Indian Journal of Neonatal Medicine & Research

John Benjamin Murphy- “The Surgical Genius.”

Murali Uthamalingam

Stapled Versus Open Haemorrhoidectomy- Evaluation of Short Term Results

Introduction: Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely used procedure. A recent novel technique called ‘Stapled haemorrhoidectomy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits. Aim: To compare Stapled haemorrhoidectomy with open (Miligan Morgan) haemorrhoidectomy in terms of post operative pain, resumption of daily activity, hospital stay, post operative bleeding, urinary retention and anal incontinence. Study Design: Prospective, comparative study from August 2011 to September 2013. Materials and Methods: A total of 100 patients between the age group of 20 and 70 years, diagnosed to have grade II, III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (50 patients) and Group 2 undergoing Stapled haemorrhoidectomy (50 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post surgery. All patients were given a questionnaire and data collected verbally and analysed statistically. Comparative analysis between the two groups were done based on Independent sample ‘t’ test or students ‘t’ test using a SPSS version 20. Results: The mean age of patients in Open haemorrhoidectomy (OH) group was 40.68 and Stapler haemorrhoidectomy (SH) group was 39.52. 78% were males and 22% were females in OH group, 90% were males and 10% were females in SH group. Post operative bleeding in both OH and SH group had an incidence of 2%. Post operative urinary retention was seen in 4% and 8% in OH and SH group respectively. In both groups, post operative anal incontinence was not seen. Based on Independent sample ‘t’ test the post operative pain, Post operative hospital stay and duration of resumption of daily activity was less in SH group compared to OH group and statistically significant with p<0.001. However, complications like post operative bleeding, urinary retention and anal incontinence are almost same in both the groups. Conclusion: Stapled Haemorrhoidectomy is less painful with shorter duration of hospital stay and resumption of daily activity is faster than the open haemorrhoidectomy. However, long term follow-up is required to know the recurrence rate in stapled haemorrhoidectomy.

Magnetic Resonance Imaging in Evaluation of Pituitary Adenomas

Introduction: Pituitary adenoma often presents with non specific symptoms like headache; Dynamic contrast MRI is important not only in confirming the diagnosis but it also provides information which helps to plan surgical treatment and to evaluate response to medical treatment. Aim: To evaluate role of MRI in diagnosis of pituitary adenoma. Materials and Methods: A prospective case series study on 85 patients with pituitary lesions was conducted at the Department of Radio-diagnosis in a tertiary care hospital in Goa (Goa Medical College) over a period of 3 years using 1.5 Tesla unit- Magnetom Avanto, Siemens unit, by using a head matrix coil. Results: Dynamic contrast enhanced imaging played a crucial role in accurate localization of hormone secreting microadenomas. MRI precisely assessed the invasion of cavernous sinus by macroadenomas on contrast enhanced imaging. Conclusion: MRI is undoubtedly an indispensible tool to evaluate hypothalamic-pituitary related endocrine disease. In addition to providing a diagnosis, MRI also helps to plan surgical strategies due to its ability to provide multiplanar information about the anatomical relationship of the gland with adjacent structures. MRI is also a modality of choice for follow-up imaging in order to evaluate response to conservative treatment as well as in post operative cases to detect residual lesions / recurrence.

A Study of Variations in the Origin of Inferior Phrenic Artery in Adult Human Cadavers with Clinical and Embryological Significance

Introduction: The knowledge of variations of the arteries is important for the clinical, radiological and surgical diagnosis. The incidence of normal origin of inferior phrenic artery from abdominal aorta is 92%. Other sources of origin may be celiac trunk, renal artery, suprarenal, and hepatic, left gastric or superior mesenteric arteries accounting for 8% of cases. Aim: To study the normal and anomalous origin of inferior phrenic artery and to discuss the embryological basis and clinical significance of the variations. Materials and Methods: Fifty formalin fixed cadavers were dissected to observe the variations in the origin of inferior phrenic artery in the Department of Anatomy, M. S. Ramaiah Medical College, Bangalore. Results: Inferior phrenic artery arose from abdominal aorta in forty three cadavers. Both right inferior phrenic artery and left inferior phrenic artery arose as a common trunk from abdominal aorta in one cadaver. Right inferior phrenic artery originated from celiac axis in one cadaver. Left inferior phrenic artery originated from celiac axis in four cadavers. Both left and right inferior phrenic arteries originated as common trunk from coeliac axis in three cadavers. Right inferior phrenic artery originated as a common trunk with right renal artery from abdominal aorta in one cadaver and as a common trunk with accessory renal artery from the abdominal aorta in one cadaver. Conclusion: Precise knowledge of usual and anomalous origin of inferior phrenic arteries are essential for surgeons, anatomists, researchers and interventional radiologist for performing transcatheter embolization of not only of hepatic artery but also of the right inferior phrenic artery, which is the commonest extrahepatic collateral supply of hepatocellular carcinoma.

Study of Prognostic Indicators in Patients with Pseudoexfoliation Syndrome Undergoing Cataract Surgery

Shruti Prabhat Hegde, Vijay Kautilya Dayanidhi, Ravi

Introduction: Pseudoexfoliation syndrome is a systemic disorder characterized by deposits on the lens and the iris. This syndrome has been reported to be associated with increased intraoperative and post operative complications during cataract surgery. In this study we have documented the complications occurring during small incision cataract surgery(SICS) in pseudoexfoliation syndrome and compared the same with prognostic indicators like pupillary dilatation. Aim: To document and compare the complications occurring during small incision cataract surgery in pseudoexfoliation syndrome with different grades pupillay dilatation as a prognostic indicator. Materials and Methods: The study was conducted at Shri Sathya Sai Medical College and Research Institute Hospital by including 50 eyes of 50 patients with pseudoexfoliation over a period of one years, between July 2014 and June 2015 after obtaining ethical clearance. All the patients underwent small incision cataract surgery (SICS) and were followed up for 6 weeks post surgery. Results: All our patients were aged more than 50 years. About 64% patients belonged to the age group of 70 – 80 years. About 20 (40%) patients had a rigid pupil which dilated not more than 3.5 mm. Zonular dialysis was seen in 8 (16%) patients and of these patients five also had vitreous loss. Four patients had subluxated PCIOL when seen on long term follow up after six weeks. Conclusion: Poorly dilating pupil is a common accompaniment with this condition and is an important prognostic indicator of intraoperative zonular dialysis and vitreous loss, the rate of these complications being inversely proportional to the maximum pupillary dilatation. Patients with poorly dilating pupil need to be given realistic expectations regarding the complications and recovery time. Sphincterotomy can be useful when modern pupil dilating devices are not available.

Evaluation of Low-Dose Ketamine Pretreatment to Reduce Propofol Injection Pain: A Randomised, Double-Blind, Controlled Trial

Deepa Ravindra Shriyan, Bhas kar Murlidhar PaPatil

Introduction: Propofol is a widely used intravenous anaesthetic that is known to cause distressing local pain at the site of injection. Several methods to attenuate this pain with varying efficacy have been described.Ketamine pretreatment is one of the methods proposed to reduce attenuate propofol injection pain due to its local anaesthetic properties. Aim: To determine if low-dose ketamine could reduce propofol injection pain in dorsal hand vein. To study haemodynamic effects of this combination of drugs, and to know if any untoward effects like emergence phenomenon occur on administering low-dose ketamine. Settings and Design: A prospective, randomised, double-blind, placebo-controlled study in a Public Health institute. Materials and Methods: In this prospective, randomised, double-blind, placebo-controlled study,60 ASA 1 and 2 patients with ages from 18 to 65 years, scheduled for minor gynaecologic surgery under total intravenous anaesthesia were randomly allocated into two groups (A and B). After obtaining written, valid and informed consent, patients in group A received ketamine as the pretreatment before receiving propofol. Those in group B received saline before administration of propofol. Pain scores were measured by the investigator immediately following injection of propofol. All patients’ responses were graded by a verbal pain score. Statistical Analysis: Results were analyzed using t-test, and Chi-square tests. Results: It was noted that low-dose ketamine was effective in reducing the incidence of pain from 93.3% in the control group to 20% in patients administered ketamine. The intensity of pain was also reduced in the ketamine group, as none of the patients experienced severe pain as compared to 33.30% in control group. Ketamine did not produce any emergence phenomenon or any other side effects at this low dose. Conclusion: Low-dose ketamine pretreatment is useful in significantly reducing the incidence of pain on injection of propofol. Haemodynamics are preserved for a short interval after administration of propofol, which was more useful when compared to placebo administration. Ketamine does not produce any emergence or side effects in low dose.

Value of SOFA Scores in Predicting Prognosis in Patients with Ventilator Associated Pneumonia

Harprit Kaur Madan, Ra jinder Singh, NITEEN D KARNI K

Introduction: Ventilator-associated pneumonia (VAP) is a frequent infection in patients on mechanical ventilators in intensive care units (ICU) .The prediction of its outcome is important in the decision-making process and management. Critical care scoring system derives a value which helps in the prediction and prognosis of the patient in ICU. Aim: The objective of this study was to assess the value of Sequential Organ Failure Assessment (SOFA) score in prediction of mortality in patients with VAP, to outline the incidence, type of infection, morbidity outcome and mortality and to correlate SOFA score with mortality in VAP in mechanically ventilated patients. Study Design: Prospective observational study. Materials and Methods: Fifty patients who were admitted to the ICU and who were on mechanical ventilation for more than 48 hours and developed ventilator associated pneumonia were included in the study. Patients were followed till discharge/death. Clinical and laboratory data conforming to the SOFA scores were recorded on day of admission and SOFA and CPIS scores recorded on the day of the diagnosis of VAP and correlated with mortality and duration of stay in ICU. Statistical Analysis: Following test were used to analyze the data: Mann-Whitney test, Pearson Chi-Square and Fisher’s Exact Test. The continuous variable SOFA score was categorized into classes by selecting the best cut-offs (Receiver-operating characteristic analysis, ROC). Results: Mortality rate was 54%. Eight patients had bacteraemia at the same time with the same organisms as those causing VAP. The mean SOFA in survivors (3.57) and non survivors (5.19) and the sofa score in survivors (8.09) and non survivors (11.67) scores determined at the time of VAP diagnosis were significantly higher in non survivors than in survivors. Area under receiver operating characteristic (ROC) curve for SOFA score on day of diagnosis of VAP was 0.816 with SOFA > 11 (sensitivity: 78, specificity: 83), p = 0.005). Conclusion: Thus, we concluded that SOFA score is a very useful score to predict the mortality and morbidity of patients admitted in ICU. It is a simple, but effective prognostic indicator and evaluator for patient progress in ICU

The Role of Brain Magnetic Resonance Imaging in the Evaluation of Children with Global Developmental Delay

T. ARUL DASAN, B. DEEPASHREE

Introduction: Global developmental delay is diagnosed when there is a significant delay in two or more of the following domains of development: gross motor, fine motor, speech and language, cognition, and social/personal development. The etiology of global developmental delay varies from specific diseases to sequelae of perinatal ischemic insult. Determination of causality may or may not lead to treatment modification but has specific implications with regard to prognosis and counseling of the family. Magnetic resonance imaging is the modality of choice in investigating infants and children with developmental delay. Aim: To study and classify brain magnetic resonance imaging findings in children aged 3 months-18 years who presented with global development delay. Materials and Methods: Clinical records and imaging studies of 90 developmentally delayed children between the ages of 3 months to 18 years who presented to the Dept of Radio-diagnosis, BMCRI for brain magnetic resonance imaging during September 2013 to August 2014 were analyzed retrospectively. Results: Out of 90 children (male-44, female-46) who presented to us, abnormal findings were present in 65 (male-32, female-33) (72%), of which most (53) of them had features sequelae to ischemic insult such as periventricular leukomalacia, encephalomalacia and thinning of corpus callosum. 10 of the children (male-3, female-7) had structural malformations including corpus callosum agenesis (4), subcortical nodular heterotopia, etc. Conclusion: Out of all 72% children with global developmental delay who underwent Magnetic resonance imaging showed positive findings, showing that MRI can contribute significantly to the determination of causality.

Cadaveric Study of Lateral Circumflex Femoral Artery

SANGEETA J RAJANI, MINAL K RAVAT, JITENDRA K RAJANI, AMUL N BHEDI

Introduction: Lateral circumflex femoral artery is typically arising from Profunda femoris artery (PFA) and supplied blood to head, neck, greater trochanter of femur, the vastus lateralis muscle and knee. Hence, knowledge of variations of lateral circumflex femoral artery is very important for the surgeons and anaesthetist. Aim: To note the site and distance of origin of Lateral circumflex femoral artery (LCFA) and also to note any other variations related to branching pattern of LCFA. Materials and Methods: Thirty three properly embalmed cadavers (17 males and 16 females) were selected for the study. Lateral circumflex femoral artery was exposed, its site and distance of origin as well as any variations in branching pattern was noted. Results: In present study, lateral circumflex femoral artery (LCFA) took origin from profunda femoris artery in 75.75% of cases and from femoral artery in 22.72% cases. Absent or short LCFA noted in 4.54% cases of each. High origin of LCFA 6(9.09%) also noted by us. In one cadaver we noted bilateral double LCFA. In two limbs (3.03%) superficial branches of thigh took origin from LCFA. Such findings are rare and important. Conclusion: Present study showed very high rate of variations (33.33%) in LCFA, which is very useful for the surgeons working in this area. Knowledge of these variations will help clinicians to improve their success in diagnosis and treatment.

Common Carotid Artery Intima Media Thickness Measurement in Cerebral Ischemic Stroke Patients Using Ultrasonography: A Prospective Study

Introduction: Cerebral ischemic stroke is the third leading cause of death in the world. Atherosclerotic changes in carotid artery and ischemic stroke have been studied and found to have a close relationship. Aim: This study was done to assess the carotid intima media thickness (CIMT) using high frequency sonography and to correlate it with cerebrovascular accidents. Materials and Methods: This prospective study consists of 50 patients. A purposive sampling technique was used. Various risk factors of ischemic stroke mainly diabetes mellitus, hypertension,family history and smoking were noted. Using high frequency B mode 5-12 MHz linear transducer the data was gathered from ultrasonographic examination of common carotid (CCA) Statistical Analysis: The data collected was analyzed using SPSS15 for windows. No tests of significance were applied as this study deals with only frequency distribution of various factors. Results: The highest incidence of cerebral ischemic stroke was found in males between 60 to 69 Years. In our study we found 72% prevalence of high CIMT (> 0.8mm) in patients with ischemic stroke. Among these 26 were males and 8 were females. Hypertension was found to be the most common risk factor compressing of 17(81%) patients followed by diabetes 5(71.4%) patients and smoking 14(63.3%) patients. Conclusion: Sonographic evaluation of CIMT is a safe, economic, reproducible and less time consuming imaging technique inthe evaluation of people who are at risk of developing cerebral ischemic stroke. This can serve as useful investigation in instituting early treatment modalities.

Diagnostic Performance of the Modern Imaging Modalities in Renovascular Disease: An Evaluation

Surg Cdr Brijesh K Soni, Surg Cdr SN Singh

Introduction: Renal artery stenosis is a very important cause of Renovascular disease. Atherosclerosis has been identified as a most common etiology for renal artery stenosis. Long standing renal artery stenosis can cause irreversible changes in kidney hence, it is imperative to identify the disease at early stage and treat. Aim: To evaluate the diagnostic accuracy of Color Doppler US, CT Angiography(CTA), and GD-enhanced MR Angiography (MRA) compared with digital subtraction angiography(DSA) for the detection of renal artery stenosis in patients with clinically suspected renovascular hypertension and to select the most appropriate noninvasive modality as alternate diagnostic tool compared with the invasive intra-arterial digital subtraction angiography. Materials and Methods: Fifty patients were prospectively recruited from the internal medicine outpatient clinics over the period of two years. All the hypertensive patients between 20 and 80 years of age with an arterial systolic blood pressure over 140 mmHg and diastolic over 90 mmHg were screened for predefined clinical clues indicating renal artery stenosis. Patients who exhibited at least 1 clinical clue were included in the study. All the recruited patient further underwent Color Doppler US, CTA and GD-enhanced MRA followed by DSA. DSA was considered gold standard. Results: Sensitivity, specificity, positive and negative predictive value for diagnosis of renal artery stenosis were 75%,90%, 60% and 95%, respectively, for color Doppler US; 90%, 93%,75%, and 97.9%, respectively, for CTA; and 90%,95%, 82%, and 98%, respectively, for GD-enhanced MRA. Conclusion: Diagnostic accuracy of CTA and GD enhanced MRA is almost similar to exclude the renal artery stenosis. Color Doppler US can be used as screening modality and CTA or MRA to further confirm the findings or as primary investigating modality where color Doppler US findings were equivocal. DSA is considered gold standard hence it can be utilized for the case with disagreement or case where therapeutic interventions are indicated.

Multi Detector Computed Tomography Evaluation of Spectrum of Facial Fractures in Motor Vehicle Accidents

Vijay Kumar K R, Bharath B Das, Venkatesha MP

Introduction: Facial fractures consist of most common injuries in cases of road traffic accidents. Road traffic injuries are a major public health problem worldwide. Each year, an estimated 1.2 million people die in road traffic accidents and around 50 million suffer from non-fatal severe injuries. In big cities like Bangalore, motor vehicle accidents are very frequent. In such accidents MDCT is the modality of choice for detection and prognosticating facial injuries. Aim: The study was conducted to assess MDCT findings in facial fractures and to elaborate incidence and spectrum of these injuries. Materials and Methods: Cases were collected retrospectively over a period of 24 months, from January 2014- December 2015, in Department of Radio-diagnosis, Bangalore Medical College and Research Institute, Bangalore. 6 slice CT GE SOMATOM scanner was used to obtain images in bone and soft tissue window and thin reconstructions were done. From the data obtained which consisted of 650 positive cases, they were divided and assessed based on age, gender predominance, site of fracture and associated complications. A specific consideration was given to clear sinus sign. The statistical analysis was performed using Microsoft Excel 2010 for Windows (Microsoft Corporation, Redmond, Washington). Results: Of the 650 cases, males constituted 533 cases and the rest were females. Most common age group was between 21-30 years. Cases with multiple fractures were more common as compared to a single fracture. Fractures of nasal bone topped the list with 20% of total cases being fracture of either single or both nasal bones, with or without other fracturesfollowed by orbital, skull base, and maxillary fractures. The Le Fort fractures are most commonly associated with opacification of the sinus indicating hemosinus. Conclusion: Road traffic accidents are very common in metropolitan cities like Bangalore and facial injuries constitute a significant number. Young and middle aged males are more prone for injury before of increased habit of risk taking and more exposure to risk. MDCT plays a major role in evaluation of patients with maxillofacial trauma. It not only gives information about site and displacement of the fracture; but also helps in detection of adjacent soft tissue injury and airway. In cases of trauma, imaging is very essential in diagnosis, treatment planning, and in prognosticating.

Variability of Lip Print Pattern in Relation to Gender Among Two Ethnic Groups of Haryana

Prabhjot kaur, Harsh, Rasalika , Subhash Kaushal, Ashish Sharma

Introduction: Lip prints don’t change during the life of a person and are unique. Lip prints are the characteristic patterns of the fissures (sulci labiorum) in the form of elevations and depressions on the labial mucosa and characterises the human being the same as finger prints. Variations in lip print patterns could help in sex determination. Aim: The present study was initiated with the aim to develop a baseline data for cheiloscopy, to investigate the variability of lip prints in relation to gender in two different ethnic groups of Haryana and also establishes the usefulness of lip print patterns in identification of a person. Materials and Methods: The study consisted of 40 families belonging to Haryanvi Baniyas and 40 families belonging to Haryanvi Jats. Out of the total subjects studied, 88 mlaes and 76 females belonged to Haryanavi Baniyas and 84 males and 81 females were from Haryanavi Jats. Study material used were transparent cellophane tape glued on one side (24 mm), Black powder (computer printer powder of Oddyessy ), White paper, Digital camera (Sony, 12 mega pixels), Magnifying lens. The lip prints were analysed by using Adobe Photoshop@7.0 software after dividing each lip print into 8 compartments. Results: Lip print analysis showed that the most predominant lip pattern in the entire study population was type IV was found to be maximum. However, separately in each endogamous group, incidence of type IV was found to be maximum in population of Haryanvi Baniyas whereas, in Haryanvi Jats, the incidence of lip prints was maximum of type II.Lip print pattern in upper lip in haryanavi baniyas is type IV in males, type II in females and in lower lip is type IV both in males and females. In case of harayanavi jats in upper lip it is type II in both males and females while in lower lip it is type IV in males and type II in females. Conclusion: The lip print patterns are similar to some extent between males and females of the same ethnic group but varied between different ethnic groups. They serve supplementary tool for identification of an individual along with other modes to recognize the sex of an individual.

Mammographic and Sonomammographic Evaluation of Breast Masses with Pathological Correlation: A Prospective Original Study

Jaipal R Beerappa, Balu S, Nandan Kumar L D, An uradha Kapali, Raghuram P

Introduction: Breast lumps are common problem affecting females, which require proper workup, early diagnosis and treatment. Mammography is used as both screening modality and as an efficient technique to evaluate clinically suspected breast lesions. High-resolution sonography is a adjunct modality used in detecting lesions in dense breast and supplementary assessment of breast lesions. Aim: To determine the sensitivity, specificity, PPV, NPV of mammography, sonomammography and both modalities together combined in assessment of breast lesions. Materials and Methods: One hundred and two palpable or suspicious breast masses from 97 patients were evaluated with sonomammography, mammography and were correlated with appropriate pathological examination. Sensitivity, specificity, positive predictive, negative predictive values and accuracy were computed for mammography, sonomammography and combined tests. Characteristics of mammography and sonomammography of breast lesions which help to differentiate benign from malignant lesions are assessed. Results: Combining the mammography and USG, sensitivity, specificity, PPV, NPV were 92.22%, 98.02%, 92.99% and 86.2% respectively. The study showed that there was no significant difference in sensitivity between mammography and USG (p=0.23). But there was a significant difference in mammography alone and mammography USG combination (p=0.002) and USG alone and combination (p=0.0015). Conclusion: Combined mammographic, sonomammographic evaluation of breast masses was more accurate than either method alone. Irregular shape, high density, spiculated margins, microcalcification, posterior acoustic shadowing, heterogeneously hypoechoic nature, internal vascularity and associated features like skin, nipple thickening and retraction favor malignancy. Oval shape, surrounding halo, wider than tall lesion, anechoic or homogenously hypoechoic lesion with posterior acoustic enhancement favor benign lesion.

Burial, Excavation and Chemical Cleaning - An Economical Approach for Extraction of Human Bones from Embalmed Dissected Cadavers in India

Introduction: The human bones are an integral tool in the study of anatomy. Bones are necessary not only for teaching anatomy but also for planning of various surgeries and assessing the efficacy of orthopaedic devices. Aim: The present study was undertaken to develop the most suitable technique for extraction of human bones from embalmed dissected cadavers. Materials and Methods: The study was conducted on the embalmed dissected cadavers in Department of Anatomy, GSVM Medical College, Kanpur, UP, India. The cadavers were buried in the soil for a period of two years at the depth of 1 foot, 2 feet, 3 feet and 4 feet. The bones so extracted were cleaned with a solution of normal water, detergent, bleaching powder and hydrogen peroxide. The result was compared with the bones extracted with other techniques. Result: The bones extracted after this procedure were clean, intact and their quality was absolutely at par with the bones extracted with other techniques. It was found that the bones of the most superficial level i.e. 1 foot from surface had some decomposition at the ends. The bones at the 2 feet were of best quality - quite clean and intact. The bones at the 3 feet were also intact but some soft tissue was still adhered around these bones while there was a minimal decomposition of the cadavers buried at the depth of 4 feet due to which bones could not be procured from this depth. Conclusion: The burial method for extraction of bones and the subsequent cleaning with a solution of normal water, detergent, bleaching powder and hydrogen peroxide is a very comfortable, cost effective, ecofriendly and suitable method for obtaining the human bone specimens from embalmed cadavers. The cadaver should be buried in superficial layer preferably 1 foot to 2 feet depth.

17869_The Relationship Between Fetal Crown-Rump Length in the Early First Trimester and Growth Parameters at Birth

Introduction: Crown–rump length (CRL) has been demonstrated to be an accurate predictor of birth growth and can cause many complications. Aim: This study was conducted to determine the association between CRL in the first trimester and weight, length and Head circumference (HC) at birth. Materials and Methods: This was a prospective, cohort study in Hajar Hospital of Shahrekord, southwest Iran from March, 2013 to June, 2014 (within 15 months). Thirty women achieving pregnancy with intrauterine insemination and in vitro fertilization were compared with 60 women getting pregnant naturally. Between the days 59 and 83 after insemination, fetal CRL was examined by ultrasound. Then, the patients were followed up and weight, length and HC at birth were recorded. The data were analyzed by SPSS 22. Results: There was a direct correlation between CRL and length in the studied infants (0.91, p<0.001). The correlation between CRL and length was derived significant in both the infants born after artificial insemination (AI) and born naturally (0.69 and 0.7 respectively, p<0.001). There was a direct correlation between CRL and HC (0.27, p=0.01) in AI and naturally born groups (0.47 and 0.26 respectively, p<0.05). There also was a significant, direct correlation between CRL and weight (0.69, p=0.001) in both AI and naturally born groups (0.53 and 0.78 respectively). Conclusion: CRL in the first trimester is significantly correlated with weight, length and HC at birth and can be used in screening. However, this index, as a diagnostic test, cannot exactly predict real length, HC and weight at birth.

The Role of MDCT in Oesophageal Cancer

L. SUMITHRA, KR. Vijay Kumar, BR. NAGARAJ

Introduction: MDCT plays an important role in detecting various finding of locally advanced carcinoma oesophagus and metastasis, which helps the surgeons to decide the line of management. Present study describes various finding of oesophageal carcinoma on CT to aid in its diagnosis and staging. Aim: The aim of our study is to evaluate and describe the various Multi Detector Computed Tomography findings of carcinoma oesophagus to aid in its diagnosis and staging. Materials and Methods: After ethical clearance, a prospective study was carried out in the Department of Radiodiagnosis, BMC & RI, Bangalore from October 2014 to September 2015. After obtaining consent, 37 patients presenting with clinical symptoms and signs pertaining to carcinoma of oesophagus, who underwent prior endoscopic biopsy, were studied with Multi Detector CT scanner (Siemens somatom emotion- 6 slice CT) using thin sections. Oral and IV contrast was used. Three dimensional reconstructions were done and various CT findings of oesophageal cancer studied. The diagnosis and staging confirmed by post-operative histopathology. Results: Carcinoma oesophagus was commonly seen in age group between 50 to 60 years (59.5%) with males (51.3%) more commonly affected than females (48.6%). All patients predominantly presented with dysphagia. Alcohol and smoking was the associated risk factor. The lower 1/3rd of oesophagus affected more commonly compare to other parts. The wall thickness in majority of the cases measured between 10-20mm (83.8%). T3N0Mx was the most common staging found in CT (56.7%).16.2% cases presented with metastasis. Squamous cell carcinoma (86.5%) was the most common histopathological type presented. Twenty six patients got operated out of 37 and CT staging was compared with the post operative histopathological staging. The sensitivity of CT-scan for ‘T’ stage were 73.0%, in ‘N’ stage 80.7% and in ‘M’ stage being 100%. Conclusion: CT-scan is excellent in the diagnosis of distant metastasis and lymphadenopathies. Thus, evaluation of various CT findings and preoperative staging of carcinoma oesophagus will help to decide management of these patients. Hence, CT plays an important role in detecting and staging carcinoma oesophagus.

Study of Inferior Thyroid Artery and its Relation to the Sympathetic Chain in Full Term Fetuses

KAFEEL HUSSAIN A, SWAYAM JOTHI S, RAJAMADHAVA R, NARAYANA RAO B.T

Introduction: Familial dysautonomia and Sudden Infant Death Syndrome (SIDS) are amongst the most frequently encountered dysautonomias were sympathetic cardiac dysfunction is indicated by prolonged corrected QT interval. The therapy for long QT includes left cervical sympathectomy and administration of beta adrenergic receptor antagonists. Also, cervical and cervicothoracic sympathectomies are emerging as choices of treatment for epilepsies, Raynauds syndrome and vascular disorders of the upper extremities. There have been few studies in fetuses, inspite of the various structural anomalies encountered in the vicinity of the thyroid gland and this warrants the need of a fetal study. Aim: The present work was undertaken to study the anatomy of the thyroid gland and its neighboring structures in fetuses with a special focus on the relation of the sympathetic chain and inferior thyroid artery. Materials and Methods: A total of 54 still born fetuses procured from the Department of Obstetrics and Gynecology, SSSMCRI and KGH, Vishakapatnam after getting informed consent from the parents and getting the approval from the ethical commitee. An observational (cross sectional) study was conducted over a period of 3 years from 2013 to 2015. All the fetuses included in this study were over 36 weeks. Fetuses with neural tube defects were excluded from this study. The fetuses were embalmed by injecting 10% formalin into the serous cavities of the abdomen, cranial cavities through the orbit and into the muscles and limbs. Result: Of the 54 fetuses studied, the inferior thyroid artery had a course behind the sympathetic chain on both the sides in 24 (44%) and anterior to it on both sides in 10 (18.5 %) fetuses. The inferior thyroid artery was anterior to it on the right and posterior to it on the left in 5 (9.25%) cases and anterior to it on the left and posterior to it on the right in 13 (24%).The inferior thyroid artery passed through the sympathetic chain on the left side in 3 (5.5%) cases. In one fetus, the inferior thyroid artery was lying parallel to the sympathetic chain .The artery was absent on the left side in 2 (3.7%) and on the right in 1(1.8 %) fetus. Conclusion: Knowledge of the varied relations of the inferior thyroid artery to the sympathetic chain encountered study may act as a cornerstone for safely performing cervical sympathectomies in infants if indicated.

Tubercular Spondylitis: Prospective Comparative Imaging Analysis on Conventional Radiograph and MRI

Gaurav Sharma, Rita Ghode

Introduction: Tuberculosis remains a major health hazard with a rebound insurgency with increasing incidence of HIV. Skeletal involvement occurs in 1-3% of patients with tuberculosis and spine accounts for almost 50% cases of skeletal tuberculosis. Imaging plays an important role in managing spinal tuberculosis by making a prompt diagnosis so as to prevent irreversible neurological deficit and spinal deformity. During this era of cross sectional imaging, plain radiography can still provides important information necessary for diagnosis, however disease may not be apparent for upto 8 weeks and or involvement of 30-50% of the vertebra. MRI remains the standard imaging modality with its high contrast resolution, multiplanar capacity and ease of assessment of spinal cord and neural element. Aim: To compare and correlate the imaging findings of tubercular spondylitis on plain radiograph and MRI. Materials and Methods: This was prospective diagnostic study carried out over 1 year of period in the department of radio diagnosis, JR Tantia Charitable Trust and Rural Hospital, comprising a sample size of 32 patients. The various spinal imaging findings were prospectively evaluated and compared on plain radiograph and MRI. Results: A definite level of lesion could be localised in 27(84.3%) on radiograph while MRI could localized the disease in all 32(100%) patients. Thoracic spine was the most common site on both plain radiograph and MRI. Paradiskal with posterior location 15(46.8%) was commonest pattern of vertebral involvement on MRI while plain radiograph could localized mostly paradiskal lesion 24(88.8%). Both modalities could detect vertebral body destruction, reduced disc height in equal number of patients (19). Skip lesion was seen in 4(12.5%) cases on MRI and in 2 (7.4%) on plain radiograph. Paravertebral soft tissue mass was evident in 26(81.2%) patients on MRI and in 15(55.5%) on plain radiograph. The two modalities showed a moderate agreement (k value: 0.685) amongst them for detection of skip lesion while they showed poor agreement (k value: 0.09) for detection of paravertebral soft tissue mass. The two modalities showed a perfect agreement (k value:1) for evaluation of reduced disc height. Conclusion: Plain radiograph does reveal the important diagnostic imaging findings and serves as the initial first line imaging modality due to its cost effectiveness and availability. However, MRI is more sensitive, specific and accurate than plain radiography in the diagnosis of spinal tuberculosis.

Anatomical Variations in the Division and Innervation of the Sciatic Nerve with its Clinical Consequences

Mohd Salahuddin Ansari, Mukesh Singla, Kumar Satish Ravi, Rajni Singh

Introduction: Commonly encountered peripheral nerve in emergency, trauma, routine surgical medical practice and neurology is Sciatic Nerve (SN). Its vulnerability to injury is because of its thickness and long course. Its vast clinical involvement warrants a more definitive study. So the study was planned with the following aims and objectives. Aim: To study the anatomical variations in the division and innervation of the sciatic nerve and to correlate these variations with the clinical consequences of the nerve. Materials and Methods: This study was carried out on 30 lower limbs of human cadavers of Indian origin. The sciatic nerves of these cadavers were dissected, photographed, observed, analysed and interpreted in the Department of Anatomy. Results: It was found that in 43% of cases division of sciatic nerve was just below the lower border of piriformis, in 36%, between the piriformis and the mid of the thigh, in 14% near the mid of the thigh, in 7%, between midway of thigh and joint line of the knee and not even in a single case, the division was found to be, in the pelvis and below the knee joint line. Conclusion: Most common site of exit and bifurcation of SN were found to be just below the piriformis which is in contradiction to the earlier reports which state apex of the popliteal fossa to be the most common site of SN bifurcation. So we emphasize that this fact should also be there in the mind of concerned surgeons, orthopedicians, anaesthesiologists and neurophysicians while dealing with and planning for the pathologies involving SN, not only for better diagnosis and treatment but also for avoidance of iatrogenic complications.

Prevalence and Spectrum of Congenital Malformations in a Tertiary Care Centre

Tapan patt anaik, Sunita Samal, Tanaya Jena

Introduction: Congenital anomaly is an abnormality of physical structure that is seen at birth or within few weeks after. These abnormalities largely contribute to neonatal and infant morbidity and mortality. The occurrence and pattern of presentation vary from region to region. The exact aetiology is not known and genetic and environmental factors may be implicated. Aim: To determine the prevalence and types of congenital anomalies in newborns and to study the associated risk factors. Materials and Methods: This observational hospital based study was conducted in Department of Obstetrics and Gynaecology MKCG Medical College and Hospital, Berhampur, Odisha. Total 100 cases of congenital malformation detected antenatally or after delivery were analysed within a study period of Jan2011 to March 2012. Result: Total 100 cases of anomalies were studied out of 7973 pregnancies. The prevalence of congenital malformation was 125 in 1000(12.5%). Major congenital malformations were 104 in 1000(10.4%) and minor malformations were 21 in 1000(2.1%). Most of the anomalous babies were born to women of fourth gravida or more (42%). Commonest system involved was central nervous system (43%). In the postpartum period maximum (56%) babies were diagnosed to have anomalies. Amniotic fluid abnormalities were the most commonly (18%) associated maternal conditions. Conclusion: Congenital anomalies are important causes of still births and infant mortality, and are also contributors to childhood morbidity. Hence prenatal diagnosis by proper antenatal care and targeted scan is essential.

Retinopathy of Prematurity- Prevalence and High Risk Characteristics in a Rural Tertiary Care Hospital in Central India

Bodhraj Dhawan, Rekha Khandelwal, Kanav Gupta

Introduction: Retinopathy of Prematurity (ROP), a disease characterized formation of a vascular barrier at junction of vascularized and non-vascularised retina is increasingly being common in developing countries due to increasingly improving neonatal fascilities. Various factors have been implicated in its causeation. Aim: Present study aimed to find prevalence of ROP and associated risk factors in rural tertiary care hospital setting. Materials and Methods: During study period, ROP screening and treatment was done by a trained retina specialist for neonates at 4-6 weeks after birth or at 31 weeks post menstrual age, whichever is later, using dilated indirect ophthalmoscopy with a 28 Dioptres condensing lens in Neonatal ICU. Risk factors including gestational age, birth weight and neonatal risk factors were noted and ROP, if present was classified and noted. Eligible babies were offered treatment. Results: Prospective study to screen 50 premature babies was undertaken over the study period of 18 months in which 11 babies (22%) were found to have ROP. The birth weight of ROP babies ranged from 968- 1650 grams with a mean weight of 1260.90 ± 215.52 gm, while that of non-ROP babies ranged from 900-2900 gm, with a mean weight of 1517.07 ± 419.04 grams. Similarly, the gestational age of ROP babies ranged from 28-36 weeks with a mean gestational age of 30.54 ± 2.54 weeks; while that of non-ROP babies ranged from 28- 39 weeks with a mean age of 33.12 ± 3.05 weeks. The difference of mean weights between two groups was statistically significant with p-value of 0.0097 (p< 0.05). Also the difference of mean gestational age between two groups was significant with p-value of 0.0105 (p< 0.05). Low birth weight and low gestational age were identified as main significant risk factors.Apnoe, oxygen administration and respiratory distress were other risk factors noted. Conclusion: ROP is a common issue in premature and low birth weight babies. ROP Screening should therefore be followed as standard protocol in paediatric NICU settings.

Utility of Sepsis Screen in the Early Diagnosis of Neonatal Sepsis

Introduction: Neonatal sepsis could be defined as a clinical entity because of generalized bacterial infection within 28 days of life and showing a positive blood culture. It is probably responsible for 30- 50% of the total neonatal deaths each year. Timely diagnosis of neonatal sepsis is critical because in neonates the illness can progress more rapidly than adults. The blood culture report takes at least 72 hours. Therefore, a simple test with quick availability of results can be helpful to reduce neonatal morbidity and mortality. Aim: To evaluate the utility of sepsis screen in early diagnosis of neonatal septicemia and to study various hematological parameters, changes in peripheral blood smear, evaluate the performance of microerythrocyte sedimentation rate, serum C-reactive protein and serum direct bilirubin in neonates with clinical suspicion of sepsis. Materials and Methods: The present, study was done in our institute from October 2013 to October 2015. CBC was done on 191 clinically suspected cases of neonatal sepsis along with Micro ESR, Serum CRP and direct bilirubin. Differential leukocyte count, absolute neutrophil count, immature neutrophils: total neutrophils ratio was done from Field stained peripheral smears. Blood culture was done in Microbiology Department. Exclusion criteria were neonates with major congenital anomalies and those who have already received antibiotics. Statistical Analysis: Statistical analysis was done using SPSS software, version 20th and unpaired ‘t’- test. Result: Out of 191 cases studied, 91 were culture positive. CRP (84.6%) and immature : total neutrophils ratio(75.8%) showed highest sensitivity, Whereas absolute neutrophil count(99.0%) along with serum direct bilirubin (93.0%) and corrected total leucocyte count (93.0%)showed highest specificity. Positive predictive value was highest for absolute neutrophil count (97.5%) and CRP (84.8%). Conclusion: Serum CRP is the most sensitive marker of sepsis. Use of peripheral smear study, serum direct bilirubin and micro ESR together with CRP can be used effectively as a sepsis screen for early diagnosis of neonatal sepsis.

20687_Prevalence of Anterior Abdominal Wall Hernia and its Associated Risk Factors

Priti Prasad Shah, Shama Shaikh, Sunil Panchabhai

Introduction: Anterior abdominal wall hernia is very common surgical problem and millions of patients are affected each year. In developing countries they are not treated on priority basis because of their benign nature in general and due to economic reasons. Despite the frequency of this procedure the ideal prevalence, associated etiological factors, results, complications, recurrence are not same everywhere and it continue to be a challenge for the surgeons. Aim: This study was done to find out prevalence of anterior abdominal wall hernia and its associated etiological factors. Materials and Methods: This is a retrospective study was conducted in Padmashree Dr. DY Patil Medical College and Hospital, Pune. Total 200 cases of anterior abdominal wall hernia excluding groin hernia were studied retrospectively. The data obtained from medical record section, and proformas were filled. The data analysis of the study was done by using statistical package for social science (SPSS) software version 17 for window. Results: The result of the study has shown the prevalence as 42% Incisional hernia, 32% umbilical hernia, 17% paraumbilical hernia, 10% epigastric hernia. Obesity, Smoking,Cough and Diabetes were the common associated etiological factors for ventral hernia in our study. Conclusion: This is a small number and single center study, a larger number and multicenter data would confer more generalized conclusion.

20940_A Cross Sectional Study of Normal Variations of Sphenoid Sinus Through CT-Scan in North Karnataka, India

Manisha S. Chougule, Preetam B. Patil

Introduction: In the humans, paranasal air sinuses play various roles like- make the skull light weight, add the resonance to the voice etc. We have frontal, ethmoid, maxillary and sphenoid sinuses. Out of these, sphenoid sinuses (SS) have got the importance because of trans-sphenoid approach for the pituitary surgeries and skull base surgeries. Therefore, the knowledge of anatomical variation of SS has a significant role in surgical access of pituitary fossa and also, can anticipate the difficulties in surgery. Aim: This is the study to find out the variations of SS and their relations to adjacent neurovascular structures with surgical point of view. Materials and Methods: Computed Tomography (CT) scans of 150 living subjects (53 females and 97 males) were taken in coronal, sagittal and axial planes. Contiguous slice CT technique was used with 1 mm section thickness. The p-value was calculated to find out the association between extent of pneumatization of sphenoid sinus and protrusion or dehiscence of maxillary nerve (MN), vidian nerve (VN), optic nerve (ON) or internal carotid artery (ICA) in the sinus. Chi square test was used for the calculation of p-value. Results: It was observed that there were 2 cases with conchal pneumatization, 29 cases with pre-sellar pneumatization, 47 cases with sellar pneumatization, 72 cases with post-sellar pneumatization. It was observed that pneumatization of greater wing of sphenoid sinus (GWS) in 40 cases, pterygoid process (PP) in 39 cases and anterior clinoid process (ACP) in 34 cases. Onodi cell were noticed in 17 sinuses. Protrusion of ICA was found in 27 sinuses. The p-value was highly significant for the association between pneumatization of sphenoid sinus and protrusion or dehiscence of nerves or ICA in the sinus. Chi square test was used for the calculation of p-value. Posterior attachment of Inter Sinus Septa (ISS) was noticed in the midline in 36 individuals (24%) and deviated from midline in 113 individuals (75%). Accessory septae were noticed in 76 sinuses (51%). Conclusion: Due to widespread pneumatization of SS, it lies in close relation with MN, ON, VN & ICA. Newer techniques were helpful for the safety of the patient during intra-operative and post-operative period.

19037_Utilization Pattern of NSAIDs and Gastroprotective Agents: A Prospective Analysis in Patients with Musculoskeletal Pain in A Tertiary Care Hospital

Resmi Douglas, Reneega Gangadhar, Annapurna Y

Introduction: Non steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications for musculoskeletal conditions. Gastroprotective agents are co-prescribed in patients using NSAIDs for long time as they are associated with gastrointestinal complications. To promote rational drug use, it is important to assess drug use pattern using the World Health Organization (WHO) drug use indicators. Aim: To determine the pattern of utilization of NSAIDs and gastroprotective agents in patients with musculoskeletal pain in Physical Medicine and Orthopedics Departments using WHO prescribing indicators. Materials and Methods: 108 case records of inpatients with musculoskeletal pain, satisfying the inclusion criteria, were analyzed prospectively for pattern of use of NSAIDs and gastroprotective agents .The data collected was analyzed for prescribing indicators, complementary indicators and other factors influencing the pattern of NSAIDs use. Descriptive statistics was used. Results: The average number of drugs prescribed per encounter was three. Percentage of drugs prescribed by generic name was 1.5% and percentage of encounters in which an injection was prescribed was 57.4%. Percentage of drugs prescribed from essential drug list (EDL) was 75.5%. Cost of drugs was affordable compared to per capita income. Diclofenac was the most commonly used NSAID. NSAIDs use was more common in women. The co-prescribed gastroprotectives were either H2 blockers (65.7%), PPIs (17.6%) or both (16.7%). Conclusion: On the basis of the finding of this study, the prescribing practices for injection and generic prescribing show deviation from the standard recommended by WHO. Overuse of injections and negligible generic prescribing need to be regulated closely. On the other hand, polypharmacy, prescribing from EDL and cost of therapy were not found to be a problem in this study. Such utilization studies will make the clinicians aware of the need for prescribing rationally.

20169_Role of MR Spectroscopy in Differentiating Tumor Recurrence and Post Radiation Changes in Treated Brain Tumors with Radiotherapy

Madhu SD, Jaipal R. Beerappa, Pr ashanth Kumar Sinha, Raguram P.

20857

Maternal and Perinatal Outcome in Pregnancies with Oligohydramnios in Third Trimester

Manisha Sharma, D K Bhagwani, Mala Chaurasia, P K Jain

Introduction: Oligohydramnios presents a threat to the fetus due to increased risk of the umbilical cord getting compressed and resulting in impaired blood flow to the fetus. Aim: The objective of the study was to find out the significance of oligohydramnios during third trimester of pregnancy. Materials and Methods: A hospital based prospective study was conducted in the Department of Obstetrics and Gynaecology at Hindu Rao Hospital, Delhi. Amniotic fluid index (AFI) estimation was done on 150 pregnant women in third trimester, who were selected after screening for inclusion and exclusion criteria. Women with AFI < 5 cm were taken as cases while women with AFI > 5 cm as controls. Results: The mean maternal age was 23.58±3.43 years and maximum women were primigravida. Mean AFI among the cases was 2.97±1.95 cm. Antenatal complications like pre eclampsia, IUGR, PROM were associated with 71% of the cases. Labour was induced in 65% of the cases compared to 21% among controls. LSCS was performed in 44% of cases compared to 10% in controls with fetal distress the most common indication (85%). 73% babies born to the cases had birth weight < 2.5 kg, 55% had APGAR score < 7 and 44% had NICU admission compared to 16%, 13% and 13% respectively among controls. There were 5 intrauterine deaths and 2 stillbirths among the cases and none among the controls. Conclusion: Identification of oligohydramnios can be done by a good clinical examination and confirmed by measuring AFI on ultrasonography. Poor fetal outcome in the form of preterm, IUD, LBW, low APGAR score at 5 minute and increased chances of still birth, NICU admission and neonatal death are seen with oligohydramnios in third trimester and more so if it is detected in early third trimester. Chances of induction of labour and risk of LSCS also increase. Thus, detection of oligohydramnios helps in proper management of the cases so that maternal and perinatal outcome can be improved.

Subcutaneous Fat Necrosis of the Newborn

Navya Handa, Dilip Kachh awa, Jai Prakash Soni, Vinod Kumar Jain, Pank aj Rao

Subcutaneous fat necrosis of the newborn is a rare type of localized lobular panniculitis resulting in firm, inflamed, skin-coloured to purple nodules in the fat. The back, limbs and buttocks are common sites affected. The disease may manifest as discrete lumps or as a large hardened area. It occurs most commonly in the first post natal week in term infants. Although, usually a self-limited condition, subcutaneous fat necrosis may be complicated by hypercalcaemia and other metabolic abnormalities and therefore, these patients need close monitoring for complications.

19580_Castleman’s Disease Presenting as an Abdominal Mass

C. Valiathan Gopakumar, P.K. Reddy, J.K.A. Jameel

Castleman’s disease is an uncommon lymphoproliferative disorder. It can present as unicentric disease or multi-centric disease. Here we present a case in which a 60 year old female who presented with upper abdominal discomfort was evaluated with contrast enhanced CT scan and was initially thought to have a paraganglioma at hepatoduodenal ligament, but was later diagnosed as having Castleman’s disease.

19691_MRI Findings in Diastematomyelia Presenting without Neurological Deficit-A Rare Case

Diastematomyelia is a rare dysraphic lesion of spinal cord and the defect occurs as a result of an incorrect development of notochord between 15th and 18th day of pregnancy. In this defect, the spinal cord splits into two hemicords in sagittal plane. We hereby present a case of 30 years old female who had been experiencing spine pain without any neurological deficit for over 10 years. Despite the confirmed osseous anomalies of the lumbar spine, the correct diagnosis was established only after performing the MRI. She was treated surgically and was asked to come for regular neurological examinations after discharge.

21165_Case report of a Mega-Appendix: Longest Non-Perforated Appendix

The appendix remains to mesmerize the surgeon in its presentations, pathologies and even functions. Acute appendicitis is the most common cause of an “acute abdomen” in young adults. Open appendicectomy remains the management of choice for acute appendicitis and is one of most frequently performed urgent emergency operation by the surgeon in training. The intraoperative appearance of appendix can be deceiving and even at times challenging even for an experienced hand. The saying goes “approach every appendicitis, as a unique case”. The size of appendix varies from individual to individual the average being 6 to 9cm in length and 7 to 8mm in diameter. The maximum length of appendix recorded so far in country is 17.5cm and globally is a case of a perforated appendix of 55cm long. We present a case report of one of the longest non-perforated appendix removed, so far in India, measuring about 18.2cm in length and 7.6cm in its largest circumference.

21183_Primary Retrovesical Hydatid Cyst causing Acute Urinary Retention in a Young Patient : A Rare Presentation

Congenital Granular Cell Tumor of a Newborn: A Case Report

Chhanda Das, Madhumita Mukhopadhyay, sucharita Sarkar, Bedabrata Mukhopadhyay

Congenital Granular Cell Tumour (CGCT) is a rare benign soft tissue tumour of newborn, different from adult GCT. The tumour has a strong predilection for the maxillary alveolar ridge with a female preponderance. Here we report an unusual case of congenital granular cell epulis in the mouth of a 2 hour old female newborn. She had a round, soft, pedunculated mass measuring (2x 2x1) cm. which was causing feeding difficulty. This case was reported as congenital granular cell epulis. We are presenting this case because of its rare nature and uncommon presentation at this age.

An Intriguing Case of Circumcaval Ureter

RAMESH KUMAR RUDRAPPA, ELAMPARIDHI PADMANABHAN, SIBHITHRAN RAJAKUMAR

Circumcaval ureter is a rare congenital condition resulting from the anomalous development of inferior vena cava due to developmental failure of supracardinal system. This results in posterior and medial looping of the right ureter around the developed IVC.

Multiple and Bilateral Primary Brain Hydatid Cyst Dowling Technique is not always Appropriate (Case Report)

Hydatid disease is a parasitic infestation caused by Echinococcus granulosus. Echinococcosis occurs worldwide and can affect multiple organs. Majority of the intracranial cysts are secondary and solitary. Bilateral and multiple primary cerebral cysts are uncommon and occur as a result of rupture of primary cerebral cyst or embolization from a ruptured peripheral cyst. Emergency surgical management of a 20-year-old man with multiple and bilateral primary hydatid cysts are presented. Eleven cysts, which were symptomatic due to their mass effect, were surgically removed in two stages, followed up with medical treatment. The patient was admitted firstly, with blindness, headache, vomiting and frontal syndrome six months later. The patient deteriorated rapidly with signs of left temporal commitment. Postoperative outcome was satisfactory. In addition to the fact, that the presented case is an additional example for the rare primary multiple and bilateral cerebral hydatid cysts.

Giant Thymoma from Ectopic Thymic Tissue in Children: A Case Report and Review of Literature

Thymoma is a rare tumor in paediatric age group. It is a locally invasive slow growing tumor with occasional occurrence of extra thoracic metastasis. The report of incidence of thymoma from ectopic thymic tissue is extremely rare and to the best of our knowledge, no case yet has been reported on a giant thymoma arising from ectopic thymic tissue in paediatric age group. We present a case of giant thymoma originating from ectopic thymic tissue in a young girl. A 13 years old female child had complaints of failure to thrive and she was found to have a large mass in the right hemithorax with encasement of mediastinal vessels in investigations. Intraoperatively, well encapsulated mass with size of 20 × 30× 15 cm was resected completely through a lower right fourth space “trap door” thoracotomy incision. Histology confirmed the tumor as World Health Organization type B2 thymoma with heavy proliferation of lymphocytes and in Masaoka stage I. The post operative course of the patient was uneventful. The rarity of it among paediatric patient makes the management challenging.

Case Report : Spontaneous Caecal Rupture – A Disaster

Aditya Arvind Manekar, Nishigandh Dnyaneshwar Patil, Tushar B Patil

We present a case of a spontaneous caecal rupture in a 70 years old man with history of undergoing Trans Urethral Resection of Prostate (TURP) prior to the above presentation. The patient presented postoperatively (after TURP) with complains of abdominal distension, pain and vomiting was absent and tachycardia along with respiratory distress. No associated intra abdominal pathology was found. Early diagnosis and prompt surgical intervention is the only way for management of such cases.

Hyperglycemic Nonketotic Hemichorea-Hemiballismus- A Case Report with Review of Literature

GIRISH BABU SWARNA, RAMESH KUMAR RUDRAPPA, ELAMPARIDHI PADMANABHAN

Hemichorea-hemiballismus can rarely present in non-ketotic hyperglycemia. Elderly aged women after attaining menopause can have this as a first presentation. We reported a case of 70-year-old women presented with loss of consciousness, hemiballismus and hemichorea associated with non-ketotic hyperglycemia. CT imaging of brain reveals no abnormality. MRI was done when patient was having the hemichorea and hemiballismus which it showed hyperintense signal on T1WI, hypointense signal on T2WI involving the putamen region of lentiform nucleus on left side. Her symptoms were not seen after correction of serum glucose value to normal level. In our case we can notice the significance of detecting rare findings which shows in diabetic patients and to differentiate by using MRI from other common pathologies causing neurological symptoms.

Splenic Artery Aneurysms: Review of Pathogenesis, Diagnosis and Treatment and Presentation of Open Repaired Case

Leszek Sulkowski, Miroslaw Szura, Artur Pasternak, Maciej Matyja, Andrzej Matyja

Splenic Artery Aneurysm (SAA) is the most common visceral artery aneurysm (60%). It remains asymptomatic in over 95% of patients. SAA occurs predominantly in women of child-bearing age. Multi-slice SC angiography can accurately and clearly display the location of the SAA. Different management strategies can be applied: open surgery, endovascular approach and laparoscopy. We present the case of a 30-year-old female with a history of breast cancer T1cN0M0. Contrast-enhanced computed tomography scanning showed a 28mm true aneurysm of the splenic artery. Due to unfavourable anatomy for the endovascular intervention (elongated and tortuous splenic artery) the patient underwent open surgery. The aneurysm was excised and the splenic artery was reconstructed with end-to-end anastomosis. The patient was discharged from the hospital without any complication after 3 days.

Melioidosis: A Rare But Emerging Infectious Disease in India and Role of Radiologist in Diagnosis

Madhu SD, Parvathi M, Jyothsna Rani, Sujatha Patnaik

Melioidosis is an endemic disease in South East Asia and in North Australian countries caused by gram-negative bacterium Burkholderia pseudomallei. It was sporadic in India, but recent trend shows increase in number of the cases in the last few years making it as an emerging infectious disease. It presents with great clinical diversity, from skin ulcers to pneumonia, fulminant septic shock or abscesses in multiple organs including liver, spleen, kidney, brain and in musculoskeletal system with diabetes mellitus being the important predisposing factor. Radiologically it presents as consolidation, nodules, cavitatory lesions and abscesses in lung, multiple abscesses in abdominal visceral organs, with multiple discrete abscess in liver and spleen, which are highly suggestive of melioidosis. In CNS it presents as parenchymal abscess or as calvareal osteomyelitis, in musculoskeletal system as osteomyelitis, septic arthritis and as abscess in muscle. Melioidosis is called “great mimicker” as it mimics tuberculosis and malignancy radiologically. Even though radiological findings are not specific and confirmation is by culture of blood, sputum, abscess or other body fluids, radiologist have a definite role to play in suspecting melioidosis with clinical background in endemic areas and in countries like India, where it is an emerging infectious disease

Uncommon Location of an Urachal Cyst-A Case Report

Umbilicus is gateway of physiologically and anatomically different body structure in intrauterine period, urachus is one of them. Urachal cysts are extremely rare and even more uncommon in adults, as it is usually diagnosed in children. Diagnosis remain herculean in adults because of nonspecific symptoms, rarity of lesion and a wide umbilical pathologies as a differential diagnosis. We presenting a case of an adult 20 years old girl with on and off abdomen pain for few years, presenting to us with chief complaint of burning micturition. Radiological and laboratory investigations and surgical finding lead us to diagnosis of urachal cyst. Patient had no history of any umbilical discharge, considering her age and cyst location, urachal anomalies were kept as rare differential diagnosis. In this case location of cyst was atypical, therefore high index of suspicion and knowledge of umbilical anatomy and related pathologies is needed to achieve a diagnosis. Complete surgical excision is the treatment of choice.

Duplication Cyst Presenting as Intussusception: Report of Two Cases

Sanjeev B. Joshi, Rohith Muddasetty, Harish B.N. Patel

Duplication cysts are one of the rare congenital anomalies affecting the gastrointestinal tract. Small intestine is the most common site followed by colonic and gastric duplications. The commonest presentation is intestinal obstruction followed by bleeding and rarely vovulus. These cysts can be detected on an antenatal scan. Postnatally these cysts can be diagnosed on Ultrasonography or Computed Tomography of the abdomen. We report two cases of cystic duplications, presented with acute intestinal abdomen due to intussusception, in the Department of Surgery.

An Imaging Enquiry into Prostatic Calcifications

Sushil G. Kachewar, Smita B. Sankaye

9947_Hydatid Cyst of Lung- Common Disease, Many Signs, All in One!

A Case of Increasing Pneumoperitoneum due to Intra-Abdominal Drain

SHASHIKANT Y KULGOD, AMIT S AMMANAGI

Scabies in Neonates: A Rare Entity

BS Karnawat, Devendra Sharma