Indian Journal of Neonatal Medicine & Research

Correlation of Gallstone Characteristics with the Clinical Parameters in Cases of Cholelithiasis

Hemlata Sharma, Ghanshyam Gupta, Manoj Kumar Sharma

Introduction- Cholelithiasis means the “presence of stone in the gall bladder” is a common clinical entity affecting the adult population of both sexes. Various sign and symptoms like severe pain in Murphy’s point in right upper quadrant of abdomen, bilious vomiting, mild to moderate increase in temperature, obstructive jaundice, loss of appetite and weight are present in cholelithiasis. Gallstones are known to produce diverse histopathological changes in the gallbladder. Aims: The study was undertaken to assess prospectively the influence of physical, clinical and biochemical characteristics on type of gallstones and their relationship in patients of cholelithiasis. Materials and Objectives: The study was done in hundred patients of cholelithiasis of both sexes, aged between 12 years to 80 years who underwent cholecystectomy. The stones were assessed for various parameters i.e. number, size, morphological types and correlated with clinical Indices of cases (Hemoglobin , TLC, DLC, Blood sugar, SGOT, SGPT , Alkaline phosphatase , total serum bilirubin , direct serum bilirubin, Indirect serum bilirubin , total serum protein and albumin values ) and also with diabetes mellitus ,smoking ,tobacco chewing, alcohol intake and dietary habits of cases of cholelithiasis. Results: Out of total 100 specimens examined in present study, 24 had cholesterol (male -4, female- 20), 46 had mixed (male-11, female- 35) and 30 had pigmented (male- 11, female-19) gallstones respectively. Number of stones varies from a single calculus in 30% cases, double in 12% cases and multiple in remaining 58% cases. Shape of stone varied from polygonal/rectangular in 1% cases, ovoid in 15%, rounded in 22%, irregular in 29% and maximum had faceted shaped gallstone in 32% of cases. Haemoglobin, TLC, DLC, Blood sugar, SGOT, SGPT, Alkaline phosphatase, total serum bilirubin, direct serum bilirubin, Indirect serum bilirubin, total serum protein and albumin values did not showed statistically significant correlation with gallstone types. The mean systolic BP (p<0.27) and the mean diastolic BP (p<0.012) in patients having cholesterol, mixed and pigmented gallstones showed statistically significant association with gallstone types. Conclusion: Mixed gallstones more common among females and association of biochemical indices needs further exploration. Therefore gender, ethnicity and other clinical features can be used as the factor to predict the formation of gallstones disease. It is also recommended that all patients should go through the analysis of all the biochemical parameters before cholecystectomy

Submental Intubation: A Simple Route of Intubation for Complex Maxillofacial Trauma

Purpose: The aim of the study was to evaluate the use of submental route of intubation for maxillofacial trauma patient, in whom oral and nasal routes of intubation were contraindicated. Achieving a secure airway is of utmost importance in patients under general anesthesia. The two most common methods of airway management (intubation) in such patients include oro-tracheal and naso-tracheal intubation. However, both may be contraindicated in complex maxillofacial trauma, like pan-facial fractures requiring surgical access to oral and nasal cavity in the same surgery. Traditionally the only other alternative available in such case is tracheostomy, which is associated with high risk of iatrogenic complications. This work presents our current experience of airway management using submental intubation in such situations. Frequency, indications, steps and outcome of the technique are discussed in details. Materials and Methods: Patients treated at Krishna hospital, Karad, Maharashtra, India from August 2011 to September 2014, for facial bone fracture under general anaesthesia, in whom both oral and nasal route of intubation was contraindicated, were chosen for submental intubation. Data pertaining to demographics, classification of fracture, time required for intubation and intra-operative & post-operative complication associated with submental route of intubation were recorded. Results: Out of 252 patients of maxillofacial trauma treated under general anaesthesia, 41 patients underwent submental intubation. Submental intubation allowed simultaneous management of all the fractures (Nasal as well as jaw fractures) and establishment of dental occlusion without any interference with the endotracheal tube. The procedure was simple to execute with no intra-operative complication. Only one patient presented with transient mild lingual haematoma post-operatively, which resolved spontaneously. Conclusion: Submental intubation is an attractive and viable alternative to tracheostomy in selected patients with multiple facial bone fracture.

Thrombocytopenia as A Predictor of Neonatal Sepsis in Very Low Birth Weight Babies and Its Correlation with Specific Organism Involved: A Hospital Based Observational Study

Introduction: Thrombocytopenia is one of the common haematological problems encountered in the neonatal period. During an underlying pathologic process, the sick newborns, premature babies and neonates admitted in neonatal intensive care units are usually predisposed to develop thrombocytopenia. Aims: To study the bacteriological profile and thrombocytopenia as a predictor of neonatal sepsis in very low birth weight neonates and its correlation with specific organism involved. Materials and Methods: This study is a prospective observational study conducted from May 2012 to April 2013. The study group included VLBW neonates admitted as neonatal sepsis. Sepsis evaluation was based on clinical signs and symptoms and rapid tests for sepsis, including change in complete blood counts and positive blood culture. The platelet parameters studied include total platelet count, durations of thrombocytopenia, change in platelet count and platelet nadir. Results: Total of 100 newborn very low birth babies with culture documented sepsis was studied. 54(54%) had gram negative sepsis, 40(40%) had gram positive sepsis and 6(6%) has fungal sepsis. Among gram negative organisms, Klebsiella pneumonia was seen in 26 (48.1%), followed by Pseudomonas 10 (18.5%) and Acinetobacter 8 (14.8%). Among gram positive organism MRSA was the commonest 21 (52.5%) followed by Enterococcus 12/40(30.0%) and CONS 4 (10.0%). Severe thrombocytopenia (count less than 50000/µl) were present in 22.2% in gram negative, 2.5 % in gram positive organism and 33.3% in fungal sepsis.(p=0.02). Mean platelet count in survivors change from 142×103/µl to 94.6×103/µl at onset of sepsis in survivors while in non survivors it changes from 150×103/µl to 80.2×103/µl within 48 hours of admission. Conclusion: Gram negative sepsis was predominant cause of sepsis followed by Gram positive organisms and fungal sepsis. Among gram negative organisms Klebsiella pneumonia predominated followed by Pseudomonas and Acinetobacter. Among gram positive MRSA was the commonest followed by Enterococcus and Coagulase negative Staphylococci. Both Severe thrombocytopenia and most significant fall in the platelet count was seen more in fungal sepsis than in bacterial sepsis. There was significant fall in platelet count in non survivors than those who survived.

Correlation of Placental Thickness Estimated by – Ultrasonography with Gestational Age and Fetal Outcome

Preeti Baghel,Vinita Bahel, Rashmi Paramhans, Pomila Sachdev, Sonal Onkar

Introduction: A normally functioning placenta is critical for normal fetal growth and development. The size of placenta increases during fetal growth to allow it to do its vital functions. If the fetal growth is compromised, it is due to the abnormal function of the placenta, it can be detected by the abnormal placental measurements. A “point of confinement” is that, the placental width of 18 cm placental thickness of 2 cm at 36 weeks predicts a low conception weight neonate. Aim: To compare fetal gestational age estimated by placental thickness with other parameters of fetal growth as BPD, FL, AC and HC, and to evaluate the role of placental thickness estimation in predicting LBW & IUGR. Materials and Methods: One Hundred pregnant patients, who were sure of dates and fulfilling inclusion and exclusion criteria were recruited from ANC clinic at 24 weeks and were followed at 32 weeks, 36 weeks. The gestational age was estimated by USG using various growth parameters: BPD, FL, AC and the placental thickness was measured in longitudinal direction at the level of insertion of umbilical cord. Mean and SD were used to summarize continuous maternal variables. Pearson’s correlation analysis and p values were calculated by the 2-tailed significance. Result: The Pearson’s correlation coefficient(r) of placental thickness and composite gestational age being 0.629 (p= 0.000) at 24 weeks, r = 0.668 (p= 0.000) at 32 weeks and r= 0.735 (p= 0.000) at 36 weeks which is statistically significant. Placental thickness < 10th percentile at-32 and 36 weeks could detect IUGR with a sensitivity of 53.5%, specificivity of 92 % and positive predictive value of 80%. Conclusion: Placental thickness on USG seems to be a promising parameter for estimation of gestational age of the fetus and predicting fetal outcome as placental thickness in mm almost equals gestational age in weeks, placental thickness below 10th percentile was found to be associated with low birth weight and IUGR.

A Rare Case of Non-immune Hydrops Fetalis

Rema V Nair, Velayudhan Nair, Mookambika RV, Vinu Gopinath, Mohandas Rao KG

Hydrops fetalis is a condition which is characterised by presence of excess body water as extracellular accumulation in tissues and body cavities. A case of hydrops fetalis born to a physiologically and genetically normal mother has been reported here. A 24 years old lady with 22 weeks gestation was diagnosed to have hydrops fetalis during her routine scan at Department of Gynaecology. Ultrasonograpy showed single intrauterine gestation of 20 weeks 5 days with gross fetal ascites, subcutaneous edema, bilateral pleural effusion and multiloculated cystic area in the neck region. However, fetal heart was active, heart rate was regular and four chamber view of heart indicated normal anatomy of heart. Termination of pregnancy was done. A dead baby with non-immune fetal hydrops was delivered. Diagnosis of a case of hydrops fetalis is made. Significance of early diagnosis of non-immune fetal hydrops is discussed in detail.

Myocysticercosis as A Rare Cause of Hand Swelling: A Case Report With Review of Literature

Arjun Agarwal, Cheena Garg, Mohit Agarwal

In developing countries, cysticercosis is a common human infestation that usually presents as neurocysticercosis. Lesions in eye, skeletal muscles and subcutaneous tissues are rare. We report this case of an uncommon clinical presentation of soft tissue cysticercosis as an isolated hand swelling without neurological involvement. We want to highlight that it should be considered as a differential diagnosis especially in endemic areas and sometimes when it does not get resolved by medical management, it should be surgically excised as it happened in our case.

Ipsilateral Medial Fibular Transposition in A Case of Chronic Osteomyelitis of Tibia: A Case Report

Chronic osteomyelitis in adults is a rare disease. It is usually seen in patients with transient or chronic immune deficiency. Chronic osteomyelitis develops as a result of inadequate or improper treatment of acute osteomyelitis. Sometimes large sequestrum develops with massive destruction of bone. Such a big sequestrum removal puts bone in real danger of pathological fracture. In such cases ipsilateral fibular transposition can be done by Huntington’s procedure. Here we are presenting a case of chronic osteomyelitis with massive sequestrum formation, that was removed and saucerization done and after controlling infection ipsilateral fibular transposition by Huntington’s procedure was done. Patient was kept in above knee POP cast and following that a patellar tendon bearing (PTB) cast was put. When fibula was united above knee walking caliper was given, which was continued for 2 years for proper consolidation and incorporation of graft. Screws removed after 2 years. After 2 years, consolidation and integration of fibula was complete without any complication. Range of motion was full. Finally in our patient ipsilateral fibular transfer to fill tibial gap gave good result but required long follow-up.

Role of Imaging in A Case of Fibrodysplasia Ossificans Progressiva

Rachit Harjai, Sushil. G. Kachewar

Fibrodysplasia ossificans progressiva is one of the rarest and one of the most debilitating and disabling disorders known to affect the mankind. Short big toes and unrestricted progressive ossification of soft tissues, are its hallmarks. Failure of early diagnosis and erroneous interpretation of histology has resulted in patients being mistreated with surgical excision and several cycles of radiotherapy. This case report describes a rare case of this bizarre entity which presented to our institute. Typical imaging findings are highlighted that clinch the diagnosis and thus enable one to avoid biopsy which can further hasten this process.

A Rare Case Report of Renal Replacement Lipomatosis With Co-Existing XanthogranulomaTous Pyelonephritis

Gopinath Ganesan, Prakash Kulothungan

Renal replacement lipomatosis is a rare entity. It is the end result of renal atrophy usually secondary to chronic obstructive conditions. Co existent xanthogranulomatous pyelonephritis is still a rarer entity, which we encountered in our department, which is presented in this report. Clinical importance of this entity is the need to distinguish this condition from fat containing tumors.

A Case Report of Aggressive Angiomyxoma of Vulva: An Often Misdiagnosed Neoplasm

Barath Raj Kumar, Krithika Chandramohan, Kavitha Sampath

Aggressive angiomyxoma of vulva (AAM) is a very rare, slow growing, locally aggressive, and rarely metastasizing soft tissue neoplasm. Its preoperative diagnosis is often difficult. It has a high recurrence rate and requires prolonged follow-up. We report a case of a 36 years old female, who presented with a swelling on her left labium majus. Imaging studies could not confirm the diagnosis. She underwent wide local excision of the lesion and her final histopathology report was Aggressive angiomyxoma of vulva. Patient has been in follow-up for the past 4 years with serial MRI without any recurrence.

Large Cell Neuroendocrine Tumor of Uterine Cervix With Metastasis To Brain – A Case Report

Primary large cell neuroendocrine carcinoma of cervix is rare and very aggressive disease. There have been only few reported cases in literature. Here, we report a case of primary large cell neuroendocrine carcinoma of uterine cervix, staged Ib2, initially diagnosed as adenocarcinoma with neuroendocrine differentiation. Patient treated with radical hysterectomy and adjuvant radiotherapy and chemotherapy. The patient developed distant metastasis to brain without any other evidence of metastasis and local recurrence.

Epitheloid Haemangioma of the Forehead: A Case Report

Surya Rao Rao Venkata Mahipathy, Alagar Raja Durairaj, Volga Harikrishnan

Epitheloid haemangioma is a tumor of soft tissues arising from the vascular endothelium. Here, we present a young female with a swelling of the forehead region mimicking clinically as a sebaceous cyst. Histopathological examination confirmed as epitheloid haemangioma. She was followed up for 2 years during which time there was no recurrence. This case is being reported as the cutaneous form of this lesion is very rare.

Chloroma of Orbit: A Rare Initial Presentation in A Case of Acute Myeloid Leukemia

Rashmi M Nagaraju, Bhimarao

Leukemia is the most common malignancy of childhood. Chloromas are rare presentations of underlying leukemic disease. It is important to diagnose these cases early in the course as they respond more favourably to focal irradiation. We present a rare case of chloroma of orbit in a young male patient who presented with severe proptosis and a large mass involving the left orbit. The orbital lesion was the initial presentation which led to further diagnosis of acute myeloid leukemia in our case. The patient was evaluated radiologically for the extension of disease and treatment planning.

Down Syndrome: Antenatal and Postnatal Radio Imaging Diagnosis

Pokhraj P. Suthar, Prakash J. Rana, Bhartan Kharadi, Narottam A. Patel

Antenatal screening of Down syndrome should be available as a routine component of standard antenatal care. Abnormalities on the mid-trimester ultrasound are nuchal fold thickness > 6 mm, hypo-plastic nasal bone, echogenic intra-cardiac focus, echogenic bowel, single umbilical artery. Central nervous system, cardiac abnormalities, GIT, renal and other multiple abnormities are associated. Ultrasonography plays vital role in diagnosis. A 27-years-old second gravida female presented for routine antenatal sonography screening first time. In sonography, femur length is 20 weeks with fetal acrania with alobar holoprosencephaly, hypotelorisum, spinal dysgenesis, bilateral pleural effusion, ascitis, congenital hydrocele, hepatomegaly, absent fundic bubble, single intra-abdominal umbilical artery was present. Cardiomegaly, ventricular septal defect, tricuspid regurgitation & mitral valve insufficiency were revealed on fetal echocardiography. Patient was opted for termination of pregnancy. Baby was still born. Postnatal X-Ray revealed absent skull vault, multiple hemi & block vertebras, reduced total number of vertebral spine & crowding of anterior ends of ribs with bilateral 11 ribs. In pathological autopsy absence of skull vault with exposed brain tissue with absent dorsal skin covering in upper back with a wide space between 2nd & 3rd digits of both hands seen. Karyotyping study was suggestive of Trisomy 21.

Congenital Lumbar Hernia with VACTERL Anomaly: A Rare Presentation

Mohd. Aamir, Harish Punia, Kamal Nayan Rattan, Aditi Singh, Pooja Tripapathi

Congenital lumbar hernia also known as Lumbocostovertebral syndrome comprises various skeletal abnormalities like hemivertebrae, rib defects, abdominal wall anomalies and abdominal muscle hypoplasia. In this case report we describe a rare case of a neonate presenting with an unusually high number of congenital anomalies including lumbar hernia, high anorectal malformation, left inguinal hernia, thoracolumbar meningomyelocele, hemivertebrae and right crossed fused ectopic kidney. We intend to describe this rare association and a brief review of literature.

Sclerosing Encapsulating Peritonitis (SEP)

Suthar Pokhraj P, Rai Archana, Suthar Bhumika P, Patel Palakkumar G