Indian Journal of Neonatal Medicine & Research

Study of Femoral Neck Anteversion and its Correlations in Bengali Population

Moulik Debnath, Sudipto Konar, Piyali Kundu, Madhumita Debnath

Introduction: Anteversion is defined as the angle by which the femoral neck deviates forward from the axis of the femoral condyles. The angle of anteversion of the femoral neck varies widely. So, it is important to know the angle of anteversion in a particular population. The accurate estimation of femoral neck anteversion in living subjects has always been difficult, with many shortcomings and lack of reproducibility. Aim: To estimate the average angle of femoral neck anteversion in Bengali population and to find its correlations with gender, side and stature. Materials and Methods: Unpaired 100 dry femurs, 54 of male (33 right and 21 left) and 46 of female (17 right and 29 left), devoid of any gross pathology were used to measure the femoral anteversion angle by parallelogram method. Maximum femoral length was measured by using osteometric board and the data were statistically analyzed. Results: Mean angle of anteversion was 20.05° irrespective of sex and side. In case of male mean value for right side was 18.3° and for left 21.61°. Mean values in female were 19.4° for right side and 21.67° for left side. Though in both males and females the mean values were higher in left sided bones; statistically significant difference was found in case of males only (p < 0.05). However, no statistically significant difference (p > 0.05) was found for the angle of anteversion between the male and female bones in the present study. A statistically significant correlation was found between angle of anteversion and maximum femoral length in both sex and sides with a p-value of < 0.01. Conclusion: The data established in this study will be useful for various orthopaedic procedures. Operative principles of hip prosthesis that capitalize on an impingement-free range of motion, achieving stability and preventing wear embrace an optimal femoral anteversion. This study will also be helpful in the fields of paleodemographic or other population studies and forensic anthropology

A Morphometric Study of Sacral Hiatus and its Importance in Caudal Epidural Anaesthesia

Md. Jawed Akhtar, Nasreen Fatima, Ritu, Avanish Kumar, Vinod Kumar

Introduction : The caudal epidural anaesthesia is a process in which medications are injected into epidural space to provide analgesia and anaesthesia in various clinical procedures. The technique of caudal epidural block entirely depends upon exact localization of sacral hiatus through which clinicians access the epidural space. The precise knowledge about different anatomical variations related to the sacral hiatus increase its success rate. Aim: To study the different anatomical variations and morphometry of the sacral hiatus in the population of Bihar that is useful in caudal epidural anaesthesia. Materials and Methods: The present study has been carried out on 124 undamaged adult human sacra of which age and sex were not predetermined. Only fully ossified, dried, macerated and thoroughly cleaned sacra which were complete in all respects, in order to give the correct observations, were included in the study while the sacra having any deformity or pathology were excluded. The different metric parameters were measured with the help of digital vernier caliper. The various shapes of sacral hiatus was also observed. The software GRAPH PAD PRISM version 4.03 is used for statistical analysis of data. Results : The most common shape of sacral hiatus recorded in the present study is Inverted U (44.36%) followed by Inverted V (35.48%). The least common shape is bifid (4.03%). In 2.42% cases sacral hiatus is absent. Apex of the sacral hiatus is mostly seen at the level of 4th sacral vertebra (71.77%), while base is commonly located at the level of 5th sacral vertebra (79.84%). The mean length of sacral hiatus is 26.92 ± 12.91 mm. The mean transverse width and mean anteroposterior diameter of SH at the apex are 12.14 ± 3.89 mm and 5.39 ± 1.96 mm respectively. Conclusion : The different variation of shape and size of sacral hiatus should always kept in mind while giving caudal epidural anaesthesia and analgesia. These variations may occur due to different genetic and racial factors.

Measurements of Hand and Foot – A Predictor of Stature in Adult Human Population of Uttar Pradesh

Rati Tandon, Syed Mobashir Yunus, Nafis Ahamed Faruqi, Adil Asghar

Introduction: The stature of human can be easily determined by femoral length, cephalometric measurements and other long bone’s length. In many studies, use of soft tissue measurement like lower limb, upper limb and arm span also well correlated with height of the person. Aim: To investigate the association of hand and foot length with height and prediction of height using hand and foot morphometrics. Materials and Methods: 238 males and 259 females in the age group of 18-30 year were considered for measurements: height, hand morphometrics and foot morphometrics. Stadiometer was used to measure the height. All morphometric measurements analyzed by SPSS. Results: In females, stature varied from 140.500 to 180.00 cm with mean value of 157.199±6.244 cm. In males, stature varied from 159.00 to 190.00 cm with mean value of 172.742 cm ±6.110 cm. The mean height of subject is 164.642 ± 9.926 cm. The mean hand length, hand breadth, middle finger length, thumb length, foot length and foot breadth are 18.304 ± 1.458cm, 7.757 ± 0.688 cm, 7.528 ± 0.597 cm, 6.092 ± 0.543 cm, 24.728 ± 1.927 cm, and 9.402 ± 0.819 respectively. Conclusion: Foot length is better predictor of stature than hand length. Using regression formula the height of subject can be easily determined and this will be used as research tool in anthropological and medicolegal issues.

Trans Urethral Resection of Prostate for Symptomatic BPH in Rural Area

Amit Kumar, Devendra Kumar Shiwach

Introduction: Benign Prostatic Hyperplasia (BPH) is quite a common disease in the older male with increasing incidence with age. Many patients require surgical treatment and presently TURP(Trans Urethral Resection of Prostate) is considered the gold standard in surgical management of bladder outlet obstruction but is still not routinely available in most resource poor areas. Aim: To observe and assess the outcome of TURP being done in our institution hospital which is situated in rural area and catering mainly to the surrounding region. Materials and Methods: The records of patients who presented to the surgical OPD with LUTS and were assessed to undergo TURP for prostatic hyperplasia. We present our experience with series of 47 patients and posit that TURP can be used for most patients presenting with BPH in peripheral areas. Results: In the study period 47 TURP procedures were performed for BPH. The mean age of the cohort was 67.9 years;( ranging from 56 to 84 years). The mean prostatic volume was 44.06 grams (range 32 to 76 grams) and mean operating time was 48 minutes (range 29 to 85 minutes). Blood transfusion was required in 3 patients (6.3%). No patients required open intervention and there were no mortalities. The common complications were bleeding (12%), UTI and clot retention. Conclusion: TURP is not available to majority of rural population having symptomatic benign prostatic hyperplasia (BPH) due to lack of facility but remains the treatment of choice provided trained surgeons and facilities are there. The overall cost of TURP is marginally higher for an average rural patient as compared to open surgery but is worthwhile in view of its inherent minimal trauma, short hospital stay and early recovery and huge cost advantage over newer therapies like HoLEP or PVP.

Survival of Split Thickness Skin Graft in Diabetic and Non-diabetic Wound Management

Introduction: Split skin grafting is widely used surgical procedure for the treatment of ulcers. Graft survival depends on number of factors like vascularity, wound infection etc. diabetes is associated with endothelial dysfunction, neuropathy, wound infection which collectively affect the graft survival. Aim: To compare the amount of graft uptake, the post operative complications and survival of split thickness skin graft in diabetic and non diabetic wound management. Materials and Methods: In our prospective non-randomized comparative study total 104 patients with ulcer were included of which 52 were diabetic and 52 were non-diabetic. All of them underwent split skin grafting as part of their wound management. Comparison was made between two groups in terms of amount of graft uptake, post operative wound infection, re-ulceration, revisional surgery, donor site infection. Results: Average wound surface area in diabetic group is 42.31 cm2 and average graft uptake is 23.67 cm2, in non-diabetic group average wound surface area is 78.06 cm2 and average graft uptake is 64.06 cm2. Compared with non-diabetics, diabetics have significantly less graft uptake (p<0.001). out of 52 patients in diabetic group 10(19.3%) underwent revisional surgery, out of 52 patients in non-diabetic group 2(3.85%) patients underwent revisional surgery (p value is <0.05) which is statistically significant. 3(5.8%) out of 52 patients in diabetic group developed re-ulceration, 1(1.9%) out of 52 in non-diabetic group developed re-ulceration (p >0.3, not significant). 13(25%) out of 52 in diabetic group developed post operative graft infection, 7(13.5%) out of 52 in non-diabetic group developed graft infection (p > 0.1, not significant). None of the patients in the study developed donor site infection. Conclusion: Diabetes is associated with poor graft survival and high post operative complication rates in patients undergoing split skin grafting.

Liver Abscess – A scourge of the Tropics

Sharad Seth, Seema Seth

Introduction: Liver abscess defined as a collection of pus within the liver parenchyma continues to remain a scourge for the population in our limited resource area. Amoebic and pyogenic etiologies predominate. Despite radiological advancements, minimally invasive therapeutic measures and availability of effective antibiotics, morbidity and mortality continue to remain high in cases of liver abscess. Aim: The present study was carried out to document the various modalities of diagnosis and treatment of liver abscess in our set up and to study what changes may have occurred overtime in these parameters. Materials and Methods: This prospective study was carried out in the Departments of Surgery and Medicine, Rohilkhand Medical College and Hospital, Bareilly between 15th September 2014 to 15th September 2015. Thirty five newly diagnosed patients of liver abscess confirmed by imaging and aspiration were included in this study. Demographic data, clinical presentation, radiological findings, management, hospital stay and follow-up of all patients was entered in a predesigned proforma for this purpose and a proportional analysis of the data was done using SPSS software version 15. Results: Liver abscess was commoner in males 32(91.4%) as compared to 3(8.6%) female patients. Amoebic liver abscess was the cause in 20(57.15%) patients the rest 15(42.85%) were those of pyogenic liver abscess. Haematogenous spread from a septic focus was the commonest source for 8(53.33%) of pyogenic abscesses. 21(60%) of all the abscesses affected the right lobe of liver. Pain in the right hypochondrium/epigastrium was the commonest symptom in 28(80%) patients. Ultrasound of the abdomen with a sensitivity of 91.42% and CECT abdomen with a sensitivity 100% were the diagnostic modalities of choice. All patients of amoebic liver abscess received metronidazole and the commonest additional measure was needle aspiration in 10(50%) of patients. Appropriate antibiotic with needle aspiration was also the commonest procedure in 8 (53.33%) of patients with pyogenic liver abscess. Conclusion: Amoebic and pyogenic liver abscesses continue to plague the poor population in our region. Antibiotics and ultrasound guided percutaneous needle aspiration which provides immediate pain relief are effective treatment for both.Clinical progress of the patient rather than blind reliance to ultrasound findings of an abscess cavity which may take up to three months to resolve should guide therapy.

Magnetic Resonance Cholangiopancreatography (MRCP) in the Evaluation of Pancreaticobiliary Tract in Gallstone Disease

SN Singh, Trilok C Bhatt

Introduction: MRCP (Magnetic Resonance Cholangiopancreatography) has rapidly gained ground and has now firmly established in the evaluation of the biliary and pancreatic ducts. It often aids in the assessment of causes of biliary obstruction and can be helpful in the evaluation of the pancreatic duct without the inherent invasiveness of an endoscopic procedure. In view of limitation of USG and CT and invasiveness of PTC, IVC and ERCP there is need for an imaging modality which is non invasive and provides high resolution projection images of the biliary and pancreatic duct. Aim: The aim of this study was to prospectively assess the accuracy of MR imaging and correlate it with ultrasonography. Materials and Methods: This study included 50 patients who had undergone MRCP prior to cholecystectomy for symptomatic gallstones. There were 23 males and 27 female patients, ranging in age from 8 to 87 years (mean, 63 years). Results: The predominant population in our study was adults ranging from 30 to 50 yrs of age. Majority of patients presented with epigastic pain and vomiting. The percentage rate of detection of gallstones and CBD stones were 89.75% and 76.19% on USG respectively. The same for MRCP was 87.18% and 95.24% respectively. MRCP showed high positive predictive value in diagnosing choledocholithaisis and diagnosing hepatobiliary lesions. Conclusion: MRCP now readily permits the study and evaluation of anatomy and pathology of the pancreaticobiliary tree including pancreatic duct very easily and is accurate, non-invasive and non-ionizing imaging method of pancreaticobiliary anatomy and pathology. Our results demonstrate that preoperative MRCP had a robust safe guarding effect on laparoscopic cholecystectomy and deserves further promotion. These results were also sited in other recent studies.

Clinical, Radiographic and Magnetic Resonance Imaging Evaluation of Cervical Spine Trauma

Aditi Himaunshu Dongre, Atul Tukaram TaTayade, Sushil Kumar Kale

Introduction: Cervical spine trauma occurs in 1.5 to 3% of patients with major trauma and in 10% of patients with major trauma and serious head injury. Imaging plays an important role in the diagnosis of spinal injuries. The various modalities used to evaluate cervical spine are plain radiography, computed tomography, CT myelography, intraoperative sonography and magnetic resonance imaging. Aim: This study compares the usefulness of conventional radiography and MR imaging in the diagnosis of acute cervical spine trauma. Materials and Methods: This prospective analytical study was carried out on 58 patients with history of cervical spine trauma. Evaluation was done on plain radiography and MR imaging. Findings were recorded on both the modalities and clinical correlation was done. Results: In this study, 94.83% were males. Hyperflexion injuries were seen in 37.93% patients.C6 vertebral fracture was seen in 12% patients. Herniation of the disc was commonly seen at C4-5 and C5-6 disc level on MRI. 64 levels were found to be affected with simple cord edema. Conclusion: MRI combined with plain radiographs provides an accurate and non invasive modality for evaluation of patients with cervical spine trauma.

Role of High Resolution Ultrasonography and Color Doppler in Assessment of Thyroid Swelling in Correlation with USG Guided FNAC

Aeshita Singh, Pratapsingh H. Parihar

Introduction: High resolution US is the imaging modality of choice to investigate the thyroid nodules. When multiple characteristics of thyroid malignancy appear in combination, US help to make an accurate diagnosis. Fine-needle aspiration cytology may help in further assessment of the thyroid swelling. Aim: Ultrasound and Doppler evaluation of thyroid swelling with differentiating benign and malignant lesions on basis of ultrasonographic characteristic and by USG guided FNAC and to determine specificity, sensitivity and efficacy of high resolution ultrasound and guided FNAC as a pre-operative tool. Materials and Methods: Total of 60 patients (10 males and 50 females), with 60 nodules detected by USG from July 2014 to September 2015. The characteristic of each nodule were determined and correlated with FNAC diagnosis. Results: Out of 60 nodules examined, 12 (20%) were found to be malignant on FNAC. The malignant nodules demonstrated following characteristics- solid or predominantly solid (sensitivity 75%, specificity 63.82%), presence of micro calcification (sensitivity 83.33%, specificity 82.97% ), irregular or poorly defined margins (sensitivity 83.33%, specificity 95.74%) , taller than wider (sensitivity 75%, specificity 82.97% ), and markedly hypo-echoic (sensitivity 66.67%, specificity 66.67%). There were 33.33%, malignant nodules found in males and 66.66% in females. Conclusion: Ultrasonographic and Doppler characteristic shows high accuracy to differentiate between benign and malignant nodules. USG guided FNAC can be used as preoperative diagnostic tool for management of thyroid swellings.

Clinico-epidemiological Study of Cutaneous Findings in Neonates in a Hospital Setting in Nepal

Sahisnuta Basnet, Brijesh Sathian, Ajay Kumar, Tejesh Malla

Introduction: Though cutaneous manifestations in the neonates are a common occurrence, its frequency has not been well documented in the Nepalese population. Majority of the lesions present in this age group are benign and transient but some require further attention. It is important to differentiate the presence of benign cutaneous manifestations in the newborns from the more serious dermatoses which need additional management. Aim: To determine the patterns of various cutaneous manifestations in a sample of Nepalese neonates and to report the relationship of the commonest dermatoses with neonatal variables . Materials and Methods: This was a cross sectional descriptive study, where we sought to determine the various types of cutaneous manifestations in 504 newborns who were either delivered in the Department of Obstetrics and Gynaecology or admitted in the NICU of Manipal Teaching Hospital, Pokhara, Nepal. Results: The commonest skin lesions seen were: Erythema toxicum neonatorum (34.1%), physiological jaundice (32.7%), Mongolian spot (28.8%), Milia (23.6%), Epstein pearl (18.8%) and Lanugo hair (17.5%). Erythema toxicum neonatorum, jaundice, Mongolian spot and Lanugo hair were found to be significantly related to birth weight (p<0.05). The presence of physiological jaundice was significantly higher in neonates delivered vaginally whereas Epstein pearl was observed more in babies born through caesarean section. Positive correlation was noted between Erythema toxicum neonatorum, Mongolian spot and Epstein pearl with the race of the baby. Conclusion: In this study we found that the majority of the skin lesions seen among the neonates were benign and transient. With this study we intend to increase the awareness of the various skin lesions in neonates among the paediatricians to enable them to treat or reassure the parents.

Ultrasonographic Evaluation of the Neonatal Brain in Cases of Birth Asphyxia

Susmita Giri, Tapan Kumar Jana, Arunabha Tapadar

Introduction: Hypoxic ischemic encephalopathy (HIE) is a common condition in newborns as a result of birth asphyxia.Affected neonates display a number of clinical features by which the condition may be suspected. Aim: To study the different varieties of gross anatomical defects of the neonatal brain in cases of HIE as seen by ultrasonography. Materials and Methods: Ultrasonography (USG) of the neonatal brain was done in 100 cases of hypoxic ischemic encephalopathy (HIE) during the first and second weeks of life, through anterior, posterior and mastoid fontanelles. The results were analysed to display the spectrum of abnormalities in the affected babies. Results: A large proportion of the neonates had a normal study (47%), followed by intracranial haemorrhage (24%), cerebral oedema and infarction (17%), dilatation of ventricles (5%), and others (7%). Conclusion: Intracranial haemorrhage is the commonest consequence of hypoxic ischemic encephalopathy. The large number of normal studies shows the need for combining ultrasonography with other imaging modalities in selected cases.

Anorectal Malformations and Posterior Sagittal Anorectoplasty- A Prospective Study for a Period of One Year in North-West Punjab

Amarjit Singh Kuka, Nishan Singh, SP Singla, Pushpinder Singh Kuka

Introduction: Anorectal Malformations (ARM) have enormous impact on the patient’s quality of life. It is not only a surgical challenge but also a shocking event for parents and whole family. Despite of advances in field of surgery, it challenges the wisdom and expertise of surgeons. Aim: To determine the incidence of ARM in North West Punjab and to evaluate the success of different types of surgeries such as Posterior Sagittal Anorectoplasty (PSARP), Anterior Sagittal Anorectoplasty (ASARP) and cut back anoplasty. The prevalence of bowel continence after surgery for high or low ARM was also studied along with proportion of cases requiring colostomy. Materials and Methods: A prospective study was done in thirty (30) patients having ARM in North-West region of Punjab, admitted over a period of one year. In low varieties of ARM, the primary surgery was done at the time of presentation. In high and intermediate varieties, primary defunctioning colostomy was done at the time of presentation followed by definitive repair later. In majority of patients definitive repair was done by PSARP, in few cases by ASARP and very few cases PSARP combined with Abdominal pull through approach. Colostomy closure was done after 4-6 weeks of regular anal dilatation. Results: The male to female ratio was 1:1, with 60% patients presenting in neonatal period and 40% in post neonatal period. The level of lesion was high in 46.66%, intermediate in 13.33%, and low in 30% patients. Cloaca was seen in 10% of cases. The common presenting symptoms were not passing meconium since birth (50%), absent or abnormal anal opening, vomiting (13.33%) with increasing abdominal distension (26.66%), excessive crying and passing of thin pipe stools with constipation (23.33%), passing stools through vagina (13.33%) or urethra (3.33%) or an abnormal opening elsewhere in the perineum (20%). Associated urogenital anomalies were seen in 13.33% cases. Other anomalies included Meckel’s diverticulum (6.66%), pouch colon (3.33%), bicornuate uterus (3.33%) hypospadias with meatal stenosis (3.33%), undescended testes (3.33%), Inguinal hernia (3.33%), bilateral choanal atresia (3.33%), band at ileo caecal region (3.33%) and terminal ileum opening in caecum attached to recto sigmoid region (3.33%). Associated fistulae were seen in 16.66% of patients. Overall morbidity of the definitive procedure was 31.58% and mortality was 10% in present study. Conclusion: In majority of patient’s definitive repair can be done by PSARP, ASARP PSARP combined with abdominal pull-through approach. Primary PSARP can be tried in rectovestibular, rectovaginal fistula and in some low varieties of ARM.

Some Variable Facts of Liver: Embryological and Clinical Perspective

Alok Saxena, Kishor Kumar Agarwal, Charul Jakhwal, Shivali Singh, Amal Rani Das

Introduction: Liver is largest gland in the body and shows rare variation. Additional fissure, additional lobes, enlarged papillary process, variations of gall bladder are more common. Morphological variations have been classified into congenital or acquired. Aim: To evaluate embryological rational of rare variations of liver and find out their impact on diagnostic and clinical procedures. Materials and Methods: We studied 20 formalin fixed liver specimens in Anatomy Department during undergraduate teaching to find out variant gross morphological features of liver. Results: Some rare variations were observed like grooves on hepatic surface (10%), tunnel for ligamentum teres (15%), enlarged papillary process (10%), absence of quadrate lobe (5%), additional fissures (20%), lingular process (15%). Conclusion: Atrophy, agenesis, presence of accessory lobes, additional fissures may mislead the diagnostic procedures. Therefore, the knowledge of these variations may be a fruitful finding for diagnosticians as well as surgeons.

“An Algorithm Based Approach To Ovarian Neoplasms”

Introduction: Cancer of the ovaries is the 2nd most common gynaecological malignancy and has the highest mortality rate among all gynaecological malignancies with an overall 5 year survival rate of 46%. A large number of the lesions are incidentally detected, for which imaging plays a vital role in treatment planning by characterizing these masses. Identifying benign lesions accurately may obviate unnecessary surgery, where as indeterminate or malignant lesions will require surgery with or without radio/chemotherapy. Aim: To inform the readers the imaging patterns of common and rarely encountered ovarian neoplasms and to provide an algorithm based approach to these ovarian lesions, which will not only aid in the management of these conditions but also obviate unnecessary investigations and surgeries. Materials and Methods: This was a prospective study conducted over a period of one year from January 2014 to January 2015 at the Department of Radiology, Father Muller Medical College, Mangalore, India. Data were collected from 82 patients who presented with ovarian cystic lesions on ultrasound and were either followed up by USG or underwent further evaluation by CT. Diagnosis was confirmed by histopathology. Statistical analysis involved percentage frequency. Results: Of the 82 patients included in the study, the largest age group belonged to the 3rd decade (41%). Patients belonging to the 6th decade and above presented with the largest cases of ovarian cystic malignancies (61%). On imaging, papillary projections, vascular solid components and thick septations (>3mm) favoured malignancy. All cases of teratoma were accurately diagnosed (100% accuracy) due to the presence of fat and calcifications. Conclusion: Both Ultrasound and CT are excellent tools in the diagnosis of ovarian cystic masses. An algorithm based approach to ovarian masses allows early detection, saves time and unnecessary burden to the patients and their families. In addition imaging is also useful to identify the extent of the disease and pre-treatment planning.

Evaluation of Carotid Intima Media Thickness and Resistive Index by High Resolution Ultrasound in Hypertensive Patients and Normotensive Subjects –A Comparative Study

P. Sathish Prabhu, Venkatraman Indiran, Prabakaran Maduraimuthu

Introduction: Intima media thickness (IMT) and Resistive index (RI)of common carotid artery are known to reflect the whole body vascular system atherosclerosis. Hypertension is one of the major risk factors for atherosclerosis. There are limited numbers of studies assessing these parameters in hypertensive patients in Indian population. Aim: To assess and compare common carotid artery (CCA) Intima-media thickness (IMT) and associated Resistive index (RI) changes in hypertensive patients and normotensive subjects using high frequency ultrasound and colour Doppler. Materials and Methods: Total of hundred patients were studied over a period of one year. Out of hundred, sixty were hypertensives (less than two years duration) and forty were normotensives. Gray scale and duplex sonography of carotid arteries were performed on both sides using high frequency transducer. IMT measurement, color flow mapping and RI measurement were done in both distal CCA. The results obtained in hypertensive patients were compared with that of normotensives. Results: Common carotid artery IMT in normotensives was 0.50mm and 0.49 mm for the right and left sides respectively. RI in normotensives was 0.55 on both the sides. IMT in hypertensives was 0.96mm and 0.97mm for right and left sides respectively. RI in hypertensives was 0.67 on both the sides. So, Intima media thickness and Resistive index in hypertensives were significantly increased in hypertensives as compared to normotensives. Conclusion: Hypertension is a major risk factor for atherosclerosis. Changes in IMT as a morphological parameter and RI as a hemodynamic parameter may aid in early diagnosis of atherosclerosis of the vascular system. These parameters can be assessed safely, easily, accurately and in an inexpensive way using high frequency ultrasound and Doppler. Our study revealed that IMT and RI of CCA were significantly increased in all hypertensive patients compared with normotensives and it is ideal to assess both IMT and RI together.

Rhabdoid Tumour of Kidney with Metastasis to Ovary – A Rare Presentation

Chhanda Das, Madhumita Mukhopadhyay, Ashis Kumar Saha, Tamannya Parvin

Rhabdoid tumour of kidney is a rare highly aggressive malignancy of early childhood. Here we are reporting an infant of six months who presented with mass abdomen in our hospital in the department of surgery. The computerized tomography finding was a hypoechoic mass occupying most of the kidney. Laparotomy followed by nephrectomy was performed. The ovary also found involved by a tumour mass, which also was excised On gross appearance the mass was solid, nodular, and variegated measuring 6 cm x 5.5 cm occupying most of the kidney. Histopathologically, it was diagnosed as rhabdoid tumour of the kidney, ovary also showed metastatic deposits from kidney mass. It was reported as rhabdoid tumour of kidney metastasizing to ovary. Immunohistochemistry was found positive for vimentin in both kidney and ovary section. As it is a very aggressive tumour early diagnosis is essential for the treatment and patient survival.

Epidermolysis Bullosa Simplex-Koebner: A Case Report

Shrayash Khare, Deepti Agarwal, Sunit Pathak, Rajesh Kumar

Epidermolysis Bullosa Simplex (EBS) has been subclassified into various subtypes on the basis of clinical features and histopathology predominantly into three divisions: Simplex, Junctional and Dystrophic. EBS is characterised by inter-epidermal blistering with minor internal engrossment. It’s always inherited in an autosomal dominant fashion and is also the least severe type of EB. More recently a recessive form of EBS has been described. The Koebner type of EBS (EBS-K), also known as the non-dowling meara or more recently the other generalised form, is usually presented at birth and is one of the rare presentations of EBS. Though always present with an extensive family history EBS-K is very rarely associated with de novo mutation.

A Case of Parotid Hemangioma of Infancy: Role of Ultrasound and Doppler in the Diagnosis

Deepa Regina John, Raman Shingade, Juhi Patel

Parotid hemangiomas constitute 1-5% of all salivary gland neoplasms. Here we present a case of a 3-month old female baby who was brought with a rapidly enlarging left parotid swelling and a cutaneous strawberry hemangioma over the face. Ultrasonography with colour Doppler may be the only investigation needed in such a case to establish the diagnosis. Other investigative modalities like contrast enhanced Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) also helps in confirming the diagnosis. As this tumour regresses spontaneously in its normal course, no active intervention was done and the child is kept under follow up.

Multiple Genitourinary Vascular Anomalies – A Case Report

Rajan Kumar Singla, Kulbir Kaur, Ravikant Sharma

Diagnostic, operative and cardiovascular procedures require the knowledge of variation of blood vessels of the genitourinary system. During routine dissection in an approximately 60 years old male cadaver in the Department of Anatomy, Government Medical College, Amritsar, we came across multiple vascular anomalies involving renal and testicular arteries and veins. The right kidney was supplied by three renal arteries i.e. superior, middle and inferior which originated from abdominal aorta separately; Right testicular artery originated from inferior renal artery instead of abdominal aorta. Venous drainage comprised of three renal veins and a superior polar vein which drained into IVC, right testicular vein instead of draining into IVC drained into inferior renal vein. The left kidney was supplied by three renal arteries i.e. superior, inferior and the one which originated from posterolateral aspect of aorta above the superior renal artery. Venous drainage of left kidney comprised of two renal veins which joined to form single renal vein which received left testicular vein and coursed behind the aorta to drain into IVC thus constituting retro aortic left renal vein. Further, the outgoing and the clinical and surgical implications of these variants are discussed.

Jejunojejunal Intussusception in an Adult Due to a Gastrointestinal Stromal Tumour

Aditya J Nanavati

Intussusception in an adult is a rare entity responsible for less than 1% of all intestinal obstructions. It is far more common in children, where the etiology is more often idiopathic. In adults most cases have a demonstrable lesion as the lead point which invariably needs surgical treatment. A gastrointestinal stromal tumour is a rare tumour of mesenchymal origin responsible for only 0.2-1% of all gastrointestinal neoplasms. There have been only a few reports of such tumours causing intussusception in adults. The case being reported is of a 37 years old male who presented to the hospital with an abdominal lump and anaemia. On investigating it was discovered that he had jejunojejunal intussusception due to a gastrointestinal stromal tumour. The high index of suspicion, appropriate use of pre-operative imaging studies and regular post-operative follow-up contributed to a successful outcome.

An Interesting Case of Isolated Renal Stab Injury

Isolated renal penetrating injury requiring exploration is rare. Kidney is retroperitoneal organ with strong muscular and rib cage support. Added to this Gerota’s fascia prevent direct injury to renal parenchyma. Here we have presented an interesting case of renal stab injury in young man who had completely divided kidney due to knife. Patient managed with nephrectomy. He fared well the procedure as well as post-operative recovery. We discussed this case with literature review but isolated renal stab injury was not found. We also presented elegant images of this case.

Role of Epiaortic Ultrasound Probe Intraoperatively to Give Clamp over Inferior Vena Cava while Removing Renal Cell Carcinoma from IVC along with Nephrectomy

Vipin kumar singh, Sandeep sahu, Rajee V Ratan