IMA Journal – March 2022

Message from Team IMA Chennai Kauvery Alwarpet Branch

Dear colleagues

Women’s day Greetings and best wishes from IMA Chennai Kauvery branch.

We are shocked to know about the sudden demise of our good friend and guide Dr Muthurajan and express our heartfelt condolences to his family.

 Our monthly academic meetings are held every first Friday and I request all our colleagues to come forward to present interesting cases.

Yours in IMA service,
Dr S Sivaram Kannan

Dear friends

Happy to release our IMA journal for this month.

Knowledge is power and we want to share this power with everyone.

This digital platform is designed to platter the various clinical discussions and to upgrade ourselves through continuous medical education.

Long live IMA.

Yours in IMA service,
Dr. Bhuvaneshwari Rajendran

Hello friends

Happy to meet you all once again with our IMA journal.

We have an interesting mix of discussions this month. We look forward to your comments and suggestions.

We have introduced “Images of the month” segment from Radiology.

Read the journal and get updated on various complicated diseases and its management.

Thanks to my editorial team and to all contributors.

Long live IMA.

With regards
Dr. R. Balasubramaniyam

Stiff Person Syndrome – A Rare Neurological Autoimmune Disorder


Stiff-person syndrome is a rare neurological disorder with a one-in-a-million occurrence rate.  Its characteristics include rigidity of the trunk and limbs with increased sensitivity to loud noises, sensory stimuli, or emotional distress.  It has an autoimmune basis. In about 60% of patients, Glutamic Acid Decarboxylase (GAD) antibodies have been observed.

Our patient presented with relapsing signs of Stiff Person Syndrome of a progressive nature. She exhibited typical features of muscle rigidity, worsening with external stimuli. However, her GAD antibodies were negative.

She had two previous similar episodes of skeletal muscle stiffness, which improved spontaneously.
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Lung Transplantation For Advanced Lung Failure In India: Current Scenario And Future Directions


Lung transplantation is an established treatment for end-stage lung disease, with the first successful lung transplantation being performed almost 40 years ago on November 7, 1983 and an estimated 6000 lung transplants now being performed worldwide each year. It is however, the most complex solid organ to transplant and also, one of the last organs to be successfully transplanted; the first successful transplantation followed almost 30 years after kidneys were successfully transplanted in 1953. Some of the key time points in the history of lung transplantation worldwide (Figure 1) and in India (Figure 2) are highlighted. Cadaveric transplantation became possible in India with the “The transplantation of Human Organs” act on 8 July 1994 (THOA) by the Government of India (GoI).

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Can Footwear Modification Attenuate Degenerative Changes In The Knee – A Quasi-Experimental Observational Study


Literature has concrete evidence correlating osteoarthritis of the knee with foot alignment and plantar pressure. Many patients with severe osteoarthritis have tropical changes in their feet. Can this causality be inverse? Can foot malalignment and related disorders be the cause or accelerating factor for osteoarthritis of the knee? This observational study intends to throw some light on this aspect.


Osteoarthritis of the knee can be primary i.e., idiopathic and secondary which is due to predisposing factors like trauma, inflammatory or metabolic disorders.
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TMJ Ankylosis (Fusion Of Mandibular Joint With Skull) - A Case Report And Review


In this article we describe how an 8-year-old girl having difficulty in mouth opening (1mm maximum opening) for 5 years was managed for full mouth opening in Kauvery hospital.


This 8 year old girl was self referred our oral and Maxillofacial unit with no mouth opening resulting in no ability to chew or eat food and difficulty in speaking. The child was hailing from Tirunelveli and approached many centers there for management.

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Radiological Evidence in Tuberculous Meningitis

Clinical history:

A 29-year-old patient presented with an altered behavioral pattern on and off for 1 month. She had been treated at another medical facility with antidepressants and anxiolytics. Before she visited our hospital she had had fever and drowsiness for 4 days and had been started on antibiotics. For further management, she was moved to Kauvery hospital. She presented with irrelevant speech, restlessness, agitation and was not intermittently oriented to time, place or person.  CSF analysis showed: 85 cells, lymphocytes predominant 80 %, elevated protein 288, glucose 21 and ADA  positivity.

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Radiotherapy For Treatment Of Portal Vein Thrombosis In Hepatocellular Carcinoma


Hepatocellular carcinoma is the most common malignancy of liver and third leading cause of cancer death. Most of the patients present in advanced stage. Portal vein tumour thrombosis is a common complication of HCC which leads to a median survival of only 2.7 months. Patients with PVTT are ineligible for liver transplantation and there is no survival benefit. PVTT is a contraindication for TACE due to chance for ischaemia and liver necrosis. Systemic management using multikinase inhibitors like Sorafenib or Regorafenib improve overall survival (OS) by 2 months only. SBRT delivers high dose of radiation in few fractions (one to five fractions). A 65 years old gentleman who is a known case of chronic hepatitis C viral infection and previous history of hepatocellular carcinoma in left lobe of liver in 2016 presented with a new lesion in the right lobe of liver.

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