Effect of foot deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum

We assessed the effect of foot deformity on the loading axis of lower limbs in 33 patients with genu varum (25 bilateral and eigth unilateral) caused by varying etiologies including achondroplasia, cerebral palsy, prior trauma, rickets, metaphyseal chondrodysplasia and primary osteoarthritis using single leg stance and both leg stance radiographs. Deviation at the knee from the hip ankle line (conventional) and hip foot line (centre of hip to centre of heel) was calculated. A comparison was made between single leg stance and two leg stance for tibiocalcaneal angle, mechanical axis angle, knee and ankle joint line convergence angle, conventional mechanical axis deviation (MADC) and ground mechanical axis deviation (MADG). In addition comparisons were also made among three groups formed depending on the tibiocalcaneal angle and MADC–MADG difference for all the above measurements.

Mechanical axis deviation (calculated using the two methods) varied with the talocalcaneal angle and single leg stance. Patients with a fixed subtalar varus and with severe genu varum, where the normal compensatory subtalar eversion could not compensate showed that conventional mechanical axis deviation was significantly higher by 3.4 ± 2.4 mm and ground mechanical axis deviation degrees was significantly higher by 3.8 ± 3.2 mm in single leg stance when compared to two leg stance (p < .0001).

Foot deformity should be included during preoperative evaluation and planning for knee deformity correction.     

Isolated idiopathic unilateral paralysis of soft palate and pharynx

Isolated unilateral palatal (velopalatopharyngeal) palsy is a clinical rarity. We report this entity in a 10 year old boy, two weeks after an episode of acute tonsillitis. The child was managed with a short course of prednisolone with complete recovery in eleven days.     

Assessment of the adequacy of closed reduction in fractures of the zygomatic arch using "C"-arm image intensifier

Major problems in closed reduction of isolated, minimally displaced, and depressed zygomatic arch fractures are blind nature of the technique, reliability on digital palpation, reduction click, and step deformity between fragments. The purpose of this study was to objectively confirm the adequacy of closed reduction intraoperatively and the usefulness of the "C"-arm image intensifier. A total of 12 patients with 1- to 8-day-old unilateral isolated and depressed zygomatic arch fracture underwent closed reduction under "C"-arm image intensifier. Of these patients, 9 were men and 3 were women, with age ranging from 18 to 32 years. Intraoperative prereduction and postreduction images were obtained using the "C"-arm image intensifier. Criteria for adequate reduction were the following: intrafragmentary gap less than 0.5 mm, no overriding of fragments, no depression of fragments, and no step deformity. After being clinically satisfied about the reduction, images on "C"-arm showed no intrafragmentary gap. In 3 patients, there were residual overriding and minimal rotation around the anteroposterior axis of the posterior fragment. In 1 patient, rotation and step deformity remained. In this patient, additional stabilization was provided. The "C"-arm image intensifier shows some poorly reduced or unstable isolated depressed zygomatic arch fractures that remain unidentified even after careful palpation. Thus, it plays a recognizable role to avoid the trouble of second intervention.     

A Comparative Evaluation of the Estimation of Rabies Virus Antibodies among Free-Roaming,Vaccinated Dogs in Bengaluru,India

Vaccination is the practical solution for the prevention of rabies in dogs. Assessment of the immunogenicity of vaccination includes estimation of specific rabies virus neutralizing antibodies (VNA) in the target species. We undertook a study to estimate the levels of VNA in free-roaming dogs with a history of rabies vaccination in Bengaluru city, India. We compared the rapid fluorescent focus inhibition test (RFFIT) and an in-house quantitative indirect ELISA (iELISA). The study area comprised the jurisdiction of Bruhat Bengaluru Mahanagara Palike (BBMP), the Bengaluru civic body. The BBMP, along with several non-government organizations (NGO), were conducting a trap- neuter- vaccinate- release program for the prevention of dog rabies. Serum samples were collected from 250 free-roaming dogs from representative regions of BBMP, of which 125 had a VNA titre of 0.5 IU or more by the RFFIT. Furthermore, 126 dogs showed percent positivity values (PP values) more than the cut off PP value of 57.1 by the iELISA, accounting for 50.4% of satisfactory post-vaccinal serum conversion. The sensitivity and specificity of the iELISA was 94.4% and 95.2%, respectively. Based on these data, a quantitative iELISA may be a complementary tool for sero-monitoring immune responses of free-ranging animals after rabies vaccination.     

Life-threatening spontaneous intracranial hypotension responding to epidural blood patch

Editor—Following the recent case series of spontaneousintracranial hypotension (SIH) as an indication for epiduralblood patch,¹ we report a severe case presenting with a decreasinglevel of consciousness,     

Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method

BackgroundA prospective study of motor milestones achieved in severe clubfeet treated by Ponseti method and comparison between unilateral and bilateral clubfoot will help us gain further insight of motor milestones in these children.MethodsProspective study of 150 consecutive children with idiopathic clubfoot who were treated by Ponseti method and in whom percutaneous tendoachilles tenotomy was performed. The gross motor milestones recorded were: rolls from back to stomach, sitting without support, standing with assistance, walks with assistance, standing alone, walking alone. This was compared with published regional and World Health Organization (WHO) normal data.Result15 patients were excluded due to non-compliance and recurrence. Children with unilateral clubfoot (80 children) and bilateral clubfoot (55 children) showed a delay of 0.2–2.1 months in various milestones, and this was statistically significant when compared with both normal data. 95% children with unilateral clubfoot had independent ambulation by 17 months and in bilateral ambulation by 17.8 months. There was also a statistically significant difference in unilateral and bilateral clubfeet in all variables except sitting without support and walking with support.ConclusionThere is a delay in achievement in all children with clubfoot, with more delay in bilateral clubfoot as compared to unilateral clubfoot. The probable reasons could be plaster treatment, possible weakness due to tendoachilles tenotomy, use of orthosis or the inherent pathology associated with clubfeet. Parents hence need to be explained about this delay.     

Clinical profile of insulinoma: analysis from a tertiary care referral center in India

Objective  

To describe the clinical presentation, localization techniques, surgical procedures and outcome in patients with insulinoma.