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   Table of Contents - Current issue
January-March 2018
Volume 15 | Issue 1
Page Nos. 1-48

Online since Monday, April 2, 2018

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Editorial Highly accessed article p. 1
RN Srivastava
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Steroid therapy in swine flu: Beneficial or harmful p. 2
Krittibus Samui
H1N1 influenza virus is responsible for respiratory illness that may range from mild symptoms of common cold to severe disease on presentation that needs hospitalization and management in intensive care. Corticosteroids are used to treat disease of immunity, inflammation or salt, and water balance. Here, the role of corticosteroid in swine flu is reviewed in various literatures. It is found that result of corticosteroid use in the management of swine flu patients is unsatisfactory. Instead of benefit, it is potentially harmful. It causes to develop higher duration of hospital stay, prolonged mechanical ventilation and ultimately increased mortality.
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Mucormycosis of the head and neck p. 6
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh
Mucormycosis is a rare clinical entity, often affecting immunocompromised patients. It is often an emergency situation and has poor prognosis. In head-and-neck region, mucormycosis spread by angioinvasion and may present with sinonasal, rhino-orbito-cerebral, palatal, cutaneous, or disseminated involvement. Prompt diagnosis with tissue biopsy, local control of the disease by aggressive surgical debridement, and appropriate systemic antifungal treatment improve the prognosis and survival of the patients. Treatment of mucormycosis needs antifungal agents such as amphotericin B and wide surgical debridement. Early diagnosis and treatment is often needed for survival of the patients. This paper will review the etiopathogenesis, epidemiology, clinical presentations, investigations, and treatment of the dreaded fungal infections called mucormycosis in the head-and-neck region.
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Mitral valve prolapse p. 11
Nekkanti Venkat Rayudu
Mitral valve prolapse, Click murmurs syndrome, Barlow's syndrome is one of the common cause of mitral valve disease with or without mitral regurgitation. Barlow gave full clinical description of the disorder in 1963. It has large clinical spectrum from asymptomatic auscultatory or Echodopler finding to frank mitral regurgitation needing valve surgery.
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Functional outcomes of type c distal humerus fractures in adults fixed by orthogonal double plating p. 15
Kapil Mani KC, Parimal Acharya, Dirgha Raj RC, Arun Sigdel
Background: Surgical reconstruction of intra-articular distal humerus fractures imposes a challenge to even experienced surgeons as it is complicated by anatomy of elbow, small area of fixation, associated comminution, and osteopenia of articular surfaces. Single-column plating does not provide stable construct for comminuted distal humerus fractures as compared to the double-column plating methods. The purpose of this study is to evaluate the functional outcomes, technical difficulties, complications, and patients' satisfactions after orthogonal double plating. Materials and Methods: This was a retrospective analytical study of 54 patients with Type C distal humerus fractures fixed with orthogonal plating from 2012 to 2016. Time to unite the fractures and functional outcomes along with other major and minor complications were noted. Results: Seven (13%) fractures were C1, 12 (22.2%) were C2, and 35 (64.8%) were C3 types according to the AO classification. Major complications were noted in 5 patients and minor complications in 19 patients. Eleven (20.4%) patients were rated as excellent, 33 (61.1%) rated as good, 7 (12.9%) rated as fair, and 3 (5.6%) rated as poor. Mayo Elbow Performance Score in overall patients (n = 54) was 81.62 ± 10.28, C1/C2 subgroup (n = 19) was 89.05 ± 60, and C3 subgroup was 77.60 ± 9.91 (P = 0.627). Similarly, the Disabilities of the Arm Shoulder and Hand Score in overall patients was 17.96 ± 15.67, C1/C2 subgroup was 8.78 ± 7.07, and C3 subgroup was 22.82 ± 16.78 (P = 0.285). Conclusion: Orthogonal dual-plate configurations can provide anatomical reconstruction and stable fixation of Type C intra-articular distal humeral fractures and allow early mobilization of the elbow after surgery; however, a significant number of patients do not satisfy after surgery.
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Unexpected complications encountered in surgical treatment of chronic subdural hematoma p. 21
Kodeeswaran M, Rajendran S, Priya Muniyandi, Ashwin Kumar Mani, Karthiraj N
Complications in chronic subdural hematoma (CSDH) surgery are usually rare. Sometimes, patients who underwent surgical treatment for CSDH develop complications such as pneumocephalus, recurrent hematoma, and subdural hygroma. We are reporting a case which had unexpected complications following CSDH surgical treatment.
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Incidental microfilaria in cervical lymph node cytology p. 24
Vandana Gite, Maruti Dhakane
Although filariasis is a major health problem in tropical countries including India, lymph node is an unusual site to present as filarial nodule. It is rare to find microfilaria in lymph node cytology. However, in the absence of clinical features of filariasis, fine-needle aspiration cytology may help in the diagnosis of lymphatic filariasis. We report this case, presented with filarial lymph node mass and diagnosed incidentally on a fine-needle aspiration.
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An uncommon knee pain: Ganglion cyst in the gastrocnemius medialis p. 26
Sandesh Madi, Vivek Pandey, Naufal Nahas, Kiran Acharya
A large symptomatic ganglion cyst occurring in the gastrocnemius has been infrequently described in the literature. Clinical presentation and management of such a symptomatic ganglion are briefly outlined here. This is perhaps the first case that describes the surgical management of symptomatic ganglion and associated internal derangement of the knee with favorable outcomes.
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A rare case of scrub typhus with complete heart block p. 29
Sharmili Sinha, Jyotirmaya Pati, Brajaraj Das
Scrub typhus is a tropical fever prevalent in South East Asia. It is a multisystem disease which can vary widely in clinical manifestations from mild generalized symptoms to multiorgan dysfunction syndrome. Myocarditis is a known complication which can present with tachycardia, heart failure, and very rarely heart blocks. We report a case of complete heart block due to scrub typhus case which was treated successfully at our center.
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Dermoid cyst of pancreas: A rare entity p. 32
Apurva S Shah, Shravan Bohra, Lakshman Khiria
Dermoid cysts or mature cystic teratomas are mesenchymal neoplasms most commonly found in the ovaries, but which may occur in any location along the pathways of ectodermal cell migration. Pancreatic dermoid cysts are rare entity and preoperative diagnosis is difficult. A 27-year-old female presented with upper abdominal pain and vomiting of 1 week duration without jaundice, diarrhea, and fever. Ultrasound abdomen showed a 4 cm × 3 cm cyst in the head of pancreas with smooth walls. Magnetic resonance cholangiopancreatography showed large multilocular cystic lesion in pancreatic head region which displaces pancreas anteriorly and mildly superiorly. Endoscopic ultrasound-guided cyst fluid aspiration was done which revealed high cyst fluid amylase and carcinoembryonic antigen. At surgery, a pylorus-preserving pancreatoduodenectomy was done. Histopathologic examination revealed a rare diagnosis of dermoid cyst of pancreas. This case report highlights difficulty in preoperative diagnosis of cystic lesions of pancreas by imaging. Therefore, we want to highlight the literature in this rare entity.
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Congenital mesenteric defect causing volvulus and intestinal obstruction in an adult p. 35
Adithya GK, Satya Prakash Jindal, Varun Madaan, Vivek Tandon, Deepak Govil
A 39-year-old female presented with a history of recurrent pain abdomen for 2 years. The pain was colicky and intermittent in nature. She had been diagnosed to have right-sided nephrolithiasis based on the findings of computed tomography (CT) abdomen and was managed conservatively during each episode of pain. During the present episode, her pain started 4 days prior to presentation and was associated with vomiting and inability to pass stool and flatus. X-ray abdomen showed evidence of dilated bowel loops. On clinical examination, her abdomen was distended with tenderness and guarding in the right lower abdomen. Her CT abdomen revealed dilated ileal loops in the right lower abdomen. The distal bowel was found to be collapsed. On exploratory laparotomy, a volvulus of the distal ileum, caecum and part of ascending colon was noted. The involved bowel loops were gangrenous. A mesenteric defect of about 10 cm was noted in the root of the mesentery, which had caused an internal herniation, volvulus and gangrene. She underwent a right hemicolectomy with covering ileostomy. Congenital mesenteric defects leading to internal herniation are a well-documented condition in pediatric population. Although the same can occur in adults, it is an infrequent cause of intestinal obstruction.
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Diagnosis and management of klippel–feil syndrome p. 38
Ashok Alapati, Susheel , Kurian Zachariah, Reddy Ravikanth
Klippel–Feil syndrome (KFS) is a congenital malformation of the cervical vertebrae, with limited treatment options. Short neck, limitation of neck motion, and low occipital hairline form the classical triad of KFS. Client/family education is vital to monitor and maintain function and to prevent neurologic deficits resulting from fusions, accidents, or trauma. Here, we present a case of KFS with management options.
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An unusual presentation of nasal septal abscess in 13-year-old boy p. 41
Santosh Kumar Swain, Sanjeev Gupta, Anwesha Banerjee, Mahesh Chandra Sahu
Nasal septal abscess is an uncommon clinical entity. There is a collection of the pus in the space between the nasal septum and its overlying mucoperichondrium and/or mucoperiosteum. It usually results from the trauma which leads to nasal septal hematoma and followed by septal abscess formation. If nasal septal abscess is not treated early, this may lead to fatal complications. In the growing child, early treatment along with reconstruction of the damaged septal cartilage is essential for normal development of midfacial area. Here, we are presenting a case of bilateral nasal septal abscess completely obstructing the nostrils in a mentally retarded child without any known history of trauma.
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Adrenal myelolipoma: Radiologic-pathologic correlation p. 44
Ashish Sachan, Hirdaya Hulas Nag, Sandip Barmann, Ravindra Kumar Saran
Myelolipomas are rare, benign tumors of adrenal gland. These tumors are generally asymptomatic and are diagnosed incidentally. Differentiating the tumor from other adrenal tumors such as liposarcoma, pheochromocytoma is important for management. We hereby describe the case of adrenal myelolipoma we recently managed, with emphasis on the radiologic and pathologic correlation of this rare disease.
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Unusual variant of leiomyoma with multiple omental feeders: Laparoscopic myomectomy with in-bag morcellation p. 47
Meenakshi Sundaram, Abdul Basith S. Fazal
This is a rare case of a large subserosal fibroid detaching itself from the uterus and in the process of attaching to the omentum by drawing blood supply from it. There were large aberrant feeder vessels. The appendix was found attached to it. The management of such fibroids is described.
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