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Sep15
Fracture Nasal Bone
(Patient information sheeth)
Fracture Nasal Bone
The disease: This is a common condition where the bone on your nose gets fractured and leads to either disfigurement and /or nasal obstruction
Diagnosis : This is done based on examination of patient. A Xray is don’t just to confirm the diagnosis. However clinical examination of patient remains the main stay for diagnosis
Treatment : The reduction of fracture is done either immediately within 4 hrs of injury or we wait for 3-4 days for the swelling over the nose to reduce.
Surgery : This is a procedure that causes some pain to patient so it is preferred to be done under full (general)Anesthesia
This entire procedure takes around 30 min.
Before surgery : Patient has to remain empty stomach for 8 Hrs. No food and water to be consumed 8 hrs before surgery.
Post surgery :
Patient has a nasal pack in his nose and he has to breathe from mouth. This pack is kept for 24-48 hrs, depending on the type of injury and amount of blood loss
You will be kept hospitalized for 1-2 days. This might be different for each patient.
A plaster of paris ( POP) cast would be kept on the nose to support and stabilize the reduced fracture. This has to be kept for 7-10 days. After that POP has to be kept only while sleep.
There is no specific dietary restriction after the surgery.
Patient can carry on with his routine day to day hectic. He has to avoid any such condition that can lead to injury to nose. Even minor injury to nose has to be avoided
Complications of Surgery: This is generally a safe surgery. However general complication of allergy to any drugs and reaction to anesthesia drugs might happen. These are very rare now a days.
As for surgery there are no major complication. However in ALL the patients after the surgery there will be some swelling on the face and around the eyes and this goes away in 2-3 days.
This is for your information and if any further clarifications needed contact your doctor
Dr (major) Prasun Mishra
MS ENT ( AFMC), DNB ( ENT)
9881676449


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Sep14
DRINKING WATER THE SAP OF LIFE FOR HOLISTIC HEALTH i.e. ENHANCING NAMASMARAN DR SHRINIWAS KASHALIKAR
DRINKING WATER THE SAP OF LIFE FOR HOLISTIC HEALTH i.e. ENHANCING NAMASMARAN DR SHRINIWAS KASHALIKAR
======================================================
Those who are not keen to read the whole article read only this
SUMMARY/CONCLUSION:
ALONG WITH NAMASMARAN; DRINK FROM 1 TO 5 GLASSES OF WATER (NOT ICE COLD OR FROM FRIDGE) IN MORNING; IMMEDIATELY AFTER GETTING UP.
======================================================
We must know that 66 % of the body weight is constituted by water. Out of this about 66 % i. e. about 28 liters is in the cells called intracellular fluid and about 34 % i. e. about 14 liters is outside the cells called extracellular fluid.

Right in the beginning it must be appreciated that water is essential for the saliva to form and give us; amongst
other things; the ability to taste.

Formation of saliva would be tremendously compromised if there is inadequate availability of water. It is common experience that drying of mouth is associated with:
a. sensation of thirst
b. speechlessness,
c. bad odor to breath [halitosis],
d. oral infections
e. caries of teeth..

Water is also required for the formation of gastric, pancreatic, intestinal and bile juices.

Water is required amongst other things for temperature regulation through formation of sweat.

It is by getting dissolved in water, that the nutrients can reach different parts of body.

It is the water that various chemical reactions take place so as to generate energy and also to build different body tissues, from the nutrients consumed.

The water is also required for dissolving and carrying away the waste material from the body cells.

Water is very much required for removal of waste products through the rectum and urinary bladder. The dry feces can be extremely painful and harmful and dry urine [oligouria, anuria] can be fatal. This probably does not require further elaboration as most of us have experienced the burning micturition and dry feces during fever and/or due even mild deficiency of water due to one reason or another.

But in addition water is also required for removal of toxic gases like CO2 by forming [ CO2 + H2O = H2CO3 = HCO3- + H+] NaHCO3.

In fact, it is required for dissolving, neutralizing and detoxifying several substances from all the body cells as well as specialized cells like those of liver.

It is worth noting that some individuals develop allergy to some substances including some drugs. In such situation, drinking large quantities of water is found to be beneficial. I myself; have experienced this.

It is also important to note that many of those who get dehydration and head ache; can get relief by drinking lot of water. This is because of lot of water is consumed for metabolism of alcohol leaving the body dehydrated.

It is interesting to note that the gastrointestinal tract is nothing else but the internalized skin! It is therefore natural that this tract has lot of sensory receptors; in as much as it has various glands and muscles. Therefore apart from everything else, mentioned above, the first thing that happens after we drink water is that we feel fresh! Secondly; it cleans various secretions of no consequence or those with injurious effects. Thirdly; it stimulates movements of the stomach, intestine, small intestine etc. as a result of which there is facilitation of movement of feces towards the anus. This helps in relieving constipation.

Drinking water is like internal bath.

Drinking of water can be beneficially used for many of those who wish to control habits such as tea, coffee or tobacco, alcohol etc. Since water has the paramount quenching effect it does allay the anxiety and restlessness associated with abstinence of these substances; and thus; helps overcome these habits [though other measures may also be required depending on the severity of habit/addiction in an individual case].

In view of all the above, the custom of drinking water in morning called USHAHPANAM. (Actually this a general and nonspecific term. Ushaa means the time before the sunrise and paanam means to drink) is very beneficial.

Water is life giving. Hence water itself is called life [JEEVANA]. It is very interesting to note that n India there is a custom of offering jaggery and water to the visitors. Water is served right in the beginning even in restaurants.

It also interesting to note and appreciate the practice of ACHAMANA i.e. drinking of water in small sips combined with NAMASMARAN.

NB: This is an article from my book "Conceptual Stress: Understanding and Management". If you like this; you are welcome to share it with others.


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Sep14
BIRBAL AND BLISS DR SHRINIWAS KASHALIKAR
BIRBAL AND BLISS DR SHRINIWAS KASHALIKAR

We all know the story of Birbal and Badashah Akabar.

The Khichadi of Birbal was not cooking because of the distance between the fire and the cooking pot. In our life we do everything resulting from our physical, instinctual, emotional and intellectual needs and urges (fire). But the "heat" from our actions does not reach the the center of bliss in our brain (the pot of khichadi) as it is far away!!!

If we practice NAMASMARAN (i.e. JIKRA, JAAP, JAP, SUMIRAN, SIMARAN i.e. remembrance of true self); then distance between our actions (fire) and the center of bliss in our brain (pot of khichadi) would reduce and the khichadi would get cooked (the bliss would manifest in individual and social life)!

Ins't this true?

बिरबलाची खिचडी शिजत नाही त्याप्रमाणे आमच्या जीवनात समाधान पिकत नाही. कारण; अग्नी (आपण जे जे करतो ते); आणि स्वयंपाकाचे पातेले (मेंदूतील हन्सपार्श्वत्रिकोणातील मध्य; गुरुस्थान) यातील प्रचंड अंतर! नामस्मरणाने हे अंतर कमी होईल आणि समाधान पिकेल. खरे ना?


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Sep12
STRESS AND DANCE: DR. SHRINIWAS KASHALIKAR
STRESS AND DANCE: DR SHRINIWAS KASHALIKAR

Whenever there is perceptible stress; we feel disturbed, depressed, suffocated, restless and so on.

One of the ways of relieving stress is to dance in harmony. If there is a music that channelizes our energy towards "true self" then our movements also take a shape of divine dance.

Can NAMASMARAN (What is NAMASMARAN? The word NAMASMARAN is derived from NAMA i.e. BRAHMA or true self; and SMARAN i.e. remembering);help in evolving such divine and de-stressing and divine dance forms?

The practice of NAMASMARAN with increasing intensity and insight; all over the world; will reestablish the divine forms of dance...In fact; the identification of SATVA, RAJA, and TAMA in every activity of life; evolves; every aspect of our life; including our art forms; making them conducive to self realization i.e. individual and global blossoming..!! In fact this is one of the objectives of TOTAL STRESS MANAGEMENT i.e SUPERLIVING.


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Sep11
GURUKRUPA DR SHRINIWAS KASHALIKAR
GURUKRUPA DR SHRINIWAS KASHALIKAR

Gurukrupa is eternal connection with super consciousness or immortality. It enters our life in the form of practice of NAMASMARAN. As the practice progresses; our vision, perspective, thinking, feelings, motivation, mission and actions evolve; and become rectified, purified and objectively benevolent. Moreover, they become stronger, effective and victorious. In addition; as our practice of NAMASMARAN progresses, we get inspired, empowered and enabled to spread the global benevolence of NAMASMARAN (JAAP, JIKRA, SUMIRAN, SIMARAN, i.e. remembering our true self); on war footing. Our life is not only fulfilled but enters the realm of immortality.

गुरुक्रुपेने साध्य होणार्‍या नामस्मरणाने सद्दृष्टी, सद्बुद्धी, सद्भावना, सद्वासना, सद्सन्कल्प आणि सद्क्रिया विकसित होतात. प्रबळ होतात. प्रभावी होतात. यशस्वी होतात. तसेच; नामस्मरण करण्याबरोबरच; त्याचा सार्वत्रिक प्रसार युद्ध पातळीवर करण्याची प्रेरणा, बुद्धी आणि क्षमता प्राप्त होते; आणि जीवन संजीवन बनते.


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Sep10
A HOLISTIC PRESCRIPTION DR. SHRINIWAS KASHALIKAR
A HOLISTIC PRESCRIPTION DR. SHRINIWAS KASHALIKAR

"A treatment of body is only a small part of treatment.

The treatment of instincts, emotions, motivations, thoughts and vision; is equally or actually far more important. But this is usually ignored or neglected; by the patients and the doctors; all over the world. This is because; the global and national policy makers in the field of education, practice, research, production, marketing and all activities involved in the healing; do not identify it as a vital part of treatment.

As a result we the medical and paramedical students, practitioners, teachers, researchers, industrialists; and above all; medical and paramedical policy makers and top executives; remain ailing along with the society.

Having understood this; with absolute certainty I began to feel the need of healing healing holistically i.e. in the direction of individual and global blossoming. After extensive study, research and experimentation I found that NAMASMARAN (JIKRA, JAAP, JAP, SIMARAN, SUMIRAN or remembering one's true self) is the PANACEA. NAMASMARAN ought to become integral part of every field so as to heal an individual and society in a holistic manner.

I realized that NAMASMARAN rectifies our physical needs, passions, feelings, motivations, thoughts and vision (perspective) and thus rectifies our behavior. This in turn leads to an ongoing fulfillment in individual life and holistic health i.e. prosperity and profundity in the society.

This is why; I not only practice NAMASMARAN, but I prescribe NAMASMARAN to my patients and advise NAMASMARAN to my students. I explain its global benevolence in every day life and in every filed of life; in my writing; and publish it for free download.

Unless I do this every day and to the best of my capacity; I do not feel I have done justice to my conscience and I am not at peace."

A doctor.


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Sep08
Primary Interhemispheric Subdural Empyemas - A report of three cases and review of literature
Abstract:
Interhemispheric subdural empyema is an uncommon condition and is considered neurosurgical emergency. These are generally seen following neglected oto-rhinological infection, but may be post traumatic or iatrogenic in origin. The source of infection can be frequently found, but in few cases no source of infection can be identified, called primary empyemas. These primary interhemispheric subdural empyemas are even rare. They can present with a rapid progression of symptoms and can carry poor prognosis. Early intervention with craniotomy and appropriate antibiotics can improve the condition of these patients.
We present three cases of primary interhemispheric empyemas who underwent emergency craniotomy and evacuation followed by antibiotics for 6 weeks. All the patients had excellent recovery on mean follow up of 10 years.
Key words:
Interhemispheric subdural empyema, neurosurgical emergency, primary empyemas, craniotomy


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Sep08
Management of pediatric colloid cysts of anterior third ventricle-A review of 5 cases
Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated.

Material and methods:
Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment.
Results:
Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died four hours after the admission. On follow up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances.
Conclusion:
Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared to the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
Key words: Colloid cyst, pediatric, transcallosal-transforaminal, anterior third ventricle, disconnection syndrome.


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Sep08
multiple burhole surgery as a treament for moyamoya disease
Objective: To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease in children.
Clinical presentation:
We report a 10 year old boy presenting with complaints of episodic headache for the last five years. At the peak of his headache he had visual disturbances and acute onset weakness of left sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of moyamoya disease.
Surgical management:
He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole.
Results:
On six months follow up he had only one episode of TIA. Post operative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and SPECT imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma.
Conclusion:
In children with moyamoya disease this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage, on both sides, and the number of burr holes made over each hemisphere depends on the extent of the disease.

Key words: indirect revascularization, multiple burr holes, moyamoya disease, children.


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Aug31
A CLOSER LOOK AT CROHN'S DISEASE
Collectively known as inflammatory bowel disease, Crohns and ulcerative colitis produce chronic, uncontrolled inflammation of the intestinal mucosa. The underlying cause of IBD isnt clearly understood but research clearly suggests that bacteria and viruses or proteins ( antibodies) cause the immune system to overreact and produce inflammation in the GI tract. Two known antibodies that are sometimes found in the serum of patients with IBD are antineutrophil cytoplasmic antibodies( ANCA) and antisaccharomyces cerevisiae antibodies( ASCA). Infact ASCA are diagnostic markers for crohn's disease whereas ANCA are more likely to be identified in the serum of patients with ulcerative colitis. There are other antibodies associated with IBD as well
Crohns disease is seen in young and older adults. Its an inflammatory disorder affecting mostly the distal ileum and colon. The intestinal lining ulcerates and scar tissue develops. Generally seperated by normal tissue, fistulas, fissures, and abscesses form. The wall of the bowel thickens and becomes fibrotic which causes a narrowing of the bowel lumen. Formation of granulomas, inflammatory masses that result from a collection of immune cells called macrophages also occur in many patients. Sometimes the lesions have a cobblestone appearance. A fibrotic bowel with abscesses and granulomas can lead to perforation. Crohns disease results in malabsorption of water and nutrients, which may lead to fluid and electrolyte imbalances. Patients experience abdominal pain and cramping in the right lower quadrant of abdomen, especially after a meal. Inflammation of the bowel mucosa prevents water absorption, and the patient may experience more than 10 bloody diarrhea episode each day. Anorexia, weight loss, cachexia, weakness and fatigue are common. Fever may be present from the inflammatory process or due to infection. Anemia results due to poor dietary intake or poor absorption of vitamins and nutrients. Lesion that bleed may also lead to anemia. Bright red blood may be observed in the stool because of bleeding lesions or excoriation of anal mucosa due to frequency and amount of diarrhea.
Diagnostic endoscopy confirms the presence of intestinal lesions. A barium study of the upper GI tract wil commonly show a constriction of the terminal ileum in the patient with Crohns disease. This constriction is known as the string sign. There are "skip areas" seen unlike what is seen in ulcerative colitis where the lesion is continuous. IBD can mpact other areas of the body in addition to the GI system, including the eyes, liver, joints and skin. Systemic complications that occur in IBD include nephrolithiasis, cholelithiasis and pyelonephritis.


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