Sumit Batra

Alcohol based surgical prep solution and the risk of fire in the operating room: a case report

A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.

Compartment syndrome with acute renal failure: a rare complication of spinal surgery in knee-chest position.

Study Design. Case report of a patient who presented with compartment syndrome with acute renal failure after surgery for lumbar disc prolapse in knee-chest position. Objective. To describe an unusual complication of compartment syndrome in lower limb with acute renal failure following discectomy in knee-chest position. Summary of Background Data. Compartment syndrome and acute renal failure following lumbar discectomy in knee-chest position has been described in only 2 cases previously. Methods. Case report and review of literature. Result. Subsequent to prolonged surgery in knee-chest position this patient developed compartment syndrome with acute renal failure. Immediate fasciotomy was done, resulting in good recovery. Conclusion. Spine surgeon performing discectomy in knee-chest position should be aware of such an unusual complication in the postoperative period, especially if the surgery gets prolonged. Time and position should be monitored carefully to avoid such a serious complication. Early diagnosis and urgent intervention in the form of fasciotomy is required for good results.

Neglected isolated plantar dislocation of middle cuneiform : a case report

BackgroundFour cases of plantar dislocation of middle cuneiform have been reported in the english literature. All of them were fresh cases and treated with open reduction. We are reporting a case of neglected plantar dislocation of middle cuneiform which was treated with excision.Case presentationA farmer presented with a painful plantar dislocation of middle cuneiform bone after 9 months of injury. The bone was deformed and was excised by a plantar incision. It resulted in painless foot with no disability.ConclusionThe neglected plantar dislocated middle cuneiform bone becomes deformed due to repeated weight bearing. The gap gets filled with Fibrous tissue. Excision of the cuneiform gives good results.

Role of calf muscle stimulation in the prevention of DVT in Indian patients undergoing surgeries for fractures around the hip

Background: The venous stasis of soleal vein during surgery may be an important factor in the development of deep vein thrombosis (DVT). The stimulation of calf muscle during surgery may help in preventing DVT. The present study is conducted to evaluate the role of peroperative calf muscle electrostimulation in prevention of DVT in patients undergoing surgeries around the hip joint. Materials and Methods: The study comprised 200 patients undergoing surgeries around the hip joint. The patients having risk factors (such as previous myocardial infarction, malignancies, paraplegia or lower limb monoplegia, previous history of DVT or varicose veins, etc.) for the development of DVT were excluded. They were randomized into two groups: 100 cases were given peroperative calf muscle electrostimulation for DVT prophylaxis (Group A) and the remaining 100 patients were taken as controls without any prophylaxis (Group B). The color Doppler ultrasound was performed to exclude pre-existing DVT and on 7th day postoperative to find out the incidence of DVT in both the groups. Results: Two patients among Group A and six patients among Group B demonstrated DVT on ultrasonography, but the difference was not found to be statistically significant (P=0.279). None of the patients had any clinical evidence of DVT. Conclusion: The role of peroperative calf muscle electrostimulation for DVT prophylaxis remains controversial. The risk of developing DVT in patients undergoing surgeries around the hip joint is very less in patients analysed in our series.

Chlamydia trachomatis elementary bodies in synovial fluid of patients with reactive arthritis and undifferentiated spondyloarthropathy in India.

Reportedly, there is little information on the magnitude of genitourinary‐induced reactive arthritis (gReA) from India. Genital infection with Chlamydia trachomatis is a major health problem in India because of its high prevalence; therefore, this study was conducted with the aim to screen ReA/undifferentiated spondyloarthropathy (uSpA) patients (n = 20) attending a major city hospital in New Delhi, for investigating the presence of intra‐articular chlamydial antigen in knee joints. Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) served as controls (n = 20).

Use of amplified Mycobacterium tuberculosis direct test (Gen-probe Inc., San Diego, CA, USA) in the diagnosis of tubercular synovitis and early arthritis of knee joint

Background: The diagnosis of knee joint tuberculosis, especially in early stages of synovial disease, has more often been based on clinicoradiological suspicion, with no single test claiming to be a dependable rapid diagnostic test with high sensitivity and specificity. Nuclear amplification tests in vogue like the polymerase chain reaction have shown variable sensitivity and false positivity rates in various studies. We evaluated the role of Amplified Mycobacterium tuberculosis Direct Test (AMTDT) or Genprobe in the diagnosis of knee joint tuberculosis in early, especially, early synovitis and arthritis cases. Patients and Methods: Thirty two patients of suspected knee joint tuberculosis were subjected to diagnostic arthroscopy during the study period. The synovial fluid and tissue were subjected to mycobacterial culture, histopathology, and AMTDT. A comparative analysis of the sensitivity and specificity of this new test with culture and histopathology was done and the time taken for reporting was calculated for each test. Results: Out of 32 tissue samples, 8 were found to be positive with mycobacterial culture [Lowenstein Jensen (LJ)/Bactec], 11 were positive with histopathology, and 5 were found to positive with AMTDT. The sensitivity of AMTDT was found to be 62.5% and specificity was 100% with a P value of 0.083. The results were obtained earliest with AMTDT with a mean reporting time of 1.2 days, while the results of histopathology were obtained in a mean time of 6.8 days, BacT alert in 22.5 days, and conventional LJ medium culture results in 48.6 days. Conclusion: AMTDT or Genprobe is a rapid diagnostic test for early diagnosis of tubercular arthritis, but has low sensitivity in knee joint tuberculosis. Nuclear amplification tests are still far from being a single promising alternative to conventional tests in cases of joint tuberculosis. Routine use of arthroscopic biopsies in all suspected cases is helpful in the early diagnosis of knee joint tuberculosis.

Traction apophysitis of medial malleolus: a case report with review of the literature.

Traction apophysitis of medial malleolus is very rare and presented in view of its rarity. A 13 years old boy presented with pain and swelling without history of trauma around left ankle of 3 months duration. The swelling was diffuse with tenderness on anterior aspect of medial malleolus. The overlying skin was normal. The X-rays revealed fragmented accessory ossification centre of medial malleolus an left side. MRI revealed multiple foci of hypointensity in T1 and T2 weighted images of left medial malleolus apophysis. Patient was treated in below knee plaster for three weeks with restriction of sports activities for 5 weeks. The patient became asymptomatic in 8 weeks.

Chlamydia trachomatis-induced reactive arthritis in India: frequency and clinical presentation

Chlamydia trachomatis ( C. trachomatis )-induced reactive arthritis (ReA)/undifferentiated spondyloarthropathy (uSpA) are unrecognised/underestimated entities, and clinicians often fail to recognise them. In India, our group was the first to report intra-articular C. trachomatis infection in patients with ReA/uSpA having genitourinary symptoms.1 Males were predominant (78%) and majority of patients presented with an oligoarthritic profile (80%), enthesitis (11%) and human leukocyte antigen (HLA) B27 (40%); however, none reported ocular infection. Despite this observation, it is also very likely that C. trachomatis -induced ReA/uSpA is underdiagnosed in women. Intra-articular C. trachomatis …