheehan’s syndrome is acute infarction and ischemic necrosis of the pituitary gland resulting from postpartum hemorrhage and hypovolumic hypotension. A 45-year-old female para 2 patient was admitted for total abdominal hysterectomy in view of pyometra. Patient was a known case of Sheehan’s syndrome with hypothyroidism. On day 2 of her surgery, she suddenly went into hypotension and tachycardia with electrocardiogram (ECG) finding of T-wave inversion. Biological marker for myocardial infarction namely creatine phosphokinase-MB was normal. The patient was started on hydrocortisone 100 mgintravenous injection thrice a day. Immediately, after the first dose of injection, she became normotensive and the pulse rate settled down. The ECG, taken 24 hours later, was normal.

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.

Prospective Study of Percutaneous Nephrolithotomy in the Management of Renal Calculi

Introduction: Kidney stones are a common problem affecting all population groups across the globe. Percutaneous extraction of renal stone – properly termed percutaneous nephrolithotomy (PCNL) which was invented over three decades ago – has become a standard, well-established procedure for the management of renal stones. This study will evaluate the role of PCNL in the management of renal calculi. Materials and methods: A total of 107 cases of renal calculi who underwent PCNL from May 1, 2014 to April 30, 2016 were studied. Intraoperative findings and immediate postoperative complications were noted. They were followed up for 1 month after the surgical procedure. Results: Mean age of cases was 43.64 years. Multiple calculi were seen in 43.9%, while a staghorn calculus was seen in 16.8%. Stone clearance was done through a single tract in 78.5%. Additional tracts were made in 21.5%. Tubeless PCNL was done in 45%; 12.1% of the cases had urinary tract infection. Pulmonary complications were noted in 4.67% in the form of hydrothorax. Urinary leak was noted in 4.6%; 70% of the cases were left stone free, with an overall success rate of 85.98%. Conclusion: This study reveals that PCNL is a safe procedure with less complications and higher stone-free rates without compromising patient safety in a short period.

Laparoscopic Ventral Hernia Repair: Our Experience in 75 Patients

Introduction and aim: Laparoscopic ventral hernia repair has become a method of choice for treatment of ventral hernias. It has benefits of shorter hospital stay, less pain, and better cosmetic results, although it continues to remain a challenging procedure, more so in reoperative abdomen and in patients with serious comorbidities. The aim of this study is to evaluate our experience of laparoscopic ventral hernia repair carried out by a single surgical team. Materials and methods: Ventral hernia, both primary and incisional hernia, was repaired by laparoscopic intraperitoneal onlay mesh (IPOM) repair in 75 patients at a single center within 3 years between January 2013 and December 2016. This was done at a tertiary care center by a single operating team standardizing the procedure and evaluating the learning curve. Results: Seventy-five patients underwent laparoscopic IPOM repair of which 45 were females and 30 males. The average age was 52 years (35–72) and size of defect ranged from 4 to 12 cm. Dual mesh with expanded polytetrafluoroethylene was used in all patients. Sixty-two cases were incisional hernias, 10 paraumbilical hernias, and 3 umbilical hernias. Of these, 14 were recurrent incisional hernias after open mesh hernioplasty out of which two cases recurred after laparoscopic IPOM. Mean operative time was 60 to 130 minutes. There were no conversions to open technique. The average hospital stay was 2 to 3 days. One patient had postoperative Richter’s hernia which was managed by relaparoscopic reduction and transfascial closure of the defect. Three patients had postoperative ileus, three developed minor wound infection, and one patient had seroma. The average follow-up period was around 12 months. Conclusion: Laparoscopic IPOM ventral hernia repair is a safe procedure in most cases with benefits of rapid recovery and better patient outcomes, more so in large recurrent incisional hernias and in patients with serious comorbidities.

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.

Alopecia Areata: An Update

Alopecia areata (AA) is a very common autoimmune disease that leads to unpredictable, relapsing patchy hair loss. Its chronic pathophysiology is still not fully understood. Hair follicles are not destroyed permanently due to which the potential for regrowth of hair is retained for many years, and is possibly lifelong. Clinical presentation varies from small alopecia patches most commonly on the scalp to full body involvement. Characteristic “swarm of bees” appearance on histopathology is confirmatory in acute cases. A variety of therapeutic options are available, but search for new modalities continues as there is a high relapse rate and a number of side effects associated with the available treatment options.

Utility of GeneXpert Mycobacterium tuberculosis/Rifampin Assay for Extrapulmonary Tuberculosis Samples

A total of 3,806 samples from suspected cases of extrapulmonary tuberculosis (EPTB) were subjected to GeneXpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) assay. Samples consisted of body fluids, pleural fluids, pus and aspirates, lymph node (LN) tissues, and others. Mycobacterium tuberculosis positivity was detected in 18.10% and RIF positivity in 2.73% samples. The MTB/RIF positivity was found highest in pus and aspirates (40.38%). In this study, assay failure rate for GeneXpert MTB/RIF assay was very low (1.99%). It is concluded from this study that GeneXpert MTB/RIF is an efficient, reliable, simple, and fast technique for rapid diagnosis of EPTB in our country where incidence of tuberculosis remains high.

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.