Complicated Cases Discussion

Greeting for the Day

With profound happiness, I wish to thank each and every member of the Vascular Society of India in supporting me during my tenure at the capacity of “Honorary Secretary” of the Society. The Midterm Met 5 & 6 conducted during my tenure is very close to my heart and I sincerely thank the Office bearers of the Society for having trusted my abilities in the conduction of the two events.
In continuation of my association with the Society I take this opportunity in expressing my willingness to contest for the post of “President”,Vascular Society Of India at the forthcoming Elections of the Society during the General Body Meet to be held on 27th September during VSICON-2013 at Kodaikanal.
As I have done in the past, I shall discharge my responsibilities in a efficient manner in order to bring a glory to the Presidentship and to the Vascular Society of India. I sincerely look forward to your support in electing me to the post of “President” of the Vascular Society of India.

With Warm Regard’s
Prof. T. Vidyasagaran
Consultant Vascular Surgeon
Former Head of the Department of Vascular Surgery
Rajiv Gandhi Government General Hospital & Madras Medical College
Secretary, Vascular Society of India
Mob- 9841074344 /944296952
Email – tvidyasagaran@gmail.com

Dear Professor Vidyasagaran:
I appreciate your announcement for candidature for the post of president-elect of the Vascular Society of India.
I have the one question for Professor SRS, Professor Tripathi and you.
How can you assure the progressive and ambitious members of the VSI, that they are free to accept positions in other societies without fear or intimidation from some vocal section of the VSI?
Thank you and regards.
Malay Patel

Calpurnia heard husband morne “…
beaten men who seeketh to befall the house cometh with masks of saviors … beseech thee armor your hind … beware!!” Suresh

Dear All:
I state my position again.
The president-elect candidates should declare what will they do about the restrictive, oppressive and unconstitutional rule.
Thank you and regards.
Malay

Dear Vascular surgeons,
we should be aware of this!!
Asymptomatic Hepatitis Viral infections in patients and health care workers
Infection with hepatitis-B virus has been a significant cause of morbidity claiming more than a million lives every year. Epidemiological data reveals that there are 360 million carriers of hepatitis-B virus throughout the globe and 78% of the world populations’ hail from Asia . Though several studies from Indian sub-continent have provided an estimate of the prevalence of this viral infection, there exist only few studies, which reflect the status in the general population. The risk of contracting Hepatitis B Virus infection by health care workers (HCW) is four-times greater than that of general adult population.
Viral Hepatitis is a chronic disorder and some people may not even that they had become positive and they may be carrying the Hepatitis B surface antigen. This will be known only during routine evaluations, preoperative screening for the interventions or surgery. Then, all the interventional team members or surgical team members get alerted to be cautioned and all the possible precautions are taken to contain the chances of viral spread. In some, viral load test, Hepatitis e antibody / antigen status are also helpful to assess the infectivity status of the person undergoing the surgery. We all know that universal precautions should be taken to avoid these viral infections and hepatitis vaccination should be taken to avoid this infection yet there seems to be inadequate implementation of the same.
Even today, 28% Health Care Workers in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India , and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India . (Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India – Sukriti1 et al, Journal of Gastroenterology and Hepatology Volume 23, Issue 11, pages 1710–1715, November 2008) A large program was conducted by the Government of India to study the prevalence and profile of chronic hepatitis B virus (HBV) infection and its risk factors in pregnant women attending a tertiary care hospital in India . From September 2004 to December 2008 consecutive pregnant women attending the antenatal clinic were screened and those found positive for HBsAg were enrolled. Healthy non-pregnant women of child-bearing age, who presented for blood donation during the same period, served as controls. Women with symptoms of liver disease or those aware of their HBsAg status were excluded. Of the 20,104 pregnant women screened, 224 (1.1%) and of the 658 controls, 8 (1.2%) were HBsAg positive (P = ns). Previous blood transfusions and surgery were significant risk factors for infection with HBV. Of the women who were HBsAg positive, the ALT levels were normal in 54% of the women and HBV DNA levels were above 2,000 IU/ml in 71% of women. The median HBV DNA levels were higher in women who were HBeAg positive compared to the HBeAg negative group. The most common HBV genotype was D (84%) followed by A + D and A (8% each). In conclusion, the prevalence of HBsAg positivity among asymptomatic pregnant women in North India is 1.1% with 71% having high HBV DNA levels. These women may have a high risk of transmitting infection to their newborns. J. Med. Virol. 83:962–967, 2011.
It is suggestible that all the doctors and others in the hospital should be aware of these facts and consider checking their status and take the vaccination under the guidance of gastroenterologist or hepatologist.
Thanking you
Pinjala R K

Case for opinion Sir.
Young Girl, 19 years
Bilateral DVT. Resolved with UFH followed by OACs for more than a year.
Wearing Graduated compression stockings regularly.
Asymptomatic TODAY.
CT Venogram shows DISTAL IVC and RT CIV Occlusion with collateralisation of veins around occlusion.
Thrombophilia profile, suggestive of AT III deficiency at the time of diagnosis. BUT now it is NORMAL .
No other prothrombotic disorders/state.
Not on OAC anymore. Only antiplatelets.
Should she be advised Rt CIV and IVC ANGIOPLASTY with or without Stenting ?
Or
She should be kept in close regular followup for any impeding signs of Venous hypertension.? and if any develops, plan accordingly.
Moreover, literature doesnot support the use of antiplatelets for this purpose, should it be continued or stopped?
Any experiences?????
Regards
Dr Parveen Jindal
Consultant-Vascular & Endovascular Surgeon
Dehradun-248001
Mobile: +91 98973 24770
E-mail: parveenjindal@yahoo.com
CMI Hospital , 54-Haridwar Road , Dehradun [11am – 2 pm]
Renal Care & Dialysis Centre, 7-Inder Road , Dehradun [5pm – 7pm]

Dr. Jindal
My recommendation is no intervention as she is asymptomatic, but regular follow up and adequate education for her to wear compression stockings. Opening up this occlusion is easy; however recurrence and repeated interventions are very high.
If you need any literature support for my recommendation, please let me know.
Rajagopalan Ravi, MD, FACS
Medical Director, Vein Center
Arizona Heart Institute
602 707 3511
rravi@abrazohealth.com