Introduction: Most patients presenting with acute vertigo are believed to suffer from acute, self-limited, presumed viral or post-viral vestibular neuritis (VN). But 25% of such cases can be “Pseudo VN”, and are due to central causes, most often stroke. The aim of the present research was to study the sensitivity and specificity of Head Impulse, Nystagmus, Skew deviation (HINTS) battery for diagnosis of stroke in patients with acute-onset first episode of spontaneous vertigo. Materials and Methods: Seventy-five patients who visited outpatient department or admitted between August 2014 and April 2016 with acute-onset first episode of spontaneous vertigo were included. Each patient was subjected to bedside oculomotor tests and HINTS. All patients underwent magnetic resonance imaging (MRI) of the brain. Stroke was diagnosed by MRI brain. If initial MRI brain was normal and still clinical signs favor stroke, repeat MRI brain-diffusion-weighted imaging study was done at 72 h after symptom onset to confirm the diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden's Index were used to quantify the diagnostic efficiency of HINTS at presentation against final MRI. Results: Patients presented with acute-onset first episode of spontaneous vertigo, HINTS battery was found to be more sensitive than the initial MRI of the brain done in first 24 h in diagnosing stroke (97.1 % Vs 82.9%). The specificity of the initial MRI of the brain and HINTS battery was 100.0 % and 80.0% respectively. Conclusions: The HINTS battery was more sensitive than the initial MRI of the brain in diagnosing stroke in first 24 h in patients presented with acute-onset first episode of spontaneous vertigo.

Although laparoscopic repair offers a quick and less morbid way of treating hernias, complications like hematoma, seroma, neuralgia, recurrence, mesh infection, hydrocele, etc. are known. The present study was undertaken to compare various clinical outcomes between mesh fixation using fibrin glue and mesh fixation with tacker in a 3-months follow-up. One hundred patients aged 18 to 60 years having inguinal hernia admitted in Poona Hospital and Research Centre, Pune, between October 2012 and November 2014 for laparoscopic hernia surgery and ready to participate in this study were included. All of them underwent laparoscopic repair of hernia by total extra peritoneal (TEP) method following sample surgical protocol in all of them except for method of mesh fixation. Mean time calculated from insertion of the first trocar to beginning of skin suturing was 54.9 min in tacker group and 50.3 min in fibrin glue group with no statistically significant difference between the two. The incidence of urinary retention was significantly higher in tacker (34 %) as compared to fibrin glue (12 %) group. Incidence of hematoma was significantly higher in tacker group in 15-day follow-up, but there was no significant difference in hematoma formation at hernial sites in both groups after 15 days of follow-up. The incidence of neuralgia was significantly higher in the tacker group (24 %) compared with the fibrin glue group (2 %). Significantly, more number of people in the fibrin glue group 68 and 90 %, respectively, returned to work during 15 and 30 days follow-up as compared to the tacker group 46 and 64 %. Fibrin glue can be considered as an alternative to tacker for mesh fixation.

No abstract

Objectives Brachial artery ultrasound imaging during reactive hyperemia is widely used tool for quantifying endothelium dependent vasomotion. Angiodefender device is used for non invasive determination of percentage flow mediated vasodilation (FMD). An attempt is made to study whether endothelial dysfunction determined by FMD of brachial artery predicts the presence or absence of coronary artery disease and its correlation with the severity of coronary artery disease. Methods One hundred six patients admitted between May 2014 and April 2015 who were posted for coronary angiography diagnosed to have chronic stable angina on clinical basis and/or by exercise stress test, for evaluation of coronary artery disease were submitted to standard clinical evaluation, calculation of percentage FMD by Angiodefender device. Statistical significance of difference of categorical variables was tested using Fisher’s exact test. Sensitivity, specificity, positive predictive value and negative predictive value of FMD were studied. Results There was no correlation between number of risk factors and percentage of FMD. Significantly higher proportion of cases with less FMD had higher prevalence of coronary artery disease and vice-versa. Significantly higher proportion of cases with positive stress test had less percentage of FMD and vice-versa. Significantly higher proportion of cases with less percentage of FMD and positive stress test had higher prevalence of obstructive coronary artery disease and vice-versa. Specificity was 100% when percentage of FMD was ≤10. Conclusions FMD an inexpensive and non-invasive test provides information regarding extent and severity of coronary artery disease.

Background: In laparoscopic cholecystectomy prevention of certain life-threatening complications are dependent on proper patient selection. Some reliable factors to predict difficulty, conversion or complications in laparoscopic cholecystectomy are needed. In the present research attempt was made to study correlation between pre-operative abdominal ultrasonographic findings and difficultly in laparoscopic cholecystectomy.Methods: Sixty patients above age of 18 years with gall stone admitted for elective laparoscopic cholecystectomy were included. Pre-operative ultrasonographic parameters such as gallbladder wall thickness and size, gallstone mobility, common bile duct (CBD) diameter, size and number of calculi, presence of pericholecystic fluid collection were given score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated to intraoperative difficulty of surgery. Operative findings were graded as difficult laparoscopic cholecystectomy if there were presence of dense peri gall bladder adhesions, difficulty in dissection of Calot triangle, tear of gallbladder, bleeding that hindered visual field, abnormal anatomy of biliary tree and buried or intrahepatic gall bladder.Results: Pre-operative USG findings such as gall bladder wall thickness and size, impacted and size of gall stones, CBD diameter, presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. Gall bladder wall thickness, pericholecystic fluid collection and impacted gall stones were accurate predictors for difficult laparoscopic cholecystectomy. Higher the pre-operative USG score, higher were the percentage of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy.Conclusions: Pre-operative ultrasonography in the form of the formulated score is a good predictor of difficulty in laparoscopic cholecystectomy.