Isolated splenic hydatidosis.

A 27-year-old female presented with pain in the left hypochondrium for the past six months. An abdominal examination revealed mild splenomegaly. An abdominal ultrasonography showed two cystic lesions at the superior pole of the spleen. Contrast enhanced CT scan abdomen confirmed the USG findings, demonstrating splenomegaly with nonenhancing cystic lesions having internal septations and suspicious daughter cysts within it, strongly suggestive of hydatid cysts. On serological testing, the patient was positive for IgG Antibodies against Eccinococcus. Following Pneumococcal vaccination, splenectomy was performed taking precautions to prevent accidental rupture or spillage of contents into the peritoneum. The postoperative period was uneventful with the patient making a swift recovery. Histopathological examination revealed extensive necrosis within the cysts. In the midst of the necrotic material, hooklets were seen. These features were consistent with a diagnosis of an infected Hydatid cyst. It is of utmost importance that a correct preop diagnosis is made since all precautions must be taken to prevent dissemination or seeding of the surgical field. Death has been reported due to anaphylactic shock resulting from spillage during excision or biopsy. The most important factor in diagnosing splenic hydatid cyst is the awareness of its possibility.

Role of Combined Circumareolar Skin Excision and Liposuction in Management of High grade Gynaecomastia.

INTRODUCTION: High-grade gynaecomastia (Simon IIb and III) has tissue excess (skin excess, enlarged areola, and displaced nipple), which is best managed surgically; however, results of conventional breast reduction surgeries and liposuction is not very good. Aim of our study was to describe a combined technique to manage these problems to produce a good result. MATERIAL AND METHOD: This was a 2-year study among 12 patients of high grade gynaecomastia. Clinical and laboratory findings were normal. Pre-operatively in standing position, diameter of breast and areola, position of nipple, and amount of skin excess were marked. Under general anaesthesia, tumescent infiltration, circumareolar de-epithelisation of skin excess, and liposuction was completed. Redundant portion of the breast was sharply dissected and pulled out. Areola was fixed over pectoralis fascia at mid humerus level, just medial to the mid-clavicular line. Outer borders of the de-epithelised area were apposed by the purse-string effect of a subdermal suture, and further apposed by few half buried horizontal mattress sutures. Drains for 24 hour and compressive dressings for 6 weeks were used. RESULT: Mean age of presentation was 25.8 year; emotional discomfort was the chief complaint. Among 12 patients, 10 patients had bilateral gynaecomastia and 8 patients had enlarged and displaced nipple-areola complex. Average hospital stay was 2.41 days and recoveries were usually uneventful. CONCLUSION: The problem of tissue excess and tissue displacement in high grade gynaecomastia can be well managed by this combined circumareolar skin reduction and liposuction technique to achieve a scar-less flat male chest.

Perforator plus fasciocutaneous flaps in the reconstruction of post-burn flexion contractures of the knee joint.

BACKGROUND: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. METHODS: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. RESULTS: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. CONCLUSION: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.

Anterior plagiocephaly in an atypical case of apert syndrome.

Apert syndrome is a congenital craniosynostosis syndrome comprising of bilateral coronal synostosis , symmetric syndactyly of hands and feet and midface hypoplasia. We present an atypical phenotype of this syndrome with right sided unilateral coronal synostosis. However, type I apert hand and other clinical and radiological features suggestthe diagnosis. Genetic analysis revealed an absence of the specific missense mutations in the FGFR 2 gene that is found in patients with this syndrome. We conclude that this patient represented a rare atypical variant of Apert syndrome. Further analysis is required to map the associated genotype.