Innovative Journal of Medical and Health Sciences

Dr. Abhay G. Sancheti, Dr. Kanakadurga Dr. Sarita S. Swami, Dr.Sushma D. Ladi Dr. Shubhada S. Aphale

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Anterior mediastinal tumours can be very difficult to manage in peri-operative period more so in paediatric age group, literature provides cases of cardio-respiratory disasters and even death. We have come across a one year old female child who was apparently asymptomatic 6 months back, admitted in our hospital with complaints of cough, breathlessness, and increased work of breathing. Her past history revealed that she was misdiagnosed and treated repeatedly for pneumonia. This worsened her present pathology. On investigation, HRCT Thorax showed anterior mediastinal mass extending upto middle mediastinum and cranial aspect of heart. This child was posted for thoracotomy and excision of mediastinal mass. On pre-operative examination, child was febrile, anaemic, Respiratory rate was 52/min with decreased air entry on right side. Child was kept on regular nebulisation and continuous O2 supplementation. Administering anaesthesia to such a child was challenging as it requires an anticipation of respiratory and circulatory collapse. Presenting here this rare case, which we could manage with general anaesthesia supplemented with thoracic epidural anaesthesia. Complete surgical resection of tumour of size 16x8cm was possible with uneventful peri-operative course with effective post operative analgesia. Histopathology of tumour turned out to be cortical thymoma. Thymomas are neoplasms of anterior mediastinum and generally occur in adults. In children, they are rare with only 30-35 reported cases in literature.

Dr. B. Abhishekh, Dr. Mayadevi. S, Dr. K. C. Usha

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Aims & objectives: To describe the various adverse reactions and determine the frequency of their occurrence in whole blood donors.
Materials & Methods: Whole blood donors who donated in the Department (27253) & in camps (466) of the Dept. of Transfusion medicine, Government medical college, Thiruvananthapuram during the period January 2009 to December 2009 were the subjects under study. Donors were accepted for donation after screening & certified to be fit by the Medical officer. Blood was collected in standard 350ml blood bags. The donors were observed for any adverse reactions during or following donation
Results: Out of the total 27719 donors observed, 564(2.04%) had an adverse reaction of which 319(1.15%) were vasovagal related and 245(0.88%) were needle injuries.
Discussion: The risk of complications related to blood donation is low. However, attention towards donor complications is warranted, as it would have detrimental effects on return of donors for subsequent donations and rate of complications resulting in long-term morbidity and disablement is not negligible.

Tamara Azarashvili, Irina Odinokova,Olga Yulia Baburina, Ekhson Holmuhamedov, Vera Teplova, Arshad Jahangir,

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Background: Ethanol oxidation alters mitochondrial metabolism that may be consequence of the closing of mitochondrial voltage dependent anion channels (VDAC) and decrease outer membrane permeability. Phosphorylation of VDAC by cytosolic kinases modulates outer membrane permeability. This study examines how acute ethanol treatment of rats affects the activity of glycogen synthase kinase-3 beta (GSK-3β) associated with liver mitochondria and the level of phosphorylation of several mitochondrial proteins, specifically porins, forming VDAC in the outer membrane of mitochondria.
Results: The level of protein phosphorylation in mitochondria, isolated from ethanol treated animals is differed from that in mitochondria of rats which were not subjected to ethanol treatment. It was found that ethanol treatment increased the activity of GSK-3β activity in isolated mitochondria and increased the rate of incorporation of 32P from [γ-32P] ATP into mitochondrial proteins of 63 kDa, 32 kDa, 25 kDa and 3.5 kDa. Enhanced level of VDAC (32 kDa band) phosphorylation correlated with increased content of phosphotyrosine residues determined in the same 32 kDa band. Additionally, it was found that levels of total GSK-3β kinase as well as phosphorylated forms of this enzyme were decreased in mitochondria isolated from ethanol treated animals as compared with mitochondria from controls. Changes in phosphorylation of mitochondrial porins/VDAC and GSK-3β in ethanol-exposed rats paralleled with decreased Ca2+-retention capacity of isolated mitochondria with accelerated opening of Ca2+-dependent mitochondrial permeability transition pore.
Conclusions: The results of this study conclude that acute ethanol exposure of rats decrease both, the total GSK-3β associated with liver mitochondria and the level of Ser9-phosphorylation of this kinase. It is reported that acute ethanol treatment of animals modulates the activity of mitochondria-associated GSK-3β, enhances phosphorylation of mitochondrial porins/VDAC, probably, due to tyrosine-specific phosphorylation and thus, modulates the permeability of the outer mitochondrial membrane after ethanol exposure

Manfred Weiss*, Moritz Huber, Maximilian Nass1, Markus Huber-Lang, Wolfgang Koenig, Marion Schneider

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Background: Cardiovasculatory dysfunction occurs in surgical critically ill patients with shock. The degree of cardiovasculatory dysfunction in the Sequential Organ Failure Assessment (SOFA) score increases with higher catecholamine infusion rates. The aim of the present study was to compare the course of NT-proBNP plasma concentrations in surgical critically ill patients with non-septic or septic shock in association with catecholamine therapy.
Methods: In a prospective observational single-centre study in critically ill surgical patients admitted to an University adult ICU, 26 consecutive patients with non-septic shock and 18 patients with septic shock were longitudinally monitored before, during and after shock.
Results: During the stay on the ICU, NT-proBNP serum concentrations declined, remained stable or increased in both shock groups. The maximal NT-proBNP concentrations in patients with septic shock (median 4,429, range 193 to > 35,000 pg/ml) were higher than in those with non-septic shock (median 902, range 39 to > 31,937 pg/ml) (p = 0.037). NT-proBNP serum concentrations were higher in surviving patients with septic than with non-septic shock at > 0.1 and ï‚£ 1.0 ug/kg/min noradrenaline. In the non-survivors, NT-proBNP concentrations were always beyond the normal range in both groups.
Conclusions: Taken together, severity of cardiovascular dysfunction defined by higher dosage of catecholamines is associated with higher NT-proBNP concentrations in septic than in non-septic shock patients. In non-survivors of shock, NT-proBNP concentrations increase or remain elevated > 1000 pg/ml.

Dr. Muktyaz Hussein, Dr. Khalid Hassan, Dr. Birendra Yadav, Dr. Nema Usman

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There is a wide range of congenital anomalies of the spleen. Some are common, such as splenic lobulation and accessory spleen. Other less common conditions, such as wandering spleen and polysplenia, have particular clinical significance. The spleen, in healthy adult humans, is approximately 11 centimetres (4.3 in) in length. It usually weighs between 150 grams. It is covered from all the sides by peritoneum and is closely related to the fundus of the stomach, left kidney, left colic flexure and the diaphragm. Anatomical variations spleen in 32 cadavers (23 males and 9 females) obtained during routine dissection classes of undergraduate medical students in Govt. Medical College, Ambedkar Nagar U.P. and S.R.M.S. Institute of Medical Sciences, Bareilly U.P. Variations were observed in 13 spleens (40.6%)in which 3 spleens (9.3%) found multiple lobes and notches were present on the superior border of spleen, 4 spleens (12.5%) present deep notches on inferior border, 2 spleen (6.2%) showed deep notches on medial border, 2 spleen had shape similar to liver (6.2%). The findings of the study may be gainfully utilised by imaging specialists and surgeons, respectively to avoid possible errors in interpretations and subsequent misdiagnosis, and to assist in planning appropriate surgical approaches.

Dr. Sreekanth Tallapaneni, Dr. Chandram Shashank Kumar Srivastav, Shaik Zakir Hussain, Samia Azaz

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The purpose of this case report is to bring into light about three renal arteries supplying the left kidney which is a rarity. The cranial and caudal accessory renal arteries were of aortic in origin and had significance lumen size. The cranial artery terminated into two segmental arteries. The caudal renal artery gave rise to the left gonadal artery and the point of emergence of it showed a deep kink.
Materials And Methods: A formalin – fixed elderly male cadaver along with Routine instruments including Scalpel, Blade, Surgical forceps, Anatomical Forceps, Dissector, Metallic Scale with Calibrations along with a pair of gloves were used. The anterior abdominal wall was dissected layer by layer. The reflection of the peritoneum was traced both horizontally and vertically The visceral organs like liver, stomach & intestines were all studied in Situ and dissected out. The duodenum, pancreas and spleen were all dissected away from the abdominal cavity and the peritoneum was stripped to visualize the kidneys.
Result: Dissection of an elderly male cadaver revealed a left kidney supplied by triple renal arteries i.e., double accessory renal arteries along with its main renal artery. The first accessory renal artery arose from the lateral aspect of the abdominal aorta by the side of superior mesenteric artery. It had tortuous horizontal course and terminated into two segmental branches. The proximal branch had its portal of entry just above the hilum and the second branch entered the kidney at the upper part of the hilum. The second accessory renal artery arose from the anterior aspect of the aorta much below the main renal artery. It had a horizontal course towards the hilum of the kidney but showed a kink due to the emergence of the left gonadal artery. There was an alteration in the hilar anatomy due to the these three arteries..
Conclusion: Knowledge of the renal vascular variations is indispensable in the exploration and treatment of renal trauma, reno vascular hyper tension, renal embolization, angioplasty or vascular reconstruction for congenital and acquired lesions, surgery for abdominal aortic aneurysm and conservative or radical renal surgery. Anatomical knowledge of such vascular variations is essential for the radiologists, urologists while performing angiograms and renal transplantations