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the next couple of years, before it became superseded by novel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