high tibial osteotomy- a joint preservation the trivia
TRANSCRIPT
February 19, 2021 Pg. 1
THE TRIVIA THEATRE
A WRITER UNBLOKING THE BLOCK
Although most physicians know Roald Dahl (1916–1990) for the many wonderful novels and short stories he wrote, due to a personal tragedy, he is also one of the inventors of the modern ventricular catheters and shunt valves. In 1960, while living in New York, his then 4-month-old son Theo was hit by a New York taxi and suffered traumatic brain injury with multiple skull fractures and cerebral damage. Back in the UK, Theo suffered from hydrocephalus due to multiple shunt obstructions with debris clogging the silicone slits of his Holter valve. Dahl was determined to find a solution to this problem. He contacted Stanley Wade, a toymaker who specialized in making small hydraulic pumps that supplied fuel to model aero plane engines. Together they came up with a solution and the WDT (Wade-Dahl-Till) valve was taken into production in 1962, and the first patient was treated around June 1962. The WDT valve was estimated to have been used in two to 3,000 children worldwide in the next couple of years, before it became superseded by novel types of valves.
Dept. of General Surgery, AFMC Pune
HIGH TIBIAL OSTEOTOMY- A JOINT PRESERVATION SURGERY: OUR EXPERIENCE High Tibial osteotomy is a well-established procedure for the treatment of early onset varus degenerative knee in patients wishing to pursue active lifestyle. It offers a joint preserving surgery with unimpeded lifestyle as compared to a joint sacrificing surgery like total knee replacement with its inherited lifestyle modifications / restrictions. We share our results of the procedure on more than 25 patients including young serving soldiers, who have resumed normal military duties after the surgery
In young individuals wishing to pursue an active lifestyle Medial opening wedge high Tibial osteotomy with its early weight bearing, ability to maintain the corrected axis, minimally encountered complications, controlled distraction with option of correcting the alignment post primary surgery, no implant retention and it’s sterling results is a worthy and attractive optional technique in the armamentarium of an Orthopedic Surgeon for performing High Tibial Osteotomy.
Dept. of Orthopedics, AFMC Pune
February 19, 2021 Pg. 2
Q-RIOSITY
1. X disease is a rare, progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The name is derived from Japanese and describes the look of “puff of smoke” due to the tangling of tiny vessels formed to compensate for the blockage. What is X?
a) Moya moya Disease b) Yamaguchi Disease c) Kyoto Disease d) Hirotori Syndrome
2. The most common cause of ventriculomegaly in newborn?
a) Arnold-Chiari Malformation b) Dandy-Walker Syndrome c) Arachnoid villi Malformation d) Aqueductal Stenosis
3. Which of the following infections can also cause aqueductal stenosis?
a) Measles b) Mumps c) Rubella d) Bacterial Endocarditis
4. Which of the following is not a cause of communicating hydrocephalus?
a) Choroid Plexus Papilloma b) Meningeal Malignancy c) Vein of Galen Malformation d) Achondroplasia
5. ETVSS is a score system devised in 2009
that predicts the success of endoscopic third ventriculostomy in patients. It was devised by?
a) Kulkarni et al b) Dr Benjamin Warf c) Dr Frank Nulsen d) Robertson et al
TORSION OVARY: A CHALLENGE IN THE YOUNG A 30-year-old P1L1A1 lady, last child birth 05 years back by caesarean section, a known case of Rheumatic Heart Disease with mild MS & MR with mitral valvuloplasty done 02 years back with right femoral stenosis (balloon angioplasty done) on Tab Ecosprin, Lasilactone and Inj. Penidure had reported with history of acute pain abdomen at the right iliac fossa in the MI room in the month of Dec 2020. She was being evaluated for acute appendicitis, but on ultrasound she was detected to have an enlarged hemorrhagic cyst 4.2x6x7.5 cm with reduced vascularity on Doppler with the possibility of torsion of right ovary with its cyst. During the evaluation for torsion she was detected to be COVID +ve. As her clinical parameters were stable and there was symptomatic improvement, elective surgery was planned once she had turned COVID -ve. After an isolation period of 14 days she was posted for laparoscopy and proceed with a consent for oophorectomy. She was also desirous for a tubectomy in spite of only one living issue due to her cardiac condition. Laparoscopy revealed a pale looking ovary with dense adhesions between the right ovary, large bowel, omentum and uterus. There were also adhesions between the anterior abdominal wall and the omentum for which adhesiolysis was done.
A decision to do a laparotomy was taken in view of frozen pelvis and possibility of injuries to bowel and bladder during adhesiolysis.
During the laparotomy two twists of the ovarian ligament along with the tube was noticed in the right adnexa. As the right ovary seemed to be unsalvageable and large in size which could have led to a repeat episode of torsion it was decided to perform a right oophorectomy with left sided lapster. On cross section of the specimen (8x8 cm), there was hemorrhagic fluid within it with no other solid components hence suggestive of a benign hemorrhagic ovarian cyst. Her post op course was uneventful and she was discharged on post op day 3.
Adnexal torsion is the fifth most common gynaecologic emergency. Most common ovarian pathologies are benign functional ovarian cysts and benign teratomas like dermoid cysts. When evaluating for suspected adnexal torsion one needs to keep in mind, preservation of ovarian function and future fertility. There are no sufficient clinical or imaging criteria to confirm a diagnosis of ovarian torsion. Doppler flow may be used along with other clinical parameters. A minimally invasive approach is preferred with a detorsion of the ovary. In our case due to her other comorbidities a decision for right oopherectomy was taken leaving behind a healthy left ovary.
Dept of Obstetrics and Gynecology, AFMC Pune
February 19, 2021 Pg. 3
Answers can be emailed to [email protected]. Names of the top 3 people who answer correctly will be published in the next issue along with the answer key.
Winners of the previous quiz Surg Lt Cdr Apphia Saphir Kathi (Resident obstetrics and gynaecology) Dr Chitrali Khanna (Resident General Surgery) Answer key: 1. A 2.B 3. C 4. D 5. A
WILLIAM HALSTED
William Stewart Halsted, (1852-1922), was an American pioneer of scientific surgery who established at Johns Hopkins University, Baltimore, the first surgical school in the United States. After graduating in 1877 from the College of Physicians and Surgeons, New York City, Halsted studied for two years in Europe, mainly in Vienna, under the noted German surgeon Theodor Billroth. Returning to New York, Halsted quickly built a successful practice that demanded his services at six hospitals. By self-experimentation he developed the concept of local anesthesia brought about by injecting cocaine into nerve trunks. Halsted continued his research and developed original operations for hernia, breast cancer, goitre, aneurysms, and intestinal and gallbladder diseases. Halsted introduced the use of thin rubber gloves that do not impede the delicate touch demanded by surger Halsted’s gloves allowed surgical access to all parts of the body.
Dept. of General Surgery, AFMC Pune
EVOLUTION OF LASER RETINAL PHOTOCOAGULATION LASER is a catchy scientific acronym that we associate intuitively with precision and sophistication, novelty and ingenuity, power and adaptability. Description of the first instance of retinal photocoagulation, albeit not with a laser, dates back to 400 BC, when Socrates first described burns of the retina during a solar eclipse. The concept of ocular therapy using sunlight first was harnessed and publicized by German ophthalmologist Meyer-Schwickerath, who took patients to the roof of his laboratory in 1940s and focused sunlight on their retinas to treat melanomas. He developed the first solar photocoagulator using a carbon arc light source. Schwickerath and Littman subsequently devised the xenon arc photocoagulator. The first medical application of the laser, which occurred less than a year after its invention, was retinal photocoagulation; since then, its effect on ophthalmology is hard to overestimate. Now, lasers are used in all ophthalmic subspecialties; they are critical for many diagnostic and therapeutic devices.
Dept of Ophthalmology, AFMC Pune
XENON ARC PHOTOCOAGULATOR
MEYER-SCHWICKERATH
THE ANNALS OF U.F.O. (UNIDENTIFIED FOREIGN OBJECTS) A 23-year-old male presented to the MI Room with history of foreign object (used Minoxidil Bottle) per rectum. He gave no history of pain, bleeding per rectum or difficulty in passing flatus. On examination the abdomen was soft, non-tender, there was no distention, guarding or rigidity. The object was not palpable on digital rectal examination. Proctoscopy was not attempted in view of a possibility of pushing the object further proximally.
The Patient underwent an X-Ray Erect Abdomen & Pelvis and Frog Leg Lateral view which revealed a well-defined perfectly circular metallic density, radio-opacity in the pelvic region.
A trial of non-surgical management was attempted with lignocaine application and enema administration. Due to the failure of the non-operative management, upon COVID-ve status the patient was taken for operative management. Another attempt was made to manually extract the object per anally after administration of spinal anesthesia. Eventually an infra- umbilical midline incision was given and an approach to the rectum was made. The bottle was identified in the upper rectum extending up to the sigmoid colon. The bottle was extracted through a 05 cm long incision over the sigmoid colon on the Tinea Coli. The bottle measuring 10x05x02cm was extracted and two-layer closure was ensured. The post-operative period was uneventful and presently the patient is afebrile, accepting orally and tolerating well.
Dept of Surgery, AFMC Pune
THE TRIVIA THEATRE
A WRITER UNBLOKING THE BLOCK
Although most physicians know Roald Dahl (1916–1990) for the many wonderful novels and short stories he wrote, due to a personal tragedy, he is also one of the inventors of the modern ventricular catheters and shunt valves. In 1960, while living in New York, his then 4-month-old son Theo was hit by a New York taxi and suffered traumatic brain injury with multiple skull fractures and cerebral damage. Back in the UK, Theo suffered from hydrocephalus due to multiple shunt obstructions with debris clogging the silicone slits of his Holter valve. Dahl was determined to find a solution to this problem. He contacted Stanley Wade, a toymaker who specialized in making small hydraulic pumps that supplied fuel to model aero plane engines. Together they came up with a solution and the WDT (Wade-Dahl-Till) valve was taken into production in 1962, and the first patient was treated around June 1962. The WDT valve was estimated to have been used in two to 3,000 children worldwide in the next couple of years, before it became superseded by novel types of valves.
Dept. of General Surgery, AFMC Pune
HIGH TIBIAL OSTEOTOMY- A JOINT PRESERVATION SURGERY: OUR EXPERIENCE High Tibial osteotomy is a well-established procedure for the treatment of early onset varus degenerative knee in patients wishing to pursue active lifestyle. It offers a joint preserving surgery with unimpeded lifestyle as compared to a joint sacrificing surgery like total knee replacement with its inherited lifestyle modifications / restrictions. We share our results of the procedure on more than 25 patients including young serving soldiers, who have resumed normal military duties after the surgery
In young individuals wishing to pursue an active lifestyle Medial opening wedge high Tibial osteotomy with its early weight bearing, ability to maintain the corrected axis, minimally encountered complications, controlled distraction with option of correcting the alignment post primary surgery, no implant retention and it’s sterling results is a worthy and attractive optional technique in the armamentarium of an Orthopedic Surgeon for performing High Tibial Osteotomy.
Dept. of Orthopedics, AFMC Pune
February 19, 2021 Pg. 2
Q-RIOSITY
1. X disease is a rare, progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The name is derived from Japanese and describes the look of “puff of smoke” due to the tangling of tiny vessels formed to compensate for the blockage. What is X?
a) Moya moya Disease b) Yamaguchi Disease c) Kyoto Disease d) Hirotori Syndrome
2. The most common cause of ventriculomegaly in newborn?
a) Arnold-Chiari Malformation b) Dandy-Walker Syndrome c) Arachnoid villi Malformation d) Aqueductal Stenosis
3. Which of the following infections can also cause aqueductal stenosis?
a) Measles b) Mumps c) Rubella d) Bacterial Endocarditis
4. Which of the following is not a cause of communicating hydrocephalus?
a) Choroid Plexus Papilloma b) Meningeal Malignancy c) Vein of Galen Malformation d) Achondroplasia
5. ETVSS is a score system devised in 2009
that predicts the success of endoscopic third ventriculostomy in patients. It was devised by?
a) Kulkarni et al b) Dr Benjamin Warf c) Dr Frank Nulsen d) Robertson et al
TORSION OVARY: A CHALLENGE IN THE YOUNG A 30-year-old P1L1A1 lady, last child birth 05 years back by caesarean section, a known case of Rheumatic Heart Disease with mild MS & MR with mitral valvuloplasty done 02 years back with right femoral stenosis (balloon angioplasty done) on Tab Ecosprin, Lasilactone and Inj. Penidure had reported with history of acute pain abdomen at the right iliac fossa in the MI room in the month of Dec 2020. She was being evaluated for acute appendicitis, but on ultrasound she was detected to have an enlarged hemorrhagic cyst 4.2x6x7.5 cm with reduced vascularity on Doppler with the possibility of torsion of right ovary with its cyst. During the evaluation for torsion she was detected to be COVID +ve. As her clinical parameters were stable and there was symptomatic improvement, elective surgery was planned once she had turned COVID -ve. After an isolation period of 14 days she was posted for laparoscopy and proceed with a consent for oophorectomy. She was also desirous for a tubectomy in spite of only one living issue due to her cardiac condition. Laparoscopy revealed a pale looking ovary with dense adhesions between the right ovary, large bowel, omentum and uterus. There were also adhesions between the anterior abdominal wall and the omentum for which adhesiolysis was done.
A decision to do a laparotomy was taken in view of frozen pelvis and possibility of injuries to bowel and bladder during adhesiolysis.
During the laparotomy two twists of the ovarian ligament along with the tube was noticed in the right adnexa. As the right ovary seemed to be unsalvageable and large in size which could have led to a repeat episode of torsion it was decided to perform a right oophorectomy with left sided lapster. On cross section of the specimen (8x8 cm), there was hemorrhagic fluid within it with no other solid components hence suggestive of a benign hemorrhagic ovarian cyst. Her post op course was uneventful and she was discharged on post op day 3.
Adnexal torsion is the fifth most common gynaecologic emergency. Most common ovarian pathologies are benign functional ovarian cysts and benign teratomas like dermoid cysts. When evaluating for suspected adnexal torsion one needs to keep in mind, preservation of ovarian function and future fertility. There are no sufficient clinical or imaging criteria to confirm a diagnosis of ovarian torsion. Doppler flow may be used along with other clinical parameters. A minimally invasive approach is preferred with a detorsion of the ovary. In our case due to her other comorbidities a decision for right oopherectomy was taken leaving behind a healthy left ovary.
Dept of Obstetrics and Gynecology, AFMC Pune
February 19, 2021 Pg. 3
Answers can be emailed to [email protected]. Names of the top 3 people who answer correctly will be published in the next issue along with the answer key.
Winners of the previous quiz Surg Lt Cdr Apphia Saphir Kathi (Resident obstetrics and gynaecology) Dr Chitrali Khanna (Resident General Surgery) Answer key: 1. A 2.B 3. C 4. D 5. A
WILLIAM HALSTED
William Stewart Halsted, (1852-1922), was an American pioneer of scientific surgery who established at Johns Hopkins University, Baltimore, the first surgical school in the United States. After graduating in 1877 from the College of Physicians and Surgeons, New York City, Halsted studied for two years in Europe, mainly in Vienna, under the noted German surgeon Theodor Billroth. Returning to New York, Halsted quickly built a successful practice that demanded his services at six hospitals. By self-experimentation he developed the concept of local anesthesia brought about by injecting cocaine into nerve trunks. Halsted continued his research and developed original operations for hernia, breast cancer, goitre, aneurysms, and intestinal and gallbladder diseases. Halsted introduced the use of thin rubber gloves that do not impede the delicate touch demanded by surger Halsted’s gloves allowed surgical access to all parts of the body.
Dept. of General Surgery, AFMC Pune
EVOLUTION OF LASER RETINAL PHOTOCOAGULATION LASER is a catchy scientific acronym that we associate intuitively with precision and sophistication, novelty and ingenuity, power and adaptability. Description of the first instance of retinal photocoagulation, albeit not with a laser, dates back to 400 BC, when Socrates first described burns of the retina during a solar eclipse. The concept of ocular therapy using sunlight first was harnessed and publicized by German ophthalmologist Meyer-Schwickerath, who took patients to the roof of his laboratory in 1940s and focused sunlight on their retinas to treat melanomas. He developed the first solar photocoagulator using a carbon arc light source. Schwickerath and Littman subsequently devised the xenon arc photocoagulator. The first medical application of the laser, which occurred less than a year after its invention, was retinal photocoagulation; since then, its effect on ophthalmology is hard to overestimate. Now, lasers are used in all ophthalmic subspecialties; they are critical for many diagnostic and therapeutic devices.
Dept of Ophthalmology, AFMC Pune
XENON ARC PHOTOCOAGULATOR
MEYER-SCHWICKERATH
THE ANNALS OF U.F.O. (UNIDENTIFIED FOREIGN OBJECTS) A 23-year-old male presented to the MI Room with history of foreign object (used Minoxidil Bottle) per rectum. He gave no history of pain, bleeding per rectum or difficulty in passing flatus. On examination the abdomen was soft, non-tender, there was no distention, guarding or rigidity. The object was not palpable on digital rectal examination. Proctoscopy was not attempted in view of a possibility of pushing the object further proximally.
The Patient underwent an X-Ray Erect Abdomen & Pelvis and Frog Leg Lateral view which revealed a well-defined perfectly circular metallic density, radio-opacity in the pelvic region.
A trial of non-surgical management was attempted with lignocaine application and enema administration. Due to the failure of the non-operative management, upon COVID-ve status the patient was taken for operative management. Another attempt was made to manually extract the object per anally after administration of spinal anesthesia. Eventually an infra- umbilical midline incision was given and an approach to the rectum was made. The bottle was identified in the upper rectum extending up to the sigmoid colon. The bottle was extracted through a 05 cm long incision over the sigmoid colon on the Tinea Coli. The bottle measuring 10x05x02cm was extracted and two-layer closure was ensured. The post-operative period was uneventful and presently the patient is afebrile, accepting orally and tolerating well.
Dept of Surgery, AFMC Pune