Atlantoaxial tuberculosis: Outcome analysis

Background: Tuberculous (TB) spondylitis occurs in <1% of patients with TB. Atlantoaxial involvement is extremely rare amounting to 0.3%–1% cases of TB spondylitis. The management of this entity has been fluctuating with time. Various classifications and management protocols have also evolved. We present our experience in managing this entity in 8 patients. Materials and Methods: Retrospective follow-up study of eight patients with atlantoaxial TB over 2 years. They ranged in age from 14 to 33 years with male preponderance. Four required surgical intervention on initial presentation, 2 were successfully treated conservatively, and 2 had to undergo surgery after a trial of conservative management. All of them were started on antituberculous therapy (ATT) for 18 months. Patients were followed up for 8–29 months. Results: Neck pain and restriction of neck movements were standard presenting features. All patients had pulmonary TB confirmed by sputum examination. Radiological investigations formed an integral part of the evaluation of disease, treatment plan, and prognosis. Improvement in symptoms has been documented in all eight. Conclusion: The involvement of the most mobile spinal segment and the potential cervicomedullary compression makes it a disease of utmost importance. Although ATT remains the mainstay of treatment, surgical intervention is needed for stabilizing the joint and decompressing the cervicomedullary junction. Strict adherence to medical advice and optimum surgical intervention tailored for each patient results in the successful management of the disease

Spontaneous mesenteric hemorrhage

Spontaneous intra-abdominal hemorrhage or abdominal apoplexy is an acute abdominal emergency which can exhibit a wide spectrum of clinical presentation. With the expanding avenues for anticoagulation therapy, this condition is becoming commoner. The association of this condition with antiplatelet therapy is less well established. We present a case of spontaneous mesenteric hematomas causing intestinal obstruction in a patient on antiplatelet therapy for ischemic heart disease. A review of etiology, clinical presentation and protocol of management is also presented. A high index of suspicion on the part of the clinician is essential to ensure a favorable outcome in this condition

Amebic liver abscess and polycystic liver disease

Polycystic liver disease is a rare disorder which remains asymptomatic. Infection of cyst is a major complication and is usually pyogenic. We report a rare case of amebic liver abscess in a patient with polycystic liver disease. In our search we found one such case report. Clinical features and radiological findings are usually sufficient, but atypical history and the presence of multiple hepatic abscesses in CT scan delayed diagnosis in our case. Histopathology of the cyst wall and enzyme immunoassay asserted the diagnosis

Primary Paraspinal Hydatidosis Causing Acute Paraplegia

The zoonotic infection hydatidosis is caused by the tapeworm cestode, Echinococcus granulosus. Though considered endemic in India where association of humans with sheep and dogs form part of the livelihood, primary skeletal muscle involvement of the disease is an extremely rare event. We report a case of primary paraspinal hydatidosis with extradural extension causing acute paraplegia. Excision of the cyst and decompression of the cord was done along with albendazole therapy. Paraspinal hydatid disease is a rare entity, and in regions where hydatid disease is endemic, it can be involved in the differential diagnosis of acute compressive myelopathy. Although antihelminthic chemotherapy forms the mainstay of the treatment, surgical intervention forms a major part of the management

Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the occurrence of complications

Context: Incisional hernia is one of the common postoperative complications of abdominal surgery. Mesh hernioplasty represents the standard of care for incisional hernia repair. Aims: We report our experience with the use of mesh for hernia repair, with respect to the postoperative complications and factors affecting the occurrence of complications. Settings and Design: Fifty four cases of incisional hernia presenting to the institute between April 2008 and September 2010 were included in the study. Materials and Methods: The predisposing risk factors were identified. Mesh hernioplasty was done by the onlay technique and the patients followed up for at least 6 months. Statistical Analysis Used: An association of complications with various risk factors was explored with chi-square test and odds ratio with 95% confidence interval. Results: Twenty four patients developed at least one complication, the most common being seroma (12 cases) and surgical site infection (9 cases). The factors that showed a significant relationship with the occurrence of complications were diabetes mellitus, obesity, smoking, hypoproteinemia, advanced age, size of fascial defects, and number of defects. The recurrence rate was 3.7% (mean follow up: 13.05 months). Conclusions: Mesh hernioplasty gives acceptable results for incisional hernia repair. A sound understanding of the factors affecting the occurrence of complications and recurrence is required to improve the results of the procedure

A comparative study of onlay and retrorectus mesh placement in incisional hernia repair

Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro-rectus mesh placement or the sub-lay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23%) and minimal complications. Aims and Objective: The purpose of this study was to compare the traditional on-lay mesh and retro-rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion), and Delayed complications (Recurrence). Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on-lay mesh method and 25 by retro-rectus mesh placement. Only the patients with midline hernias up to 10 cm in diameter were included in the study. Result: The operative time for retro-rectus mesh placement was insignificantly higher than that of on-lay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in on-lay mesh repair. The recurrence rate was found to be 4% in on-lay mesh repair and 0% in retro-rectus mesh repair. Conclusion: The follow-up period in this study was 6months; hence, late recurrences were not taken into account. However, the low rate of local complications and the low recurrence rate indicate that retro-rectus mesh repair has an advantage over traditional on-lay repair

Combustion synthesis of Ga<SUB>2</SUB>O<SUB>3</SUB> nanoparticles

Nanophase of Ga<SUB>2</SUB>O<SUB>3</SUB> has potentially important applications in photocatalysis. We report the synthesis of nanophase of the metastable &#947;- and stable &#946;-Ga<SUB>2</SUB>O<SUB>3</SUB> and demonstrate that it is possible to prepare a continuously varying mixture starting from the pure metastable &#947;- to the pure &#946;-phase. This is achieved by employing a facile and reliable combustion route, using urea as a fuel. Typical grain sizes, as estimated from XRD studies, are about 3 nm. Given the importance of surface chemistry for potential applications, Thermogravimetric coupled with mass spectrometry is used in conjunction with FTIR to elucidate the chemistry of the adsorbed surface layer. Studies on the &#947;-Ga<SUB>2</SUB>O<SUB>3</SUB> phase indicate the occurrence of weight loss of 8.1% in multiple steps. Evolved gas analysis and FTIR studies show presence of physisorbed H<SUB>2</SUB>O molecules and chemisorbed -(OH) ions bonded to active surface states and accounts predominantly for the observed weight loss