DOI: 10.5005/jp-journals-10045-00101 |
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Dinesh P, Raj JA, Kumar YH. Inflammatory Dermatoses of the Superficial Cutaneous Reactive Unit—Study of Morphological Features with Clinical Correlation. J Med Sci 2019; 5 (1):10.5005/jp-journals-10045-00101.
Background and objectives: Inflammatory dermatoses of the superficial cutaneous reactive unit are a common and complex variety of clinical conditions. This study was undertaken to perform a detailed morphological evaluation of lesions classified in this category, and to correlate the clinical details to arrive at the most appropriate diagnosis.
Methodology: Skin biopsies of clinically diagnosed/suspected cases of inflammatory dermatoses were processed and stained with hematoxylin and eosin (H&E), followed by microscopic examination.
Results: A total of 160 skin biopsies of superficial inflammatory dermatoses were studied. Lesions were categorized into papular/non-vesiculobullous (non-VB) (142 cases/88.75%) and VB (18 cases/11.25%) lesions. Papular lesions were frequent in males, with a peak incidence in the fourth decade. Patients presented mostly with pigmented plaques and papules over the extremities. Papular lesions were categorized based on epidermal changes: 8 cases without epidermal changes and 134 with epidermal changes. Lesions with epidermal changes were further categorized into interface dermatitis (60 cases), psoriasiform dermatitis (58 cases), and spongiotic dermatitis (16 cases). Commonly reported lesions were lichen planus (LP) with its variants followed by psoriasis vulgaris. VB lesions were common in the third and fourth decades, predominantly in females. These patients presented mostly with generalized vesicles. Common lesions reported were erythema multiforme (seven cases) and pemphigus vulgaris (six cases). Of the 160 cases, clinicopathological concordance was seen in 156 cases (97.5%) and discordance in 4 cases (2.5%).
Interpretation and conclusion: The incidence of superficial inflammatory dermatoses in our study was comparable with those reported in other studies. Despite advances in molecular techniques, morphology remains the gold standard for the diagnosis and prognosis of many inflammatory dermatoses. This study emphasizes the importance and utility of a systematic approach to superficial inflammatory dermatoses which is relevant from the treatment perspective.
Background: Awareness during anesthesia is a frightening experience. Benzodiazepines like lorazepam have been used to decrease awareness and also to cause amnesia. However, there is insufficient evidence established regarding their efficacy and effectiveness. This study was carried out to evaluate the efficacy of benzodiazepines in minimizing the awareness during general anesthesia.
Methods: This randomized controlled trial was undertaken on 100 patients who underwent various elective surgical procedures. Each group consisted of 50 participants who were randomly allocated based on the computer-generated random numbers. The experimental group received midazolam as a premedicant in addition to atropine, while the control group received only atropine.
Results: In this study, the overall incidence of awareness was 16%. The incidence was higher in the control group (24%) compared to that in the experimental group (8%). In the control group, awareness was characterized by hearing conversation/music in 58.3% of the participants, followed by remembrance of intraoperative events in 41.6% of the participants. In the experimental group, awareness was pertained to dreaming in all the four participants (100%).
Conclusion: There was a significant higher incidence of awareness under anesthesia in the patients who had received only atropine as premedication. Hence, it is recommended to include benzodiazepine like midazolam, a water-soluble agent, routinely as a premedicant to decrease the incidence of awareness.
Pheochromocytomas (PCCs) are rare neuroendocrine tumors originating from the chromaffin tissue.1 These tumors produce, store, and secrete catecholamines. Most PCCs produce both epinephrine and norepinephrine, with the percentage of secreted norepinephrine being greater than that secreted by the normal gland.2
The incidence of PCCs is 2 to 8 per 1 million populations per year. They are highly vascular and catecholamine-producing tumors. They are derived from the sympathetic or parasympathetic nervous system. It is estimated that 0.1% of all hypertensives may have neuroendocrine tumors like PCC. In these patients, usual presenting signs and symptoms are tachycardia, hypertension, etc.,3 which are the result of sympathetic stimulation. The literature also shows a high prevalence of familial and extra adrenal tumors in patients carrying germline mutations in genes.1 It may be as high as 50%.1 Surgery and anesthesia in these patients pose a high risk of cardiovascular complications from hypertensive crisis. Here, we report a case of PCC scheduled for surgical resection.
Arnold-Chiari malformations, Foramen magnum decompression, General anesthesia, Myelomeningocele
DOI: 10.5005/jp-journals-10045-00104 |
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John A, Katari Y, Murthy V, Sahajananda H. Anesthetic Management of a Rare Case of Type 2 Arnold-Chiari Malformation with Hydrocephalus, Lumbar Myelomeningocele and Thoracolumbar Scoliosis. J Med Sci 2019; 5 (1):10.5005/jp-journals-10045-00104.
Arnold-Chiari malformation is a group of deformities seen in the hindbrain that is cerebellum, pons, and medulla oblongata. Based on the morphology of the malformations as seen radiologically or during an autopsy, Chiari II includes brainstem, fourth ventricle, and greater than 5 mm descent of the caudal tip of cerebellar tonsils past the foramen magnum with spina bifida.
In the present case, a report of anesthetic management of a 29-year-old school clerk presented with hydrocephalus and myelomeningocele and MR imaging revealed herniation of cerebellum and medulla through foramen magnum, hence, confirming it to be a case of type II Chiari malformation posted for ventriculoperitoneal shunting and foramen magnum decompression.
Situs inversus totalis is a rare syndrome, with an estimated prevalence of 1/10,000 births, characterized by the inverted position of the thoracic and abdominal organs with respect to the sagittal plane. The condition affects all major structures within the thorax and the abdomen. The etiological factors for which are still not completely understood. In a patient with situs inversus totalis, the anesthetic management during the respective surgical procedure is challenging. We are reporting a patient who was incidentally detected with situs inversus totalis with dextrocardia and was operated for Angle's grade 3 malocclusion. The present case report lays an emphasis on the potential difficulties during anesthetic management and its various implications.
Introduction: Seminal vesicle cyst is very rare and is usually associated with ipsilateral renal agenesis. It was first reported by Zinner in 1914. Method: A young boy of 17 years presented to us for computed tomography of abdomen and pelvis. Observation and results: We found retrovesicular mass of near water density which was projecting above prostate. Patient did not have right kidney in normal or ectopic location. Our findings confirmed right renal agenesis and same side seminal vesicle cyst. Conclusion: Zinner syndrome is very rare and is associated with infertility. Computed tomography of abdomen and pelvis with contrast is the modality of choice.
Bindushree Thimmanahalli Manjunath,
Ajit K Reddy,
Anil K Shukla
Introduction: Adult intussusception is an infrequent cause of intestinal obstruction and differs from childhood intussusception in its presentation, etiology, and treatment. Almost 90% of adult intussusceptions are secondary to a pathological condition that serves as a lead point and most of them require surgical intervention.
Method: Computed tomography (CT) is the most sensitive diagnostic modality which distinguishes intussusceptions with and without a lead point. This paper presents the clinical presentation and etiopathogenesis of adult intussusception as demonstrated by CT.
Observation and results: Five cases of adult intussusception were evaluated and the various etiologies included an intestinal polyp, bowel wall leiomyoma, jejunal lipoma, calcified lymph and idiopathic causes.
Conclusion: Adult intussusception is a rare but challenging condition for the surgeon. Diagnosis is usually missed because of nonspecific and subacute symptoms. With the advent of MDCT in imaging of acute abdominal emergency, the detection of intussusception has increased.
Introduction: The third stage of labor is the time from the birth of the baby to the expulsion of the placenta and membranes. Management are normally categorized into two types; active management and physiological management. Active management of the third stage involves a package of care comprising the following components: routine use of uterotonic drugs, deferred clamping and cutting of the cord controlled cord traction after signs of separation of the placenta. Most common complications of third stage of labor are postpartum hemorrhage and retained placenta.
Aims and objectives: The present clinical audit aims to improve the care of healthy women and their babies during the third stage of child and to review the practices regarding the third stage of labor and to develop and implement action plan regarding management strategies.
Materials and methodology: The audit was carried out on 218 pregnant women admitted in RajaRajeswari Medical College and Hospital from April 2018 to September 2018. The inclusion criteria, exclusion criteria and data collection on excel sheet were based on NICE guidelines.
Results: Among 218 cases, vaginal blood loss was recorded in 181(83%) cases whereas the color, respiration and general condition was recorded in all 218 cases. Active management of third stage was carried out and decision regarding the same was recorded in all 218 cases. The time of cord clamping was recorded in only 6% of the cases. The management of PPH and retained placenta met audit standard in all 218 cases.
Conclusion and recommendations: The present clinical audit suggests that there is a need to follow specific guidelines and treatment strategies to avert the complications. Recording of vaginal blood loss in all cases, instructions for compulsory recording of the cord clamping time following birth of baby and continue to follow the remaining steps according to NICE guidelines to reduce the complications of third stage of labor.