Indian Journal of Neonatal Medicine & Research

Study of Cystic Neck Swellings Over A Period of 5 Years

Darshan Goyal

Background and Aim: The swellings in head neck region are of great clinical significance. The pathology of swellings may vary from cysts, benign tumours and malignancy to metastatic tumours. So, these neck swellings are a great dilemma to surgeon for diagnosis and treatment. The aim of present study is to diagnose the different types of cysts out of total head neck swellings because these cysts are commonly present in head neck region . Materials and Methods: In this study 100 patients of different cystic neck swelling were studied over a period of five years from 2008-2013 to compare the findings with clinical diagnosis, FNAC and histopathological report for its diagnostic reliability. This study was done in ENT department of GGS Medical College and Hospital Faridkot . Patients of 1-70 yrs age were taken for study. History of patients was taken, clinical examination of swelling was done followed by FNAC and histopathology examination of postoperative specimen of neck swelling. Results: The analyzed data was presented by various tables. Out of these 100 cases of neck swellings 40 cases were of various cysts. 16 were males and 24 were females. The male, female ratio was 1:1.5. Age range was 1– 70 years with maximum frequency in the 1-30yrs of age. Clinical, cytological and histopathological diagnosis was done in all the cases. Out of the cases studied 50% were thyroglossal cyst, 25% were Epidermoid cyst, 15% were dermoid, 10 % of total were brachial cyst, retention cyst and ranula. Conclusion: It is concluded that head and neck swellings are very common conditions encountered. Our study found that simple clinical examination followed by FNAC and histopathology is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swellings. In this study out of different head and neck cystic swellings thyroglossal cyst was most common followed by dermoid cyst.

Management of Uterine Leiomyoma at A Tertiary Care Hospital

Archana Sinha, Minu Sharan

Introduction: Fibroids or leiomyomas are benign slow growing tumors arising from smooth muscle, usually of the uterus, though it may arise from any of the organ having smooth muscle as its content. They are one of the commonest tumors affecting women of reproductive age group. Only about 30% of women diagnosed with fibroid become symptomatic. Aims and Objectives: The aim of our study was to evaluate uterine leiomyomas, their varying presentations and the treatment options available at our centre, a hospital of eastern India. Materials and Methods: This retrospective study was conducted in the Department of Obstretics & Gynaecology, IGIMS Patna, India, during August 2013 to September 2014. Fifty women diagnosed with uterine leiomyoma elsewhere and referred to us, were included in the study group. Patients were managed medically and surgically depending on age, parity ,desire for future pregnancy and severity of symptoms.The diagnosis of fibroid was confirmed post operatively by histopathological examination of the specimen in surgical patients. Conclusion: This study reconfirmed that uterine fibroid though asymptomatic in majority, can be mysterious in its presentations in few patients leading to diagnostic dilemmas. In this study we got some interesting locations like broad ligament fibroid & cervical fibroid confirmed on laparotomy. Also the myriad of treatment options available are very helpful to patients in choosing what would be best for them.

Outcome of Early Cpappap in the Management of Respiratory Distress Syndrome (RDS) in Premature Babies with < 32 Weeks of Gestation, A Prospective Observational Study

R.V.Jeya Balaji,P.K.Rajiv, Vaibav K Patel, Mathew Kripail

Background: Controversies still exist in the management of Respiratory Distress Syndrome (RDS) in Premature infants. The standard treatment of Intermittent positive pressure ventilation (IPPV) with surfactant therapy may not be the ideal intervention in resource limited settings like India, considering the invasive nature, higher cost and high risk of chronic lung disease. Even though early CPAP therapy has been shown to be successful in many clinical trials in the management of RDS, studies documenting the outcome of early CPAP therapy are very scarce in India. Aims: To assess the outcome and incidence of various adverse outcomes of early CPAP therapy in premature neonates with = 32 weeks of gestation, in a tertiary care teaching hospital Materials and Methods: The study was a prospective observational study, undertaken in neonatal care unit of a tertiary care teaching hospital, located in Kochi, Kerala, between January 2007 to December 2010. All the eligible children were included in the study, no sampling was done. Statistical Analysis: Quantitative variables were presented is mean and standard deviation, categorical variables were presented as frequency and percentages. 95% CI for the primary outcome measures were assessed using Z-test. Results: Seventy premature newborn with < 32 weeks of gestation were included in the final analysis. Majority of the cases received bubble CPAP. The incidence of CPAP failure was 30% (95% CI 19.3% to 40.7%) in study population. The proportion of neonates who required surfactant was 18.6% (9.5% to 27.7%), Who developed ROP was 37.1% (25.8% to 48.5%) and the proportion of children, who met with mortality was 7.1% (1.1% to 13.2%) Nasal Trauma, Hypotension, Intra Ventricular Hemorrhage and CPAP belly were the most common complications, occurring in 80% (70.6% to 89.4%), 11.4% ( 4% to 18.9%) and 10% (3 % to 17%) of neonates each respectively. No case of pulmonary hemorrhage was reported. Conclusion: Early institution of CPAP in the management of RDS in premature neonates, can significantly reduce the need for mechanical ventilation (MV) and surfactant therapy, with minimum associated complications.

Twin to Twin Transfusion Syndrome (TTTS): An Interesting Entity in Twin Pregnancy

Srinivas Prasad RH, BV Balakrishna, Ankur Aneja, Vikram N R, Kudva N

Twin-Twin transfusion syndrome (TTTS) is a condition with high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosis and treatment. Early diagnosis during antenatal ultrasound is very important in reducing the morbidity and mortality rates. TTTS is a phenomenon exclusive to monochorionic twin pregnancies. The donor twin is characterized by oligohydramnios or anhydramnios, growth restriction and abnormal umbilical artery by Doppler velocimetry. The recipient, on the other hand, is characterized by polyhydramnios, abnormal venous dopplers, cardiac enlargement /failure, and eventually hydrops. Sonologists while evaluating the monochorionic twin should have high index of suspicion for TTTS. The present study reports a classical case of TTTS which was detected accurately by ultrasound and managed efficiently resulting in birth of healthy twins.

Streeter Dysplasia in Association with Cleft Palate: A Case Report

Fairy Susan Varghese, Sunil. K. Agarwalla, Shantanu Kumar Meher

Streeter dysplasia, a synonym of Amniotic Band Syndrome (ABS) is a wide spectrum of complex, controversial congenital anomalies. The disease varies in its severity which can range from a simple constriction ring to more severe and lethal forms like limb body wall complex or acalvaria .The usual manifestations include constriction rings around the digits, arms and legs, amputation of digits and limbs, club feet, club hands, etc. Here, we report a case of amniotic band syndrome with multiple digit anomalies and a cleft palate.

Renal Vessels: Anatomical Variations

Anju Bala, Arvind Deswal

Variations of renal vessels are more significant due to gradual increase in interventional radiological procedures, urological and vascular operations and renal transplantation. Usually, the renal arteries take origin from the lateral aspect of aorta below the origin of superior mesenteric artery at the level of L2 vertebra. During routine dissection of 60-year-old female cadaver, we found double renal arteries with double renal veins for the right kidney and in the left kidney, there were double renal arteries and two renal veins coming out from the hilum and they joined to form the main left renal vein, which passed in front of the aorta. The incidences of variation of renal arteries are about 30%. Knowledge of the unusual variations of the renal arteries is necessary for selection of kidney donor as well as during nephrectomy and segmental resection and could help the clinician in its prior recognition and due protection accordingly during renal surgeries.

Imaging of Osteochondromas Suspected of Malignant Transformation

Kumar Venu Madhav Ramavathu, Swapndeep Singh Atwal, U.C.Garga

Osteochondroma is regarded as the most common benign osseous neoplasm, which is a developmental anomaly, rather than a true neoplasm. Findings such as increase in size of a previously stable osteochondroma, irregular or indistinct margins, development of areas of lysis or erosions, or a soft tissue mass with or without foci of calcifications on radiography or Computed Tomography (CT) are suggestive of malignant transformation. Magnetic Resonance Imaging (MRI) is useful in demonstrating pressure effects on adjacent soft tissues and in detection and characterization of cartilaginous cap, which when measures more than 2cm in thickness is highly suggestive of malignant transformation.

Wernicke’s Encephalopathy: MRI Features

Ramakrishna Narra, Mary Varunya Jehendran, Suseel Kumar Kamaraju

Walking Man with A Large Heart

Raghavendra Bhat, Parul Kodan, Meenakshi Shetty