iosr-JDMS   Volume-14 ~ Issue-11 ~ November-2015

Abstract: Controversies exists between primary nailing and external fixator application as treatment of choice for severely open fractures. This study was conducted to assess the outcome of Intramedullary nailing in compound tibia fracture and evaluate its complication Methods: Between 2006 and 2011 a total of 40 cases of open tibial shaft fractures classified according to Gustillo and Anderson classification, were operated with primary Intramedullary Interlocking nail. There were 25 type II and 15 type III open fractures. Proper wound debridement done with Care taken to give adequate soft tissue coverage for wound.

[1]. Gustillo RB, Merkow RL, Templeman B.Curent concept review: The management of open fracture.JBJS 1990; 72 A: 299-303
[2]. Ruidi T, Webb JK, and Allgoer M;"Experience with the Dynamic Compression Plate (DCP) in418recnt fractures of tibial shaft"1976: Injury, 7:252-257.
[3]. Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial shaft fractures: A randomized trial. Clin Orthop Relat Res 1989; 241:89-94.
[4]. Henley B,Chapman,J R. Agel J. et al: treatment of type II ,IIIA and IIIB open fractures of tibial shaft; A prospective comparison of unreamed interlocking IM nails and half pin external fixation for grade II and III open fractures. J Orthop Trauma ;( 1198)4:233-234.
[5]. Tornetta P 3rd, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade IIIB open tibial fractures: A prospective randomized comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br 1994; 76:13-9.
[6]. Wanson TV, Spiegel JD, Sutherland TB, Bray TJ, Chapmann MW. A prospective evaluation of the Lottes nail versus external fixation in 100 open tibial fractures. Orthop Trans 1990; 14:716.

Abstract: In recent periods, laparoscopic appendicectomy is the treatment of choice for appendicitis. Other approaches for appendicectomy are open appendicectomy and laparoscopic assisted appendicectomy. In the present study, we are going to compare laparoscopic assisted appendicectomy(LAA)with laparoscopic appendicectomy(LA) Materials and methods: This study is a prospective study of the cases of appendicitis treated between October 2013 to march 2015. Patients treated byLAA and LA were compared using variables like operative time, post operative complications and cost.

[1]. Varlet F, Tardieu D, limonne B et al, laparoscopic vs open appendicectomy in children comparative study of 403 cases. Eur J Pediatric Surgery 1994; 4:333-337
[2]. Leape L, Ramenosky ML, laparoscopy in infants and children. J Pediatric surgery 1977;12:75-81
[3]. Patel SC, Jumba GF, Akmal S.Laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi, East Afr Med J 2003 sep;80(9); 447-51.
[4]. Shalaby R, Arnos A, Desoky A, Samaha AH. Laparoscopic appendicectomy in children; Evaluation of different techniques surg laparoscopic Endoscopic percutan tech 2001 Feb;11(1):22-7.
[5]. Scott- Conner CE, Hall TJ, Anglin BL, Muakkassa FF. Laparoscopic appendicectomy Initial experience in a teaching program Ann Surg.1992;215(6):660-7;dinunion7-8.s
[6]. Visnjic S. Transumblicial laparoscopically assisted appendectomy in children: high tech low budget surgery SurgEndosc. 2008 Jul;22(7):1667-71

Abstract: Oncocytic neoplasms comprise a group of rare tumors of the parotid glands
 Their incidence represents approximately 1% of parotid neoplasms.
 Histologically they are classified according to the new World Health Organization (WHO) classification in three distinct types, namely
 oncocytosis,
 oncocytoma and
 oncocytic carcinoma.
 We herein describe the rare case of a 37-year old male patient with right side benign parotid oncocytoma

[1]. DeVitta, Cancer Principle & Practice of Oncology 9th ed. Lippincott Williams & Wilkins:2011
[2]. Courtney M.Townsend, R Daniel Beauchamp, B Mark Evers, Kenneth L Mattox. Sabiston: Textbook of Surgery. 19thed. Elsevier: 2013.
[3]. F.CharlesBrunicardi, et al Schwartz's: Principals of Surgery, 9thed, Tata McGraw Hill : 2010
[4]. Stomeo F, Meloni F, Bozzo C, Fois V, Pastore A: Bilateral oncocytoma of the parotid gland. ActaOtolaryngol 2006, 126:324-326.
[5]. Seifert G: Tumour-like lesions of the salivary glands. The new WHO classification. Pathol Res Pract 1992, 188:836-846.
[6]. Capone RB, Ha PK, Westra WH, Pilkington TM, Sciubba JJ, Koch WM, Cummings CW: Oncocytic neoplasms of the parotid gland: a 16-year institutional review. Otolaryngol Head Neck Surg 2002, 126:657-662.
[7]. Araki Y, Sakaguchi R: Synchronous oncocytoma and Warthin's tumor in the ipsilateral parotid gland.AurisNasus Larynx 2004, 31:73-78.

Abstract: Obesity is defined as excessive accumulation of fat in the body and is the most common nutritional disorder in humans. The incidence of obesity has increased rapidly during recent decades. According to WHO definition, a person is considered overweight if her/his BMI is >25, and obese if BMI≥30.Emerging data indicate an association between obesity and infectious disease. Infections that occur in wound created by invasive surgical procedure are referred to as surgical site infection (SSIs). Risk of SSI increased with increase with BMI.

[1]. R.Huttunen and Syrjanen .Obesity and the risk and outcome of infection. International Journal of Obesity 2013;37,333-340.
[2]. Surgical Site Infections National Collaborating Centre for Women's and Children's Health Clinical Guideline October 2008;1.
[3]. Miriam E.Tucker,Thelwall Dr.Simon, Obesity increases surgical site infection risk.Family practice news digital network Health Protection Agency, London 2012 may 10.
[4]. R.Richards and M.deCassers. The problem of obesity in developing countries : Its prevalence and morbidity obesity symposium 1973 Dec;74.
[5]. Yajnik C.S. Obesity epidemic in India: intrauterine origins? Symposium on 'Adipose tissue development and the programming of adult obesity 2004;63:387-396. [6]. Article obesity in India Wikipedia Available from http://en.m.wikipedia.org/wiki/Obesity In India.

Abstract: Autoimmune hepatitis occurs when own immune system attacks hepatocytes of an individual causing inflammation with symptoms of fatigue or muscle aches or signs of acute liver inflammation like fever,jaundice& right upper quadrant abdominal pain.The disease most often diagnosed in females between age 40-50yrs.Usually a number of specific antibodies found in blood like antinuclear antibody (ANA),anti-smooth muscle antibody (ASMA),liver/kidney microsomal antibody (LKM ),anti soluble liver antigen and liver-pancrease antigen(SLA/LP).But here we found a case otherwise consistent with Autoimmune hepatitis without the presence of autoantibodies. Patient was started on Prednisolone and Azathioprine with other supportive treatment and showed clinical improvement.Liver biopsy repeated after 6 months and 2 yrs showed histological regression of HAI (3/18).Patient is on maintenance dose of Azathioprine (50mg) and is on regular follow up for last 3 yrs.
Key words: Autoimmune hepatitis,Antinuclear antibody,Anti-smooth muscle antibody,Liver kidney Microsomal Antibody,Anti-soluble liver antigen & liver pancrease antigen.

• Czaja,AJ (May 2004)."Autoimmune liver disease"Current Opinion of gastroenterology 20(3):231-40.
• National Digestive Diseases Information Clearing house."Digestive Disease : Autoimmune Hepatitis" 2010.
• Manns,MP;Czaja,AJ;Gorham,JD;Krawitt,EL;Mieli-Vergani,G;Vergani,D;Vierling,JM;American Association for the Study of Liver ,
Diseases(June 2010)."Diagnosis and Management of autoimmune hepatitis".Hepatology (Baltimore,Md.) 51 (6):2193-213.
• Manns MP,CzajaAJ,Gorham JD,et al,Diagnosis and Management of autoimmune hepatitis.Hepatology 2010;51(6):1-31.
• Alvarez F,Berg PA,Bianchi FB et al.(Nov 1999) "International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of
autoimmune hepatitis."
• Czaja AJ,Freese DK.Diagnosis and tt
of autoimmune hepatitis.Hepatology.2002;36:479-497.
• Summerskill WH,kOrman MG,Ammon HV,Baggenstoss AH.Prednisolone for Chronic active liver disease:dose titration standard dose
and combination with azathioprine compared.Gut 1975;16:876-883.
• Johnson PJ,Mc Farlane IG,Williams R.Azathioprine for long-term maintenance of remission in autoimmune hepatitis.N Engl J Med
1995;333:958-963.

Abstract: Lymphoma is a malignant disorder which is arising from cells of the lymphoid tissue. It commonly presents with lymphadenopathy and constitutional symptoms of fever, weight loss and night sweats. However, atypical presentations like extra nodal involvement can also be there. With regard to the varied clinical picture, especially in HIV-positive patients, symptoms may mimic other diseases, particularly tuberculosis (TB). Three cases of non-Hodgkin's lymphoma (NHL) which were initially misdiagnosed as extrapulmonoary TB are presented here. They both were initially treated with Antitubercular treatment (ATT) from other health care setups with no remission of symptoms. Clinical examination and investigations revealed mediastinal masses in these cases , on further biopsy and immunohistochemistry, diagnosis of Non Hodgkin's lymphoma was made.

[1]. Andrew D. Zelenetz, MD, PhD et al, Non Hodgkins Lymphoma. Journal of the National Comprehensive Cancer Network | Volume 9 Number 5 | May 2011.
[2]. Groves FD, Linet MS, Travis LB, Devesa SS. Cancer surveillance series: non-Hodgkin's lymphoma incidence by histologic subtype in the United States from 1978 through 1995. J Natl Cancer Inst 2000;92:1240–1251.
[3]. Dr. James O. Armitage MD. Staging Non Hodgkins Lymphoma A Cancer Journal of Clinicians. Volume 55, Issue 6, pages 368–376,November/December 2005
[4]. Bolukbas F, Kutluturkan S; Symptoms and symptom clusters in Non Hodgkin's lymphoma patients in Turkey. Asian Pac J Cancer Prev., 2014; 15(17): 7153-7158.
[5]. Jigisha Patadia , Prashant Kariya , Pinakini Tollawala , Pavan Patel , Dhairya Lakhani: Lymphoblastic Lymphoma Masquerading as Tuberculous Pleural Effusion. Sch J Med Case Rep 2015; 3(3):198-201.

Abstract: For understanding this work, we must differ preganglionic of postganglionic paralyses of the vegetative system. How postganglionic fibers do not have myelin's coat, they cannot find their distal parts and grow into them after cutting. Postganglionic cut sensitize the smooth musculature on adrenaline after cutting, leading to considerable rise of vasoconstrictors' reactions of arteries in the innervation's parts of organism, especially on cold. (So, for example, limbs, on which is carried out a postganglionic sympathectomy, strong react on a stimulus with cold that appeared necrosis. At postganglionic paralyses lacks any coordination. The best treatment is preganglionic sympathectomy.

[1]. H. Hellner – R. Nissen – K. Vossschulte: Textbook of Surgery (Lehrbuch der Chirurgie. Georg Thieme, Verlag, Stuttgart.)
[2]. Max Saegesser: Spezielle chirurgische Behandlung. (7. Auflage, 1963.). Medizinischer Verlag Hans Huber, Bert und Stuttgart. Die peripheren Zirkulationstörungen, der Page 1064.)
[3]. Die chirurgische Behandlung des arteriellen Hochdruckes, page 1081
[4]. Christopher's Textbook of Surgery, W.B. Saunders Company - Philadelphia, London, Toronto -1968. Autonomic Nervous System, page 1388.
[5]. Bailey and Love's: Short Practise of Surgery, 14th Edition. H. K.Lewis and Co, Ltd. 1968. Sympathectomie, pages 121, 136, 139,140, 704.
[6]. J. Englebert Dunphy, Lawrence W. Way: Current surgical Diagnosis and Treatment. 2nd Belgrad's Edition. 1975. Lange medical Publication, Los Altos, California. Sympathectomie, page 907.

Abstract: Dermatophytes are the main cause of onychomycoses, but various nondermatophyte filamentous fungi are often isolated from abnormal nails. The correct identification of the aetiological agent of nail infections is necessary in order to recommend appropriate treatment. To evaluate a rapid polymerase chain reaction (PCR) assay based on 28S rDNA for fungal identification in nails on a large number of samples in comparison with cultures.

[1]. Ajello, L. 1962. Present day concepts in the dermatophytes. Mycopathol. Mycol. Appl. 17:315–324.
[2]. Ajello, L. 1968. A taxonomic review of the dermatophytes and related species. Sabouraudia 6:147–159.
[3]. Ajello, L. 1974. Natural history of the dermatophytes and related fungi. Mycopathol. Mycol. Appl. 53:93–110.
[4]. Ajello, L. 1977. Milestones in the history of medical mycology: the dermatophytes, p. 3–11. In K. Iwata (ed.), Recent advances in
medical and veterinary mycology. University of Tokyo Press, Tokyo.
[5]. Ajello, L. 1977. Taxonomy of the dermatophytes: a review of their imperfect and perfect states, p. 289–297. In K. Iwata (ed.),
Recent advances in medical and veterinary mycology. University of Tokyo Press, Tokyo.

Abstract: The cost of nursing human resources is rising. There is a need to control cost of human resource on nursing staff in health care industry. Objective: To decrease the cost pertaining to nursing human resources in tertiary care hospital. Method: The present study was conducted in NIZAM'S INSTITUTE OF MEDICAL SCIENCES, a tertiary care teaching hospital, Hyderabad, Telangana, India. The study design adopted was retrospective for the time period of 6 months between July 2014 and December 2014 using descriptive statistics.

1]. Conrad DA. Lessons to apply to national comprehensive healthcare reform. Am J Manag Care. 2009 Dec;15(10 Suppl):S306-21.

[2]. Flood, S., & Diers, D. (1988). Nurse staffing, patient outcome, and cost . Nursing Management, 19, 34-4

[3]. Heinz, D. (2004). Hospital nurse staffing and patient outcomes: A review of current literature. Dimensions of Critical Care Nursing, 23, 44-50

[4]. Kunen, J. (1996). The new hands-off nursing. Time, 148, 56-57

[5]. Needleman, J., Buerhaus, P., Stewart, M., Zelevinsky, K., & Mattke, S. (2006). Nurse-staffing in hospital: Is there a business case for quality. Health Affairs, 25, 204-211erly, 79, 55-79

Abstract: Acute appendicitis treatment trend is changing. Emergency operation can be deferred conservative antibiotic treatment is preferred alternate choice .[1] Introduction: Before the advent of higher antibiotics appendicitis was one of formidable threat to humanity and high priority emergency. with advance of time its complications will be worse Emergency appendicectomy was once mandatory risking post operative complications,though very few and minimum. Now conservative treatment with higher antibiotics is advised buying time for definitive treatment later

Key words: Acute and chronic appendicitis _defer emergency operation _wait for appropriate time_Coservative treatment_Elective appendicectomy _after social obligations are complied

[1]. Sang Hyun Kim, Sun Jin Park, Youn Young Park, and Sung Il Choi (2015) Delayed Appendectomy Is Safe in Patients With Acute Nonperforated Appendicitis. Int Surg: June 2015, Vol. 100, No. 6, pp. 1004-1010.
[2]. The Normal Appendix on CT: Does Size Matter? Inneke Willekens1 *, Els Peeters2 , Michel De Maeseneer3 , Johan de Mey3
[3]. Primatesta P, Goldacre MJ (1994) Appendicectomy for acute appendicitis and for other conditions: an epidemiological study. Int J Epidemiol 23:155–160
[4]. Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–348.
[5]. Van Breda Vriesman AC, Kole BJ, Puylaert JB (2003) Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol 13:2278–2282
[6]. Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G (2005) CT appearance of the normal appendix in adults. Eur Radiol 15:2096–2103

Abstract: Obesity is a causative factor for the development of coronary artery disease. The integrity of vascular endothelial function affects vascular homeostasis and development of atherosclerosis and coronary artery disease. Recent studies have indicated that endothelial dysfunction is associated with obesity, serum nitric oxide metabolite and oxidative stress. The aim of the present study was to evaluate serum inflammatory markers, nitric oxide metabolite, oxidative stress and their association with cardio metabolic risk factors in obese male volunteers.

[1]. World Health Organisation 2000 Obesity: preventing and management of the global epidemic. Report of a WHO consultation hppt://whqlibdoc.who.int/trs/WHO_TRS_894 pdf accessed 20 June 2009.
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[4]. Wilding J. Science, medicine, and the future. Obesity treatment. Br Med J 1997, 315:997-1000

Abstract: Untreated asymptomatic bacteriuria in pregnancy leads to number of complications such as acute and chronic pyelonephritis, toxemia, anaemia, hypertension, prematurity, intrauterine growth retardation and increased perinatal mortality. These complications can be prevented by early detection and treatment of asymptomatic bacteriuria in pregnant women.

[1]. Kalantar Enayat. Asymptomatic bacteriuria among pregnant women reffered to outpatient clinics in sanandaj, Iran. International Braz. J. Urol. 2008; 34(6):699
[2]. DK. James, P.J. Steer, C.P. Weiner. High risk pregnancy and management option. 2nd ed. North Yorkshire: United Kingdom; 2006. Chapter 34, Other infectious conditions in pregnancy; p. 559-598.
[3]. R.A. Hussain, B.J. Wadher, H.F. Daginawala, A.A. Pathak, S.R. Deshmukh, B.S. sNagoba. Clinico-Bacteriological analysis of urinary tract infections. The Indian Practioner. 1994; XLVII(7): 549-554.
[4]. Abdelaali Bahadi, Driss El Kabbaj, Hicham Elfazazi, Rachid Abbi. Urinary tract infection in pregnancy. Saudi J Kidney Dis Transpl 2010; 21:342-344.
[5]. John E. Delzell, Micheal L. Lefevre. Urinary tract infection during pregnancy. Am. Fam. Phisician. 2000; 61:713-721.
[6]. Cariola Marcelo, Pedro Paulo, Marcelo Zugaib. Treatment of urinary tract infection in pregnancy. RBM Brazilian Journal of Medicine. 2012;6:549-554.

Abstract: The lungs are paired organs which are essential for respiration and are situated in thoracic cavity. Each lung is divided into lobes by fissures. Knowledge of variations in fissures and lobes is important for cardiothoracic surgeon, radiologists and physicians. Objective of study: To study the morphological variations of fissures and lobes of Lung. Materials and Methods: Fifty formalin fixed lungs from The Department of Anatomy, Andhra Medical College, Visakhapatnam were studied.

[1]. Lung fissures http://radiopedia.org/articles/lung fissures.
[2]. Climan.M, Erdil.H, Karalepe.T. A cadaver with azygos lobe and its clinical significance. Anat.Sci.Int. 2005;80;235-237
[3]. Hayashik . K, Aziz.A, Ashizawa.K, Hayashi.H, Nagauki.K ,Otsuji.H . Radiographics and CT appearances of major fissures,
Radiologists.2001; 21:861-874
[4]. Medler E.M. variations interlobarfissures AM.J.Roentoenol.Radium Ther. 1947;57:723-725.
[5]. Raasch BN, Carsky.EW , Lane EJO, Collaghan JF, Heitzman ER, Radiographic anatomy of the interlobar fissures. A study of 100
specimens AJR. 1982:1043-49.
[6]. Leukose R, Paul.S, Sunitha et al. Morphology of lungs: variations in lobes and fissures, Biomedians1999:19:227-32.

Abstract: The coeliac trunk is one of the mostwell-documented arterial trunks, with many researchers pondering on the topic, as well as providing detailed studies and an impressive number of specimens. The CT arises just below the aortic hiatus at the level of thoracic 12–lumbar 1 (T12–L1), and is the first anterior branch of abdominal aorta. It divides into the left gastric, common hepatic and splenic arteries. The trifurcation of the celiac trunk was first described by Haller 1756 as Tripus Halleri. This "tripus Halleri" was and is still
considered to be the normal appearance of the CT. This research work has been carried out during the past 6 years in cadavers in the Department Of Anatomy.AMC, Visakhapatnam.

[1]. Adachi B. [Das Arterien system der Japaner]. Vol. 2.Verlag derKaiserlich-JapanischenUniversitatzu Kyoto, 1928.Japanese.
[2]. Acker R. Atlas of vascular anatomy an angiographic approach. USA:Williams and wilkins; 1997: 406-411.
[3]. Michels. N. A. Variational anatomy of the hepatic, cystic, and retroduodenal arteries. Am. Med. Assoc. 1953b; 66:20-34.
[4]. Sadler TW. Langman's Medical Embryology. 10th Ed., Baltimore, Williams and Wilkins.2006; 183.
[5]. Cunningham's textbook of anatomy, 10th edition by G.JRomanes. Page no. 895,896.
[6]. Gray's anatomy 38th edition pg 1548-1553; pg 318.

Abstract: Birth asphyxia is the most common and important cause of preventable cerebral injury occurring in the neonatal period. World Health Organisation (WHO) estimates that between four and nine million newborns worldwide suffer birth asphyxia annually with most occurring in developing countries. Twenty five to sixty percent of this number die or develop severe neurodevelopmental complications. The Apgar score has gained worldwide use as a marker of a child's vitality immediately after birth, but its value as a predictor of later
disabilities is debated.

[1]. World Health Organization.The World Health Report, (1998): Life in 21st century-A vision for All WHO: Geneva.
[2]. Ellis M, Dharma M. Progress in perinatal Asphyxia. Semin Neonatol 1999;4:183-91.
[3]. Ellenberg JH, Nelson KB. Cluster of perinatal events identifying infants at high risk for death or disability. J Pediatr 1988;113:546-
52.
[4]. Dalal EA, Bodar NL. A Study on Birth Asphyxia at Tertiary Health centre. Nat J Med Reasarch 2013;3(4):374-6.
[5]. Prakesh SS, beyene J, To T, Ohlsson A, Perlman M. Postasphyxial Hypoxic-Ischemic Encephalopathy in Neonates. Arch Pediatr
Adolesc Med 2006;160:729-36.
[6]. Dongol S, Singh J, Shrestha S, Shakya A. Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study. J Nepal
Paediatr. Soc. 2010;30(3):141-6.

Abstract: Isolated macrodontia of a second premolar is a very rare dental anomaly that has been described in the literature only in nine patients, but never in the upper jaw. Case presentation:This case report presents for the first time the clinical, radiographic, and macroscopic findings of isolated macrodontia of the impacted maxillary permanent second premolar in a 12-year-old female of Caucasian ethnicity. The X-ray and CBCT examination revealed the presence of an impacted macrodontic second premolar and its distinct morphology characterized by large multitubercularmolariform crown and two short conical roots. Orthodontic treatment was proposed; the second deciduous molar as well as macrodontic second premolar weresurgically removed and space was orthodontically closed. The treatment was performed without any unexpected complications.

[1]. J.Holmes, M. S.Tanner, Premature eruption and macrodontia associated with insulin resistant diabetes and pineal
hyperplasia,British dental journal,141, 1976, 280-284.
[2]. J. A.Nemes, M.Alberth, The Ekman-Westborg andJulin trait: report of a case, Oral surgery, oral medicine, oral pathology, oral
radiology, and endodontics, 102 (5), 2006, 659-662.
[3]. C. R.Dugmore, Bilateral macrodontia of mandibular second premolars: a case report,International journal of paediatric dentistry,11
(1), 2001, 69-73.
[4]. F.Namdar, M.Atasu,Macrodontia in association with a contrasting character microdontia,The Journal of clinical pediatric
dentistry,23 (3), 1999, 271-274.
[5]. P. A.Reichart, J. Westergaard, K. A. Jensen,Macrodontia of a mandibular premolar,Oral surgery, oral medicine, and oral
pathology,44 (4), 1977, 606-609.
[6]. V. F.Rootkin-Gray, E. C.Sheehy, Macrodontia of a mandibular second premolar: a case report,ASDC journal of dentistry for
children,68 (5-6), 2001, 347-349,302.

Abstract: L'hémorragie ou l'hématome surrénalien spontané bilatéral est une affection rare de causes diverses et pouvant se compliquer d'une insuffisance surrénalienne qui met en jeu le pronostic vital en l'absence d'une prise en charge précoce et adéquate. La présentation clinique est variable selon l'abondance de l'hémorragie. Dans la majorité des cas il n'y a pas de signes cliniques évidents d'insuffisance surrénale, et c'est une découverte fortuite sur une imagerie faite pour un autre motif.

[1]. El Khader K, El Ghorfi MH, Ouali M, Ibnattya A, Hachimi M, Lakrissa A. Hématomes spontanés des glandes surrénales. Prog Urol 2001; 11:517
[2]. Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma 2001; 51:597-600.
[3]. N. Surga, R. Makdassib, G. Choukroun J. Vandwallea, J. Petita, F. Saint. Adrenal hemorrhage acutised by adrenocorticotropin hormone progress en urologie (2010) 20, 425- 429
[4]. Caron PH, Chabannier M, Cambus J. Definitive Adrenal Insufficiency Due to Bilateral Adrenal Hemorrhage and Primary Antiphospholipid Syndrome. J Clin Endo 1998; 83:1437-9.
[5]. Armand JP, Soulie D, Girault JM, Andrieu P. Hémorragie surrénalienne bilatérale par stress. Diagnostic radiologique. À propos d'une observation. Ann Radiol 1995; 38:153-5.

Abstract: Foreign bodies may be endogenous or exogenous and provoke chronic inflammation of the foreignbody type. The reaction provides a mechanism for elimination of the foreign body and the reaction pattern depends on the kind of tissue involved (1).The foreign body granuloma is a response of biological tissue to any foreign material in the tissue (2).Detection of retained foreign bodies can be extremely difficult when the patients present with non-specific symptoms such as pain and/or swelling without recognizing a previous trauma (3) and granuloma is a tumor-like mass or nodule ofgranulationtissue, with actively growingfibroblasts andcapillary buds,consisting of a collectionofmodifiedmacrophagesresemblingepithelial cells, surrounded by a rim of mononuclear cells,chiefly lymphocytes,andsometimes acenter of giant multinucleate cells;it is due to a chronicinflammatoryprocessassociatedwith infectious disease or invasion by aforeign body (4).

[1]. Donath, Karl, Monika Laaß, and Hans-Joachim Günzl. "The histopathology of different foreign-body reactions in oral soft tissue and bone tissue." VirchowsArchivA 420, no. 2 (1992): 131-137.

[2]. Rapini, Ronald P., Jean L. Bolognia, and Joseph L. Jorizzo. Dermatology: 2-Volume Set. St. Louis: Mosby.ISBN 1-4160-2999-0, 2007.

[3]. Ando, Akira, Masahito Hatori, Yoshihiro Hagiwara, ShujiIsefuku, and EijiItoi. "Imaging features of foreign body granuloma in the lower extremities mimicking a soft tissue neoplasm." Upsala journal of medical sciences 114, no. 1 (2009): 46-51.

[4]. Farlex, I. N. C. "The free dictionary." Retrieved June 28 (2009): 2012.

Abstract: Teratomas are the germ cell tumours which comprises of tissues from all the three germ cell layers. Primary retroperitoneal teratoma is a relatively rare tumour in adults. The primary retroperitoneal teratoma constitutes 6–11% of the retroperitoneal tumours. Sixty percent of the retroperitoneal teratomas occur in children less than 15 years. It occurs more commonly in females than males. The order of frequency for teratoma is ovary, testis, mediastinum and the retroperitoneum at last. Early diagnosis and surgery is the mainstay of treatment. We report a rare case of retroperitoneal teratoma presented to us as left parietal wall abscess. Exploratory laparotomy with tumour resection was performed. Histopathological diagnosis confirmed a benign cystic teratoma. The patient is doing well and is on regular follow up. Keywords: Retroperitoneum, teratoma, laparotomy, mediastinum

[1] Gschwend J, Burke TW, Woodward JE, et al. Retroperitoneal teratoma presenting as an abdominal-pelvic mass. Obstet Gynecol 1987; 70: 500-502.

[2] Lane RH, Stephens DH, Reiman HM. Primary retroperitoneal neoplasms: CT findings in 90 cases with clinical and pathologic correlation. Amer Jour Roentgenology 1989; 152: 83-89.

[3] Wang RM, Chen CA. Primary retroperitoneal teratoma. Acta Obstet Gynecol Scand 2000; 79: 707-708.

[4] Panageas E. General diagnosis case of the day. Primary retroperitoneal teratoma. AJR Am J Roentology 1991; 156; 1292-1294

[5] Engel RM, Elkins RC, Fletcher BD. Retroperitoneal teratoma. Review of the literature and presentation of an unusual case. Cancer 1968; 22: 1068-1073.

[6] Lambrianides AL, Walker MM, Rosin RD. Primary retroperitoneal teratoma in adults. Urology 1987; 29: 310-312.

Abstract: Midline diastema in periodontally compromised patient with aggressive periodontitis is very uncommon situation and can represent negative impact on esthetics and function. The purpose of this article is to describe a rare case report of 19 year old male patient with midline diastema due to aggressive periodontitis treated successfully by removable orthodontic appliance.

[1] Mavreas D. Self-Ligation and the Periodontally Compromised Patient: A Different Perspective. Seminars in Orthodontics, Vol 14, No 1 (March), 2008: pp 36-45
[2] Huang W J, Creath C J. The midline diastema: a review of its etiology and treatment. Pediatric dentistry 17:3,1995
[3] Angle EH: Treatment of malocclusion of the teeth, 7th Ed. Philadelphia: SS White Co, 1907.
[4] Bergstrom K, Jensen R, Martensson B: The effect of superior labial frenectomy in cases with midline diastema. Am J Orthodont 63:633-38, 1973.
[5] Ceremello PJ: The superior labial frenum and the midlin diastema and their relation to growth and development ofthe oral structures. Am J Orthodont 39:120-39, 1933.
[6] Ong M M A and Wang H L. Periodontic and orthodontic treatment in adults. Am J Orthod Dentofacial Orthop 122(4); 420-428
[7] Hazan Molina H, Levin L, Einy S. Aressive periodontitis diagnosed durin or before orthodontic treatment. Acta Odontologica Scandinavica, 2012; Early Online, 1–9 nts.

Abstract: Gingival crevicular fluid (GCF)is anexudatethatcanbecollected fromthe sulcusorperiodontalpocket.It containsa variety ofsubstancesincludingimmunoglobulins,microorganisms, toxins,cells,andlysosomalenzymesandmarkersAnalysis of GCF is anon-invasive method to study the host response of the periodontium and inflamed tissues. Ithasbeenconsider asapromising mediumfor an early indicator for early detection of periodontal diseaseactivity . Cytokines play a fundamental role in the inflammatory process associated with the destruction of the periodontium.interleukin- IL-1β(IL-1β) and interleukin-6 (IL-6) are two pre-inflammatory cytokines that play a major role in destruction of periodontal tissue.

[1]. Albandar JM and Rams TE (2002). Global epidemiology of periodontal diseases: an overview. Periodontol. 2000 ;29: 7-10.

[2]. Batool H Al-Ghurabei1, Zahraa F. Shaker, RaghedFadhel, NahlaG Al-Khayli, Leen K Mustafa.SerumLevels of Interlukine-1Beta andInterlukine-2 in Chronic Periodontitis. Al- Mustansiriya J. 2012; 23(3) [3]. Maryam Robati1, Ardeshir Ranjbari2, MehriGhafourian Boroujerdnia3*, Zahra Chinipardaz Detection of IL-4, IL-6 and IL-12 Serum (title of G28) Levels in Generalized Aggressive Periodontitis Iran.J.Immunol.2011; VOL.8 NO.3 .

[4]. Callard R, George AJ, Stark J. Cytokines, chaos, and complexity. Immunity 1999;11:507-13.

[5]. Stashenko P, Fujiyoshi P, Obernesser MS, Prostak L, Haffajee AD, Socransky SS.. Levels of interleukin 1 beta in tissue from sites of active periodontal disease. J ClinPeriodontol. 1991;18:548-54.

[6]. Kinane DF, Lindhe J. Pathogenesis of periodontitis. In: Lindhe J, Karring T, Lang NP, (Editors). Textbook of Clinical Periodontology and Implant Dentistry. 3rd ed. Mosby: Blackwell Munksgaard; 1997. p. 189–222.
[7]. M MogiJOtogoto,N Ota, H Inagaki, M Minami,K Kojima.Interleukin 1β, interleukin 6, β2-microglobulin, and transforming growth factor-α in gingival crevicular fluid from human periodontal diseaseArchives of Oral Biology.1999;Volume 44, Issue 6, Pages 535–539.

Abstract: A postmenopausal pyometra caused by Mycobacterium tuberculosis is an extremely rare disease. Here, we present a case of a postmenopausal woman with pyometra caused by endometrial tuberculosis. Patient was given empirical antibiotic therapy but she did not respond to it and there was persistence of symptoms. Pus was drained through stenotic canal after cervical dilatation. On endometrial curettage, endometrial tissue was obtained and sent for histopathological examination. The diagnosis of endometrial tuberculosis was made on histopathological examination. The patient was put on antitubercular treatment. She is recovering well without further development of pyometra .

Keywords: Postmenopausal; Pyometra ; Endometrial tuberculosis

[1]. Chan LY, Lau TK, Wong SF, Yuen PM. Pyometra. What is its clinical significance? J Reprod Med 2001;46:952-6.
[2]. Chan LY, Lam MH, Yuen PM. Sonographic appearance of Mycobacterium pyometra mimicking carcinoma of uterine corpus. Acta Obstet Gynecol Scand 2005;84:1124-5.
[3]. Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N, et al. Genital tuberculosis: an important cause of Asherman's syndrome in India. Arch Gynecol Obstet 2008;277:37-41.
[4]. Güngördükb K, Ulker V, Sahbaz A, Ark C, Tekirdag AI. Postmenopausal tuberculosis endometritis. Infect Dis Obstet Gynecol 2007;2007:27028.
[5]. Simon HB, Weinstein AJ, Pasternak MS, Swartz MN, Kunz LJ. Genitourinary tuberculosis. Clinical features in a general hospital population. Am J Med 1977;63:410-20.

Abstract: Background: Many of patients with rheumatoid arthritis was currently successfully treated with infliximab(anti-tumor necrosis factor);however, about 30% of the patients do not responded to infliximab.one of postulated hypotheses of not responding is the fast clearance of infliximab due to development of infliximab-anti-infliximab complexes. Objective: to study the correlation between anti CCP and anti-infliximab antibodies in patients with rheumatoid arthritis treated with infliximab.

[1]. Scott, D.L., Wolfe, F. & Huizinga, T.W. Rheumatoid arthritis. Lancet 376, 1094–1108 (2010).
[2]. Helmick CG, Felson DT, Lawrence RC, et al; National ArthritisData Workgroup. Estimates of the prevalence of arthritis andother rheumatic conditions in the United States. Part I. ArthritisRheum. 2008;58(1):15-25.
[3]. Englund, M., Jöud, A., Geborek, P., Felson, D.T., Jacobsson, L.T. & Petersson,I.F. Prevalence and incidence of rheumatoid arthritis in southern Sweden 2008 and their relation to prescribed biologics. Rheumatology (Oxford) 2010, 49, 1563–1569.
[4]. Al-Rawi ZS, Al-Azawi AJ, Al-Ajili FM, et al. Rheumatoid arthritis in population samples in Iraq. Ann Rhem Dis 1978; 37(1):73-5.
[5]. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for themanagement of rheumatoid arthritis with synthetic and biologicaldisease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69:964–75.
[6]. Entezami P, Fox DA, Clapham PJ, Chung KC. Historical perspective on theetiology of RA.Hand Clin. 2011 Feb; 27(1):1-10.
[7]. Nam JL, Winthrop KL, van Vollenhoven RF, and et al. Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of RA. Ann Rheum Dis 2010; 69:976–86.

Abstract: This study was done to evaluate the role of imprint smear cytology in various diseases affecting the lymph nodes. A correlation was done between the imprint smear cytology and histopathology to assess the accuracy and reliability of the imprint cytology in different lymph node lesions. Methods: From 52 cases of lymph node excision, imprint smears were taken and stained with PAP, H & E and MGG. The findings in imprints were compared with those of histopathology.

[1] Agarwal PK, Gosh M, Wahal KM, Mehrotra RML. Study of imprint smears of lymph nodes. Ind J. of Cancer. 1997; 14 : 157 – 163.
[2] Patra SP, Bhattacharya N, Mangal S. : FNAC, Imprint cytology and Histopathology for diagnosing diseases of lymph node. Journal of cytology. 2003; 20 (3) : 124 – 128.
[3] Nagpal BL, Dhar CN, Singh A, Bahl RA. Evaluation of Imprint Cytodiagnosis in cases of Lymphadenopathy. Indian J. of Pathol Microbiol. 1982; 25 : 35 – 39
[4] Ultmann JE, Koprowska I, Engle RL. A cytological study of lymphnode 18imprints Cancer, 1958; 11 : 507-24.
[5] Suen KC, Wood WS, Syed AA, Quenville NF, Clement PB : Role of imprint cytology in intra-operative diagnosis : value and limitations. Journal of Clinical Pathology. 1978; 31 : 328 – 337.

Abstract: Eclampsia continues to be a major problem in developing countries like India contributing to significant maternal and perinatal morbidity and mortality. We conducted a study to establish the clinical profile and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A prospective study of all women presenting with eclampsia was performed from January 2014 to August 2014. Ninety primigravida patients presented with eclampsia out of a total 10264 deliveries during the study period. Majority of the patients were unbooked (63.4%).

[1] Sibai BM. Diagnosis, prevention and management of eclampsia. Obstet Gynaecol. 2005; 105(2): 402-10 [2] Edgar M. Ndaboine, Albert Kihunrwa, Richard Rumanyika, H Beatrice IM, Anthony N. Massinde. Maternal and perinatal outcomes among eclamptic patients admitted to Bugando medical centre, Mwanza, Tanzania. Afr J Reprod Health. 2012. 16(1):35. [3] Sunita, T. H., et al. Eclampsia in a Teaching Hospital: Incidence, clinical profile and response to Magnesium Sulphate by Zuspan's regimen. IOSR-JDMS. 2013; Vol 4(2): 01-05
[4] MacKay AP, Breg CJ, Atrash Hk. Pregnancy related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001; 97:533-38
[5] Sudharshan kumari., et al. Outcome of low birth weight babies with special reference to some maternal factors. Indian Paediatrics. 1989; 26(3): 241-246
[6] Onuh SO, Aisien AO. Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria. J Obstet Gynaecol. 2004 Oct;24(7):765-8.

Abstract: Objectives:This study aimedto evaluate the frequency and severity of nasal trauma secondary to nasal continuous positive airway pressure (NCPAP) in neonates.
Methods: This is a prospective observational study carried out in the Neonatal Care Unit (NCU) of Baghdad teaching hospital,maternity ward, Medical City, Baghdad, Iraq. The study included newborns that underwent NCPAP with prongs on admission and those receiving NCPAP after weaning from ventilation, from 1st March, 2014 - 1st July, 2014. Patients' noses were monitored from the first day of NCPAP treatment until its weaning. Nasal trauma was reported into three stages: (I) persistent erythema; (II) superficial ulceration; and (III) necrosis.

[1]. PolinRA,Sahni R. "Newer experience with CPAP." Seminar on Neonatology, 2002 Oct.; 7(5):379-89.
[2]. Liptsen E, Aghai ZH, Pyon KH, Saslow JG, Nakhla T, Long J, et al. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs. variable-flow devices.J Perinatology 2005; 25(7):453-458.
[3]. Kahn DJ, Habib RH, Courtney SE.Effects of flow amplitudes on intraprong pressures during bubble versus ventilator-generated nasal continuous positive airway pressure in premature infants. Pediatrics 2008; 122(5):1009-1013.
[4]. Kaur C, Sema A, Beri RS, Puliyel JM. A simple circuit to deliver bubbling CPAP.IndianPediatr 2008; 45 (4):312-314.
[5]. Campbell DM, Shah OS, Shah V, Kelly EN. Administration of the continuous positive airway pressure (CPAP) nasal mask versus nasal prong in premature baby.J. Perinatology 2006 sep.; 26:546-9.
[6]. Cartlidge P. The epidermal barrier.SeminNeonatol2000; 5:273–80.
[7]. Kopelman AE, Holbert D. Use of oxygen cannulas in extremely low birth weight infants is associated with mucosal trauma and bleeding, and possibly with coagulase-negative staphylococcal sepsis. J Perinatol2003; 23:94.