Publications by authors named "Dinesh Sood"

41 Publications

A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile.

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):541-545. Epub 2021 Jan 18.

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Anesthesia in obese patients is difficult due to associated comorbidities and altered physiology. Desflurane and sevoflurane have a low fat-blood solubility coefficient and are better suited in these patients to achieve a rapid emergence. We studied BIS guided drug titration to compare the postoperative recovery characteristics and cognitive function of desflurane versus sevoflurane in obese patients undergoing laparoscopic abdominal surgeries.

Material And Methods: After institutional ethics committee approval and written informed consent, sixty obese patients (BMI ≥30 kg/m) were randomized to receive either BIS guided desflurane or sevoflurane. Recovery was assessed by time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person after discontinuation of volatile anesthetic agent. For cognitive function, time taken to complete Mini mental state examination (MMSE) score to baseline was compared in both study groups.

Results: Difference of time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person was not significant between both anesthetic groups. Patients in sevoflurane group took significantly (-value = 0.001) less time (40.07 ± 13 min) to achieve preoperative MMSE score than desflurane group (51.2 ± 11.7 min).

Conclusion: Both desflurane and sevoflurane have similar recovery profile in obese patients when anesthetic concentration is carefully titrated. Reversal of cognitive function is significantly earlier in obese patients anesthetized with sevoflurane.
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http://dx.doi.org/10.4103/joacp.JOACP_307_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022057PMC
January 2021

Premedication with pregabalin 150mg versus 300mg for postoperative pain relief after laparoscopic cholecystectomy.

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):518-523. Epub 2021 Jan 18.

Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Pregabalin has been used in various studies for postoperative pain relief in varying doses. However, there is no conclusive evidence to support a safe and effective dose of pregabalin. The present study was designed to compare the efficacy of two different preoperative doses of pregabalin (150 mg and 300mg) in patients undergoing laparoscopic cholecystectomy for postoperative pain relief.

Material And Methods: Ninety adult patients of either sex with American Society of Anesthesiologist physical status I and II scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomized to receive pregabalin 150mg (group A), pregabalin 300mg (group B), or placebo (group C) orally 1 h before surgery. The pain was assessed using a visual analog scale (VAS) and a verbal rating scale (VRS) for the initial 24 h postoperatively. The primary outcome of our study was the comparative assessment of the severity of pain in the postoperative period in three groups. Postoperative analgesic consumption and incidence of side effects were assessed as secondary outcome measures.

Results: VAS score was significantly more in group C than group A and B (-value <0.05). The total amount of fentanyl required in 24 h was least in group B (228.33 ± 42.41μg) followed by group A (292.50 ± 46.49μg) and group C (322.50 ± 39.58μg) (-value 0.0001). The incidence of sedation, dizziness, and visual disturbances was more in group B as compared to group A and was least in group C.

Conclusions: Pregabalin 150 mg is effective in decreasing postoperative pain after laparoscopic cholecystectomy with fewer incidences of adverse effects such as sedation and visual disturbances as compared to pregabalin 300 mg.
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http://dx.doi.org/10.4103/joacp.JOACP_440_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022042PMC
January 2021

Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial.

Indian J Anaesth 2020 Aug 15;64(Suppl 3):S175-S179. Epub 2020 Aug 15.

Department of Urology, Father Muller's Medical College and Hospital, Mangalore, Karnataka, India.

Background And Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed.

Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows.

Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C.

Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.
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http://dx.doi.org/10.4103/ija.IJA_264_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641052PMC
August 2020

Pictorial Essay: Classic Signs in Pediatric Neuroradiology.

Curr Pediatr Rev 2020 ;16(1):6-16

Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India.

Background: A number of metaphorical imaging signs have been described in the radiology literature.

Objective: These signs not only make the learning process easier but also increase diagnostic confidence. For this reason, these signs are quite popular among radiologists.

Conclusion: In this article, we have demonstrated classic signs described in pediatric neuroradiology with appropriate examples and illustrations.
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http://dx.doi.org/10.2174/1573396315666190916141023DOI Listing
January 2021

Acute necrotizing encephalopathy of childhood.

Neurol India 2019 Mar-Apr;67(2):610-611

Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra, Tanda, Himachal Pradesh, India.

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http://dx.doi.org/10.4103/0028-3886.257990DOI Listing
December 2019

Quantitative assessment of airway and parenchymal components of chronic obstructive pulmonary disease using thin-section helical computed tomography.

Pol J Radiol 2019 21;84:e54-e60. Epub 2019 Jan 21.

Dr Rajendra Prasad Government Medical College Tanda, India.

Purpose: The purpose of this study was to diagnose and characterise chronic obstructive pulmonary disease (COPD) into its forms, patterns, and severity using MDCT.

Material And Methods: In this prospective study, spirometric and MDCT evaluation was done in 52 consecutive patients diagnosed with COPD. In each patient six segmental bronchi were evaluated for CT morphometric indices of bronchial wall thickness (BWT) and wall area percentage (WAP). Quantitative evaluation of emphysema was done using inbuilt software, and volume of emphysematous lung was determined using percentage low attenuation area (LAA). COPD was categorised into the following: emphysema predominant; airway predominant; or mixed phenotypes, and severity grading was assigned as mild, moderate, or severe.

Results: Centrilobular was the predominant emphysema pattern occurring alone (36.5%) or in combination with paraseptal changes (34.6%). Among COPD phenotypes, emphysema predominant was the commonest (44.3%), followed by mixed (30.8%), and bronchitis predominant (25.0%). The mean BWT in the airway-predominant group was significantly higher (1.94 ± 0.28 mm) than in the emphysema-predominant subgroup (1.79 ± 0.23 mm) with a value of 0.005.

Conclusion: MDCT is an indispensable tool in quantitative and qualitative evaluation of COPD patients. Measurement of CT indices like BWT, WAP, and %LAA can reliably categorise COPD into phenotypes like emphysema predominant, airway predominant, or mixed, which serve as a guide for patient management.
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http://dx.doi.org/10.5114/pjr.2019.82737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479059PMC
January 2019

MR Imaging of hypoxic ischemic encephalopathy - Distribution Patterns and ADC value correlations.

Eur J Radiol Open 2018 16;5:215-220. Epub 2018 Nov 16.

Department of Radio-diagnosis, Dr RPGMC, Kangra, Tanda, Himachal Pradesh, India.

Background And Purpose: Neonatal hypoxic-ischemic encephalopathy causes hypoxic brain injury. Due to differences in brain maturity at time of insult, severity of hypotension and duration of insult, there are four distinct patterns of brain injury. Magnetic resonance imaging is the most sensitive modality for evaluating these patterns of brain injury. Additional role of Diffusion weighted imaging and ADC values can be useful in the evaluation of such cases. We conducted this study to analyse the usefulness of ADC values in the brain tissue affected by hypoxic-ischemic injury.

Materials And Methods: We conducted a prospective study of all the patients referred to our department for magnetic resonance scanning of brain with history of hypoxic ischemic encephalopathy and clinical features cerebral palsy. 23 Cases with imaging manifestations of hypoxic ischemic encephalopathy were included in the study. We studied distribution patterns of HIE in our cases and calculated the ADC values of involved as well as normal grey and white matter. Further, sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized diffusion and ADC values were obtained Wilson Score method.

Results: The most common distribution pattern in our study was involvement of peri-rolandic area (15 cases, 65%). ADC values were significantly (p < 0.005) increased in abnormal white matter. No significant changes (p = 0.8) were seen in ADC values of normal and abnormal grey matter.

Conclusions: Due to significant increase in ADC values of affected white matter, ADC value can be used as a marker to detect chronic sequel of hypoxic ischaemic brain injury. Another observation was the perirolandic brain tissue being most common area of involvement in the cases with cerebral palsy.
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http://dx.doi.org/10.1016/j.ejro.2018.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240807PMC
November 2018

US of Right Upper Quadrant Pain: Some Uncommon but Noteworthy Causes.

Radiographics 2018 Nov-Dec;38(7):2212-2213

Department of Radiology, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh 176001, India.

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http://dx.doi.org/10.1148/rg.2018180190DOI Listing
July 2019

CT Chest in Cavitary Lung Disease: Looking Beyond the Lungs.

Chest 2018 06;153(6):1513-1515

Department of Radiology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.

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http://dx.doi.org/10.1016/j.chest.2018.03.055DOI Listing
June 2018

Comparison of Local Wound Infiltration with Ropivacaine Alone or Ropivacaine Plus Dexmedetomidine for Postoperative Pain Relief after Lower Segment Cesarean Section.

Anesth Essays Res 2017 Oct-Dec;11(4):940-945

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Context: Dexmedetomidine, α-adrenergic agonist, when coadministered with local anesthetics, improves the speed of onset, duration of analgesia and decreases the dose of local anesthetic used.

Aims: The aim of this study was to compare the efficacy of local subcutaneous wound infiltration of ropivacaine alone with ropivacaine plus dexmedetomidine for postoperative pain relief following lower segment cesarean section (LSCS).

Subjects And Methods: The study was a prospective, randomized control, double-blind study. Sixty female patients belonging to physical status American Society of Anesthesiologists Grade I or II scheduled for LSCS under spinal anesthesia were randomly allocated into two groups of thirty patients each. Group A: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) diluted with normal saline to 40 ml. Group B: local subcutaneous wound infiltration of 0.75% ropivacaine (3 mg/kg) plus dexmedetomidine (1.5 μg/kg) of the body weight diluted with normal saline to 40 ml. Standard spinal anesthesia technique was used and LSCS was conducted. The allocated drug was administered by local subcutaneous wound infiltration before closure of the skin. In postoperative period, pain was assessed using visual analog scale (VAS) over a period of 24 h, time of giving first rescue analgesic consumption, mean analgesic consumption, patient satisfaction, and incidence of side effects in 24 h postoperative period was noted.

Statistical Analysis Used: All observations were tabulated and statistically analyzed using Chi-square test and unpaired -test.

Results: A total number of patients requiring rescue analgesic, mean VAS each time rescue analgesic was given, and the mean analgesic required in 24 h postoperative period was lesser in Group B than in Group A.

Conclusions: Dexmedetomidine added to ropivacaine for the surgical wound infiltration significantly reduces postoperative pain and rescue analgesic consumption in patients undergoing LSCS. No serious adverse effects were noted.
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http://dx.doi.org/10.4103/aer.AER_14_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735492PMC
December 2017

Superior semicircular canal dehiscence: A new perspective.

Eur J Radiol Open 2017 14;4:144-146. Epub 2017 Nov 14.

Department of Radiodiagnosis DRPGMC, Tanda, Kangra, H.P., India.

Objective: To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its association with ear pathologies and to find whether it is an acquired condition and its association with increase in age.

Materials And Methods: study was performed in a tertiary care institute present in a village, following approval of the institutional ethical committee. Retrospective review of temporal bone CT examinations performed between September 2016 and March 2017 was done. 1 mm interval axial images with sagittal and coronal reformatted images were reviewed for the presence of canal dehiscence and thinning by investigators. We characterised the Superior semicircular canal status as normal, frank dehiscence or thinning. Frank dehiscence was further classified anatomically as anterior limb, apex and posterior limb dehiscence.The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group.

Results: Retrospective review yielded 80 positive cases which included SSC dehiscence (N = 39) and thinning (N = 41). 80 normal scans were selected as control group retrospectively. Statistical analysis was performed to assess for differences between the groups studied. Pearson chi-square test applied. there was a significant association of SSC pathologies prevalence with increasing age (p = < 0.001). No significant relationship was found between SSCD and presence of either CSOM or Cholesteatoma (p = 0.285). Vertigo rather than Tullio phenomenon was the statistically significant complaint (p = <0.001). which brought the patient to the hospital.

Conclusions: The SSCD and thinning belong to the same spectrum and are acquired conditions. Increasing prevalence in old age suggests it to be an acquired condition rather than a congenital one. No significant association of these condition was seen with CSOM and cholesteatoma. Vertigo is the predominat symptom bringing the patient to hospital along with Tullio phenomenon.
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http://dx.doi.org/10.1016/j.ejro.2017.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717502PMC
November 2017

Comparative efficacy of clonidine versus magnesium sulfate as an adjunct to lignocaine in intravenous regional anesthesia for postoperative analgesia: A prospective, randomized, double-blind study.

J Anaesthesiol Clin Pharmacol 2017 Jul-Sep;33(3):387-390

Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Intravenous regional anesthesia (IVRA) is a very good technique to be used in unstable patients. Various adjuvants have been added, but till date, there is no ideal adjuvant. Clonidine is one of the most widely used adjuvants in IVRA. However, it has many side effects. Hence, the search continues for a better adjuvant. The aim of the present study was to compare the efficacy of clonidine versus MgSO as an adjunct to lignocaine in IVRA for postoperative analgesia and to compare their side effect profile.

Material And Methods: This prospective double-blind randomized controlled study was conducted in a tertiary care institute. Forty adult patients were included. Patients were assigned into two groups; Group 1 ( = 20) received 3 mg/kg of 2% lignocaine + 50% MgSO 1.5 g diluted with normal saline to 40 ml. Group 2 ( = 20) received 3 mg/kg of 2% lignocaine + clonidine 150 μg diluted with normal saline to 40 ml. Pain score, time to first rescue analgesic (TTFA), total number of rescue analgesics required, and the side effects of the two drugs were compared for 24 h postoperatively.

Results: The mean TTFA was significantly longer in Group 1 (193.9 ± 38.4 min) than in Group 2 (169.5 ± 33.3 min); < 0.05. The mean number of rescue analgesics required was 1.6 ± 0.7 in Group 1 as compared to 2.1 ± 0.8 in Group 2 ( < 0.05). More serious side effects such as hypotension and bradycardia were noted with clonidine, although all patients experienced transient pain during intravenous injection of MgSO.

Conclusion: MgSO provides better postoperative analgesia as compared to clonidine when used as an adjunct to lignocaine in IVRA with fewer side effects.
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http://dx.doi.org/10.4103/joacp.JOACP_18_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672520PMC
November 2017

Magnetic Resonance Imaging (MRI) Characterization of Perianal Fistulous Disease in a Rural Based Tertiary Hospital of North India.

Pol J Radiol 2016 22;81:611-617. Epub 2016 Dec 22.

Department of Radiology, Dr. Rajendra Prasad Government Medical College - Tanda, Kangra, Himachal Pradesh, India.

Background: To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India.

Material/methods: This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery.

Results: The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment.

Conclusions: MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.
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http://dx.doi.org/10.12659/PJR.899315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201120PMC
December 2016

Vibration sensation as an indicator of surgical anesthesia following brachial plexus block.

Saudi J Anaesth 2016 Oct-Dec;10(4):432-435

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power.

Materials And Methods: This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach. The baseline values of vibration sense perception using 128 Hz Rydel-Seiffer tuning fork, motor power using formal motor power of wrist flexion and wrist extension, and sensory score by pinprick method were recorded preoperatively and every 5 min after giving block till the onset of complete surgical anesthesia.

Results: The mean ± standard deviation of time (in minutes) for sensory, motor, and vibration block was 13.33 ± 3.26, 21.10 ± 3.26, and 25.50 ± 2.02, respectively ( < 0.05). Although all the patients achieved complete sensory and motor block after 25 min, 14% of the patients still had vibration sensations intact and 100% of the patients achieved complete sensory, motor, and vibration block after 30 min.

Conclusions: Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel-Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block.
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http://dx.doi.org/10.4103/1658-354X.179114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044729PMC
November 2016

Giant Atretic Occipital Lipoencephalocele in an Adult with Bony Outgrowth.

Pol J Radiol 2016 21;81:392-4. Epub 2016 Aug 21.

Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, India.

Background: We present unique case of a giant extracranial atretic occipital lipoencephalocele in an adult patient with new bone formation within it which was not associated with any developmental malformation of brain. Resection of the lipoencephalocele was performed for esthetic reasons.

Case Report: 18 year old female patient presented to the surgery OPD with complains of a large mass in the occipital region present since birth. It was of size of a betel nut at the time of birth and gradually increased in size over a long period of time. It was painless and not associated with any other constitutional symptoms. On examination the rounded fluctuant mass was present in the midline in occipital region covered with alopecic skin with dimpling in the overlying skin. On MRI there was mass showing both T1 and T2 hyperintense signal area suggestive of fat component. Herniation of meninges and atretic brain parenchyma was also seen through a defect in the occipital bone in the midline. There was a Y shaped bony outgrowth seen arising from occipital bone into the mass which was quite unusual in association with an atretic lipoencephalocele.

Conclusions: A large lipoencephalocele with bony outgrowth in an adult patient is a rare presentation of atreic occipital encephalocele.
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http://dx.doi.org/10.12659/PJR.895453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994857PMC
September 2016

Contrast Intravasation During Hysterosalpingography.

Pol J Radiol 2016 17;81:236-9. Epub 2016 May 17.

Department of Radiodiagnosis, Dr Rajendra Prasad Government Medical College, Kangra, India.

Hysterosalpingography is an imaging method to evaluate the endometrial and uterine morphology and fallopian tube patency. Contrast intravasation implies backflow of injected contrast into the adjoining vessels mostly the veins and may be related to factors altering endometrial vascularity and permeability. Radiologists and gynaecologists should be well acquainted with the technique of hysterosalpingography, its interpretation, and intravasation of contrast agents for safer procedure and to minimize the associated complications.
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http://dx.doi.org/10.12659/PJR.896103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874266PMC
June 2016

Neglected vaginal foreign body leading to vaginolith, vesicovaginal fistula and vesical calculus formation in an adolescent girl.

BJR Case Rep 2016 8;2(2):20150474. Epub 2016 May 8.

Department of Radiodiagnosis, DRPGMC Kangra at Tanda, Kangra, India.

Vaginal foreign body insertion is not an uncommon clinical entity; however, long-standing neglected vaginal foreign body causing vaginolith, vesicovaginal fistula and vesical calculus formation is unusual. We present a case of a neglected vaginal foreign body (plastic cap of a nail colour) leading to vesicovaginal fistula, vaginolith and vesical calculus formation in a 12-year-old female child presenting with continuous dribbling of urine per vagina. Diagnosis was confirmed on ultrasonography, non-contrast CT scan and MRI of the pelvis. The MRI demonstrated the exact size and site of the urinary bladder wall defect, besides the foreign body and the vesical calculus. The foreign body along with vaginolith and the vesical calculus were removed suprapubic approach under general anaesthesia; the fistula was repaired by suturing the urinary bladder and vagina wall defect.
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http://dx.doi.org/10.1259/bjrcr.20150474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180853PMC
May 2016

Complete septate uterus with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) in a young woman-a rare variant of Herlyn-Werner-Wunderlich syndrome.

BJR Case Rep 2016 25;2(2):20150241. Epub 2016 Feb 25.

Department of Radiodiagnosis, DRPGMC Kangra at Tanda, Kangra, India.

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is an unusual and special type of Müllerian duct anomaly. Patients usually present in adolescence, soon after menarche, with pain and pelvic mass and rarely with infertility in adulthood. Majority of the cases of OHVIRA have been reported in association with uterus didelphys and the presentation of uterus didelphys with OHVIRA is known as Herlyn-Werner-Wunderlich syndrome. A complete septate uterus with OHVIRA is exceedingly unusual. Less than 30 cases of complete septate uterus with OHVIRA have been reported to date, to the best of our knowledge. We present a rare case of incidentally detected complete septate uterus with OHVIRA in a young woman who presented with acute pain in the right iliac fossa owing to acute appendicitis.
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http://dx.doi.org/10.1259/bjrcr.20150241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180896PMC
February 2016

A Classic Case of Tuberous Sclerosis with Multisystem Involvement Including Giant Bilateral Renal Angiomyolipomas Presenting as Massive Hematuria.

Pol J Radiol 2015 21;80:435-41. Epub 2015 Sep 21.

Department of Radiology, Baroda Medical College, Vadodara, India.

Background: Tuberous Sclerosis (TSC) also known as Bourneville disease is a neurocutaneous syndrome having an autosomal dominant inheritance pattern, though the condition has a high rate of spontaneous mutation. It is the second most common neurocutaneous syndrome after neurofibromatosis. This disease demonstrates a widespread potential for hamartomatous growths in multiple organ systems.

Case Report: We report a case of a 36-year-old female with TSC presenting as massive hematuria with underlying giant bilateral renal angiomyolipomas (AML) with estimated total tumor burden of more than 8 kg which is to the best of our knowledge the highest ever reported. The patient also had lymphangioleiomyomatosis and lesions in the brain, skin, teeth and bones.

Conclusions: TSC has a wide variety of clinical and radiologic manifestations. It should be suspected when some of the common radiological manifestations are found, including CNS involvement, renal and hepatic AMLs and LAM, even if clinical signs are not obvious. Renal AMLs in setting of TSC may reach giant proportions and may present with massive hematuria.
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http://dx.doi.org/10.12659/PJR.894741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588676PMC
October 2015

A Classic Case of Tuberous Sclerosis with Multisystem Involvement Including Giant Bilateral Renal Angiomyolipomas Presenting as Massive Hematuria.

Pol J Radiol 2015 21;80:435-41. Epub 2015 Sep 21.

Department of Radiology, Baroda Medical College, Vadodara, India.

Background: Tuberous Sclerosis (TSC) also known as Bourneville disease is a neurocutaneous syndrome having an autosomal dominant inheritance pattern, though the condition has a high rate of spontaneous mutation. It is the second most common neurocutaneous syndrome after neurofibromatosis. This disease demonstrates a widespread potential for hamartomatous growths in multiple organ systems.

Case Report: We report a case of a 36-year-old female with TSC presenting as massive hematuria with underlying giant bilateral renal angiomyolipomas (AML) with estimated total tumor burden of more than 8 kg which is to the best of our knowledge the highest ever reported. The patient also had lymphangioleiomyomatosis and lesions in the brain, skin, teeth and bones.

Conclusions: TSC has a wide variety of clinical and radiologic manifestations. It should be suspected when some of the common radiological manifestations are found, including CNS involvement, renal and hepatic AMLs and LAM, even if clinical signs are not obvious. Renal AMLs in setting of TSC may reach giant proportions and may present with massive hematuria.
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http://dx.doi.org/10.12659/PJR.894741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588676PMC
October 2015

An Ectopic Pelvic Kidney.

Pol J Radiol 2015 9;80:425-7. Epub 2015 Sep 9.

Department of Radiology, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India.

Background: If a kidney does not ascend as it should in normal fetal development, it remains in the pelvic area and is called a pelvic kidney. Often a person with a pelvic kidney will go through his/her whole life unaware of this condition, unless it is discovered during neonatal kidney ultrasound screening or if complications arise later in life due to this or a completely different reason and the condition is noted during investigations. Generally, this is not a harmful condition but it can lead to complications like in our case. With appropriate testing and treatment, if needed, an ectopic kidney should cause no serious long-term health complications and all that may be required for the patient is reassurance with advice to follow up at regular intervals.

Case Report: A 28-year-old male presented with recurrent pain in his lower left abdomen for one month and an episode of hematuria 3 days earlier accompanied by an attack of acute pain lasting for 3-4 hours. He gave a history of passing 2 small (about 5 mm each) calculi in his urine after the occurrence of hematuria, following which pain decreased in intensity. No history of fever was present.

Conclusions: Although a simple ectopic kidney seldom causes symptoms, the association of malrotation of the renal pelvis with calculus increases the risk of hematuria and/or hydronephrosis, presenting with colicky pain as in the present case. The clinician should be aware of these in such a case. If asymptomatic, no treatment is required. However, the patient should be advised to have follow-up ultrasounds at regular intervals to detect complications like calculus, hydronephrosis, etc. With appropriate testing and treatment, if required, an ectopic kidney should not cause serious long-term health complications.
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http://dx.doi.org/10.12659/PJR.894603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571541PMC
September 2015

Membranous IVC Obstruction Presenting with Antegrade/Retrograde Respiratory Flow in the Intrahepatic Segment in Doppler Imaging and Prostatic and Urethral Congestion.

Pol J Radiol 2015 9;80:350-5. Epub 2015 Jul 9.

Department of Cardiology, Saint Francis Hospital, Hartford, CT, U.S.A.

Background: Obstruction of the inferior vena cava (IVC) is infrequent, membranous obstruction of the IVC (MOIVC) being one of its rare causes. Early diagnosis is important, as it can lead to hepatic congestion, cirrhosis and Budd-Chiari syndrome (BCS) and can predispose to development of hepatocellular carcinoma (HCC) in severe cases.

Case Report: We report a case of membranous IVC obstruction at the junction of hepatic and suprahepatic segments in a young male with extensive collateralization and venous aneurysms. Unique findings involved antegrade and retrograde flow during respiration in the upper part of intrahepatic IVC proximal to a large collateral vein as well as prostatic and urethral congestion leading to intermittent urinary hesitancy, which have not yet been described in such cases.

Conclusions: MOIVC is a rare cause of IVC obstruction with typical radiological features. Early diagnosis and management is required due to risk of cirrhosis and HCC. Antegrade and retrograde flow may be seen in incomplete MOIVC above the level of a large collateral vein and it may lead to prostatic and urethral congestion.
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http://dx.doi.org/10.12659/PJR.894408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501637PMC
July 2015

Congestive Myelopathy due to Intradural Spinal AVM Supplied by Artery of Adamkiewicz: Case Report with Brief Literature Review and Analysis of the Foix-Alajouanine Syndrome Definition.

Pol J Radiol 2015 1;80:337-43. Epub 2015 Jul 1.

Department of Physiology, Baroda Medical College, Vadodara, India.

Background: Spinal arteriovenous malformations (AVMs) can lead to development of congestive myelopathy (Foix-Alajouanine syndrome). Spinal AVMs are rare and so is this syndrome. Diagnosis is often missed due to its rarity and confusing definitions of the Foix-Alajouanine syndrome.

Case Report: We report a case of a 47-year-old male patient suffering from this rare syndrome with an AVM arising from the artery of Adamkiewicz, which is another rarity. Our patient was treated by embolization of the lesion with 20% glue, after which he showed mild improvement of symptoms. We also present a brief review of literature on spinal AVMs and elucidate the evolution of the term Foix-Alajouanine syndrome.

Conclusions: Use of the term "Foix-Alajouanine syndrome" should be restricted to patients with progressive subacute to chronic neurological symptoms due to congestive myelopathy caused by intradural spinal AVMs. CT angiography should supplement DSA as preliminary Imaging modality. Patients may be treated with surgery or endovascular procedures.
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http://dx.doi.org/10.12659/PJR.894304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492508PMC
July 2015

Role of dexmedetomidine in early extubation of the intensive care unit patients.

J Anaesthesiol Clin Pharmacol 2015 Jan-Mar;31(1):92-8

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Patients on ventilatory support in intensive care unit (ICU) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance. The selection of the agent should be such that it does not interfere with the early extubation of the patients. We compared the efficacy of dexmedetomidine with midazolam to facilitate extubation of patients from mechanical ventilation in terms of the sedative properties, cardiovascular responses, ventilation, and extubation characteristics and safety profile.

Materials And Methods: A total of 40 adult, mechanically ventilated patients of either sex, aged 18-60 years, meeting the standard criteria for weaning, randomized into 2 groups of 20 patients each, received intravenous infusion of dexmedetomidine (0.2-0.7 mcg/kg/h) or midazolam (0.04-0.2 mg/kg/h) as needed for Ramsay sedation scale 2-4. Extubation following standard extubation protocol was done. Time for extubation and vital parameters were regularly recorded.

Results: The time to extubation in the dexmedetomidine group was significantly lower than in the midazolam group. Heart rate and blood pressure was significantly lower in dexmedetomidine group than the midazolam group at most of the times.

Conclusions: Dexmedetomidine has clinically relevant benefits compared with midazolam in facilitating extubation due to its shorter time to extubation, more hemodynamic stability, easy arousability, and lack of respiratory depression.
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http://dx.doi.org/10.4103/0970-9185.150554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353161PMC
March 2015

[Not Available].

Braz J Anesthesiol 2014 May-Jun;64(3):216-8. Epub 2014 May 1.

Departamento de Anestesiologia, Dayanand Medical College & Hospital, Ludhiana, Punjab, Índia.

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http://dx.doi.org/10.1016/j.bjan.2013.08.005DOI Listing
August 2015

Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block.

J Clin Diagn Res 2014 Jun 20;8(6):GC01-5. Epub 2014 Jun 20.

Professor, Department of Anaesthesia, DMCH, Dayanand-Medical-College-Hospital- , Ludhiana, India .

Background: Spinal anaesthesia is the primary anaesthetic technique for many types of surgeries. Adjuncts to the local anaesthetics (LA) used in spinal anaesthesia can exhibit undesirable side-effects like respiratory depression, urinary retention, pruritis, haemodynamic instability and nausea and vomiting, limiting their use. Magnesium when used in therapeutic doses avoids all of these side-effects.

Materials And Methods: We conducted a randomized double blind study on 90 patients, 30 in each group, scheduled for orthopaedic lower limb surgery under subarachnoid block. Group I: received bupivacaine (0.5%), 12.5 mg + 0.5 ml of preservative free 0.9% normal saline, Group II received bupivacaine (0.5%), 12.5 mg + 0.2 ml (50 mg) of preservative free 25 % magnesium sulphate + 0.3 ml of preservative free 0.9% normal saline Group III: received bupivacaine (0.5%) 12.5 mg + 0.3 ml (75 mg) of 25 % magnesium sulphate + 0.2 ml of preservative free 0.9% normal saline for subarachnoid block. The onset and duration of sensory block, the highest dermatomal level of sensory block, motor block, time to complete motor block recovery and duration of spinal anaesthesia were recorded.

Statistical Analysis: ANOVA was applied to determine the significance of difference between different groups. If p-value was significant then Turkey's Post Hoc Multicomparison test was applied. Values of p<0.05 were considered to be statistically significant.

Results: The time of maximum sensory block, time of onset of motor block, duration of sensory block, duration of motor block and time of analgesia request were prolonged in patients given magnesium 50mg and 75mg along with local anaesthetic intrathecally.

Conclusion: N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium when administered intrathecally along with local anaesthetics prolongs the duration of spinal analgesia without adverse effects.
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http://dx.doi.org/10.7860/JCDR/2014/8295.4510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129284PMC
June 2014

Palatoplasty in a patient with Seckel syndrome: an anesthetic challenge.

Braz J Anesthesiol 2014 May-Jun;64(3):216-8. Epub 2013 Nov 6.

Department of Anesthesiology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.1016/j.bjane.2013.08.005DOI Listing
April 2015

Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy.

J Anaesthesiol Clin Pharmacol 2013 Oct;29(4):478-84

Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity.

Materials And Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h.

Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations.

Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.
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http://dx.doi.org/10.4103/0970-9185.119141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819841PMC
October 2013