Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
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Dr. K.V.L.N.Raju
Managing Director
ALUMNI
REUNION
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~ A N U A R Y 1997
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Prof. C.S. Bhas ERSITY OF HEATH SCIENCES
M.D., F.R.C.PATH ANDHRA PRADESH
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Dear D i Seskg@ri Rao ..$ .
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I am gl&i to learn that the Rangaraya Medical
~tudgnt'o.~ss&iationis cel~bratingits 5tbAlumni
5tb~Ianuary.11997and &out 500 Old Students Q&
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adiaF~s ..... . is being organised during thg celebrdons. 1,.# .i
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RANGARAYA ~!L~LI=AI,
COLLEGE
Yours Sincerely
Indira Mutyala
Vice-President
RAlMCANA
DR. M.V. SANYASI RAO
Principal, Rangaraya Medical College, Kakinada
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DR.V.V. RAMA RAO
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. Superintendent, Govt. General Hospital, Kakinada
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A Centre of Excellence
ReconstructiveSurgeryetc.,
* Ion Wophoresis etc.,
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Dr. M. Venkatesh,
Dr. M. Sasikala, M.o.,oco.
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M.B.B.S.,
; Dr. K.SIVIIJI
Dr. D. I S 0 6 A RAJU
Dr. D.V.V.I(ESAVA AAJU
DR. KARRI RAMA REDDY
M.B.B.S., M.D., (Psysch), M.A., (Pol. Sci),
M.B.A., M.A., (Litt), M S . (Psych),D.F.E., D.C.E., D.F.M.
Ph : 431509,432949
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P- t, Parrctot
1. Ability grows in peace; charecter in the current of affairs. Goethe.
2. Contentment is a pearl of great price and who procures it at an expense of ten
thousand desires makes a wise and ha y purchase. Gohn Balguy.
no meaning.
1
5. Freedom in the mere sense of independence as no content and therefore
Dr. S. Radhakrishnan.
6. Integrity without knowledge is weak and useless;
Knowledge without integrity is dangerous and dreadful. Samuel Johnson.
7 Life grants no boon to man without much toil. Horace.
8. Morality knows nothing of eographical boundaries and distinction of race.
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9. Obedience alone gives rig t to command.
10. Purity is the feminine, truth is masculine of honour
Herbert spence.
Emerson.
I.C.& A. W. Hare.
1 1. Studies serve for delight, for ainament and for ability. Francis Becon.
12. Time : That man is always trying to kill, but which ends in killing him. Herbert Spacer.
I
THE HANDS THAT TETIIz(
Sri G.SANKARA BHANU M.sc.,
Head of the bparhnent of Chemisty (Retd.)
Just as a sappling requires protection till Government. Dr.P.V.N.Raju never
it develops into a tree and iust as a child needs compromised with any external pressure.
parental love till it grows into man, an Dignity of the college was the dearest to him.
instituion also requrires protective gaurd and Our first Principal was Dr.D.Narayana
loving care in its formative period. As one Rao. Shy and reserved by nature, he was
associated with our institution right from the dignified and humance ind out-look. He took
beginning I feel it my duty to inform the present great care in developing our laboratories and
generation o f staff and students the encouraged the staff very much in their work.
personalities that contributed their mite to the In the inaugural function of our college, though
healthy growth of our Medical College in the it was his prefogative to inaugurate, he
first twenty years ( 1 958-77). invited me to give the first lecture on 17-9-
The seed of Medical College was brought 1958 before that eager gathering of students,
here by Dr. M.V.Krishna Rao. He placed it in parents and invitees. Our next principal was
the noble hands of Col. Dr.D.S.Raju. Together Dr.Basudev Narayana former Vice-Chancellor
they planted it in Kakinada in 1958 winning of Patna University. He had wide contacts and
the cooperation of the elite of this district. The that helped our college to recruit staff from
plant was timely fertilised by Sri Mullapudi West bengal and bihar when there was scarcity
Harischandra Prasad and it was named as of eligible candidates in our sate. Our College
Rangaraya Medical College. It was strongly acquired recognition at national level in his
fenced by Dr.P.V.N.Raiu and host of dedicated tenure. Dr.G.Ramadas, who worked as Head
people. of the Department of Physiology, Assistant to
In that era, political leaders were much Principal and warden of our Hostel did a lot to
against the concept of Medical College in the the development of physiology, Assistna to
private sector. Dr. Suseela Nayyar, the then principal and Warden of our Hostel did a lot
Minister for Health in the Centre openly to the develoment of his department and
expressed her anguish that collecthingdonation streamlined the administration of college and
for a seat was against the policy of Socialistic Hostels. He had loud voice which kept all alert
pattern of Society. Dr.M.V.Krishna Rao a in the campus. He was phenomenonly strict in
veteran freedom fighter and Ex. Minister of the coduct of examinations.
Education in composite Madras state struggled Dr.Vissa Ramachandra Rao came next
a lot to convince leaders in the centre and the on deputation as principal and professor of
state the need'of a private Medical College in Anatomy. He was the illustrious son of an
this part of our state. He succeeded in getting illustrousfather, Sri Vissa Appa Rao an eminent
permission to start the college in the present educationist. Dr. V.R. Rao soon won the heats
main campus which was once the orphange, of staff and students, memnbers of Governing
a precious child of Brahamarshi Raghupathi Body and the elite of the town. His rich
Venkata Ratnam Naidu. Col Dr. D.S.Raju was experience as Vice-Principal in Guntur Medical
the noblest among noble people. He was the College stood in good steadin the development
first President of our Governent Body. Srin of healthy traditions in our college. He energised
Mullapudi Harischandra Prasad is a great curricualr and extra curricular activities. In his
industialist and i s endowed with a golden regime, all departmens developed and the
touch. He donated manificiently to meet the college was wellestablished.
conditions laid by Medical council and state Then came Dr.B.Shanmukheswara Rao
3
as Principal. By that time, he was alreaedy a voice to cut ItJhort by Rs. 200/- Faith fully I
renowned Surgeon. Very calm and cool by tried and struggled bui could not do so. b n the
temperament he was a man of few words but day when we were ready to start he called me,
of quick and correct decisions. He knew how gave me more amount than Iasked and advised
to scissor away what was unnecessary and me to be liberal in spending for students.
cut the problem to its correct depthe and close Dr. M.Vallabha Rao, Dr. P.Narasimha
the operation of any file in the shortest time. Rao and Dr. S.Banerjee were very popular
Staff enioyed his administrative acumen. among staff and students. Students and staff
Dr.P .Rama chandra Rao was intimately of that era remember with love and gratitude
involved in the all-round development of our the services of eminent Professors. Like Dr.
college as Professor of Pathology, Vice C.Mallikharjuna Rao, Dr. T.Srinivasan,
Principal and later as Principal. His zeal for Dr.G.Ramakrishna Raju, Dr.K.G.K. Gupta, Dr.
work was unparalleled. He was a pragmatic N.V.S.Naidu, Dr. T.Durga Prasad,
person of determination and dedication Like Dr.P.S.N.Murthy, Dr. Pitchaiahand many more
Dr.V.R.Rao, Dr.P.R.Rao too encouraged extra- of that order.
curricular activities. Not only the, he himselg Preprofessional staff who were the first to
acted in leading roles in several dramas and receive students (Freshers) did their best in
play-lets along with us. those two decades to establish good traditions
Dr.DSundarasiva Rao was th a l of discipline, throughness in the concerned
for the longest perid . prior to that he was subject and healthy relation between staff and
associated with our college as professor of students. Every Principal or Vice Principal
pathology and Viceprincipal. Dry Sundarsiva maintained very cordial relation with
Rao is an eminent pathologist, growing stronger preprofessional staff who functioned as the
. with age. His lessons, particularly in the earlier backbone of the college in administration,
period, created history in our college. He was discipline, conduct of examinations and extra-
uncompromising bur very humane. An incident, . curricular activities, Amongst us Sri S.Jankirama
I quote to indicate his stern exterior and Satry is an accomplished speaker.
affectionate interior. I had to lead a team of Above all, what wonderful batch of
students to the youth festival hosted by A.M.C., students we had Individually a few mighy be
Visakhapatnam. I Prepared a budget and naughty but none were cowardly. All looked to
showed it to him. He asked me in a -steran the Alma Mater with love and regard.
The Maxi Dress is women's attempt to make man curious about what he already knows.
A Hammer sometimes misses its mark - A Bouquet Never.
Philosopher bertrand russel, asked if he was willing to die for his beliefs replied: "Of course not. After
all, I may be wrong. "
w
.Sign in a Newyork store : "Complaint Department on the 45th floor lift out of order, pleaseuse the
stairs. "
A boy asked his father, "Dad, how muchdoes it cost to get married ? I don't know, " replied his father.
''I am still paying".
Farmer us senator Fred harris quoted advice from a friend: " Son don't ever brag about poverty, and
don't be ashamed of it. Just get rid of it as fast as you can."
Classified ad in the statesman: " lady doctor wished to share doctor's chamber for practice. "
The Ultimate test of whether you possess a sense of humour is your reaction when some one tells you
don 't
It is strange but mathematically fact that when a 17 yearold boy borrows the family car, he can,
in one night, subtract five years from the life of the car and add them to the age of his father
mSerious Infections !
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* There is no Comparsion between that which is lost by not succeeding and that which is
1 lost by not trying.
* In A British survey. 621, 000 Women Claimed they were engaged or about to be
married,Unhappily for a quarter of them, the survey showed that 476.000 men felt
themselves to be in the same position.
* A Bore is Somebody who talks incessantly about himself when you want to talk about
yourself.
A group of buildings is a Complex. A Psychological fixation is likewise a complex, Thus
an Architect who insists on desiging nothing but industrial complexes can be said to haave
complex complex. Complex also means complicated. So If the Architect's Problem is
Complicated by their factors a s well, he has a Complex Complex Complex.
All if proves. we suppose, that the more complex our civilization becomes, the more
versatile each word mustbe.
* These instructions were left fo a parcel delivery-man: "I am not home, but the dog is.if
I you ring the bell for a few minutes, his barking will set off the next door dog as well. His
master is hard of hearing. but he will come the door. Please leave the parcelwith him.
"Weare pleased to inform you that you are &a&5rp3 %236 ~ 3 9 g wo3 3 0 &&Jfiu&?
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Dr. M.V.Sanyasi Rao, M.D !
,
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2.
Dr. K.Vishnu Murthy M.S., D.N.B.
Plastic Surgeon, Kakinada
Interaction between H.I.V. & after S.T.D.
Dr. M. Ashok Babu
I
CULTURAL PROGRAMME
: President :
Dr.P.S.N.Reddy. Vice President Rarncosa, Vizag
Destinguished Guests
Dr. T.Durga Prasad
Former Prof & Head of the Department of orhtopaedics
RMC,Retd superntendent R.C.D,Hospital Vizag
Dr. Paruchuri Rajararn
Rangarayan , Guntur
Distribution of Prizes to the Contributors of articles in
the souvenir Dr. P.S.N.Reddy
Induction of oath to the New Executive
: Cultural Events
Prize Distibution to the Winners by
Sri S. Janaki Rarma Sasty
Former head of the Dept. of English, RMC
CODE OF MEDICAL ETHICS
MEDICAL COUNCIL OF INDIA
{@
1. I solemnly pledge myself to consecrate my life make available to their patients and colleagues the
to the service of humanity2. Even under threat, lwill benefits of their professional attainments. The
not use my medical knowledge contrary, to the laws physician should practise methodsof healingfounded
of humanity. 3.1will maintain the utmost respect for on scientific basis and should not associate
human life form the time of conception. 4.1 will not professionalywithanyonewhoviolatesthis principle.
permit consideration of religion. nationality. race, The honoured ideals of the medical profession imply
party-politicsorsocialstanding to intervene between that the responsibilities of the physician extend not
my duty and my patient. 5. 1 will practise my only to individuals but also to societv.
with cdnscience and dignity. 6. ~ h b
health of my patient will be my first consideration.
3. Advertising :Solicitationof patients directly
or indirectly, by a physician, by groupsof physicians
7. 1 will respect the secrets which are confided in or by institutions or organisations is unethical. A
me. 8: 1 will give to my teachers the respect and
physician shall not make use of or aid or permit
gratitude which is their due, 9. I will maintain by all
others to make use of him (or his name) as subject of
means in my power, the honour and noble traditions .
any form or manner of advertiing or publicity
of medical profession 10. My collegues will be my
through lay channels either alone or in conjuction
brothers. I make these promises solemnly. freely
with others which shall be of such a character as to
- - uoon
and -r
mvI
honour.
invite attention to him or to his professional position,
CODE : GENERAL PRINCIPLES skill, qualification, achievements, attainments,
specialities, appointments, associations, affiliations
1. Character of the
object of the medical profe;sion ir to render slrvice or honours and/or of such character as would
ordinarily result in his self-advertisementnot
. ,shall he
to humanib; rewardof financial aain
I ' " isa subordinate
consideration.Who-so-ever choose this ~rofession. give to any person who-so-ever, whether tor
assumes the obligation to conduct himself in accord compensation or otherwise, any approval,
recommendation, endorsement, certificate report or
ance with its ideals. A phyisician should be an
upright man. istructed in the 'art of healing1'.He statement whith respect of any drug, medicine,
nosterm remedy, surgical or therapeutic article,
must keep himself pure in character and be diligent
in caring for the sick. He should be modest, sober, apparatus or appliance or any commercial product
or article with respect of any property, quality or use
patient, prompt to do his whole duty without anxiety;
thereof or any test, demonstrationor trial thereof, for
~ i o uwithout
s going so far as superstitionconducting
himself with propriety in his professionand in all the use in connection with his name, signature, or
photograph in any form or manner of advertising
actions of his life.
through lay channel nor shall he boast of cases,
2. The Physician's responsibility : The operations, cures or remedies or permit the
principle objective of the medical profession is to publication of report thereof through lay channels.
render service to humanity with full respect for the A medical practitoner is permitted a formal
dignity of man. Physicians should merit the announcement in press regarding the following :-
confidence of patients entrusted to their care,
rendering to each a full mesure of service and (I) On starting practice. (2)On change of type of
devotion. Physicians should try continuously to practice. (31On changingaddress. (41On temporary
im~rovemedical knowledae and skill and should absence from duy. (5)On resumption of practice.
(6) On suceeding to another practice. dispensing by a physician of secret medicine or
other secret remedial agents of which he does not
4. Payment of professional services: The
know the composition, or the manufacture or
ethical physician, engaged in the practice of
promotion of their use in unethical.
medicine limits the sources of his income received
from professional activities to services rendered to 9. Evasion of legal restrictions : The
the patient. Remunerations received for such services physician will observe the laws of the country in
should be in the form and amount specifically regulating the practice of medicine and will not
announced to the patient at the time the service is assist others to evade such laws. He should be ccl
rendered. It is unethicl to enter intoa contract of "no operative in observance and enforcement of sanitary
cure no payment". laws and regulations in the interest of public health.
A physician should observe the provisions of the
5. Patent and copy rights :A pshysician
State acts like Drugs Acts, Pharmacy Act, Poisonous
may patent surgical instruments, appliances and
and Dangerous Drugs Act and such other Acts,
medicine or copy right publications methods and
Rules, Regulations made by the Central Government/
procedure. The use of such patents or copy right or
State Governments or local Administrative Bodies
the receipt of remunerationfrom them which retards
for protection and promotion of public health.
or inhibits research or restrict the benefits deriable
therefrom are unethical. DUTIES OF PHYSICIANS TO THEIR PATIENTS
6. Running an open shop (Dispensingof 10. Obligations to the sick : Though a
drugs and appliances by physicians) A - ~h~sicia is nnot and bound to treat each and every
physician should not run an open shop for sale of one asking his services except in emergencies for
medicine, for dispensing prescriptions prescribed the sake of humanity and the noble traditions of the
by doctors other than himself or for sale of medical profession, he should not only be ever ready to
or surgical appliances. It is not unethical for a respond to the calls of the sick and the iniured, but
physician to prescribe or supply drugs, remedies or should be mindful of the high character of his
appliances so long as there is no exploitation of the mission and the responsibility he incurs is the
patient. discharge of his professional duties. In his
7. Rebates and commission :A physician ministrations, he should never forget that the health
and the lives of those entrusted to his care depend
shall not give, solicit, or receive nor shall be offer
to give, solicit or receive, any gift, gratuity on his skill and attention. A physician should eneavour
commission or bonus in considerationof or in return to add to the comfort of the sick by making visits at
for the referring, recommending or procuring of the hour indicated to the patients.
any patient for medical, surgical or other teatment. 11. Patience, delicacyandsecrecy: Patience
A physician shall not directly or by any subterfuge and delicacy should characterize the physician.
participate in or by a party to the act of division, Confidences concerning individual or domestic life
transference, assignment, sub-ordination, rebating entrusted by patients to a physician and defects in
splitting or refunding of any fee for medical, surgical the disposition or character of patients observed
or other treatment. during medical attendance should never be revealed
The provisions of this paragraph shall apply unless their revelation is required by the laws of the
with equal force to the referring. recommending or State. Sometimes, however, a physician must
procuring by a physician or any person, specimen determine whether his duty to society required to
employ knowledge, obtained through confidences
or material for diagnostic, or other study or work.
to him as a physician, to protect a healthy person
Nothing in this section, however, shall prohibit
against a communicable disease to which he is
payment of salaries by a qualified physician to
about to be exposed. In such instance, the physician
other duly quallified person rendering medical
should act as he would desire another to act toward
care under his supervision.
one of his own family in like circumstances.
8. Secret remedies : The prescriptions or
12. P w i s : The physician should neither
exaggerate nor minimize the gravity of patient's sessions or by special or duly appointed committees
condition. He would assure himself that the patient on ethical relations, provided such a course is
his relatives or his responsible friends have such possible and provided, also that the law is not
knowledge of the patient's condition as will serve hampered thereby. If doubt should arise as to the
the best interests of h e patient and the family. legality of the physician's conduct, the situation
13. The patient must not be neglected: A under investigatioi may be placed before officers of
physician is free to choose whom he will serve. He the law, and the physician investigators may take
should, however, respond to any request for his the necessary steps to enlist the interest of the proper
assistance in an emergency orwhenever temperate authority.
public opinion expects the service. One having PROFESSIONAL SERVICES OF PHYSICIANS
undertaken a case, the physician should not nenlect
" TO EACH OTHER :
the patient, nor should bewithdrawn from the case
8. Depsndanceof physicinson each
without giving notice to the patient, his relatives or
:~h~~~is no rule that a physician shouldnot charge
his responsible friends sufficiently long in advance another physician br his but a physician
of his withdrawal to allow them to secure another Shouldcheerfully andwithout recornpence give his
medicalattendant. No provisionally Or fully professional services to physiciansor his dependants
registered medical ~ractitionershall willfully commit if they are in his vicinity.
an act of negligence that may deprive his patient or
patients from necessary medical care. 19. Compensationfor expenses :A physician
should consider it as pleasure and privilege to
OF THE PHYS'CIAN
To THE render gratutious service to all physicians and their
PROFESSION AT LARGE immediate family dependants. When a physician is
14. Upholding the honour of the called from a distance to attend oc ad&; another
pfession :a physician is expected to uphold physician or his dependants reimbursement should
the dignity and honour of his profession. however be made for travelling and other incidental
expenses.
15. Mecnbership in medical profession :
For the advancement of his profession, a physician DUTIES OF PHYSICIAN IN CONSULTATION
should affiliate with medical societiesandcontribute 20a Consu~+ation should be encoumged :
of his time, energyand mean~sothatthesesocieties illness,especially in doubtfulor
ln case of serious
may represent the ideals of the profession. difficult conditions the physician should request
16. Safeguarding t h ppofgsdon ~ : Every consultations.
~hysicianshould aid in safeguarding the profession 21. Consultation for patients,
benefit : In
1 against admission to it of those who are deficient in evev consultation,the benefitto the patient is of first
moral character or education. Physician should not importance. All physicians interestedin the case
employ in connection with his professionalpractice shouldbe candid with !he patient, a memberof his
any attendant who is neither registered nor enlisted familyor responsiblefriend.
under the Medical Acts in force and should not
permit such persons to attend, treat or perform 22. PuncutalifY in consultation : Utmost
operations upon patients in respect of matters P U ~ C Cshould
~ ~ I be
~ ~observed
Y by J physician in
regarding professional discretion or skill as it is meeting for ~onsulfafion.
dangerous to publfc health. L.v , , - ! 2 3 Conduct in consultation :In consultations,
17. ~ x p a s u nof unehical conduit : no insincerity, rivalry or envy should be indulged in.
~ h ~ i c i should
an expose, without fear or favour, All due respect should be observed towards the
incomp~entor corrupt, dishonest or unethical physician incharge of the case and no statement or
conduct on the part of members of the profession. remark be made, which whould impair the
Question of such conduct should be considered, confidence reposed in him For this purpose no
discussion should be carried on in the presence of
-
first bebre proper medical tribunals in executiw
the ~atientor his re~resentatives.
24. Statements to patient after to the interestsandreputationoftheabsent physician.
consultation All such patients should be restored to the care of the
latter upon his return.
(a) All statements of the case to the patient or his
reresentativesshould take place in the presence of 29. Visiting another physician's case :A
all the physicians consulting, except as otherwise physician called to visit a patient who has recently
agreed; the announcement of the opinion to the been under the care of another physician in the
patient or his relations or friends shall rest with the same illness, should not takechargeof, nor prescribed
medical attendant. for such patient except in a case of emergencywhen
he should communicate to the former explaining the
(b) Differences of opinion should not be divulged
circumstnces under which the patient was seen and
unnecessarily but when there is an irreconcilable
treatment given, or when the physician has
difference of opinion the circumstances should be
relinquished his case, or when the patient has
frankly and impartilly explained to the patient or
notified such physician to discontinue his service.
his friends. ltwould be open to them to seek further
advice should they so disire. When it becomes the duty of physician
occupying an official position to see and report
25. Treatment after consultation : N o
decision should restrain the attending ~ h ~ s i c i a n upon an illness or injury, he should communicate to
from making such subsequent variations in the the physician in attendance so as to give him an
treatment as any unexpected change may require, option of being present. The medical officer should
but at the next consultations reasons for thevariations avoid remarks upon the diangosis or the treatment
should be stated. The same privilege, with its that has been adopted.
obligations, belongs to the consultant when sent for 30. Engagement for an obstetric case: If a
in an emergency during the absence of attending physician agrees to attend a woman during her
physician. The attending physicians may prescribe confinment, he must do so. Inability to doi so on an
at any time for patient the consultant only in case of excuse of any other engagement is not tenable
emergency. except when he is already engaged on a similar or
26. Consultant not to take charge of the other serious case. When a physician who has been
case : When a physician has been called as a engaged to attend an obstetric case is absent and
consultant, none but the rarest and most exceptional another is sent for the delivery accomplished the
circumstances would iustify that consultant taking acting physician in entiled to his professional fees,
charge of the case. He must not do so merely on the but should secure the patient's consent to resign on
solicitation of the patient or friends. the arrival of the-physician engaged.
t2
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By : d r S.V.Lakshminarayana, M.B.B.S,D.A.
. 1 ,.t -'
"
. ; .,
Dept.of Anaesthesiology,
L I :-,!?, ,
8
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-
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Govt. General Hospital,
KAKINADA.
Direct Laryngoscopy and Bronchoscopy pose a real challenge to both the surgeon and the
Anaesthetist,as they are commonly done in the extremes of age,i.e. Children (Foreign body,
Papilloma) and Old eople (Neoplasms of the Tracheobronchial tree). Also the procedure poses
P
certain technical dif iculties due to the anatomical variations seen in the above age groups due
to age and pathology, competition between the surgeon and the Anaesthetist for the same
anatomical area presence of secretion~~bleeding due to high vascularity and also the highly
sensitive nature of the area with h e presence of various reflexes.
So before proceeding to Know howthe procedures can be enabled to be carried out, a brief
note on the Nerve supply is in order. The anterior 2/3 rds of the Tongue is supplied by the
HYPOGLOSSAL Nerve. This area cn be easily bloacked by the topical application of 4%
Xtlocaine with a soaked cotton swab.
The posterior 1 /3 rd of the Tongue is supplied by the GLOSSOPHARYNGEAL Nerve with
Pharynx and Superior surface of EPIGLOTT1S.This nerve canbe easily blocked at the Posterior
Tonsillar pillars.
m'
The Superior laryngeal Nerve supplies tnelnter~oraspect of EPIGLOTTIS. Mucous membrane
of the lower part of Pharynx, Vallecula, Vestibule of Larynx, the Aryepiglottic fold and mucous
membrane of Posterior part of Rima glottidis. this Nerve can be blocked at the superior horn of
Hyoid bone.
Please note that the Superior Laryngeal nerve supplies motor fibres to Croicthyriod muscle
which acts as a tensor of the Vocal cords.The rest of the motor innervation is by Reccurent
Laryngeal Nerve which also supplies sensory supply to mucous membrane of Larynx belowvoval
cords, This area can be anaesthetisecl by the TRANSLARYNGEAL BLOCK.
Direct Laryngoscopyand Bronchoscopycan be done under Local of General Anaesthesia,The
selection of the Anaesthetic techniqueis dictated by the age of the patient, technical difficulties,
the prefernece of the scopist of Anaesthetist, indication for the procedure and the type of
instrument used.
First LOCAL ANALGESIA will be considered :
The techinque of Local analgesia for Direct Laryngoscopy is more or less similar to the one
used for Rigid Bronchosopy, except that we may not need analgesia of the area below the Vocal
cords which is achieved by Trans laryngeal block. Rigid Bronchoscopy which is the referred
technique for foreign body removal, though better done under General Anaesthesia, in
experienced hands it canbe comfortably doneunder Local analgesia, Previously analgesia of the
structures cencered was achieved by topical X~locaineover the tongue Xylocaine swabs in the
Pyriform fossae (to bolck Internal Laryngeal nerves)with the help of a Krause forceps and then
spraying of Xylocaine over the Pharynx, Cords, Larynx and Trachea as the scope is advanced,
But better operating conditions canbe achieved by blocking the Superior Laryngeal nerves and
Glossopharyngeal nerves on both sides plus the Translaryngeal block, which I will be describing
next:
A. SUPERIOR LARYNGEAL NERVE BLOCK :,
Patient Lies supine with neck extended. TheHYBID bone is displaced laterally towords the
side to be blocked, I
A 25G, 2.5 cm needle is inserted over the greater cornu of HYOlD towords the tip and
walked off over its caudal edge.
Then it is advanced by 2 to 3 mm,when you can feel it puncturing the Thyrohyoid membrane.
At this Level you should stop and aspirate NO AIR should come, as now the needle Lies Lateral
to Laryngeal mucos.Here 2 to3 ml of 2% Xylocaine is deposited and one more ml as the needle
i s withdrawn.
The procedure is repeated on the opposite side.
CAUTION : Since the airway reflexes may be ablated this block is better avoided in full
stomach cases.
B. GLOSSOPHARYNGEAL NERVE BLOCK :
Patient lies supine with extended Neck and Mouth opened widely. Macintosh Laryngoscope
with appropriate blade is introduced gently until the posterior tonsillar pillars (Palato pharyngeal
folds) are identified.
An angled 22G and 9 cm needle is taken and inserted at the midpoint of the pillar for half
a centimeter.
Aspiration should be NEGATIVE FOR BLOOD.
5 ml of 2% Xylocaine is iniected.
Same procedure is repeated on the opposite side.
CAUTION: The INTERNAL CAROTID ARTERY is nearby, so risk of it's injury and Hematoma
must be kept in mind.
Cotton swab soaked in X~locaineviscousin the mouth prior to the procedure aids
in asmoother technique of block.
C. TRANSLARYNGEAL RLOCK :
Patient is Supine with ekinded neck.
Cricothyroid membrane is identified and punctured in the midline with a 20G, 3 to 5 cm
Catheter over cannula.
Aspiration should be positive for AIR, Needle is removed and 3 to 4 ml of 4% Xylocaine is
quickly depos,ited, This results in a vigorous cough and aids in the spread of the solution with
in Trachea.
CAUTION : Surgical emphysema is aproblem with this technique.
These three blocks given together, can providegood conditions for doing Direct Laryngoscopy
and Bronchoscopy as they cause analgesia of the TONGUE, EPIGLOTTIS, PHARYNX, LARYNX
and most of TRACHEA, However the danger of aspiration must be kept in mind, ans as for any
localy lechmiwe food prernedication and meticulouattention to aseptic technique must be
observed.
The FIBREOPTIC BRONCHOSCOPE revolutionised Bronchoscopy as it can be comfortably
done under local Anaesthesia and also has bete t reach-upto subsegmental bronchi. The
technique of Local analgesia consists of first an aesthetising the nose with 4%Xylo caine soaked
gauge thenspray 4% Xylocaine directly on the pharynx, this Larynx, Trachea and Bronchi,as the
instrument is advanced.During procedure Anticholinergics like Glycopyrrolate may be used to
control secretions and Oxygen given through nasal prongs or through a Patil-syracuse face mask
which has a diagphram through which the scope can be passed.
Next GENERAL ANAESTEESIA for Rigid Bronchoscopy will be dealt with. This area of
Anaesthesia is receiving constant attention for the Last four decades with the advent of iet
ventilation and High frequency ventilation and, has benefited much from the development in the
field of Bioengineering which enabled r development of sophisticated Monitors and
Ventilators.
In spite of all the technological advances, General anaesthesia to Rigid Bronchoscopy has
certain inherent problems which need thorough understanding and careful and sometimes
prompt handling, failing which there can be catastrophic consequences.
I Certain specific problernswhich are inherent to Bronchoscopy under General Anaesthisia are: 1
I 1 . Thereis competition between the Bronchoscopistand Anaesthetist for control of the airway. 1
2. Sometimes the procedure is done as an emergency. So the patient is unprepared and
inadequately investigated-? impaired C V S and R S.
3. Instrumentation of respiratory tract can cause - BRONCHOSPASAM LARYNGOSPSM -
CARDIAC DYSRHYTHMIAS.
4. Sensitivity to relaxants may be there due to the presence of Myesthenic (Eaton Lambert)
Syndrome. .
5. Excessive secretions if present can make the technique very difficult and pro
longed.
6. Ventilation which mighthave been already impaired, may further be impaired during or after
the procedure if a Lobar bronchus is obstructed by the Bronchoscopeof Haemorrhaeisp caused
by the procedure:
7. Excessive suctioning by the surgeon may lead to Hypoxia and also reduce F RC
8, Excessive use of Oxygen flush, to compensate for leaks around the scope
may dilute the Anaesthetic gases and lighten anaesthesia.
9. Hypercarbia which might occur with some techniques may cause arrhythimas.
10.Barotrauma may occur with some modes bf ventilation if there is no out let for the gases of
ir the scope enters a segment.
REALATIVE CONTRAINDICATIONS TO RIGID BRONCHOSCOPY :
1. Sever acute Hypoxia.
2. Respiratry obstruction.
3. Massive bro~chopleuralfistula.
4. Marked superior vena caval Obstruction.
AIMS OF GENERAL ANAESTHESIA : General anaesthesia must provide the following to
be effective.
. .A !el. LLl-
-First the lungs are denitrogenated with 100% Oxygen. >c &J,, I' +* d : $ ~
, +&',
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through the Bronchoscope.The gases are administered through a sidearm of the scope, the
proximal lumen of which is occuluded with a sliding glass window. The surgeon periodically
removes the window for suction and Biopsy. During these periods the patient cannot be
ventilated and also too much suction may produce Hypoxia. &.;* :{d ! & :+r-l ~ f 7 > 2.; Y%--?IG.T
'. - 4 f;
Here the leaks are very much high, so flows upto 2 0 litres per minute may have to L;;,
- ..- .
employed. . g
Ti 4I. . . . , l ~ ~ .. . ~.K.. c ~..e ~ , , ~ ~ ; . ~ ~ , ~
FreqiJent use of oxygen fI&h to overcome 1eaks'dil"tes gases and lightens anaesthesia,so
instead high initial rateibf Fresh Gas flows areodmisable. he cords ma; also be sprayed with
4% ~ ~ l o c a i to
n eavoid post procedural Bronchospasm.
Ill VENTURI INJECTOR DEVISE :
This was first described by Sanders in
The oxygen from a high pressure source (45 to 60 psi) is injected intermittantly through a
narrow needle palced at the proximal end of a Bronchoscope. This creates a Venturi effect and
entrains atmosphericair, so the lungs are inflated by oxygen enriched airas lunguas the scope
is beyond larynx. a L.i;,
Here the system consists of high pressure oxygen source, low compliance tubing, on-off tap
and needle of suitable size.
A 14G needle if usedwith an Adult Negus Bronchoscope, produces a maximum inflation
pressure of 50cm of water
similarly 17G needle produces maximum inflation pressure of 25cm of water
I A 19G needle used with a child Negus Bronchoscope produces a maximum inflation I
I pressure of 18cm of water.
By this technique we can maintain Pa02 and keep PaC 02 within normal limits.
Intermittant I V anaesthetics wil Ibe needed to control awareness.
CAUTION : Barotrauma can occur if proximal end is obstructed and distal end is tight in Larynx.
IV HlGH FREQUENCY VENTILATION :
This was first described by Oberg and Siostrand in 1967 as a means of ~ r o v i d i positive
n~
presure ventilation free of circulatory effects. Luckenheimer and coworkers constructed the first
High frequency oscillatory ventilator in 1 972.
By definition is 'MECHANICAL VENTILATION USING HIGHER THAN NORMAL FREQUENCIES',
usually more than 1 Hz.
HereTidal volumes less than anatomical deadspace are delivered at friquencies of 60 to 100
breaths per minute (bpm) at a low airway pressure. The inspiratory times are short and I:E ratios
of gases could be de1ivered.h achieves good oxygenation and reasonable C 0 2 elimination.
I -
-
to make special procedures like Extracorporeal shock wave Lithotripsy and Bronchoscopy
technically easier.
to achieve better gas exchange where controlled mode of ventilation fails.
I
- to minimise pulmonary barotrauma associated with CMV.
There are two types of High Frequency Ventilation as used for Bronchoscopy. Thery are:
1 . High Frequency Positive Pressure Ventilation.
2. High Frequency Jet Ventilation
3. In addition High Frequency Oscillation will also be discussed here.
1. HlGH FREQUENCY POSITIVE PRESSURE VENTILATION :
Here.small tidal volumes are delivered through an insuflation catheter or Tracheal tube using
highIgas flows through a circuit which has minimum interndl compliance. The effective
respiratory rate is found to be 60 to 100 bpm and the I:E ratio 1 :3
This mode uses a high pressure flow generator coupled to a folw interruptor fluidic
mechanism or a motorised rotating interruptor.
2. HlGH FREQUENCY JET VENTILATION :
1 This was introuduced by Klain and Smith in 1977.
Here a pulse of gas is dilivered at a pressure of 5 to 50 psi from a ventilator which has a
I
rapidly responding valve mechanisoum (usually a Solenoid valve) that acts as a flow inter
uptor.This can be used to adiust respiratory frequency and Inspiratory time. The pulse of gas is
delivered into the lungs through a small cannula. Gas entrainment occurs around the iet and
contributes sig i f i c a n t l to
~ inspiratory folow.To avaidentrainment of exhabed gases a continuous
flow of warm and humidified air oxygen mixture i s provided. Exhaled gases exit from the patient
through the endotracheal airway around the jet cannula into the continuous folw circuitry..
Optimal gas exchange is obtained with rates of 60 to 150 bpm and 30 precent lnspiratory time
:,(I:E-1:3). This technique is ideal for both Laryngoscopy andBronchosocpy. PEEP can also be
applied if needed. ,qc.;:. W 7.-
. 1 ,, (.'?:
,$;v! :..:. FIG NO. 1
.v
Both HFPPV and HFJV dependon passive recoil of lungs for expiration, This is inefficient at
very high rates as gases ten to get trapped, resulting in poor Carbon Dioxide elimination and
high mean intrathoracic pre
3 HIGH FREQUENCY 0
Here respiratory gases i
oscillated in a to and fro fashio
pump, thereby producing a si
of gas delivery. Consequently there is no net
delivery of inspired volume.
Rates of 1 8 0 to 3 0 0 0 b p
-
volumes of 2to 3ml/Kg.
HFO differs from HFPP
mechanism of expiration. In HFPPV and HFJV at
I high frequencies of ventilation expiratory time becomes insufficient to allow exhallation of the
inspiratory volume. In HFO there is an active withdrawl of inspired volume during expiratory
phase. Hue to these reasons in HFO
and no raise in intrathoracic pressures.
The following is a table comparing the 3 types of
Flow
HFPPV Sq
HFJV Sq
HFO Sine
bpm
wave 60
wave 100-200
,_;
$ ,_L
.:
..;-
-i+''
. .
wave 1 8 0 to 3 0 0 0
-
< ;-/
.-.a
..-d
FCZ:'.'
.+', Froese et. al. suggested that the post fix A or P be used to indicate wether expiration
.b.a
in detail.
I-,
.-p
explanations which werelisted below the firest two arethe most popular and will be explained
' '"'
i#+&&
A. Process of augmented dispersion ?This involves a mixture of turbulent mixing,
convection and enhanced diffusion. This can be explainedas-in the larger proximal airways flow
i s turbulent, so causes some mixing. In The smaller distal airways velocity is low and flow laminar,
and the gas movement follows a parabolic pattern,that is gases at the centre move faster than
those near the wall. This creates a larger interface between fresh gases cnd the gas in the
airways, so more diffusion now takes place.
I Disco lung : In IPPV considerable regional differences in gas flow and hence in gas
:incentrations are common.ln contrast such regional -
mechanism is probably ;Regional PhasicUndulationsl, that is
difference are minirel i.n HFV.The I
different lung regions empty into and fill from each other (Inter
regional gas mixing or Super mixing) without altering the
spatial distribution of pulmonary bl9od
- flow.
C. Directa lveolar.vehtilation can occur with Tidal volumes
greater than 0.8.
FLOW
I
D. Taylordispersion -enhancement of molecular dispersion
by convective flow.
E. Pendelluft-dueto differences in regional time constants.
F. Convective streaming
G. Molecular diffusion
H. Cardiogenic mixing FLOW
I. . Assymetric velocity profiles 0111
Final conclusions:
Points in favour of High Frenquency Ventilation:
1. Because of enhanced inspired ga sdiffusion and interregional mixing, HFV may prove to
be better than IPPV in the presenceof diseased lung.
2. The requirement of lower mean intrathoracic pressure means better CVS satbility and
decreased chance of barotrauma.
3. In some pulmonary pathologies the increase in mean lntrathoracic pressure seen with high
rates of HFPPV and HFJV may act like PEEP and improve oxygenation.
Disadvantages of HFV:
1 . Inadequate humidification-leads to tracheal mucosal damage and thick 'caked' secretions.
2 . Massive barotrauma may occur due to high minute volumes being delivered to the lung,as
in the follwing situations :
- when there is total or partial occlusion of the exit pathway.
- when there is failure of cycling mechanism to terminate inspiratory flow.
- when there is wedging of catheter tip in a small airway.
3. lnadvertant PEEP-when ventilator uses passive mechanism for expiration at frequencies of
more than 1 50bpm.
4. Necrotising tracheobronchitis-probabkydue to injection injury, inadequate humidification
and excessive airway temperature.
5. Airway pressure amplification-animal studies have shown that during HFV pressure swings
xeasured at the airway opening maybe significantly smaller than the swings in alvelolar pressure
SO in humans too the alveolar pressure may be higher than anticipated.
LYMPHOLOGY is an infant medical science following OMENTUM transposition has not been
neglected in India, for a long time. Filarial Lympho evaluated and reported so far.
dema is endemic in many parts of the World. The In my new Concepts of Lymphoedema
estimated number of cases in different parts of management; the immediate definitive procedure
world according to WHO 1994 are around 104 for the reduction of Limb size following OMENTUM
millions : out of this 48 millions cases are in India.transposition has shown very good results. The
Filarial Elephantiases is a Common Surgical swelling began to reduce fron the very first post
problem in coastal district of Andhra Pradesh. operative day and reaching a maximum in week.
Many surgical procedures that were designed for The gross reduction in sized is noted with
its correction are not entirely satisfactory. f i .t,g
5-OMENTUM, when Compared to N.V.Shunt.The
~ ~hefeasibilityof~ymphaticb
~ ~ skin wrinkled
~ and could be~ picked up like a~fold of ~
-Venus anas~omosis andOMENTUM transposition flap. These 100s Skin can be easily excised and
in by-passing the obstruction. The usefullness of primary sutured OR skin grahed in few places if
immediate reconstructive Surgery in filarial is no Lymphorrheafrom the wound
elephantiasis OR in primary Lymphodema cases #f'nd the healing is excellent.
-. .
.-:
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~posul&mt
.:
:~astroint&tinalEn&scopy
<
coqsultant :~aparoscopic.
Surgery
NARASIlUEA RAO NAIDU S
,- SURYARAOPET,
WAYAWADA - $20 002 7 3 43679B,435712
m .
W & k ~ ~
HOSPITAL FOR
& , :Police Out Post
75-6-13, Piakash ~ a ~ Opp
-f- - -
PHONE : 432512
.
1 Dr. Yalarnanchi Sadasiva Rao
3:
'
DK
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K.L. SAMPATH KUMAR, M.B.B.s.,
SUMMARY :a reportofthe firstwell ~ a l n n e d cholecystectomy, using four ~ o r t s . t h e
double gall bladder removal by laparoscopic diagnosisof double gall bladder was con-
reviewed. the incidence of the anomaly and complete duplication of the system with two
literature on management are discussed. cystic ducts opening he~eratelyinto the common
gepatic duct and two cystic afteries. The same
KEYWORDS :laparoscopic removal :double
were disscted carefully the arteries and cystic
gallbladder anomaly.
ducts were s e ~ e r a t e l y clippedand
INTRODUCTION : laparoscopic divided-thetwo gallbladders were dissected
dure compared to open surgery, it is safer but epigastric port. patient had uneventful
technically more demanding the different postoperative period and was discharged after
anomalies of the biliary tract constitute about 24 hours. she is under followup for the last 3
10%of the necropsies Double gall bladder is months and is asymptomatic.
an extremely rare anomaly, very often missed
pathologically, the gall bladder showed
on preoperative if evaluation. ultras~nograph~
evidence of calculi with changes of chronic
and contrast studies can miss the deagnosis
cholecyst it is and mucocoele formation. the
due to intrahepatic position of one of the twins
. other moieiy which did not contain the calculi
or superimposition of the shadows.
but showed mucosal thickening. -
CLINICAL REPORT : a 16 year old lady
DISCUSSION :the frontiers of laparoscopic
presented with recurrent episodes of right
surgery are increasing by leaps and bound
upper abdominal pain of one yera duration.
with a little experience and ingenuity, the
clinical evaluation was unremarkable but for
scopeof laparoscopic surgery can be increased
tenderness right hypochondrium. laboratory
enormously.cholecystectomy by this route is
evaluation showed good general condition
now standardised and i s followed a s a routine
and absence of jaundice. ultrasonography
in several centres. congenital anomalies of the
confirmed gall bladder calculi and the gall-
biliary tract are not uncommon. however,
bladder was fond to be duplicated.
'double gall bladder is a raroiy. there are very
the patiet was taken up for laparoxopic few reports of the dbuble gall bladderremoval
by the laparoscopic rout double gall bladder without much difficulty provided one is familiar
recognised following complication of with gall bladder duplication and the surgical
laparoscopic removal or cases where a second considerations. intraperitoenal fibrous bands
operation i s needed were described and loculated gall bladder can sometimes
importance of preoperative cholangiography mimick a double gall bladder
i s stressed by some authors in suspected cases
an encounter with the double gall bladder
of double gall bladder.
is a challenge for the laparoscopic surgeon.
the available literature reveals that this is meticulousdissection at the hepatocystic triangle
the first case of planned removal of double gall is called for in view of the anomalous vessels.this
bladder in a completely duplicated biliary case draws attention to the rarity of the anomaly
tract. this case shows that it is technically and its management.
nt of Biochemistry
and lab. medicine
Salivary gland is rich in arginase activity and its activity in saliva is 400 times more than
that of Serum. So far the Functional significance such high activity in saliva has not been
studied. (The results of my work on) Some biochmical aspects of Salivary Arginase and its
Level in Hepatic Coma and Oral Cancer are reported in this presentation. The increased not
to bacterial count, because in all patients activity of the salivary Arginase is same after
passing through bactierial filter there by showing the raise of Salivary Arginase activity is
absolute. One of the important biological roles of high Salivary Arginase activity may be
supplying ornithine which is utilized for polyamine synthesis and Amion acid proline and
lutamic acid.
DR.YARRA NAGESWARA RAO.
GUNTUR
INTRODUCTION : a) NEWLY MARRIED COUPLES : Come
In my Practice I have come across lot of with the problems of first night failure, prema-
patients complaining sexual problems. To help ture e jaculation, painful sex for women, para-
them I became a member of ICSEP & IASECT phimosis, first night bleeding and etc. I prefer
and equipped my self as a full pledged sex to council both husband and wife to gether to
councillor and started sex counsilling centre in achieve better results. As you Know sex is two
1990. Since then I have been carrying out this way traffic not oneway. Hats off to the zeal
study. This study includes-historytaking, physi- and inquisitiveness of modern women. She has
cal examination, sex counsilling and therapy. no hesitation to accompanying her hsuband to
MATERIAL & METHOD : my clinic. Common causes are sexual innosence
So far I have seen about 1 200 pa- & ignorence and "fear of failure1' in sex for
tients. patients are the following groups- 1 .Par- males and pain in sex for females. Sex
ents 2. Youth 3. Couples 4. Aged Group. counsilling and my sex education book solve
1. PARENTS :-Parents and grand parents their problems.
approach with the fears about their children b) Middle aaed Couples :- Common
regarding small penis, no erection and penis is problems for men are no sexual desire, no
not growing in size according to their ages. ercetion, week erection, premature ejaculation
Strangely parents requirc counsilling but not and no orgasm. For women no sexual desire,
children. I counsil and advise parents to read dysperunia, vaginismus and no pleasure in
my book sex Education which solve thier fears. sex. common causes are no foreplay in sex by
I warn parents not to express their fears be fore partners, diabetis, hyper tention, anxiety and
children because maiorityof youth sexual p r o b tensions in day busy life.
lems are due to poisinous seeds (negative I enlighten to couple the causes of their
feeling of sex) implanted in the minds of chil- sexual problems and teach them latest sexual
dren by parents and society. techniques and skills by showing films and
2. YOUTH : -(Students & Unmarried)- They photos. Sexual problems seems to be more in
approach with, the following problems-a) Small modern couples because modern husband is
Penis b) Failure in their maiden attempt with a after materialistic gain in the competitive world
prostitute (or) girl friend c) doubts about where as the modern house wife is no more
masturbation and Homo sexual habits d)STD passive in sex. This ultimately results in sexual
and AIDS e) Nightejaculation and f) for pre- problems. I give them a magic-T-formula for
marital I Counsilling. I counsill to clear their successful married life.'
doubts and advise them to read my sex educa- A) TRUST- Trust each other without suspicions
tion book which will make them perfect "man" B) TOUCH -Touching each other (not only in
for happy married life. bed room) while walking and sitting inT.V.
3. COUPLES :- room etc., C) TALK- Free communication at all
a) Newly married couplesand b) Middle levels without reservations and fears. D) TIME-
aged couples. Spend atleast one hour a day in bedroom
caressing each other. history taking, so that he does not miss patients
4. AGED GROUP : - The most common with sexual disfunctions. In India; if a person
problems among the aged people are "no has a sexual problem there is no qualified sex
desire and no erection" for males and painful counsillor available except in few cities. But lot
sex for females. He an't walk without a stick, of pseudo sex-specialists are present every
but he wants his penis to erect as if he was in where. I.M.A. must paln to start applied sexual
his twenties. I counsil them to accept the facts medicine subiect in medical colleges and di-
of old age yet without pouring cold water upon ploma courses in sex-counselling and therapy.
their spirits and teach them a few techniques to So that qualified sex therapist can be available
enjoy sex even without erect penis. even to common man. At the same time
TREATMENT : - Only sex counselling I.M.A.must bring pressure on Government to
and sex education i s sufficient for 85% of the ban quakery and sex clinics. If sex education
patients. 10%of the patients require surgical, starts at college level and good sexeducation
medical and HORMONE treatment 5% of the book are made available in market Liberally,
patients require psychiatrist's or urologyst's people con enloy "Happy Married Life".
help. Overall, after treatment majority of my
clients O.K.
CONCLUSION : The patients, with MAN CAN FIGHT WORLD WARS,
sexual problems, we are seeing is only tip CAN SWIM MIGHTY OCEANS, WIN ANY
of an "ICE BERG". Lot of people are suffering THING IN THIS WORLD BUT HE CAN'T FACE
silently without medical aid. Many people are A SINGLE SEXUAL FAILUTRE IN HIS BED
shy of coming even to their family doctors. ROOM THAT IS MALE'S EGO-CAUSE OF ALL
Doctor must be very careful and tactful in HIS SEXUAL PROBLEMS.
1
DR. (SMT).O. SURYAKUMAlPI
M.B.B.S., D.G.O. g
SpceCaCCty%'y?md@
BONES, JOINTS,POlIO, WEAVE DISEASES
69-5-13,GAIGOLUPADU CENTRE,KAKINADA - 533 005. Phone :75904
Managing Director :
Mrs. FEROZfl BEGUM
7-4-5, ~ e s h aSai Streel
Ramaraopet, kakinaaa - 533 004
Phones :76913 (H), 72200 (R)
Dr.D,V€NKATARAC
MODo,
(General Medicine)
r).NoBo (Cardiology)
Vijaya Nursing Home Building,
Jowahar Street, Salipeta,
HPHINRDP-533 001
I "PRECAUTION'SFOR HEALTH CARE 1
i
WORKERS IN THE AID'S RR *" 1
DR. M. ASHOK BABU, Professor & Head of the Department,
DR. M. GOPIKRISHNA, Assistant Professor
Department of S.T.D., K.G.H., Visakhapatnam.
In view of present pandemic of Hivin fection following are guidlines for the benefit of medical
b r e - r e s i j m e g v i h l m e forrureckut
~ ad msCpgrd&kersc - - ---- --
Yes - - No --
~
a. 7
- %#,MS.,
%d&$
Gen. Surgeon & Endoscopist
I
3 HOSPITALS
KAKINADA
Dr. KANTE DURGA,
M.B.B.S., D.G.O.
Dr. T.V.BALAKRISHNA, M.S.(Gen. s~rg.1
Dr. T. VIJAYANTHI, M.B.B.s.,D.G.o.,
I
: MAKERS OF :]
Riingaraya medical College Old Students' Association
(RAMCOSA)
Ex-Officio Advisers : Zonal Representatives :
Principal, R.M.C. Kakinada Dr. T. Gopala Krishna, Vizianagaram
Superintendent, G.G.H. Kakinada Dr. L. Karamchand, Gudiwada
President : Dr. K. Udaya Shankar, Tirupati
Dr. K.L.N. Ra-ju Dr. K. Krishna Swamy, Hyd
Vice-Presidents : Dr. P. Venkateswara Rao, Sec
Dr. P. Butchi Reddy Dr. P. Srinivasulu Reddy, Madras
Dr. P.S.N. Reddy, Vizag N.R.I. Representatives
Dr. N. Apparao, U.K.
Secretary : Dr. K.V. Ramarao, U.A.E.
Dr. G . Seshapiri Rao Dr. S.V.L. Fleming, West Indies
Joint-Secretaries : Dr. S. Suryanarayana Murthy, U.S.A.,
Dr. K.L. Sampath Kumar
Dr. S. Swami Naidu
Building Committee Convener :
Treasurer : Dr. A.V. Krishnam Raju
Dr. V . Satyadev
Past President :
Executive Members Head Quarters : Dr. P. Venkatarama Raju
Dr. P. Viswanadha Kumar
Dr. T.V. Balakrishna Past Secretary :
Dr. M. Sasikala Dr. S.S.C. Chakra Rao
Dr. U. Sudheer Past Treasurer :
Dr. K.S.N. Prasad Dr. D.V.S.S. Prasada Rao
Outside Head Quarters :
Legal Advisor :
Dr. P . Chandra Mouli, Mandapeta
V . Krishna Brahmam
Dr. B. Gangadhara Reddy, Guduru
Dr. P. s e t h i Babu, Hyd - Auditor
Dr. Y. Rajarao, Vijayawada B.V. Kameswara Rao
Convener: Dr.A.V.KrishnamRaju
Advisors : Principal, R.M.C., Kakinada
members : Dr. G. Pulla Rao Dr. Ch. Sornasundara Reddy, Ex MLA
Dr. M.S. Reddy Dr. M. Pedarattayya, MLA
Dr. V. Ravi Dr. K. Srinivas, E. MLC
Dr. Metla Satyanarayana Rao, Minister
Dr. Y .S. Kamalendranath Dr. I.S. Raju, Ex. MLA
Dr.(Mrs.)T.UmaDevi . Dr. K.V. Ramachandra Rao, Ex Member P.C.C.
Dr. K. Viswanadha Raiu, Member,Ex Governing Body, RMC
RANGARAYA MEDICAL COLLEC 1
SILVER JUBILEE COMMEMORATION AWARD
RECIPIENTS
Dr. RA.Jayakar :
A renowed Microbiologist and a good administrator was born in 1938
at Rajahmurzdry. He had his early education in Bhimanvaram. He
obtained his M. B. B.S degree in 1959. and D. C.H. in 1961form Ahdhra
Medical College Visakhapatnam. He Joined govt. service in 1962 and
worked at variousplaces. He obatined Masters Degree in Microbiology
in 1967. He is promoted as Professor arzdHead of the dept. of
Microbiology in 1975. From 1986 to 90 hte worked as Professor of
Labaratory Medicine at Arab Medical University in Libya. After
woriking in various Capacities in Vijayawada and Kakinada, he was
promoted as Principal and Additonal Director in 1994 and worked at
Kurnool till Feb 95. he worked as Principal of the institution till Dec 95
and then at Andhra Medical College till the day of his retirment in
Marcht96. he was a member of many academic bodies and was an
examinerfor several universities. It is gratifying to note that he had 25
research papers to his credit.
Sri R K. R. M. Sarma
Popularly kizown as N.C.C.Sarma garu in Rangaraya Medical College,
obtained his Master's Degree in applied P h y s w o r m Andhra University
with distinction in 1956. He started his career as Radio Supervisor in
state Broad Casting Department but resigned to take up teaching
profession. He joined as Assistant Lecturer in Rangaraya Medical
College in Julyt59. Later he became Lecturer, waspomoted as the head
of the depratment of physics in 1973 and worked in that capacity till
1984. As the pre professional Cours was been bolished and the college
taken over by the government he was transferred to the education
department andworked as the head of the department of physics at
Tadepalligudem and Rajahmundry. He was promoted as Principal
Degree college Baruva in 1990 and retired from service in Septt94.
Even now to satisfy his he is inner wige still continuing the art of
teaching.
Dr. U.Ramakrishna Rao
Who retired as tutor in physiology in Nov'96 from Rangaray Medical
College was bron in 1938. He was a 3rd batch Rangarayan and
obtained M.B.B.S. Degree from this institution in 1967.
He started his career as Civil Assistant Surgeon in 1969 at
S.V.Medica1 CollegeTirupathi. He worked till 1979. He obtained his
Diploma in oborhino Lungageology in 1980from RMC and worked as
tutor in various department like pathology, Radiology, Biochemistry
etc., till the date of his retiremet.
Dr. (Mrs)M.Saraswathi
Wife of Dr.M.Ramakrishna Raju the founder President of Ramcosa
was associated with Rangaraya Medical Collegefor over 3 decades as
a teacher. She was born in 1938at Nidubrolu of West Godavari Distirct.
' ' She was a first Bactlt Rangarayan. She obtained her M.B.B.S Degree
1964 and joined the staff of Rangaraya Medical College in 1965 as
i' s
. ,
g
;
biochemistry tuor. (She took her M.D.Degree in bi@chemisttyin I980
from RMC. She was assistant Professor till 1986, Became professorof
Biochemistry in 1986 and worked in that capacity at G.V.Medica1
College and Guntur Medical College. In june'91 She was transferred
to this Institution and worked as Professor of Biochemistry till her
retirement in July'96
.&RlIhPr(7r?@
7
efi
Y k#/
C Z;/
& 9i-B-
Dr. S. Kotewsara-Artld' "
-'
' A\*
was born on lstNov'39atgollaprolu. He wassecond batch Rangarayan.
he was the Drametic secretary during the college days. He wcas B e
secretary, president in various assocations and orgaakations. We
I
Dr. B.Anasuya
Presently working as Regional Director of Medical and Health Services
at Rajahmundry. She was born in the year 1941. She joined the
Rangaray Medical College in 1959. Obtained her M.B.B.Degreein
1965. She joined the A.P.Mediea1 and health Services i n 1966
andwerkedas a woman assistant surgeon in variousplaces of Westand
East godavari Districts. She was promoted as deputy civil surgeon in
Oct 90 and Civil surgeon in NQV1995 as Zonal Malaria Offlicer.
Dr. R. KSeshavatharam
Wasborn in 1944. He was a 4th batch rangarayan and utter obtaininig
his M.B.B.S.Degree he joined the Staff of Rangararaya Medical
College and after obtaining his M.B.B.S Degree he joined the Stagof
Rangaray Medical College in 1970 as tutor in Anatomy. He obtained
his Master's Degree in Anatomy in 1979 from Rangaray Medical
College. He was Assistantprofessor ofAnatomyfrom 1979 to 1994 and 1
becameprofessor of Anatomy in 1994. It is a matter ofpleasure that his
son Dr.R.B. V.Sudha was also a student of this institution. 1
Dr.M.Prahakara Rao
Was associated with Rarrgaraya Medical College for two and half
decades. Born in 1942. he took his M.B.B.S.Degree from Kasturba
College Manipal in 1968. Hejoined this instituiton as tutor of Anatomy
in 1970. He obtained M.S.Degree in Anatomy in Aug'80 from this
institution and was Assistant professor of Anatomy from 1980 to 1995
He became professor in Feb'95, He is presently working as professor
and Head of the Department ofAnatomy at Siddartha Medical College,
Vijayawada.
Dr. RRambabu :
Professor of S.T.D. in Siddhartha Medical College Vijayawada was
born orz 16-6-1955. He obtainedhb M.B.B.S.degree in 1978. He didhis
postgraduation in Venereology froin Osmania Medical College in
1984. Starting his career asassistant professor at Siddhatha Medical
College, Vijayawada and got promoted in 1990 as a Civil Surgeon
speciulist.
Dr. ;I:C.Varghese
A good paediatrian Dr. Varghese was born in 1939. His father Sti
Chacko was a famous botainst and former Principal of P.R.Govt.
College, Kakinada. Dr. Vargese had his early Schooling at Kakinadd.
he obtained his M.B.B.S.Degree in1964 and D.CH in 1969 from
Andhra Medical College. He joined the stag of Rangaraya Medical
Collegeas tutor in Pharmacology in 1970. He obtained Masters Degree
in Paediutricsform Rangaraya Medical College in 1980. He rejoined
the S t a f f f this institution and worked in Pharmacology andphysiology
Departments. He became Assistantprofessor of Paediatricsin 1984 and
was promoted as professor of Paediatric in Jan'96. He presented many
papers in various conferences.He isa goodsportsman and he represented
Andhra Medicaly College at the Inter Collegiate Cricker meet and
bagged many prizes.
2,651-00
Investment as Fixed Deposit 65,000-00
Balance in the Savings Bank Alc.
on 31-3-95 705-00
- 68,356-00
,s7
. Kakinada SECRETARY TREASURER AUDITOR
' Dt. RAMCOSA RAMCOSA
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DETAILS OF FIXED DEPOSITS OF RAMCOSA AS ON 31-4-1 995
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(iii) Vijaya Sree UnitsVSU. 093753 No. 100095194 Maturity date 12-2-96 O 10%
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+
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8 . .
iv) FDR. No. 0235671 91 I708 Maturity date 23-11-96 O 13%
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v) FDR. No. 416370 901502 Maturity date 29-1-96 O 11%
&:' vi) FDR No. 046805 - 94/l80 Maturity date 5-8-95 O 10%
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viii) FDR. No. 308447 - 941611 Maturity date 13-5-95 8 8%
. , ix) FDR. No. 478738 - 95/83 Maturity date 5-8-95 8 9%
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8
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Total 3,89,238/-
TREASURER
RAMCOSA
RAMCOSA INCOME & EXPENDITURE STATEMENT FOR THE YEAR 1994-1995
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Treasurer
RAMCOSA
-
ISORIFAZIN-S
ISORIFA-450
*
rC '
rn MALAQUIN (TabslSyp.)
Siko (Chloroquin)
jg;:;*
#' QUINAPRIM (2.5 mg, 7.5mg., 15 mg. Tabs)
-it,: (Premaquin Phosphate)
* METASULFIN (Tabs)
(Sulphadorin + Pyrimetharnine)
i3:.+ 7.: rn
-% * RUBIQUIN (Tabslinj)
(Qunine Sulphate)
W e also extend our thanks to the Pharmaceutical Companies for exhibiting their stalls
and making the show more colourful
1. M/s Uni Sankyo Limited, Hyderabad
2. M / s Cross Lands Research Laboratories Ltd., Bombay
3. M/s Sun Pharmaceuticals
4. M / s Blue Cross
5 . M/s Aristo Pharmaceuticals Ltd., Hyderabad.
6. M/s Biological E.Limited, H ~ d e r a b a d
7. M / s Core health care Ltd., ( Therapy Division) Ahmedbad.
A Special word of thanks to :
Dr.k.Ragini
We earnestly thank
Staff a n d Students of R.M.C., G.G.H
M / s Vinar Paper M a r t \
IN MEMORIUM
Dr.CHUNDZ MASTAN RAO
Dr-nurstan rao, Passed away quite suddenly on 7th Nov'95 at a very
young age of 47.
He was graduated from rangaray Medical College and then
obtained MasterlsDegreein General Medicinefrom Andhra Medical
College. He worked as Assistant Professor of Medicaine at Andhra
Medical College. He resigned the job in 1987 to set up Ph'vate
Practice.
He was founder president of Ramcosa north costal Adhra
Zone and donated Rs.l0,000 towards Ramcosa building fund d
took active part in raising building fund of over 1 luck rupees.
As aman, Dr. Mastan Rao wasfork right andfrank& the same
time those who came close to him greatly appreciated his sense of
loyalty, Fairness andsubtle humour.lt will not be easy toforgeta man
of such nature.
FACILITIESAVAILABLE
mares: 66434(FM? h)
S W A T AHOSPITALS
~
(Multi Specialities) Rn. Ltd.
Near Kambala Tank. Rajahmundry 5 -
CIPIC
(Ciprofloxacin 250fiOOmg Tablets)
TbPick of all Antibadert'als
.-
(Amoxycillin Caps & Distabs)