Comparision of colour duplex ultrasound, ankle brachial pressure measurement in peripheral vascular disease in type 2 diabetes patients with foot infections

This is the study done in our Hospital Government Stanley Hospital, Department of General Surgery. The following study is a prospective study, for which ethical clearance was obtained. No. of Patients studied were 50, and consent was taken from all the patients. The Patients studied were diabetic, which included all types of Type II DM patients on treatment and with foot infections. No individuals with rest pain, or signs suggestive of lower limb critical ischaemia and other causes of peripheral neuropathy or history of reconstructive vascular surgery were taken into consideration. The study period was from January 2013 to December 2013. After doing thorough history taking and clinical examination, including proprio reception, capillary blood glucose, arterial colour duplex imaging (CDU) and ankle brachial pressure index (ABPI) were done in the all the patients. The sensitivity and specificity of ABPI was compare with CDU. We concluded that ABPI has high specificity (85.71%) and Low sensitivity (72.72%) has compare to CDU. The overall agreement of ABPI with CDU was poor

Perforated Right Side Colonic Diverticulum with Abscess

Colonic perforation is a rare cause of intraabdominal abscess. It presents, more frequently in frail elderly patients, with heterogeneous signs and symptoms which hamper the clinical diagnosis. Subcutaneous emphysema with pneumomediastinum and  muscle abscess are unusual signs. Colonic  perforation may be consequent to diverticulitis or locally advanced colon cancer. Due to the anatomy of the abdominal space and different physiopathology, diverticular perforation may present with air and pus collection; on the other hand perforated colon cancer may cause groin mass and psoas abscess

Living-donor liver transplant for HAV induced acute liver failure

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Endoscopic biopsy yielding upper gastrointestinal malignancies

Objective:Aim of this study is to find the optimal number of endoscopic biopsies needed to diagnose the upper gastrointestinal malignancies in the patient who undergoes endoscopic evaluation. Methods:This is an observational study conducted in Government Stanely Medical College. Patients with upper gastrointestinal symptoms underwent esophago gastroduodenoscopy using forward viewing scope after getting the proper consent from them. Procedure was done by well experienced endoscopist. In patients with suspected lesion of malignancy in the tract, biopsies are taken. Number of biopsies aimed are eight and serially taken biopsies are labelled in four separate vials. Each vial contains two consecutive samples in the 10% formal saline solution.Details of the site, extent, and type of the lesion were recorded.In case of haemorrhage or any complications the procedure is terminated with proper monitoring of patient until discharged. Results:The yield of endoscopic biopsy specimens from 50 patients after combining the results from successive vials. The yield in the first vial is 94% and the cumulative percentage of the second vial yielded 100%, which means the malignancy in the specimen is proved without doubt in the first two vials itself for all the patients.Conclusion:In conclusion, this study shows that four biopsy specimens are likely to yield a 100% diagnosis in advanced upper gastrointestinal malignancies. Whereas the endoscopic biopsy yield in the early stages of carcinomas should be evaluated in further studies

Successful conservative approach to covid 19 with extensive splanchnic circulation thrombosis

The novel 2019 coronavirus disease (COVID-19), which is caused by infection with the severe acute respiratory syndrome corona­virus 2 (SARS-CoV-2), was first reported in Wuhan, China, in December 2019 . Since that time, the COVID-19 pandemic has spread rapidly around the world in an exponential fashion and has caused many deaths.  Preliminary data have reported an increased risk of venous thromboembolism and acute myocardial infarctions, most likely caused by excessive inflammation, platelet activation, endothelial dysfunction, and stasis.The high mortality and its relationship with thromboembolic diseases in COVID-19 have increasingly attracted attention . D-dimer has been repeatedly reported to be a useful biomarker associated with the severity of disease and is a predictor of adverse outcomes . The high incidence of venous thromboembolism (VTE) and the importance of giving anticoagulant thromboprophylaxis is stated in guidance documents and supported by consecutive autopsy findings noting frequent deep vein thrombosis in 7 of 12 COVID-19 patients (58%) with complicating pulmonary embolism in 4 patients (33%) . An increased incidence of arterial thromboses such as stroke and acute coronary syndromes has also been reported in COVID-19 . The effectiveness of prophylactic and therapeutic anticoagulant use in this context is controversial.Hereby we are reporting a case of covid 19 with extensive splanchnic circulation thrombosis presented to Narayana hospital, Mysore, managed successfully with conservative approach without any surgical intervention

Pancreatic ketoacidosis-a rare case report

Euglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation