Pulmonary embolism (PE) is a life-threatening condition or complication frequently seen after surgeries. Despite its all fatal potency, the clinical manifestation of PE is neither sensitive nor specific. Therefore it could be easily underdiagnosed or overdiagnosed, PE could be considered as one of the worst nightmares of cardiac surgeons. Decreasing the mortality from PE depends on rapid and accurate diagnosis, which should be based on objective evidence. Risk factors for venous thromboembolism, diagnostic values of symptoms and signs and the new diagnostic technologies are discussed, and a practical algorithm on PE diagnosis is presented in this review.

Locked intramedullary nailing is the preferred treatment for femoral shaft fractures but it requires a relatively expensive implant. Patients have to pay for the specialized implants and those who could not afford the cost had open Kuntscher nailing. This study was done to see the outcome of open Kuntscher nailing for femoral shaft fractures with regard to infection, time to union, limb shortening, malunion and range of motion at the knee. Method: Thirty-two patients with 34 femoral shaft fractures underwent open Kuntscher intramedullary nailing. Their average age was 23 years. Ten fractures involved the upper third of the femoral shaft, 19 the middle third and 5 the distal third. When categorized according to degree of comminution there were 18 Type I, 11 Type II and 5 Type III fractures. Comminuted type IV fractures, per-trochanteric and supracondylar fractures were not included in the study. Results: All 34 fractures healed on an average in 14 weeks. One patient developed deep seated infection. There was one nail breakage at 10 weeks, which required re-nailing. 6 patients had shortening of one cm or less. No patient had symptomatic rotatory malunion. All patients could fully squat at one year. Conclusion: Kuntscher intramedullary nailing gives good clinical results in fractures with minimal comminution. Locked nailing is not essential for less severely comminuted fractures.

To assess and compare autoimmune activity in patients with premature ovarian failure (POF) and menopause. Method: Thirteen women with premature ovarian failure but with no history of autoimmune disease were recruited into the study group and 15 women with natural menopause into control group between January 1999 and November 2000. The mean FSH levels of patients with premature ovarian failure were 73.95±29.11 (range: 41-130.7 U/L). Nuclear (antinuclear antibody=ANA, double-stranded DNA antibody=antidsDNA) and cardiolipin antibodies (IgM, IgG), immunoglobulins (IgM, IgG, IgA) and complement (C3, C4) levels were determined. Student’s t test was used to compare the groups. Results: Antinuclear antibody was positive in 30.7% of patients with premature ovarian failure and in 13.3% of controls. There was no significant difference in anticardiolipin antibodies, immunoglobulins and complement levels between the groups (p>0.05). Conclusion: In our study, no autoimmune deficiency was found in patients with POF.

Assessment of copper nutriture amongst pregnant women of a rural area in India. Method: A community based cross-sectional study was conducted amongst pregnant women (PW) in a rural block (randomly selected) of Haryana State, India. All the villages of the block were listed and six villages were randomly selected for the detailed study. Two hundred and eighty-two PW with gestational age 28 weeks and more were enrolled into the study. Data on age, gestational age, socio-economic status, and other demographic parameters were collected by utilizing a pre-tested semi-structured questionnaire. Copper nutriture was assessed by measuring the serum copper levels (by the atomic absorption spectrophotometric method) and the dietary intake of copper (by the 24-hr dietary recall methodology). Results: The mean serum copper concentration of the study subjects was 192.9 ± 60.9 µg/dl. Only 2.7% of the PW had deficient copper nutriture (serum copper concentration < 80 µg/dl). Dietary intake data revealed that 75% of the PW were consuming 50% and more of the recommended dietary allowance (RDA) for copper (2g). A significant positive correlation (p<0.01) was found between gestational age and serum copper levels. Conclusion: The prevalence of copper deficiency amongst PW was 2.7%.