Seemab Khan, Anand Shah

Congenital aural atresia is a rare congenital anomaly. Most of the cases diagnosed at the time of birth have a traumatic impact on parents psychology. This condition is often associated with other congenital anomalies.

The role of ENT surgeon along with his plastic surgery colleague has been emphasized and the methods by which an otologist make way for sound to reach the normal inner ear through anomalous external and middle ear are discussed. The importance of embryology and radiological and audiological investigations has also been highlighted.

Swagata Sarkar, Karobi Lahiri

This is a prosective study of 36 eyes of 18 children with type 2 retinopathy of prematurity where there were 4 pair of twins.

The gestational age ranged between 25-29 weeks, birth weight between 750-950 grams, oxygen was given to all 18 patients (100%) in a concentration of 40%-70%.

There were other associated risk factors like anaemia, RDS, surfactant therapy, blood transfusion, jaundice. Associated early detection and treatment of this condition starting at prethreshold level, with laser cryo or in advanced cases with surgery will be discussed.

Treatment result were improvement of 31 of 36 eyes (86.11%) in the laser group and surgical improvement in primary + retreatment group was 61.53%.

Complications of these procedures and outcomes will be highlited.

Jyotsna Jedge, Maya Parihar-Malhotra

Malaria can be a fatal disease if not diagnosed immediately or improperly treated. It has typical symptoms of fever with chills but nowadays presentation may not be with typical symptoms. It is transmitted by Female Anophelus Mosquito.

It is caused by protozoa of Genus Plasmodium and having 4 species infective to humans namely P. vivax, P. falciparum, P. ovale, P. malariae.

Transfusion of infected blood or blood components may also transmit Malaria because the malarial parasite can remain viable in stored blood for 1 week and P. falciparum and P. malariae upto 14 days. More than 3500 cases have been identified in last 65 years caused due to infected blood/blood components transfusion.

In India it is mandatory to do screening test for malarial parasite along with Anti-HIV, HBsAg, HCV, VDRL. Traditionally the blood smear examination has been used for diagnosis. Some advanced methods include acridine orange staining, PCR and immunocapture assay. Out of these we have recently started using immunocapture assay based Pan Malaria card which is manufactured by Biomed industries.

The principle is based on sandwich principle which uses anti pan specific pLDH antibody conjugated to colloidal gold and another anti pan specific pLDH antibody immobilised on nitrocellulose strip in thin line.

We started using the kit from 21/04/2006 to 10/08/2006 for all blood Donors in our Blood Bank. We are presenting the result of the tests.

Observations: Total samples run :- 2567. We ran 8 (known positive samples for quality control and all were positive by pan malaria card). True positive :- 01 (which was repeated and confirmed P. vivax with blood smear examination).

Comments: Previously we were using QBC method which is based on immunofluorescence technique but it had some disadvantages like error due to improper filling of the tubes, operator variation, difficulties in supply of tubes and impractical for use in outdoor blood donation drives. The Pan Malaria card has advantages in our setting like ease of use, no user variation, time required is less, result can be crosschecked by another technicians, we can perform test blood collected at outdoor camps. We will reevaluate for sensitivity and specificity over time period of 3-6 months.

Shubhangi Gaikwad, Maya Parihar-Malhotra

Bombay Hospital being one of the recognised hospitals of our city treats significant number of patients; as such blood requirement is also high. The blood that transfused is mostly arranged by the blood bank initially, which relatives replace.

Blood that is collected in our blood bank is through voluntary blood donor who donates in blood bank and then those who donate in drives. Then there are replacement donors and DGS. The National Blood policy currently recommends 100% voluntary blood donation over replacement donors.

The aim of increasing voluntary blood donation is to get adequate blood for the patients, to get safe blood for transfusion and to encourage and motivate the voluntary donors.

In order to achieve 100% voluntary blood donation we should motivate and felicitate regular voluntary donors and blood donation drive organisers and by increasing the number of blood donation drive.

From our data collected voluntary donation has increased from 2.75% in 1999 and 5.9% in 2002 to 30.08% in 2005 and number of drives from 2 in 2002 in which 244 units were collected to 30 drives in 2005 in which 2062 blood units were collected. Thus, we can conclude that voluntary blood donation has increased in the past few years.

The benefits of voluntary donation are that the blood is safe, which is less likely to transmit infections, it is easily available during emergencies, and easy availability of blood components.

There is significant increase in voluntary blood donation from 3.09% in 1999 to 30.10% in 2006 (till July 2006).

Maya Parihar-Malhotra, Hitesh Pagare

Introduction: Blood donated by blood donor can be separated into various blood components, which can be used as per the need of patients. At present Bombay Hospital Bank is providing Red Blood Packed Cells and Whole Blood only.

Preparation of blood components is possible because of - Multiple plastic pack’s system, Refrigerated centrifuge, Different specific gravity of cellular components.

Various blood components which can be separated :

Currently there is a request for components for our patients, which are being met from outside blood banks.

June 2005 to June 2006 : 1. FFP’s - 1036, 2. Random donor platelets - 284, 3. Platelet concentrate - 11

Advantages of components:

Conclusion: Our Hospital being a tertiary care centre availability of blood components is a must. Total number of blood donation was 9543, which would currently suffice the need of FFP, Platelets and Other blood components for the patients.

We are in process of acquiring the equipments for setting up the component lab.

Hence we look forward to start our component as early as possible.

Shrinkhala Kumar, Asha Andyal

Disorder characterized by pain and loss of motion or stiffness in the shoulder. More common in women between 40-70 years and the cause is unknown. Process involves thickening and contracture of capsule surrounding the shoulder joint. Other factors responsible for frozen shoulder are diabetes, injury to shoulder and immobility for a period of time.

Important symptoms are pain - usually dull/aching which worsens with attempted motion. Pain located over the outer shoulder area and sometimes the upper arm. Precautionary measures include restricted motion and avoid stiffness in the shoulder.

There are 3 stages of frozen shoulder : 1. Freezing for 6 weeks to 9 months. Slow onset of pain. As pain worsens, the shoulder loses motion., 2. Frozen for 4 months to 9 months. Slow improvement in pain but stiffness remains, 3. Thawing shoulder motion slowly returns toward negative 5 months - 26 months.

Differential diagnosis : a. Painful shoulder, b. Adhesive capsulitis

Painful shoulder : Any condition that causes pain and restriction of movement in shoulder - comes under this. There is no true contracture of the capsule of shoulder joint.

Tendinitis of rotation cuff, biceptal tendinitis, sprain and tears of rotation cuff.

Adhesive capsulitis : Capsular adhesive form as a result in inflammation in capsule and synovium classification : 1. Pre-adhesive stage, 2. Acute adhesive stage, 3. Stage of maturation, 4. Chronic stage.

A Rao, SR Tambwekar, K Khadalia, VS Tambwekar, A Patil

The finger ring is a far too commonly worn ornament which does not come with a statutory warning “Wearing a finger ring can prove to be injurious to the finger” despite the recommendation of the Consumer Safety Commission, France, “Inform consumers of the potential hazard of wearing finger jewellery”. “Injuries to fingers caused by wearing rings and wedding bands are among the most severe hand accidents and are the hardest to treat”. The injury can occur in “routine situations of home life”. One of the mechanics of the injury involves the hand grasping an object having even a very slight protrusion, hand position continuing to change, the ring gets snagged at the time of the release of the grip while the body has been set into motion involving momentum and the harm is done before any attempt can be made to stop the movement e.g. ring caught on the top of a fence while jumping over it, holding a pivotal object when running round a sharp turn, slipping off a vertical ladder or a rock wall, stepping down from a train or bus while the ring is stuck on an overhead handhold, alighting from a moving train, or ring caught on moving part of a machine. Ring-related injuries can range from mere skin damage to total degloving of the digit to partial degloving and distal amputation depending on the magnitude, direction and duration of the forces involved. The extent and nature of the trauma is the result of the momentum, the position of the finger, the point of hooking of the ring, the ring structure, the snugness of the fit, distortion of the ring and also on how and when the ring is removed following the injury. However, slight this injury may appear, the zone of trauma should be envisaged in terms of depth and distal degloving. A thorough evaluation which may involve the use of the microscope, is necessary to diagnose the full extent of the damage and thereby plan the adequate treatment. Despite all possible restorative surgery, imminent vascular problems resulting from thrombosis of digital vessels secondary to the intimal damage produced by crushing or stretching at the time of injury should also be anticipated. Sensory and autonomic derangements may manifest later.

Since the hand is always being put to use and comes in contact with a vast variety of objects in our environment the ring has every chance of getting caught on protruding object. This alone may not produce an injury, however when momentum is added to the picture, the result can even be instant amputation of the digit. All the persons treated in this series continue to wear rings.

Priti K Shah, Roshan M Vania

The spine is the central skeletal axis of the body. Its uniqueness lies in a perfect balance between flexibility and stability. As humans assumed bipedal posture from quadruped, spine formed an upward bridge between forelimbs and hindlimbs. Inturn, human beings have paid the price of erect posture in the form of acquiring low back pain. 50% of adult population will experience back pain at some point in their lifetime. 25-30% of those with back pain seek professional help. There are various causes and risk factors for low back pain i.e. heavy and frequent lifting, sedentary life styles, postural stresses, etc.

Posture is the most important but often neglected area in the total management and prevention of back pain.

There are different muscles around the spine with varying functions. These are : 1. Local stabilizers like transversus abdominus and multifidus. 2. Global stabilizers like internal oblique, gluteus medius etc. 3. Global mobilizers like rectus abdominus.

In the past lot of importance was given to strengthening of global mobilizers by performing abdominal crunches.

Evaluation of low back pain includes history taking, Joint and soft tissue examination, tightness, strength and brief neurological evaluation.

Rehabilitation of lumbar spine requires a global approach and specific exercise training. It includes postural reeducation, strengthening of trunk muscles, stretching and good ergonomic care. Retraining of deep stabilizer muscles needs to become an integral part of rehabilitation of low back pain patients. It provides foundation for the performance of more general exercise programmes directed at general stability, strength or cardiovascular fitness.

We have utilized the knowledge of core stabilisation for management of low back pain patients, “failed back” patients, pre and post lumbar surgeries, postural impairments and also in symptom free individuals for preventive purposes since three years. We have achieved 60 to 80% results in terms of relief of pain, improved stability and posture depending upon chronicity of problem.

HR Jhunjunwala, Prashant Dwivedi

Introduction: Bone grafts enjoy an important role in the practice of orthopaedics and traumatology. Autografts though being the best available option has its own limitations in turn of quantity and donor site morbidity.

Fresh frozen bone allografts are good alternative to the limitation to the autograft, but the allografts unlike autografts do not have any osteoinductive or osteogenic potential, merely severe as a scaffold around which new bone is formed after its resorption.

We recommend the fresh frozen bone allograft as safe and viable option.

Supriya Bambarkar, Yashodhan Bodhankar, MM Begani, Niranjan Agarwal

GI Lymphoma is not so rare condition. It can involve any part of the GI tract, from stomach to rectum. In last 10 years we have come across 10 cases of gastrointestinal lymphomas - stomach - 3, small intestine - 5, colon - 2 and rectum - 1 C Burkitt’s lymphoma.

We report a case of 72 year old man presenting with intermittent pain in abdomen, nausea, weight loss. Patient was diagnosed of lump in abdomen with subacute intestinal obstruction. After investigating he was operated for exploratory laparotomy which on histopathology revealed lymphoma of the ildocecal junction. Patient is now on chemotherapy.

Yashodhan Bodhankar, Supriya Bambarkar, MM Begani, Niranjan Agarwal

We report a 62 year old male which is known case of cirrhosis with ascites since one year having undergone repeated paracentesis and now presenting with tense ascites and its severe pressure symptoms. The peritoneovenous shunt procedure was done under local anaesthesia and sedation. The procedure was uneventful.

Yashodhan Bodhankar, Supriya Bambarkar, MM Begani, Niranjan Agarwal

In routine surgical practice, major surgical procedures are performed usually under general anaesthesia, some patients with their co-morbid conditions can land up with complications of General Anaesthesia.

Here we report some of the major surgical procedures which were carried out under local anaesthesia with sedation. In patients with associated medical conditions like decompensated heart disease, hepatic failure, renal failure, major surgeries can be carried out in local anaesthesia with minimizing the risk of postoperative and general anaesthetic complications.