Thoracic Cardiovascular Complications of Tuberculosis.

ABSTRACT: Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.

Saviour tool now a foreign body.

ABSTRACT: Foreign bodies are commonly seen in children, here presenting a case of a male adult with an impacted thumb pin in the left lower lobe bronchus. Extraction required fiber-optic bronchoscopy, failure of which led to thoracotomy with bronchotomy.

Study of behavioral and psychosocial factors relating to needle stick injuries in nursing staff of a tertiary care cancer hospital of Punjab, India.

Background and Objectives: Needle stick injury (NSI) is the most dreaded occupational health hazard affecting a healthcare worker (HCW) psychologically and physically. The risk of infection post needle stick injury ranges between 1.9% to greater than 40% for HBV infections, 2.7-10% for HCV and 0.2-0.44% for HIV infections. As per National AIDS Control Organisation (NACO) records, nursing staff is at highest risk (43%) followed by physicians (28%). The main objective of this study was to evaluate knowledge of nursing staff about needle stick injuries and to study factors leading to such incidents in their working areas, impart them knowledge regarding the same and fill gaps in knowledge. Materials and Methods: This is a cross-sectional retrospective analysis involving nursing staff and students. p values were calculated using SPSS software. Results: Overall NSI prevalence among nursing staff and students was 51.6% whereas in more exposed and less exposed group was 47.45% and 10.16% respectively (p=0.2056). The most common cause of NSI incident was recapping of needle (38.5%) followed by transferring needle to sharp container (35%). Conclusion: Consequences of NSI are serious and this study has tried to emphasize on the need to study the factors leading to NSI.

A Clinicopathological Analysis of Molecular Subtypes of Breast Cancer using Immunohistochemical Surrogates: A 6-Year Institutional Experience from a Tertiary Cancer Center in North India.

Puneet Kaur SomalObjective Classification of breast cancer into different molecular subtypes has important prognostic and therapeutic implications. The immunohistochemistry surrogate classification has been advocated for this purpose. The primary objective of the present study was to assess the prevalence of the different molecular subtypes of invasive breast carcinoma and study the clinicopathological parameters in a tertiary care cancer center in rural North India. Materials and Methods All female patients diagnosed with invasive breast cancer and registered between January 1, 2015, and December 31, 2020, were included. Patients with bilateral cancer, missing information on HER2/ER/PR receptor status, absence of reflex FISH testing after an equivocal score on Her 2 IHC were excluded. The tumors were classified into different molecular subtypes based on IHC expression as follows-luminal A-like (ER- and PR-positive, Her2-negative, Ki67 < 20%), luminal B-like Her2-negative (ER-positive, Her2-negative and any one of the following Ki67% ≥ 20% or PR-negative/low, luminal B-like Her2-positive (ER- and HER2-positive, any Ki67, any PR), Her2-positive (ER- and PR-negative, Her2-positive) and TNBC (ER, PR, Her2-negative). Chi square test was used to compare the clinicopathological parameters between these subtypes. Results A total of 1,625 cases were included. Luminal B-like subtype was the most common (41.72%). The proportion of each subtype was luminal A (15.69%), luminal B Her2-negative (23.93%), luminal B Her2-positive (17.78%), Her2-positive (15.26%), TNBC (27.32%). Majority of the tumors were Grade 3 (75.81%). Nodal metastases were present in 59%. On subanalysis of the luminal type tumors without Her2 expression (luminal A-like and luminal B-like (Her2-negative), luminal A-like tumors presented significantly with a lower grade ( p < 0.001) and more frequent node-negative disease in comparison to luminal B-like (Her2-negative) tumors. In comparison to other subtypes, TNBC tumors were more frequently seen in the premenopausal age group ( p < 0.001) and presented with node-negative disease ( p < 0.001). Conclusion This is one of the largest studies that enumerates the prevalence of various molecular subtypes of breast cancer in North India. Luminal B-like tumors were the most common followed by TNBC. TNBC tumors presented more commonly in premenopausal age group and with node negative disease in comparison to other subtypes.

Primary extradural hydatid cyst associated with nephrotic syndrome in a pediatric patient.

BACKGROUND: Primary intracranial extradural hydatid cyst is a very rare entity. Overlying bony erosion and extension of an extradural hydatid cyst into the scalp has never been described in literature. Association of nephrotic syndrome is described in pulmonary and hepatic hydatid cysts, but never reported in intracranial hydatidosis. CASE REPORT: We report a 6-year-old girl with primary extradural hydatid cyst having unusual radiological features. The child initially presented with features of nephrotic syndrome. Steroid therapy failed to achieve complete remission of the nephrotic syndrome, which was later abolished by cyst removal and albendazole therapy. CONCLUSION: Because of the very slow increase in the volume of the extradural hydatid cyst, intensification of symptoms may also be very slow. Sometimes, the cyst may already be very large at the time of the diagnosis. The hydatid disease should be considered in the etiology of nephrotic syndrome especially in the endemic zones.

Pure Endoscopic Excision of Parenchymal Brain Tumors: Feasibilty, Risks, Advantages and Realities - A Beginners Perspective

Background Neuroendoscopy is gaining popularity and is reaching new realms. Young neurosurgeons are exploring the various possibilities associated with the use of neuroendoscopy. Neuroendoscopy in excision of parenchymal brain tumors is less explored, and young neurosurgeons should be aware of the realities. The present article is an approach to put forward the difficulties faced by a young neurosurgeon and the lessons learnt. Objective To report the experience of surgical excision of parenchymal brain tumors, in selected cases, using pure endoscopic approach and to discuss its feasibility, technical benefits, risks and comparison with conventional microscopic excision. Method Eight patients of variable age group with parenchymal brain tumors were operated upon by a single surgeon and followed up for a period varying from6months to 2 years. Data regarding operating time, illumination, clarity of the field, size of craniotomy, blood loss and course of recovery was evaluated. All of the tumors were resected using rigid high definition zero and 30° endoscope. Results Out of eight cases, seven had lesions in the supratentorial and one in the infratentorial location. The age group ranged from 27 to 74 years old. Near to gross total resection was achieved in all except two cases. All of the patients recovered well without any significant morbidity or mortality. Hospital stay was reduced by 1 day on average. Conclusion Excision of parenchymal brain tumors via pure endoscopic method is a safe and efficient procedure. Although there is an initial period of learning curve, it is not steep for those already practicing neuroendoscopy, but the approach has its advantages.

Reduced left internal mammary artery blood flow on normal sternal retraction.

The left internal mammary artery is the conduit of choice for bypassing the left anterior descending artery. A 72-year-old man underwent off-pump triple-vessel coronary artery bypass. The left internal mammary artery was harvested with brisk blood flow from the distal artery on completion of harvesting, but normal sternal retraction with a Medtronic OctoBase retractor led to cessation of flow. A vein graft was utilized for the left anterior descending artery, and the internal mammary artery was grafted to the first diagonal branch. Computed tomography-angiography on postoperative day 5 demonstrated no possible cause of the reduced flow on sternal retraction.

MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs.

Magnetic resonance imaging (MRI) has been found to be an excellent imaging tool for meniscal injuries. Various MRI signs have been described to detect displaced meniscal injuries, specifically the bucket-handle tears. Although these signs are quite helpful in diagnosing meniscal tears, various pitfalls have also been reported for these signs. Double anterior cruciate ligament (ACL) sign refers to presence of a linear hypointense soft tissue anterior to the ACL, which represented the flipped bucket-handle tear of the meniscus. Disproportional posterior horn and flipped meniscus signs represent asymmetrically thickened horns of the menisci due to overlying displaced meniscal fragments. We report a case wherein MRI of the knee showed tear and displacement of the medial patellofemoral ligament (MPFL) and vastus medialis complex, medial collateral ligament (MCL), and posterior cruciate ligament (PCL) mimicking these signs. To our knowledge, internally displaced MPFL and MCLs have not been described as mimics for displaced meniscal fragments.

Idiopathic spinal cord herniation.

Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy. This condition has recently seen an increased frequency of diagnosis, possibly due to increased awareness and the use of magnetic resonance (MR) imaging. ISCH is characterised by herniation of the thoracic spinal cord through an anterior or anterolateral dural defect. Patients usually present with a Brown-Séquard-like syndrome, which is gradually progressive and may evolve into severe paraparesis. This disease has a characteristic radiological appearance, and in most cases, excellent postsurgical outcome. We report ISCH and its imaging appearance in a 31-year-old woman with classical presentation, and discuss the current concepts regarding the aetiopathogenesis, radiological features and management of the disease.

Anomalous origin of right coronary artery: an anatomico-clinical perspective of 2 cases.

The prevalence of anomalous origin of right coronary artery is 0.25%.Though the patients may be asymptomatic the recognition of the condition is important as they may present with angina pectoris, myocardial infarction or even sudden death. A retrospective analysis of 60 cases of CT coronary angiograms revealed two such rare cases. We have compared the features of these rare variants with the expected norm and attempted to explain the possible anatomical mechanisms which may lead to the production of clinical signs and symptoms.

Pancreatic choledochal fistula complicating acute pancreatitis.

BACKGROUND: Biliary tract involvement in acute necrotizing pancreatitis is rare. CASE REPORT: We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up. CONCLUSIONS: Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.