Appearance of a double bubble in achalasia cardia: a case report.

INTRODUCTION: Achalasia cardia is characterized by failure of the lower esophageal sphincter to relax in response to swallowing and by an absence of peristalsis in the esophageal body. Absence of a gastric air bubble is a well known radiological finding. Pneumatic balloon dilatation results in reappearance of the gastric bubble. CASE PRESENTATION: We report the case of a 43-year-old Indian man with achalasia cardia whose chest X-ray at the time of presentation showed an air bubble in the gastric region causing a diagnostic quandary. Successful dilatation of the lower esophageal sphincter resulted in the appearance of another air bubble in the gastric region. Proper analysis showed that the first bubble was actually a colonic air bubble of the splenic flexure and the appearance of the second bubble was the anticipated gastric air bubble. CONCLUSION: In patients presenting with achalasia cardia, a colonic air bubble may be seen in the gastric region causing diagnostic difficulty. In these patients, a gastric air bubble may appear after pneumatic dilatation. At the end of the procedure, there will be two air bubbles ("double bubble"): a colonic and a gastric air bubble. To our knowledge, this finding has not been reported in the literature thus far.

Chromobacterium violaceum diarrhea.

This is the first case of Chromobacterium violaceum diarrhoea from coastal Karnataka reported in a 2 year 10 months old girl. Stool culture yielded Chromobacterium violaceum and was sensitive to ampicillin, gentamicin, chloramphenicol, erythromycin and septran. Patient completely recovered with ampicillin and gentamicin.

Juvenile myasthenia gravis with predominant facial weakness in a 7-year-old boy.

Myasthenia gravis is the most prevalent of the diseases of the neuromuscular junction in children. The most common clinical finding is ptosis, although ophthalmoplegia and facial weakness are commonly present. This paper reports juvenile myasthenia gravis in a 7-year-old boy with predominant facial muscle weakness without ophthalmoplegia and ptosis. This was detected post-operatively after adenotonsillectomy, as there was severe respiratory distress. Prompt diagnosis and treatment was life saving. A CT scan of the chest revealed thymoma. After the surgical removal of the thymoma, the child has been followed up for a year and is asymptomatic.

Noninvasive imaging and analysis of skin lesions for early detection of cutaneous malignant melanoma.

Knowledge of the depth of invasion and three-dimensional (3D) characteristics of skin lesions is crucial to the early diagnosis and prognosis of malignant melanoma. These parameters are currently available only after biopsy. A clinical prototype of an optical imaging instrument, called a nevoscope, has been developed to noninvasively image skin lesions. The nevoscope provides multiple views of a transilluminated skin lesion. These views provide a three-dimensional perception of the lesion. In addition, image-analysis techniques are applied to these images to quantify various diagnostic parameters, such as 3D geometric features and surface texture and pigmentation characteristics. Clinical trials are under way to evaluate the utility of the nevoscope as a diagnostic tool for early detection of melanoma. The construction of the clinical prototype and the integrated clinical imaging environment are described. The development of iterative reconstruction techniques suitable for nevoscopy data is also described. Experimental reconstructions of a physical tissue-like phantom and an in-vivo lesion are presented. The phantom is recovered effectively. Thus, nevoscopy is of potential diagnostic value.

Severe derangement of the coagulation profile following multiple bee stings in a 2-year-old boy.

Occasionally, insect bites producing systemic complications are the reason for admission to paediatric intensive care. We report an interesting case of multiple bee stings in a 2-year-old boy. The boy, who was stung more than 200 times by honey bees, had a severely deranged coagulation profile with marked elevation of the hepatic enzymes. This complication has not been reported to date. Prompt intensive supportive care led to the child's total recovery.

Unusual presentation of cytomegaloviral infection in a 5-month-old baby: case report.

Painful restricted movements of the extremities, hyperpigmentation over swollen joints, and a sclerema-like feel to the skin with increased serum triglyceride was seen in a 5-month-old baby with postnatal CMV infection. In an infant with pseudoparalysis of the limbs, the possibility of CMV infection has to be considered.

Bone changes in Herpes simplex infection mimicking congenital syphilis: case report.

A great many perinatal infections may be missed, especially during the early months of life, owing to their diverse modes of presentation. A simple skeletal survey is a helpful radiological study, in addition to virological and serological suspected Herpes simplex infection.

Three-dimensional imaging and reconstruction of skin lesions.

An optical instrument called a "nevoscope" is used to image skin lesions by transillumination with visible light. The lesion is transilluminated by a fiber-optic annular ring light source that directs light into the skin area surrounding the lesion, forming a virtual source just beneath the lesion. Mirrors uniformly spaced around the lesion and tilted at various angles provide orthographic projections of the skin lesion. Additional views are obtained by rotating the mirror assembly. These multiple views are used in a direct three-dimensional (3D) reconstruction of the lesion using a filtered backprojection method. In this paper, we discuss the methodology of direct 3D reconstruction from 2D views of a transilluminated skin lesion as obtained using the new prototype nevoscope. We present the results of direct 3D reconstruction of a simulated phantom and a test object imaged using the nevoscope. In addition, a skin lesion was scanned in situ using the new prototype nevoscope. Results of the reconstruction of this lesion are also presented.

Chronic utero-rectal fistula with menochezia and amenorrhea.

Utero-intestinal fistulas are commonly acute in nature and usually follow malignancies of the intestines. Here we report a chronic uterorectal fistula with uncommon symptom of cyclical rectal bleeding (menochezia) and amenorrhea.

Single coronary artery: right coronary artery originating from distal left circumflex.

This report describes a patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. However, this anomaly was not of clinical significance based on atypical nature of chest pain, negative thallium exercise test and absence of coronary obstruction.

Double-blind comparison of cefazolin and cephalothin in open-heart surgery.

Ninety-nine patients undergoing cardiac surgery were randomly assigned to treatment with cefazolin and cephalothin to compare the effectiveness of these cephalosporins in the prevention of postoperative infections. The incidence of infections was low with both antibiotics (cefazolin 2.1 percent, cephalothin 4.6 percent). Intraoperative serum cefazolin levels were more evenly distributed, whereas a wide dispersion of cephalothin levels was observed. There was no measurable antibiotic detected in cardiac tissue samples in the majority of the cases. Adverse reactions (skin rashes) occurred only in three patients, all receiving cephalothin. It is concluded that cefazolin is as safe and effective as cephalothin in the prevention of postoperative infection in patients undergoing open-heart surgery.