Extramedullary hematopoiesis is a compensatory response in patients with thalassemia and other chronic anemia and can result in compressive myelopathy, if untreated. Two young adults with history of thalassemia presented with symptoms of spinal cord compression. Presence of extramedullary hematopoiesis was confirmed by magnetic resonance imaging. Both the patients were treated with blood hypertransfusion and showed improvement clinically and radiologically. Although there are various options in the management of such condition, including decompression surgery and radiation treatment, hypertransfusion can be very effective even in severe compression of the spinal cord. Hypertransfusion should be tried as the first line of management in patients with thalassemia presenting with compressive myelopathy to decrease the bulk of extramedullary hematopoietic tissue.
The subclavian steal syndrome is characterized by a subclavian artery stenosis located proximal to the origin of the vertebral artery. In this case, the subclavian artery steals reverse-flow blood from the vertebrobasilar artery circulation to supply the arm during exertion, resulting in vertebrobasilar insufficiency. As the vertebrobasilar arterial system feeds both the peripheral and central auditory and vestibular systems. In subclavian steal syndrome, neurotological symptoms are expected because of the vertebrobasilar insufficiency. In this report, we describe a patient suffering from subclavian steal syndrome, who presented with isolated dizziness, recurrent vertigo, on moving around, while sitting no complaints were there and no postural vertigo was seen. Upon magnetic resonance imaging no ischaemic lesions were observed, suggesting that the central auditory and vestibular system are more likely to be involved in the pathogenesis of neurotological symptoms in subclavian steal syndrome. Patients complaining of numbness of the upper arm and isolated neurotological symptoms should be thoroughly examined for subclavian steal syndrome. Furthermore, regular follow-up must be undertaken in order to prevent other neurological deficits in the vertebrobasilar arterial territory.
Background:The etiological spectrum of ascites is vast and practically includes pathology of all the systems. In most cases ascites will appear as a part of a well-recognized illness i.e. cirrhosis, tuberculosis, congestive heart failure, nephrosis or disseminated carcinomatosis. Few patients have more than one cause of ascites formation. Majority of cases of ascites are due to portal hypertension, mainly as a result of cirrhosis. Other subset of cause includes pathology of peritoneum, which are not related to portal hypertension. A portal hypertension ascites was distinguished from the non-portal hypertension causes by determining whether the fluid is transudate or exudate. But many infected and malignancy related samples have been reported to have transudative fluid and many samples obtained from patients with cirrhosis or heart failure had exudative ascitic fluid. Hence there is a need for this study to know the efficacy of serum ascites albumin gradient and serum ascites cholesterol gradient to differentiate ascites of portal and non-portal hypertensive etiology. Ascites associated with portal hypertension has high serum -ascites albumin gradient i.e ≥1.1 gm/dl, whereas ascites associated with peritoneal inflammation or malignancy has low gradient <1.1gm/dl. Methods: In this study 130 patients of ascites proved by ultrasound were included. They were studied using two parameters -serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradient (SACG). Serum albumin, ascitic fluid albumin, serum cholesterol and ascitic fluid cholesterol was done in all patients. Results: SAAG was in portal hypertensive range in 96 of the 99 patients with portal hypertension and in non-portal hypertensive range in 24 of the 26 patients in non-portal hypertension causes. SAAG has efficacy of 96.15% in classifying ascites of portal hypertension and non-portal hypertension causes. Conclusions: The Mean±SD of SAAG in portal hypertension is 1.423±0.188 and in non-portal hypertension is 0.725±0.189 and is statistically significant in classifying ascites of portal and non-portal hypertension causes. A SAAG >1.1 gm/dl is suggestive of portal hypertension not only in patients with transudative type of ascites but also in cases with high protein concentration. The Mean±SD of SACG in malignant ascites is 38.2±10.8 and in nonmalignant ascites is 78.1±20.2 and is statistically significant in classifying ascites into malignant and non-malignant etiology.
Upper extremity deep venous thrombosis (UEDVT) is also known as thrombosis of the axillary-subclavian vein, or Paget-Schroetter syndrome. It has primary and secondary varieties. Once considered rare, over the past decades U.E.D.V.T. has emerged as an increasingly important clinical entity. It makes up approximately 1-4% of all episodes of deep venous thrombosis (DVT) and carries a potential for considerable morbidity. Pulmonary embolism (PE) is present in up to one third of patients. Primary UEDVT is still a relatively infrequent disorder of predominantly young, otherwise healthy people who participate in repetitive upper extremity activity. From an epidemiologic perspective, the general incidence of UEDVT remains low (approximately 2/100 000 persons per year), even though it is the most common vascular condition among athletes. Although early clinical recognition of UEDVT is important, diagnosis can be difficult due to its indeterminate cause and indistinct pathophysiology. PRIMARY (idiopathic) UEDVT is rare with controversial pathogenesis and treatment. KEY WORDS; UEDVT, DVT, PE, LEDVT, SVC REVIEW OF LITERATURE: Symptoms of UEDVT are nonspecific, ranging in severity, and may be position dependent. Occasionally, patients may be entirely asymptomatic. Most commonly, however, patient complaints include initial "heaviness" in the affected arm, as well as a dull ache and pain in the neck, shoulder, and/or axilla of the involved limb. The differential diagnosis is complex because patients typically display compressive signs usually associated with thoracic outlet syndrome. Other more dramatic signs may include ecchymosis and non-edematous swelling of the shoulder, arm, and hand; functional impairment; discoloration and mottled skin; and, distention of the cutaneous veins of the involved upper extremity. Risk factors for UEDVT include central venous catheterization, strenuous upper extremity exercise or anatomic abnormalities causing venous compression, inherited thrombophilia, and acquired hypercoagulable states including pregnancy, oral contraceptive use, and cancer. Unexplained or recurrent UEDVT should prompt a search for inherited hypercoagulable states or underlying malignancy. In the present era the increased incidence is directly related to the increasing use of central venous catheters for chemotherapy, bone marrow transplantation, dialysis, and parenteral nutrition.. Pulmonary embolism (PE) is present in up to one third of patients with UEDVT (1). As high as 25 % of the patients with indwelling catheters can have UEDVT (2). Kabani et al (3) a study of 1,275 patients admitted to the surgical ICU over a 12-month period found that the incidence of UEDVT was higher than that of LEDVT (17% vs. 11%;
portal hypertension and non-portal hypertension etiology was 98.4%. In malignant cases the SACG was found significantly lower than non-malignant cases.SACG was able to accurately differentiate the malignant and non-malignant cases in 99.2% of cases at cut off value of 53mg/dl. Conclusion: In view of the good diagnostic efficacy, easy availability and cost-effectiveness, serum ascitic albumin and cholesterol gradientcan be an excellent parameter for the diagnosis of portal hypertension and malignant ascites respectively.Background: The aim of present study was to differentiate the portal hypertension as well as malignant causes of ascites by estimating Serum Ascites Albumin Gradient (SAAG) and Serum Ascites Cholesterol Gradient(SACG ) respectively.Material and method: A total of 130 patients having ascites were included in the study. Serum and Ascitic albumin and cholesterol was measured. SAAG and SACG were calculated by subtracting ascitic values from the respective serum values.Results: There was significant difference in SAAG in portal hypertension cases of ascites as compared to non-portal hypertension cases of ascites. The efficacy of SAAG in the present study to classify
Background and Objectives: Diabetes has emerged as a major health challenge in India due to a rapid rise in the number of diabetes cases. Early identification of high risk individuals through screening and early interventions in the form of lifestyle modifications and treatment would help in the prevention of diabetes and its complications. This study was done to assess the risk of type 2 diabetes mellitus (T2DM) in an urban slum population using the Indian Diabetes Risk Score (IDRS) and to determine the factors associated with high risk score. Methods: A cross-sectional study was conducted among Department of Gen. Medicine Sri Aurobindo Medical College and Post Graduate Institute, Indore (18 Months). With the institutional ethical committees permission. A total of 100 study participants were selected randomly. A pre-designed and pre-tested structured questionnaire was used for data collection. Assessment of risk of T2DM was done using the IDRS. Results: Of the 100 study participants, 74% were at high risk (IDRS ≥60) followed by 24% at moderate risk (IDRS 30-50) and 2% at low risk (IDRS <30). 45 individuals in the age group ≥50 yr were at high risk compared to 25 in 35-49 yr age group. Most (n=25, 87.5%) of sedentary workers were at high risk compared to those employed in moderate (n=38, 75.4%) and strenuous work (n=10, 51.9%). Interpretation & Conclusions: 74.3 percent of study participants were high-risk for T2DM. High-risk IDRS scores were associated with age, occupation, abdominal obesity, general obesity, and high blood pressure.
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