[Kannivelu Badrinath]

Soft pitting dependent oedema must always be assessed and proper treatment started without wasting time. You must rule out a cardiac or renal cause before starting treatment. Untreated dependent oedema of other causes can become permanent if neglected.

[Kannivelu Badrinath]

Jyothi,

This is a remarkable piece of information/story that you have provided on how and what a medical student at Madras Medical college is capable of thinking and putting in to words what he or she feels when seeing a seriously ill patient on the ward. If 10% of the students in our college can think and feel the way you do, I feel we can all be proud of our college and the new graduates who come out every year. Keep up your good work and do keep us informed of all the good things that happen in our college. I wish this article is read by every medical student in the country!

 

[Kannivelu Badrinath]

Dear Sarath,

Your point about general practitioners not being aware of serious hip problems in children is very valid. When they are missed by senior doctors in the UK, I can well understand how a rural practitioners or a primary health centre can easily miss them in India. I would be interested to find out how we can mitigate this problem or how to spread the message.

Vishal mentions that it is important to rule out hip pathology in children presenting with thigh and knee pain. It is very important indeed. In UK I have come across adult patients who presented with knee pain being posted for Knee replacement. Many of these patients in the NHS are transferred to other surgeons because of the long surgical waiting lists. On two or three occasions when I took over these patients and examined them for a preoperative check I was often horrified to note that they had minor arthritis in the knee and severe arthritic changes in the hip. A hip replacement cured their knee pain like magic! So it is not just the children. Symptoms of knee pain with pathology in the hip can also occur in adults

[Kannivelu Badrinath]

Results of Gama Knife surgery in Trigeminal Neuralgia was discussed in J Radiat Oncol. 2014; Published online 2013 Nov 20.

Thirty-six consecutive patients with medically intractable TN were reviewed. The incidence of early pain relief was high (80.5 %) and relief was noted in an average of 1.6 months after treatment. At minimum follow-up of 3 years, 67 % were pain free (BNI I) and 75 % had good treatment outcome. At a mean last follow-up of 69 months, 32 % were free from any pain and 63 % were free from severe pain. Bothersome post treatment facial numbness was reported in 11 % of the patients. A statistically significant correlation was found between age and recurrence of any pain with age >70 predicting a more favorable outcome after radiosurgery.

In conclusion they report that the success rate of GKRS for treatment of medically intractable TN declines over time with 32 % reporting ideal outcome and 63 % reporting good outcome. Patients older than age 70 are good candidates for radiosurgery. This data should help in setting realistic expectations for weighing the various available treatment options.

[Author]

Posts