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A Prospective Study on Clinical Profile of Autosomal Dominant Polycystic Kidney Disease (ADPKD) in Jammu for a Period of 1 Year

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Open Journal of Nephrology 2012年第4期2卷 123-135页

作者： Ashwani Kumar Zaffar kawoosa Sajad Hamid Surendar Kumar Bali Mymoona Akhter Shahnawaz Hamid Department of Medicine Government Medical College Chandigarh India Department of Medicine Government Medical College Srinagar India Department of Medicine SKIMS Medical College Srinagar India Government medical college Jammu India Sher-i-Kashmir Institute of medical Sciences KashmirIndia skims medical college Srinagar India

The Present Study was conducted in department of Medicine, Govt. medical college, jammu, Where a total of 41 patients—29 males and 12 females—fulfilled the inclusion criteria of ADPKD, were gathered during the period of 1 year starting from Nov. 2011 to Oct. 2012. All the patients were subjected to a detailed history, clinical examination and laboratory investigations. X-ray chest (PA view), ECG and ultrasound of abdomen for kidneys, liver and spleen were done. Intravenous pyelogram and CT scan of abdomen was done when a definitive diagnosis of (ADPKD) could not be made on abdominal ultrasound. Echocardiography was done to evaluate cardiac murmurs and associated mitral valve prolapse, based on standard criteria. Male to female patients with ADPKD was 2.42:1. Maximum 17 (41.5%) patients of both gender were seen in 30 - 40 years age group, Family history of ADPKD was present in 18 (43.9%) patients;Hypertension, alone or in combination with renal failure, was present in 65.8% patients;Hypertension alone was present in 19 (46.3%) patients;8 (19.5%) patients with hypertension had renal failure;Low back pain was present in 24 (58.5%) and abdominal pain in 22 (53.7%) patients;15 (36.6%) patients presented with at least one episode of gross haematuria;Headache was experienced by 18 (43.9%) patients. On clinical examination, 24 (58.5%) were found to have palpable kidney and 10 (24.4%) had palpable liver. Spleen was palpable in 1 (2.4%) patient, Murmur of mitral valve prolapse was found in 2 (4.9%) Patients;3 (7.3%) patients having left ventricular hypertrophy;mean Hb was 11.2 g/dL. The liver cysts were found in 24.4% of the patients;Out of 10 (24.4%) patients with hepatic cyst involvement, 1 patient each was found to have evidence of portal hypertension and evidence of hepatic cyst infection. In the present study, hypertension was most common presentation of this disease. So, control of hypertension is very important to prevent progression of this disease. Patients who are d

关键词： Autosomal Dominant Polycystic Kidney Disease Ronic Kidney Disease End-Stage Renal Disease

Hepatobiliary and pancreatic ascariasis

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World Journal of Gastroenterology 2016年第33期22卷 7507-7517页

作者： Mohammad S Khuroo Ajaz A Rather Naira S Khuroo Mehnaaz S Khuroo Sher-I-Kashmir Institute of medical Sciences Srinagar Kashmir 190010 India Digestive Diseases Centre Dr. Khuroo's medical Clinic Srinagar Kashmir 190010 India Department of Surgery SKIMS Medical College and Hospital Bemina Srinagar Kashmir 190010 India Consultant Radiology Digestive Diseases Centre Dr. Khuroo's Medical Clinic Srinagar Kashmir 190010 India Department of Pathology Govt. Medical College Srinagar Kashmir 190001 India

Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

关键词： Ascaris lumbricoides Cholecystitis Biliary calculi Cholangitis Pancreatitis Recurrent pyogenic Cholangitis

Asymptomatic Paget＇s disease of bone presenting with complete atrioventricular block

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Chinese medical Journal 2008年第22期121卷 2357-2359页

作者： A. Rauoof Malik Nazir A. Lone Hilal A. Rather Vicar M Jan Javid A. Malik Khursheed A. Khan S. Jalal Departments of Cardiology Sher-I-Kashmir Institute of Medical Sciences Soura Pulmonary Medicine SKIMS Medical College Bemina Srinagar Kashmir India

Paget＇s disease of bone is a deforming bone disease （osteitis deformans） characterized by increased bone remodeling, bone hypertrophy, and abnormal bone structure, leading to bone expansion, deformities, easy fractures, and occasionally, neoplastic transformation. It is the second most common bone disorder after osteoporosis. The disease is relatively rare in Asia but is common in Europe and North America, affecting approximately 2% of the population over 50 years,

关键词： Paget's disease atrioventricular block, cardiac calcifications

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Portal biliopathy

World Journal of Gastroenterology 2016年第35期22卷 7973-7982页

作者： mohammad s khuroo ajaz a rather naira s khuroo mehnaaz s khuroo Sher-I-Kashmir Institute of medical Sciences Srinagar Kashmir 190010India Digestive Diseases Centre Dr.Khuroo’s medical ClinicSrinagarKashmir 190010India Department of Surgery SKIMS Medical College and HospitalBeminaSrinagarKashmir 190010India Consultant Radiology Digestive Diseases CentreDr.Khuroo’s Medical ClinicSrinagarKashmir 190010India Department of Pathology Govt.Medical CollegeSrinagarKashmir 190001India

Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures(hepaticojejunostomy or choledechoduodenostomy).

关键词： Biliary disease Extrahepatic portal venous obstruction Portal cavernoma Bile duct strictures Bile duct calculi

Clinic Pathological Profile of Neuroblastoma, Our Experience at Tertiary Care Hospital;Government medical college Hospital Srinagar J &K

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Surgical Science 2016年第8期7卷 368-373页

作者： Zahida Akhter Shahnawaz Mansoor Shah Perveez Ahmad Malik Showkat Ahmad Kakroo Sher-i-Kashmir Institute of medical Sciences (skims) Srinagar India

Introduction: Pediatric tumors account for a small proportion of all cancers;amongst them neuroblastoma is the most common solid tumor as well as malignant tumor. They have varied clinical presentation. Recent advances in diagnostic methods and multidisciplinary treatment approach have resulted in early diagnosis, treatment, better prognosis and survival. Aims and Objectives: To study the clinical profile, histopathology, grading and correlate that with clinical diagnosis, efficacy of various investigations for early diagnosis, and management of neuroblastoma in our hospital. Material and Methods: A total of nine patients of neuroblastoma were studied from May 2013 to January 2015. All the nine patients were operated. Neuroblastoma was staged according to the International Neuroblastoma Staging system. Follow-up was carried in all the patients. Results: Two patients in our study were Stage 1, two were Stage 2A and 5 patients were Stage 4S. In Stage 1, pre-operative chemotherapy was not given. Tumor was excised in toto. Post-operatively, no adjuvant therapy was given. Patients are alive till date. In Stage 2A, patients were operated and received post-operative chemotherapy. One patient is alive and disease-free. Other patient died in post-op. period while on chemotherapy. Patients in Stage 4S were operated after receiving pre-op radiotherapy of 500 - 1000 radians and adjuvant chemotherapy. One patient expired in follow-up while four patients are still alive. We have achieved 100% survival rate in Stage 1, 50% in Stage 2 and 80% in Stage 4S.

关键词： Child Hood Malignancies Neuroblastoma

Etiology and Management of Small Bowel Obstruction with Special Reference to Role of Laparoscopy—A Single Centre Experience

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Surgical Science 2019年第4期10卷 113-126页

作者： Showkat Ahmad Mir Rauf Ahmad Wani Yaqoob Hassan Fazl Q. Parray Nisar Ahmad Chowdri Department of General and Minimal Access Surgery SKIMS Srinagar India Department of General and Minimal Access Surgery Sher-i-Kashmir Institute of Medical Sciences Medical College Srinagar India

Background: Small bowel obstruction (SBO) is the commonly diagnosed disease in the emergency department. The diagnosis and management of small bowel obstruction varies among institutions. The role of laparoscopy in the management of small bowel obstruction is debatable. Aim: To study the profile, clinical features and management options of patients of small bowel obstruction with special emphasis on role of laparoscopy. Material and Methods: 51 consecutive patients with documented small bowel obstruction admitted in our department were studied from June 2016 to December 2018. All the patients above 12 years of age with small bowel obstruction were included. The diagnosis of small bowel obstruction (SBO) was made in these cases by detailed history, clinical examination and investigations. All these patients were received and adequately resuscitated. Non-operative (conservative) treatment was confirmed to those who met the standard parameters for such treatment and early surgical treatment was carried out whenever indicated. The operative procedure done was laparoscopy or open depending on the clinical features and condition of patient. Results: In our study, 51 patients mean age was 44.7 years with 27 Males and 24 females. 28 (54.9%) patients of our study presented with continuous abdominal pain followed by colicky pain in 23 (45.1%) patients. 34 (66.7%) patients on admission gave history of effortless vomiting. Distension of abdomen was present in 30 (58.8%) patients and constipation was present in 40 (78.4%) of our studied patients. On CT scan interloop fluid was present in 23 (45.1%) patients while transition point was present in 31 (60.8%) patients. Adhesion obstruction was found to be most common cause of obstruction 27 (52.9%) patients, followed by malignancy in 8 (15.7). 25 (49.0%) patients were managed conservatively and 26 (51%) were operated. 11 (21.6%) patients underwent laparoscopic adhesiolysis and 15 (29.4%) underwent exploratory laparotomy. The average

关键词： Bowel Obstruction Laparoscopy Adhesions Non-Operative Small Bowel

Fracture of the humerus caused by a slingshot projectile

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Chinese Journal of Traumatology 2011年第5期14卷 319-320页

作者： Tahir Ahmed Dar Riyaz Ahmed Dar Mubashir Rashid Shabir Ahmed Dhar Department of orthopaedics Government Hospital forBone and Joint Surgery Barzullah Srinagar 190005 India skims medical college Bemina Srinagar 190001 India

Unconventional and ＇non-lethal＇ weapons are being used in crowd control regularly nowadays. The use of these arms is not risk-free. The paramilitary forces in 2010 used the old fashioned slingshots for crowd control in Kashmir. A young male suffered from a fracture of the distal humerus due to a marble from a slingshot. He was managed by debridement and plaster splintage. Use of apparently innocuous weapons for crowd control is not without risk, as the projectiles fired from them can achieve high velocities and cause significant damage.

关键词： Humeral fractures Conducted energy weapon injuries Firearms

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

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Chinese Journal of Traumatology 2014年第3期17卷 130-135页

作者： Shahid Hussain Manzoor Ahmad Tufail Muzaffar Registrar Orthopedics SKIMS Medical College &Hospital Srinagar India Registrar Anaesthetist Hospital for Bone & JointSurgery Barzulla Srinagar India MBBS DNB physical Medicine and RehabilitationSrinagar India

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral *** were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced

关键词： Humeral fractures Fracture fixation,internal Bone wires Child

A review of upper limb injuries in bear maul victims： Consistent pattern and inverse relation in severity with facial and scalp injuries

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Chinese Journal of Traumatology 2018年第1期21卷 38-41页

作者： Towseef Ahmad Bhat Amara Gulzar Aejaz Ahmad Bhat Tariq Ahmad Bhat Zameer Ali Department of Orthopaedics Pt. Jawahar Lal Nehru Govt. Medical College Chamba Himachal Pradesh India Department of Emergency Medicine SKIMS Medical College Bemina Srinagar India Physical Medicine Govt. Medical College Srinagar India Department of Orthopaedics Govt. Sub District Hospital Chadora Srinagar India Department of Orthopaedics New City Hospital Srinagar India

Purpose： Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. Methods： Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. Results： All the patients had facial[scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and I had clavicle fracture. Only I had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. Conclusion： Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such comolex limb injuries.

关键词： Bear maul Upper limb fractures Facial Scalp

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