A rare encounter - Unveiling the mysteries of biliary hamartoma: A case report.

INTRODUCTION: Biliary hamartomas are rare congenital development anomaly of bile ducts, which are detected incidentally. They often present as multiple lesions on liver surface which resembles metastatic lesions. We report a case of acute calculous cholecystitis ultimately diagnosed to have asymptomatic multiple biliary hamartomas. CASE DESCRIPTION: A 42-year-old male with no co-morbidities presented with pain in upper abdomen associated with fever and vomiting. Contrast enhanced computed tomography (CECT) of abdomen showed acute calculous cholecystitis, hepatomegaly with fatty changes in liver. On laparoscopy the liver was found to have grey-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both the lobes. One of the lesion was biopsied along with cholecystectomy. DISCUSSION: Biliary hamartoma commonly referred to as "von Meyenburg complexes" are uncommon lesions found in the liver which are usually asymptomatic. In this case the patient presented with symptoms of acute cholecystitis but the biopsy report from liver lesions proved to be benign biliary hamartoma which on initial impression looked like multiple liver secondaries. CONCLUSION: We have described a case of an adult with multiple biliary hamartoma which was an incidental finding. Biliary hamartoma is a rare entity which can sometime mimic metastasis in the liver. Thus, histopathological confirmation is essential before planning any further treatment.

Rare presentation of rectal duplication cyst as perineal hernia in an adult.

Rectal duplication cysts are rare congenital anomalies of the gastrointestinal tract. They can present with pain, gastrointestinal bleeding, infection or compressive symptoms on the rectum and urinary bladder. A 79-year-old man presented with a 8×5 cm swelling in the sacral region above the natal cleft with a positive cough impulse. During surgical exploration, there were two cysts with the posterior one presenting as the hernia. The cyst was excised and histopathological examination confirmed a diagnosis of rectal duplication cyst. Rectal duplications can lie anterior or more commonly posterior to the rectum. Differential diagnoses include dermoid cyst, diverticular cyst, sacrococcygeal teratoma or meningocele and endoscopic ultrasound is imaging of choice for diagnosis. Surgical excision is the treatment of choice. This is a rare presentation of a rectal duplication cyst as a perineal hernia with only a handful of cases in literature.

Clinical and microbiological profile of diabetic foot ulcer patients in a tertiary care hospital.

AIM: To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital. METHODOLOGY: This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively. RESULTS: We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3±2.3 and 167.6±52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection. CONCLUSION: Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria.

Development and validation of health related quality of life questionnaire (Indian scenario) in diabetic foot ulcer patients.

AIM: To develop and validate Health Related Quality of Life Questionnaire in Diabetic Foot Ulcer Patients (HRQLQDFU) for Indian scenario. MATERIALS AND METHODS: This study was conducted in two phases. First phase was Development of HRQLQDFU which included literature search and expert interview. Second phase was validation of HRQLQDFL which included face validation, content validation and construct validation. Face validation was done by ten diabetic foot ulcer patients, ten practicing nurses and ten care givers. They were asked to read and respond to questionnaire and report any difficulty in understanding the questions. Further they were asked to add any item to the questionnaire which according to them has a significant effect on quality of life. Content validation was done by six subject experts who judged the content relevance of questionnaire with score ranging from zero to four; zero being least relevant and four being most relevant. Content validity index was calculated for each question. Questions having content validity index≥0.8 were selected for the study. Reliability was tested by calculating Cronbach's alpha. RESULTS: In the development phase a questionnaire containing 37 questions with six domains was developed. None of patient had difficulty in understanding questions. After content validation a new questionnaire containing 20 questions was developed. Cronbach's alpha was 0.86 which shows good reliability. CONCLUSION: The new health related quality of life questionnaire on diabetic foot ulcer patients for an Indian scenario is validated and can be a reliably measure for quality of life in diabetic foot ulcer patients.

Penile Metastases From Prostate Adenocarcinoma: A Rare Presentation.

Penile metastases are rare in occurrence and are usually secondary to other genitourinary primary tumours. It is a debilitating near terminal condition at presentation with a dismal prognosis and poor survival rates. Supportive and palliative care is generally recommended to improve the quality of life of patients. We present a case of penile metastases in a 74-year-old male patient with prostatic adenocarcinoma in association with multiple skeletal metastases.

Giant peritoneal loose body: a case report and review of literature.

A 52-year-old man was presented with discomfort in lower abdomen and irritative voiding symptoms. Computed tomography showed a well circumscribed mass with calcification in front of bladder compressing the bladder diagnosed as leiomyoma with calcifications, probably araising from rectum. Surgery revealed a giant peritoneal loose body measuring 6cm in diameter. After the removal of peritoneal loose body patient was relieved of symptoms. Peritoneal loose bodies are usually small and are found incidentally at surgery. Giant peritoneal loose bodies are rare. A comprehensive review of literature is presented.

Phaeohyphomycotic cyst in the Foot by Exophiala.

A 52-year-old male, presented to us with a swelling over plantar aspect of right foot following trauma. Clinically it was a cystic swelling diagnosed as an abscess; ultrasound showed thick walled multilocular collection with thick echogenic debris, following which complete excision of the swelling was done. A part of the swelling was sent for histopathological examination and cut section showed thick purulent material. Other part sent for culture sensitivity grew, Exophiala, which belongs to Dematiaceous group of fungi. Surgical excision with antifungal treatment is the management in general for fungal cyst, whereas in our case complete excision was done without antifungal treatment.

Giant scrotal lymphoedema - A case report.

INTRODUCTION: Giant Scrotal Lymphoedema is a rare disease. Such Scrotal elephantiasis presents multiple problems both to the patient as well as the treating clinician obstruction, aplasia, or hypoplasia of the lymphatic vessels. The most common cause world wide is lymphatic Filariasis. PRESENTATION OF CASE: We present a particularly grotesque where the resected scrotal tissue weighed 32kg which is one of the largest so far mentioned in literature. The lymphoedema was progressive over 8 years duration and the testes were not palpable with the penis deeply buried. DISCUSSION: Scrotum was explored and penis was recovered deep within the pit of lymphoedema. Careful dissection done with cautery to delineate penis circumferentially from the root of scrotal lymphoedema. Foleys catheterisation was done. After the separation of penis scrotal skin flaps were raised on either side by extending the incision horizontally. De bulking of lymphoedema was done and the remaining scrotal skin was closed in Y shaped manner with root of penis in centre. Meticulous technique of dissection, cautery and ligasure use of Ligasure enabled excision with minimal blood loss. CONCLUSION: Once fibrosis sets in resectional therapy will be needed in most cases. Successful reduction scrotoplasty with acceptable cosmetic results can be obtained in giant scrotal lymphoedemas weighing as large as 32kg as in our case.

Coexistent gastric primary choriocarcinoma and adenocarcinoma.

Choriocarcinomas are commonly gestational and intrauterine or gonadal in origin. Nongestational and extragonadal disease, especially in the stomach is extremely rare with a poorer prognosis and early metastasis. We herein describe a case of primary gastric choriocarcinoma with liver metastasis in a 69-year-old male. The patient presented with abdominal pain and irregular bowel habits of one month duration. Both endoscopic and radiographic imaging revealed an ulcerated and necrotic circumferential tumor in the pyloric antrum of the stomach. The histopathologic findings of the resected tumor were that of an extensively necrotic and hemorrhagic neoplasm with combined choriocarcinomatous and adenocarcinomatous element. A strongly positive immunohistochemical staining for beta- subunit of human chorionic gonadotropin (beta-HCG) in the choriocarcinomatous component and a proper correlation with elevated serum beta-HCG levels confirmed the diagnosis.

Multifocal tuberculosis of the nose and lymph nodes without pulmonary involvement: a case report.

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.