Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.

Uncommon occurrence of pleomorphic adenoma in submandibular salivary gland in old age males: case series

Pleomorphic adenoma is the most common tumor of the benign salivary gland neoplasms, the submandibular gland is the second most common site of PA after the parotid gland. Authors present 3 series case of pleomorphic adenoma in submandibular salivary gland in institution which were admitted in institution within a month interval. Fine needle aspiration cytology (FNAC) of all 3 cases proved to be benign lesion arising from submandibular salivary gland. All 3 cases underwent excision in to and the postoperative period was uneventful. DT removed on 3rd POD and discharged in POD 10. Biopsy report proved to be pleomorphic adenoma in all cases. past studies showed pleomorphic adenoma most commonly occurs in the parotid gland and its occurrence in the submandibular salivary gland is uncommon. Also, age occurrence involves 30s-50s and is more common in females. But all this case was male and occurred in older age group. Early intervention with surgical excision in toto after definite confirmation with FNAC is the treatment of choice in preventing its malignant transformation.

Study of management strategies in ACTH secreting pituitary microadenoma of Cushing disease

Background: Pituitary Microadenomas can be defined as small lesions less than 1 cm in the pituitary and detected as incidentalomas. Partial development or late development around puberty leads to maldevelopment of secondary sexual characteristics due to pituitary adenomas. Clinically this may manifest as secondary amenorrhoea and may lead to hyperprolactinaemia, galactorrhoea and Amenorrhoea. ACTH secreting micro adenomas of the Pituitary Gland is a clinical entity where the role of surgery is contemplated. This study attempted to explore the management options and strategies for pituitary microadenomas. The aim of the study: To highlight the characteristics of Cushing’s disease and discuss the management strategies including trans-sphenoidal surgery to treat ACTH secreting pituitary microadenomas. Materials and methods: This was a non-randomised prospective observational study involving all adrenal tumors from 2007-2017 in Madras Medical College, Chennai. Two adrenocortical adenomas M.S. Senthil Kumar, Rajan Ganesan, A. Nithyanandham, V. Kannan, T. Suresh Babu, K. Prabhakaran. Study of management strategies in ACTH secreting pituitary microadenoma of Cushing’s disease. IAIM, 2019; 6(3): 253-258. Page 254 with virilising features were ruled out and 8 ACTH secreting Cushing's disease with microadenomas were identified. 3 Patients with ACTH secreting microadenomas of Cushing's disease underwent surgery whereas 3 underwent medical treatment based on which this paper attempted to discuss management strategies for Cushings disease. Results: ACTH levels were measurable with an average of 136.71pg/ml (normal 7.2-63.3 pg/ml) Corticotrophin releasing hormone test was planned to evaluate an exaggerated response of serum cortisol consistent with pituitary disease. It was not carried out and inferior petrosal sampling also was not done. Biochemical evaluation confirmed pituitary dependent Cushing’s disease. MRI revealed a prominent circumscribed lesion suggestive of a Pituitary Micro Adenoma in All 6 Cases. Conclusion: Pituitary micro adenomas are operable and in Cushing’s disease offer an effective cure. The outcome is good with minimal complications, but surgeons must have a thorough knowledge of the surrounding anatomy and potential complications.

Evaluation of prevalence of neuromuscular disorders in thyroid disorders in tertiary care institution – An interdepartmental inter institutional study

Background: The prevalence of Neuromuscular disorders in thyroid disorders is reported to be from 20% to 60% and varies from neuropathy to proximal myopathy. This study attempts to evaluate the prevalence of neuromuscular disorders in thyroid disorders. Aim and objectives: To study the correlation and prevalence of Nerve conduction abnormalities in hypothyroidism and hyperthyroidism, to determine neuropathy and myopathy in subsect of patients with thyroid disorders. Materials and methods: This study setting was in tertiary medical care centres which are major teaching institutes confined to the same geographical zone with a similar type of patient inflow. The departments of Medical endocrinology Out Patient patients and Endocrine surgery along with Internal medicine were included to evaluate patients. All patients were subjected to evaluation by Neurologist, Endocrine surgeons, Physician and Nuclear Physician. A total number of 400 patients over a period of three years were included from 2015 till 2018 with one year follow-up after treatment. The inclusion M.S. Senthil Kumar, Rajan Ganesan, A. Nithyanandham, E. Prabhu. Evaluation of prevalence of neuromuscular disorders in thyroid disorders in tertiary care institution - An interdepartmental inter institutional study. IAIM, 2019; 6(3): 176-181. Page 177 criteria were newly detected thyroid dysfunction predominantly hypothyroidism and hyperthyroidism and a subset of patients refractory to medical treatment where intervention was total thyroidectomy. The exclusion criteria were toxic nodules, thyroiditis, unmarried girls and postoperative disease states. All Patients were subjected to a questionnaire and nerve conduction study was performed using standard RMS ENMG EP Mark Ii Machine to derive results for comparative analysis. Results: Out of the 400 patients studied 144 had neuropathy of which 4 patients had hyperthyroidism and 56 had hypothyroidism. 8 patients had mononeuropathy and 64 had polyneuropathy. Proximal Myopathy was present predominantly in hyperthyroidism especially Graves’ disease. Conclusion: The outcome of the evaluation in the study revealed that hypothyroid patients predominantly had Neuropathy and Hyperthyroidism patients had proximal Myopathy especially in Graves’ disease. The commencement of hyperthyroidism especially in Graves’ Disease is significant along with commencement of therapy to assess the progression of proximal Myopathy which is prevalent three fold in Graves Disease than in hyperthyroidism.

Estimation and correlation of salivary thiocyanate levels in periodontally healthy subjects, smokers, nonsmokers, and gutka‑chewers with chronic periodontitis.

Aim: This study was conducted to estimate and correlate salivary thiocyanate (SCN) levels in periodontally healthy subjects, smokers, nonsmokers, and gutka‑chewers with chronic periodontitis. Methodology: The study population consisted of 40 systemically healthy subjects in the age group of 18–55 years that was further divided into four groups: Control, smokers, nonsmokers, and gutka‑chewers with chronic periodontitis. Gingival index (GI) (Loe and Silness‑1963), probing depth (PD), clinical attachment loss was assessed. Estimation of SCN was performed by ultraviolet spectrophotometer at 447 nm wavelength. Statistical analysis was performed using the one‑way ANOVAs Welch test and Pearson’s correlation test using SPSS version 17 software. Results: Results showed statistically significant increase in SCN levels in smokers as compared to gutka‑chewers with chronic periodontitis, control, and nonsmokers with chronic periodontitis subjects. Significantly higher PD and loss of attachment were seen in smokers group compared with other groups. A negative correlation observed between the GI and thiocyanate levels. Conclusion: The present study revealed a significant increase in SCN levels in smokers with periodontitis as compared to nonsmokers.

An audit of febrile neutropenia cases from a rural cancer center in India.

BACKGROUND: Data of febrile neutropenia (FN) from rural cancer centers is sparse. We did a audit of outcome of patients with FN in the period of March 2013‑August 2013. The aim was to help us to develop rational antibiotic usage policies. MATERIALS AND METHODS: Retrospective analysis of all consecutive patients presenting with FN. Data regarding demographic profile, tumor type, intent of treatment, chemotherapy regimen, blood culture susceptibility details, use of antibiotics, response to antibiotics and complications of FN were noted. SPSS (Statistical Product and Service Solutions) 16 was used for analysis. RESULTS: 67 patients had FN and there were 91 episodes. The median day of presentation with FN after start of chemotherapy was 10 days. The nadir absolute neutrophil count was 161.5 and nadir platelet count 1,00,000. The median multinational association for supportive care in cancer (MASCC) Score was 24. In accordance with MASCC there were 27 high risk FN and 64 low risk FN episodes. On multivariate analysis using logistic regression MASCC score strata was the only significant variable that predicted failure to 1st line antibiotics (P = 0.03) and mortality (P = 0.01). Nine patients (9.9%) had positive isolates on blood cultures. The blood culture isolates were predominantly Gram negative (66.7%). CONCLUSION: The importance of developing local guidelines for rational antibiotic usage is highlighted.

Role of γ-oryzanol in drought-tolerant and susceptible cultivars of rice (Oryza sativa L.).

Drought-tolerant cultivars and their phytochemical composition, which has a role in providing drought tolerance are gaining importance. In this study, rice bran oil and semi-purified oryzanol (SPO) obtained from five rice (Oryza sativa L.) cultivars, namely P1401 and PB1 (drought-susceptible) and N22, PNR381 and APO (drought-tolerant) were analyzed for the γ-oryzanol content, an antioxidant present in considerable amount in the rice bran. The higher level of γ-oryzanol and its antioxidant activity was observed in drought-tolerant cultivars (N22, PNR381 and APO) as compared to drought-susceptible (PB1 and P1401), suggesting the role of γ-oryzanol in drought tolerance, as antioxidants are known to play an important role by scavenging free radicals. The total antioxidant activity of γ-oryzanol might be attributed to 24-methylene cycloartanyl ferulate, a major component of γ-oryzanol. By enhancing the level of active oryzanol components identified in this study by genetic and molecular means could impart increased drought tolerance.

Evaluation of the efficacy of a 5% calcium sodium phosphosilicate (Novamin®) containing dentifrice for the relief of dentinal hypersensitivity: A clinical study.

Context: Dentinal hypersensitivity (DH) is a commonly encountered problem. Several products are used in management of DH with varying results. Need is felt in dentistry for a material that chemically reacts, physically occludes and adheres intimately to dentinal tubules to reduce the possibility of its recurrence. One such material is calcium sodium phosphosilicate-Novamin ® . Aim: To evaluate an efficacy of a 5% calcium sodium phosphosilicate (Novamin ® SHY NM TM ) containing dentifrice compared to placebo for the relief of DH. Settings and Design: Outpatients visiting Dept of Periodontics, Yenepoya Dental College with DH were deemed eligible for this case-control clinical trial after an informed consent. Materials and Methods: 30 patients having at least 2 sensitive teeth with a VAS (Visual Analogue Scale) of >3 cm after air blast stimulation, qualified to participate in the study. Test (SHY NM TM toothpaste containing 5% calcium sodium phosphosilicate) and control (Pepsodent toothpaste without a desensitizing agent) groups, each containing 15 participants, were subjected to cold water and air blast stimulation for an assessment of DH at baseline, 6 th and 8 th week using VAS. Statistical analysis used: Unpaired t-test and repeated measures ANOVA. Results: 5% Novamin ® containing dentifrice significantly reduced DH within 6 th and 8 th week of usage when compared to a placebo dentifrice. Conclusions: A Novamin ® containing dentifrice significantly reduced DH when compared to a placebo dentifrice.

Clinico-pathological profile of Hairy cell leukemia: Critical insights gained at a tertiary care cancer hospital.

Context: Hairy cell leukemia (HCL) is a rare, low grade, B-cell neoplasm with a characteristic morphologic and immunophenotypic profile. It has to be distinguished from chronic lymphoproliferative disorders because of different treatment protocol and clinical course. Aims: To evaluate clinicopathological features including immunophenotypic analysis of cases diagnosed as HCL. Materials and Methods: The present study included 28 cases diagnosed over a period of nine years (2002-2010). Clinical presentation, complete blood count, bone marrow aspirate, and flow cytometric analysis of cases were reviewed. Treatment and follow-up details (ranging from 3-90 months) were noted. Results: This study revealed 28 cases (referrals-7, indoor-21), aged 26-69 years with a median age of 47 years, with a male predominance (M:F=6:1). The presenting complaints were weakness (80%) followed by fever (56%) and abdominal pain. Physical examination revealed splenomegaly in most patients (92%) and hepatomegaly in a minority (28%). The common laboratory features were anemia in 23 cases, pancytopenia in 14 cases, while two patients had leukocytosis and three patients had normal WBC count. Dry tap was observed in 84% of the cases where hairy cells constituted 16-97% of non-erythroid nucleated cells. Tartarte resistant acid phosphate staining was positive in all the eight cases where it was done. CD5 was negative in all the cases, while CD10 was expressed in three cases (13%) and CD23 in five cases (19%). Conclusions: Though pancytopenia is common, occasional patient can present with normal blood counts or leukocytosis. Few unusual findings include presence of lymphadenopathy, absence of palpable splenomegaly, and expression of CD23 and CD10 by the leukemic cells.

Inhibition of local effects of Indian Daboia/Vipera russelli venom by the methanolic extract of grape (Vitis vinifera L.) seeds.

Although anti-venom therapy is available for the treatment of fatal bite by snakes, it offers less or no protection against the local effects such as dermo- and myonecrosis, edema, hemorrhage and inflammation at the bitten region. The viper species are known for their violent local effects and such effects have been commonly treated with plant extracts without any scientific validation in rural India. In this investigation, the methanolic extract of grapes (Vitis vinifera L.) seed was studied against the Indian Daboia/Vipera russelli venom-induced local effects. The extract abolished the proteolytic and hyaluronidase activities and also efficiently neutralized the hemorrhage, edema-inducing and myonecrotic properties of the venom. In addition, the extract also inhibited partially the pro-coagulant activity of the venom and abolished the degradation of Aα and Bβ chains of human fibrinogen. Thus, the extract possesses potent anti-snake venom property, especially against the local effects of viper bites.

Occurrence of extended spectrum beta-lactamases among Enterobacteriaceae spp. isolated at a tertiary care institute.

Increasing resistance to third generation cephalosporins has become a cause for concern especially among Enterobacteriaceae that cause nosocomial infections. The prevalence of extended spectrum beta-lactamases (ESBLs) among members of Enterobacteriaceae constitutes a serious threat to current beta-lactam therapy leading to treatment failure and consequent escalation of costs. A detailed study was initiated to identify the occurrence of ESBLs among the Enterobacteriaceae isolates at a tertiary care hospital using the double disk potentiation technique. Antibiogram profiles were determined to commonly used antibiotics and confirmation of ESBLs production was carried out by the disk diffusion assay using ceftazidime and cefotaxime in the presence and absence of clavulanic acid. Our results indicate that the majority of ESBLs were expressed in Escherichia coli.

Antioxidant and antimicrobial activities of Bauhinia racemosa L. stem bark

The present study was carried out to evaluate the antioxidant and antimicrobial activities of a methanol extract of Bauhinia racemosa (MEBR) (Caesalpiniaceae) stem bark in various systems. 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) radical, superoxide anion radical, nitric oxide radical, and hydroxyl radical scavenging assays were carried out to evaluate the antioxidant potential of the extract. The antioxidant activity of the methanol extract increased in a concentration-dependent manner. About 50, 100, 250, and 500 æg MEBR inhibited the peroxidation of a linoleic acid emulsion by 62.43, 67.21, 71.04, and 76.83 percent, respectively. Similarly, the effect of MEBR on reducing power increased in a concentration-dependent manner. In DPPH radical scavenging assays the IC50 value of the extract was 152.29 æg/ml. MEBR inhibited the nitric oxide radicals generated from sodium nitroprusside with an IC50 of 78.34 æg/ml, as opposed to 20.4 æg/ml for curcumin. Moreover, MEBR scavenged the superoxide generated by the PMS/NADH-NBT system. MEBR also inhibited the hydroxyl radical generated by Fenton's reaction, with an IC50 value of more than 1000 æg/ml, as compared to 5 æg/ml for catechin. The amounts of total phenolic compounds were also determined and 64.7 æg pyrocatechol phenol equivalents were detected in MEBR (1 mg). The antimicrobial activities of MEBR were determined by disc diffusion with five Gram-positive, four Gram-negative and four fungal species. MEBR showed broad-spectrum antimicrobial activity against all tested microorganisms. The results obtained in the present study indicate that MEBR can be a potential source of natural antioxidant and antimicrobial agents.

Angioplasty of membranous obstruction of inferior vena cava.

Membranous obstruction of vena cava (MOVC) is a common cause of hepatic venous outflow obstruction. Surgical procedures utilized to relieve symptoms carry a high morbidity and mortality. A patient who presented with gradual onset ascites and dilated, tortuous veins over the anterior abdominal wall and the back was found to have MOVC by inferior vena cavogram. Balloon dilatation of the obstruction was done successfully through a transvenous approach. Following this, the patient improved remarkably. The procedure is safe, effective and easy to perform. This balloon angioplasty provides alternative method for treatment of membranous obstruction of vena cava.

Spontaneous pneumothorax complicating rheumatoid lung disease.

This case report describes the pleuro-pulmonary involvement in a young patient with rheumatoid arthritis (RA) of one and half year duration. The early involvement of lung interstitium in a 27-year-old male and development of pneumothorax were the unusual features. The various aspects of rheumatoid lung disease (RLD) and its clinical significance were briefly discussed.