iosr-JDMS   Volume-7 ~ Issue-2

Abstract: We present a case of a patient with myelodysplastic syndrome where in impreciation persists for case analysis . The cytogenetic study revealed Philadelphia negative with multiple breakpointS and isolated monosomy of chromosome 5 revealing the likely consideration for myelodysplastic myeloproliferative syndrome terminating to acute myelogenous leukaemia (unclassified RAEB category).There is absolute paucity of presentation in the world literature of cases of myelodysplastic syndrome having atrial fibrillation as the initial presentation.

[1]. Roberts WC , Bodey GP , Wertlake PT. The heart in acute leukaemia. A study of 420 autopsy cases. Am J Cardiol. 1968;21(3):388-412.
[2]. Jost E, Lorenzen J, Haage P, Bos G, Beelen D, Galm O et al. Heart and muscle involvement by extra-medullary myeloid leukaemia : a case report and review of the literature. Leuk Lymphoma. 2005;46(12):1819-24.
[3]. Hatake K, Saito K, Saga T, Akashi N, Doishita K. A case of acute myelogenous leukaemia with advanced atrioventricular block and pericardial effusion caused by leukaemic cell infiltration. Jpn J Med 1982;21(2):115-19
[4]. Ottaviani G, Matturri L, Rossi L, Jones D. Sudden death due to lymphomatous infiltration of the cardiac conduction system. Cardiovasc Pathol 2003;12(2):77-81.
[5]. Wikipedia.Myelodysplastic Syndrome
[6]. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89(6):2079-88.
[7]. Oliva EN, Dimitrov BD, Benedetto F, D Angelo A, Nobile F. Haemoglobin level threshold for cardiac remodeling and quality of life in myelodysplastic syndrome. Leuk Res. 2005;29(10):1217-19.
[8]. Greenberg PL. Myelodysplastic syndromes:iron overload consequences and current chelating therapies. J Natl Compr Canc Netw. 2006; 4(1):91-96.
[9]. Athens JWJ. Complications of haematopoietic neoplasms. Wintrobes Clinical Haematology. Vol 2.Edited by Lee GR. Philadelphia , Lea and Febiger ; 1993 : 1792 – 1842 .
[10]. Bincoletto C, Saad ST, Soares da Silva E, Queiroz ML. Autonomous proliferation and bcl-2 expression involving haematopoeitic cells in patients with myelodysplastic syndrome. Br J Cancer. 1998;78(5):621-24.

Abstract: Lupus manifesting as an ascites is extremely rare as aptly assessed by the figures available in world literature. We report a case which clinically and cytologically mimicked a malignant process. Further investigations and conservative approach taken in the case led to definitive diagnosis of florid peritoneal reaction associated with systemic lupus erythematosus. The clinical presentation is discussed in the context of other similar rare reports.

Key words : Fibrosis, sclerosing peritonitis, florid ascites, systemic lupus erythematosus.

1]. Kaklamonis P, Vayopoulos G, Stamatelos G, Dadinas G,Tsokos GC. Chronic lupus peritonitis with ascites. Ann Rheum Dis. 1991; 50 : 176-177.
[2]. Pepels M.J.A.E. Peters F.P.J. Mebis J.J.I.R., Ceelen Th L. Hoofwijk A.G.M., Erdkamp F.C.G. Sclerosing peritonitis : an unusual cause of ascites in patients with systemic lupus erythematosus. Netherlands Journal of Medicine. 2006; 64(9): 346-349.
[3]. Finney AL, Spagndo DV, Crawford GP, Shilkin KB. Pseudosarcomatous sclerosing peritonitis. Case report of an unusual form of chronic lupus peritonitis. International Journal of Surgical Pathology. 1996; 4(2) : 121-128.
[4]. Wilkins K, Holffman G. Massive ascites in systemic lupus erythematosus. J Rheum. 1985; 12 : 571-574.
[5]. Mier A, Weir M. Ascites in systemic lupus erythematosus. Ann Rheum Dis. 1985; 44 : 778-779.
[6]. Miller MH, Urowitz MB, Gladmann DD, Tozman ECS. Chronic adhesive lupus serositis as a complication of systemic lupus erythematosus. Arch Intern Med. 1984; 144 : 1863-64.
[7]. Schousboe J, Koch A, Chang R. Chronic lupus peritonitis with ascites : review of literature with a case report. Semin Arthritis Rheum. 1988; 18 : 121-126.
[8]. Garosi G, Di Paolo N. Morphological aspects of peritoneal sclerosis. J Nephro. 2001; 14 (4) : 530-8.
[9]. Kelly JK, Hwary WS. Idiopathic refractile sclerosing mesenteritis and its differential diagnosis. AM J Surg Pathol. 1989; 13 : 513-521.
[10]. Dehn TCB, Lucas MG Wood RFM. Idiopathic sclerosing peritonitis. Postgrad Med J. 1985; 61 : 841-841.

Abstract: We report a case with infrequent cause of myopathy related to hypothyroidism who presented to us with pseudohypertrophic mass on left calf with serological findings consistent with diagnosis of hypothyroidism. The syndrome of pseudohypertrophic etiology (Hoffman's syndrome) remains obscure. The case is discussed and reviewed briefly.

Keywords: Pseudohypertrophy, myopathy, hypothyroidism.

1. Vasconcellos LF Peixoto MC, de Oliveira TN, Penque G, Leite AC. Hoffman's Syndrome : pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report. Arq Neuropsiquiatr. 2003 Sep; 61(3B) : 851-4. Epub; 2003 Oct.28 [PubMed].

2. Deepak S, Harikrishnan, Jayakumar B. Hypothyroidism presenting as Hoffman's syndrome. J Indian Med Assoc 2004; 102 : 41-2.

3. Mastropasqua M, Spagna G, Baldini V, Tedesco I, Paggi A. Hoffman's Syndrome : Muscle Stiffness, Pseudohypertrophy and Hypothyroidism. Case Report . Horm Res 2003; 59 : 105-108.

4. Ono S, Inouye K, Mannen T. Myopathology of hypothyroid myopathy : some new observations. J Neurol Sci 1987; 77 : 237-248.
5. McKeran RO, Slavin G, Ward P, Paul E, Mair WGP. Hypothyroid myopathy : a clinical and pathological study. J Pathol 1980; 132

Abstract: Knowledge of embryology ,teratology , clinical genetics and diagnostic ultrasonography have paved way to identity the anomalies and treat them successfully in pre/postnatal phase .Tremendous advancement in the imaging technique and availability of sophisticated instruments have made prenatal fetal surgery to repair many of the anomalies possible – an unimaginable dream come true. In this era where family planning has been accepted by all. It is imperative to take measures to identify anomalies during prenatal phase, so that in cases of major anomalies, MTP can be advised to avoid economic burden and domestic difficulties to the parents. The present study was done on 50 still born and aborted fetus around age group of 26 weeks to 40 weeks obtained from Gandhi Hospital Secunderabad. Observations found are Gastrointestinal tract anomalies are 5, Central nervous system anomalies were 6, Urogenital system anomalies are 1 in number, normal foetus are 40 cases. The primary importance to examine the malformed foetus is to derive more information which can be used to counsel parents in respect of future pregnancies.

Keywords: Anencephaly, Spinabifida, Imperforate anus, Gastroschisis, Congenital anomalies, Foetus.

[1]. Aiyer P.R. (1969) congenital malfarmations. Paediatric clinic of India Volume No: 4 October: 369-371.
[2]. Coffvi .V.P. and Jessop .W.J.E. a study of 137 cases of anencephaly Brit. Preventive Medicine (1957) 11:174-180.
[3]. Commenford. J.Pregnancy with congenital anomalies Lancet X.1965 Cited by Vare-Banasal.
[4]. Edward .J.H. congenital Malformations in Scotland British journal. Preventive social and Medicine 1958, 12:115.
[5]. Farhataziz.N. Engels.J.E, Ramus .R.M, Zaretsky.M, Twickler.D.M, AmJ.Roentgenol 2005 June 184 (6) PMID 15908548
[6]. Jones, Edger .OHorga ultrasound diagnosis of fetal malformations.Americal Journal of Obstretics & Gynaecology 1973 163: 42.
[7]. Lammer 1985 in fetal congenital Anomalies –an analysis Americal Journal of Obstretics & Gynaecology 1985 91:870.
[8]. Lamire.J, Ronald. Brue Beck with and Thomas A comparitive study of eight human specimens 1972 Tetralogy 6: 27-36.
[9]. Mac Mohan .B. Paugh.TE and Ingalls .T.H. Congenital defects incidence related to sex, race and siblings. British Journal Prev and
Soc and Medi 1953, 7:211
[10]. Muffarij .I.K, and Kilejan, V.O. Anencephaly-an analysis of anencephalic births 1963, 22:257.

Abstract: Purpose: The aim of the present investigation was to review and evaluate the current literature on the mini-implants in orthodontics with regard to their materials properties. The ultimate aim of biomaterials as applied to mini-implants is to serve as efficient temporary anchorage devices. The attainment of this objective is dependent upon a complex interplay of material properties, device design, and physiologic requirements. It is the orthodontist's responsibility to understand both the materials and structural limitations of these devices and the principles of application to minimize performance failure. Manufacturers use six different titanium-based biomaterials to fabricate mini implants. Each of these materials, including four grade of commercially pure titanium and two titanium alloys and 316L Stainless steel used as a mini implant materials each has distinct mechanical and physical properties. Clinician should recognize these differences for to minimize performance failure and patient care.

Key Words: Biomaterials, corrosion, mini-implants, stainless steel, titanium, titanium alloys

[1] Morais LS, Serra GG, Palermo EFA, Andrade LR, Muller CA, Meyers MA, Elias CN. Systemic levels of metallic ions released from orthodontic mini-implants. Am J Orthod Dentofac Orthop 2009;135:522-529
[2] Wehrbein H, Glatzmaier J, Yildirim M. Orthodontic anchorage capacity of short titanium screw implants in the maxilla. An experimental study in the dog. Clin Oral Implants Res 1997; 8:131-41.
[3] Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod1997;31:763-7.
[4] Park YC, Lee SY, Kim DH, Jee SH. Intrusion of posterior teeth using mini-screw implants. Am J Orthod Dentofac Orthop 2003;123:690-694.
[5] Eliades T, Zinelis S, Papadopoulos MA, Eliades G. Characterization of retrieved orthodontic miniscrew implants. Am J Orthod Dentofac Orthop 2009; 135:10.e1-10.e7
[6] Rasmussen RA. The Branemark system of oral reconstruction: a color atlas ( Ishiyaku Euro-America Inc; Tokyo, 1992)
[7] McCraden M. Dental implant Materials: Commercially pure Titanium and Titanium alloys. J Prosthod 1999;8:40-43
[8] Greenfield EJ: Mounting for Artificial Teeth. Patent #943, 113, 1909, pp 1-3. Wichita, Kansas
[9] Strock AE: Experimental work on a method for the replacement of missing teeth by direct implantation of a metal support into the alveolus. Am J Orthod Dentofac Orthop 1939;25:467-472.
[10] Branemark PI: Osseointegration and its experimental background. J Prosthet Dent. 1983; 50:399-410.

Abstract: Arch length, inter-canine width, and inter-molar width are essential for diagnosisand treatment planning and are closely related factors in orthodontics. Aim:The aim of the present study was used to determine correlations between these measurements and to predict some of these measurements based on others. Method:The dental casts of 30 patients (15 females and 15 males) with a mean age of 18 years (11 – 26 years) in the permanent dentition attending the Orthodontic Department of the Jaipur Dental College, Jaipur,were selected. Intercanine width, intermolar width, and arch length on each dental cast were measured. Correlation between variables was determined using Pearson's correlation coefficient. Linearregression analysis was applied and the 95 per cent confidence intervals for slope and interceptwere determined. Result: The data showed very high correlations between inter-canine width and arch length, both for the upper and lower arches and for males and females, r = 0.925. This coefficient was very close to 1, indicating a linear relationship.The regression equation for arch length and inter-canine width was arch length = 1.36 inter-canine width + 29.39 for both arches. Conclusion: There was very high correlations between arch length and inter-canine width for the upper and lower arches and a regression equation between both magnitudes was established indicating that the size of one factor can be predicted by knowing the other. For an increase of 1 mm in inter-canine width, the arch length increases approximately 1.36 mm with a 95 per cent confidence intervals (1.30 – 1.42).

Key Words: Arch length, inter-canine width, inter-molar width.

[1]. Adkins MD , Nanda RS , Currier GF 1990 Arch perimeter changes on rapid palatal expansion .Am J OrthodDentofacialOrthop 97 : 194 – 199
[2]. Germane N, Lindauer SJ, Rubenstein LK, Revere JH, Isaacson RJ1991 Increase in arch perimeter due to orthodontic expansion.Am J OrthodDentofacialOrthop 100 :421 – 427
[3]. Hnat WP, Braun S, Chinhara A, Legan HL 2000 The relationship of arch length to alterations in dental arch width . Am J OrthodDentofacialOrthop 118 : 184 – 188
[4]. Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S 2002 An experimental study on mandibular expansion: increases in arch width and perimeter .Eur J Orthod 24 : 125 – 130
[5]. Paredes V, Gandía JL , Cibrian RM 2005 New, fast and accurate procedure to calibrate a 2-dimensional digital measurement method.Am J OrthodDentofacial Orthop127 :518 – 519

Abstract: A two and a half year old child sustained low tension electric burns in left thigh and abdominal wall leading to multiple jejunal perforations. Segmental resection followed by primary anastomosis was done with delayed repair of abdominal wall defect. The baby recovered uneventfully.

Key Words: Jejunal perforation, electric burn, abdomen.

[1]. Dr. C. Behera, Dr. (Col) Ravi Rautji, Dr. T. D. Dogra. Fatal Gastro-duodenal perforation following electrocution - A case report. J Indian Acad Forensic Med, 32(3) ISSN 0971-0973
[2]. Kumar S, Thomas S, Lehri S. Abdominal wall and stomach perforation following accidental electrocution with high tension wire: a unique case. J Emerg Med 1993 Mar-Apr;11(2):141-5.
[3]. Sandhir RK, Tiwari IN, Goel A. Management of electrical injuries of the abdomen. Burns. 1992 Jun;18(3):253-5
[4]. Zhong DC. Intestinal perforation caused by severe electrical burn: report of 5 cases. Zhonghua Wai Ke Za Zhi. 1993 Nov; 31(11):671-2
[5]. Honda T, Yamamoto Y, Mizuno M, Mitsusada M, Nakazawa H, Sasaki K, Nozaki M. Successful treatment of a case of electrical burn with visceral injury and full-thickness loss of the abdominal wall. Burns. 2000 Sep;26(6):587-92.
[6]. Rijhwani A, Sunil I. Colonic fistula complicating electric burns--a case report. J Pediatr Surg. 2003 Aug; 38(8):1232-3.

Abstract: Background: Hepatobiliary ascariasis is commonly reported from highly endemic regions like India, Bangladesh, Latin America, parts of Middle East and Africa. In humans, the usual habitat of Ascaris lumbricoides is the small intestine. When the worm load is high, then the worms tend to migrate away from the usual site and invade the biliary system. Material & Methods: Patients attending general surgery department of NEIGRIHMS hospital with biliary ascariasis and its complications were included in the study. Results: Most cases of biliary ascariasis can be managed conservatively. The worm usually returns to the intestine and only in complicated cases, some therapeutic interventions like ERCP or surgical management may be required. Conclusion: Biliary ascariasis may present with biliary colic or with various complications like cholangitis, acute pancreatitis, liver abscess, etc. Sonography has been shown to have a high diagnostic accuracy in the diagnosis of biliary ascariasis. Most of the patients can usually be managed conservatively, and surgery or ERCP are required only in a very limited number of cases.

Keywords: Ascariasis, hepatobiliary.

[1]. Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet 1990; 335:1503-1506.
[2]. Pawlowski ZS. Ascariasis. In Warren KS, Mahmoud AAF, et al editors. Tropical and Geographical Medicine, 2nd edition, New York, McGraw- Hill, 1990;369-378.
[3]. Khuroo MS. Ascariasis. Gastroenterol Clin North Am 1996;25:553-577.
[4]. Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastrenterol 1997;92:2264-2267
[5]. Shah OJ, Dar MA, Wani NA, et al. Postoperative biliary ascariasis: presentation and management experience. World J Surg 2000;24:1143-1145
[6]. Khuroo MS, Zargar SA, Yattoo GN, et al. Sonographic findings in gall bladder ascariasis. J Clin Ultrasound 1992; 20:587-589.
[7]. Louw JH. Biliary ascariasis in childhood. S Afr J Surg 1974; 12: 19-25.
[8]. Khuroo MS, Zargar SA. Biliary ascariasis: a common cause of biliary and pancreatic disease in endemic area. Gastroenterology 1985;88: 418-423.
[9]. Yang SCH, Laube PL. Biliary ascariasis: report of 19 cases. Ann Surg 1946; 123:299-303.
[10]. Wright RM, Dorrough RL, Ditmore HB. Ascariasis of the biliary system. Arch Srg 1963;86:402-406.

Abstract: A retrospective review of the patients with childhood cholelithiasis managed by laparoscopic cholecystectomy at NEIGRIHMS Hospital in North East India between January 2009 and December 2012 was done. Data reviewed were the following – patient demographics, clinical history, hematological studies, imaging studies, operative techniques, postoperative complications and recovery and also the final histopathological diagnosis from the gallbladder specimen. During the study period of 3 years, 15 children (all females) were managed in the department of surgery of this hospital by laparoscopic cholecystectomy and none of the patients had any history suggestive of any hemolytic disorders. The mean age was 7.6 years (range 3 to 14 years). Pigment stones were found in eight of the patients and the remaining seven patients had mixed stones. The mean duration of operation was 45 mins (range 30- 60 mins). No significant postoperative complications occurred in any of the patients. The average duration of hospital stay was 2 days (range 2 – 4 days). The incidence of cholelithiasis in children is not very common, but non- hemolytic causes may also lead to gallstone formation as in adult population. Laparoscopic cholecystectomy is a very safe and efficacious management option for cholelithiasis in children.

Key Words: Cholelithiasis, childhood, non haemolytic causes, laparoscopic cholecystectomy, indigenous retrieval bag.

[1]. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge i children. J Pediatr Gastroenterol Nutr 2000;31:411-417.
[2]. Kaechele V, Wabitsch M, Thiere D, Kessler AL, Haenle MM, Mayer H, et al. Prevelance of gallbladder stone disease in obese children and adolescents: Influence of the degree of obesity, sex and pubertal development. J Pediatr Gastroenterol Nutr 2006;42:66-77.
[3]. Bailey PV, Connors RH, Tracy TF Jr, Sotelo- Avila C, Lewis JE, Weber TR. Changing spectrum of cholelithiasis and cholecystitis in infants and children. Am J Surg 1989;158: 585-588.
[4]. Treatment of gallstone and gallbladder disease. SSAT patient care guidelines. J Gastrointest Surg. 2004; 8: 363–364.
[5]. Ransohoff DF, Gracie WA. Treatment of gallstones. Ann Intern Med. 1993;119:606–619
[6]. Kim PC, Wesson D, Superina R, Filler R. Laparoscopic cholecystectomy versus open cholecystectomy in children: which is better? J Pediatr Surg. 1995;30:971–973
[7]. Esposito C, Gonzalez Sabin MA, Corcione F, Sacco R, Esposito G, Settimi A. Results and complications of laparoscopic cholecystectomy in childhood. Surg Endosc. 2001;15:890–892.
[8]. Mattioli G, Repetto P, Carlini C, Granata C, Montobbio G, Cagnazzo A, Barabino A, Gandullia P, Jasonni V. Medium-term results after cholecystectomy in patients younger than 10 years. Surg Endosc. 2001;15:1423–1426.
[9]. Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, Pietsch JB, O'Neill JA Jr, Shyr Y. Laparoscopic cholecystectomy in children: lessons learned from the first 100 patients. J Pediatr Surg. 1999;34:1236–1240.
[10]. Clements RH, Holcomb GW 3rd. Laparoscopic cholecystectomy. Curr Opin Pediatr. 1998;10:310–314

Abstract: Objective: To study the rate of specimens rejection received in the laboratory. Design: A cross-sectional survey was conducted over a period of six months across Community Health Centres (CHC), Primary Health Centres (PHC), District hospitals and Govt. multi-specialty tertiary care hospital and trust autonomously run charity hospital. In-depth interviews were also conducted with the laboratory staff. Rejection of samples with the aim of proper processing of the samples and for providing report of high standard comes under good lab practices. Results: A total of 2000 sample were studied and followed. A total of 5.3% samples were rejected. The rejection rate was higher among the hospitals run by trusts than govt. In all, the rejection rate was higher blood sample (9.1%) as compared to body fluid (8%), urine (6.8%), stool (5.3%) and sputum (3.3%) sample. The main reason of rejection was due to inadequacy of specimen collection by the paramedical staff. Conclusion: The rejection rate was higher in trust hospitals due to higher awareness at the analytical level of the sample processing in the lab as compared to govt. run hospitals where every sample is processed irrespective of its adequacy/inadequacy and the report is provided. Thus, the emphasis should be given to make such diagnostic kits in future which are less dependent collection and handling.

Key Words: Specimen, Rejection rate, laboratory

[1]. Carraro P, Plebani M. Errors in a stat laboratory: Types and frequencies 10 years later. Clin Chem.2007;53:1338–134
[2]. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem. 2002;48:691–695.
[3]. American Association for Clinical Chemistry. Expert Access—Dedicated Phlebotomy Improves Patient Care in an ED Setting. Fantz C. Nov 11, 2010.
[4]. Azadeh Stark, Bruce A. Jones, Deborah Chapman, JD, Karen Well, Richard Krajenta, Frederick A. Meier, Richard J. Zarbo, MD. Clinical Laboratory Specimen Rejection—Association With the Site of Patient Care and Patients' Characteristics. Arch Pathol Lab Med. 2007;131:588–592.
[5]. Dale JC, Novis DA. Outpatient phlebotomy success and reasons for specimenrejection: a Q-Probes study. Arch Pathol Lab Med. 2002; 126:416–419.
[6]. Arch Pathol Lab Med. 2007 Apr; 131(4):588-92.

Abstract: Post operative adhesion is the commonest cause of intestinal obstruction in the developed world whereas obstructed/strangulated external hernias are the commonest in tropical Africa. Open abdominal or pelvic surgery is often associated with this condition. Laparoscopic surgery is said to reduce the incidence of this condition, probably because there is less tissue handling compared to open surgery. Though the initial management of adhesive bowel obstruction is conservative, surgery remains an inevitable option in some cases.The aim of this study was to see the prevalence of post adhesive acute bowel obstruction amongst causes of acute abdomen in the University of Calabar Teaching Hospital within the study period.This was a one year prospective study done in this centre. All adult patients who presented with acute intestinal obstruction to the emergency unit of the hospital were included in the study. A total of 46 patients presented with acute intestinal obstruction during the study period. Eleven (23.9%) of this number had post operative adhesions as a cause of the obstruction and it was commoner in females than males with a ratio of almost 2:1. Acute appendicitis was the commonest surgery associated with this condition (45.5%).

Keywords: Acute intestinal obstruction, Laparoscopic surgery, Post operative adhesions,.

[1] M.C. Winslet, Intestinal obstruction, in R.C.G. Russel , N.S Williams , C.K. Bulstrode (Eds), Bailey & Love's Short Practice of Surgery, 23(London: Arnold 2000) 1064 -1065.

[2] S.B. Naaeder, J.F.K. Tandoh, Acute Intestinal Obstruction,in E.A. Badoe, E.Q. Archampong ,J.T. Da Rocha-Afodu (Eds), Principles and Practice of Surgery – including Pathology in the Tropics, 3 (Accra: Assemblies of God Literature Centre Ltd. 2000) 537-538.

[3] O.E.Ngim, The Pattern of presentation, management and outcome of acute abdomen at the University of Calabar Teaching Hospital (UCTH), Calabar: A 12-month prospective study, National Postgraduate Medical College of Nigeria Part 2 Diss.,2008.

[4] O.E. Ngim, A. Essiet , S.E.E. Efem , O.O. Bassey . Acute Intestinal Obstruction in Adults in the University of Calabar Teaching Hospital, Calabar, Nigeria. Int J. Trop Surg ,3, 2009,44-49.

[5] M. Pomata , E. Erdas , B. Casu, G. Pinna , S. Licheri et al, Small bowel obstruction caused by post operative adhesions: personal experience and review of the literature, Chir Ital,58,2006,449 – 58.

[6] A. Dia , B. Fall , P. Thognon , A.K. Ndoye , M.L. Sow , A. Diop , Intestinal obstruction caused by post operative adhesions 79 cases, J de Chirurgie,128, 1991,548-551.

[7] D. Menzies, H. Ellis. Intestinal obstruction from adhesions – how big is the problem? Ann R Coll Surg Engl ,72, 1990,60 – 63.

[8] J. Kossi , P' Saminen, M. Laato, The epidemiology and treatment patterns of post operative adhesion induced intestinal obstruction in Varsinaissuomi Hospital District, Scan J Surg, 93,2004, 68-72.

Abstract: An impacted esophageal foreign body is most often an urgent, rather than a life-threatening, medical situation. Typically, two types of foreign bodies are encountered: true foreign bodies (buttons, coins, pieces of balloon etc) and food-related foreign bodies. Ingestion of true foreign bodies generally occurs in persons less than 40 years old, with the vast majority being children. The incidence of true foreign body ingestion is also high in incarcerated individuals and in persons with psychiatric disorders. Food-related foreign bodies are more prevalent in persons who are over 60 years of age, who have esophageal disease, anatomic narrowing, motility disorders or who have recently consumed central nervous system depressants, especially ethanol. This article describes the clinical presentation, radiological findings and management of impacted mutton fat bolus as foreign body in an adult male patient.

Key Words; Foreign body, Adipose tissue, Endoscopy

[1]. Pavan Sardana, Arvind S Bais, V. P. Singh, Meeta Arora. Unusual Foreign Bodies Of The Aerodigestive Tract Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 54 No. 2, April - June 2002 125
[2]. C.A. Rojas, D. Vermess, J.C. Bertozzi, J. Whitlow, C. Guidi andC.R. Martinez. Normal Thickness and Appearance of the Prevertebral Soft Tissues on Multidetector CT. American Journal of Neuroradiology 30:136-141, January 2009
[3]. Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in childrenJ Pediatr Gastroenterol Nutr. 2011 Jan; 52(1):43-6.
[4]. Larsson H, Bergquist H, Bove M. The incidence of esophageal bolus impaction: is there a seasonal variation? Otolaryngol Head Neck Surg. 2011 Feb; 144(2):186-90
[5]. Blair SR, Graeber GM, Cruzzavala JL, Gustafson RA, Hill RC, Warden HE, Murray GF: Current management of esophageal impactions. Chest 1993; 104:1205-1209.
[6]. Hin Hin Ko, Robert Enns, Review of food bolus management. Can J Gastroenterol. 2008 October; 22(10): 805–808.
[7]. Kozarek RA, Sanowski RA. Esophageal food impaction; description of a new method for bolus removal. Dig Dis Sci 1980; 25:100-103.

Abstract: Objective: To compare and evaluate the efficacy of Terminalia arjuna (aqueous extract) with digoxin on (i) Heart rate and amplitude of frog's heart in situ. (ii) Heart rate and amplitude of hypodynamic frog's heart in situ. (iii) Heart rate and amplitude of isolated perfused rabbit heart. (iv) Coronary flow of isolated perfused rabbit heart. Methods: (i) The dried bark of Terminalia arjuna was Soxhlet extracted with distilled water. (ii) The Terminalia arjuna (aqueous extract) was evaluated for its effcacy on frog and rabbit heart. (iii) Efficacy of Terminalia (aqueous extract) was compared with digoxin in reference to above mentioned parameters. Results: Terminalia arjuna (Aq.E) increased the force of contraction of cardiac muscle in frog's heart in situ, hypodynamic frog's heart in situ and isolated perfused rabbit heart. It also increased the coronary flow at a 400 μg dose in isolated perfused rabbit heart along with dose dependent bradycardia. However the doses required were high as compared to digoxin so the agent proved to be less potent as compared to digoxin. Conclusion: Terminalia arjuna (Aq.E) produced cardiotonic effects along with increase in the coronary flow in experimental animals where as its cholesterol lowering property has already been reported. So, it can be expected to be a good choice for CHF patients with hypercholesterolemia and requires further exploratory studies.

Key Words: Terminalia arjun (Aq.E), Soxhlet Extraction. CHF, Hypodynamic.

[1]. Haldman GA, Corft JB, Giles WH, Rashidec A. Hospitalization of patients with heart failure: National Discharge Survey,1985 to 1995. Am Heart J 1999; 137:352-60.
[2]. Sharma SB, Dwivedi S. Medicinial plants with hypolipidemic activities. Indian Drugs 1997; 34: 242-51.
[3]. Miller AL Botanical influences on cardiovascular disease. Alternative Medicine Review 1998; 3 (6): 422-31.
[4]. Dwivedi S and Agarwal MP. Antianginal and cardioprotective effects of Terminalia arjuna , an indigenous drug in coronary artery disease. J. Assoc. Phys. India 1994;42:287-9.
[5]. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia arjuna in patients with severe refractory heart failure. Int J Cardiol 1995; 49: 191-9.
[6]. Burn JH. Practical pharmacology, Blackwell Scientific publication, Oxford; 1952.p. 25, 30-31.
[7]. Kulkarni SK. Handbook of Experimental Pharmacology, Vallabh Prakashan, 3rd Edition; 1999.p.158.
[8]. Perry WLM Pharamacological experiments on isolated preparations. E & S. Livingstone, Edinburgh. 2nd Edition; 1970.p. 116-7.
[9]. Radhakrishnan R, Wadsworth RM, Gray Al. Terminalia arjuna an Ayurvedic cardiotonic, increases contractile force of rat isolated atria. Phytotherapy Res 1993; 7: 166-8.
[10]. Colabawalla HM. An evaluation of the cardiotonic and other properties of Terminalia arjuna. India Heart J 1951; 3 : 205-30.

Abstract: Lipoleiomyoma is a rare benign uterine tumour consisting of smooth muscles and mature adipose tissue. Most cases of lipoleiomyomas cannot be distinguished clinically from leiomyoma and to a large extent diagnosis can be made on the typical gross appearance of the tumour. Incidence of this neoplasm is estimated to be 0.03-0.2%. The majority of patients do not report any symptoms. Almost all of the cases of lipoleiomyoma have been reported in postmenopausal women and predominantly located in the uterus; however, extrauterine locations have been reported as well. We are reporting a case of lipoleiomyoma of uterus in a 28 yrs old female. To the best of our knowledge, this is the only case reported of lipoleiomyoma of uterus at such an early age.

Keywords: lipoleiomyoma, leiomyoma, uterine tumor.

[1]. A. Prieto, C. Crespo, A. Pardo, I. Docal, J. Calzada, P. Alonso, Uterine lipoleiomyomas: US and CT findings, Abdom Imaging, 25, 2000, 655-657.
[2]. L.M. Kauser, C.H. Carrasco, C.R. Sheehan, et al, Lipomatous tumour of the uterus; Radiographic and ultrasonic appearance, Br J Radiol, 52, 1979, 992-993.
[3]. D. A. Oppenheimer, B. A. Carroll, S.W. Young, Lipoleiomyoma of uterus, J Comput Assist Tomogr, 6, 1982, 640-642.
[4]. R. Aizenstein, A. C. Wilbur, S. Aizenstein, CT and MRI of uterine lipoleiomyoma, Gynecol Oncol, 40, 1991, 274-276.
[5]. Y. Tsushima, T. Kita, K. Yamamoto, Uterine lipoleiomyomas: MRI, CT and Ultrasonographic findings,Br J Radiol, 70, 1997, 1068-1070.
[6]. S. Sudhamani, Durgaprasad Agrawal, Ajita Pandit, V. M. Kiri, Lipoleiomyoma of uterus: a case report with review of literature, Indian J. Pathol. Microbiol., 53(4), 2010, 840-841.
[7]. Rony Avritscher, Revathy B. Iyer, Jae Ro, Gary Whitman, Lipoleiomyoma of the Uterus, Radiologic-Pathologic conferences of the University of Texas, M. D. Anderson Cancer Center, AJR, 177, 2001, 856.
[8]. K. C. Lin, B. C. Sheu, S. C. Huang, Lipoleiomyoma of the uterus, Int. J. Gynaecol. Obstet., 67(1), 1999, 47-49.

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is contributing to the burden of chronic diseases. Current Gold guidelines define the severity of COPD in terms of the % predicted FEV1 and also uses MRC dyspnea scale for comprehensive assessment. MRC dyspnea scale can easily be applied for quantification of severity of COPD where as spirometry requires standardized testing conditions. Materials And Methods: This is a cross sectional study consisting of 260 COPD patients who attended the chest and internal medicine clinics of Dr.Pinnamaneni Siddhartha Institute of Medical Sciences. Informed consent was taken from all the patients. Personal interview was held to collect data including age, gender and occupation. Dyspnoea was graded by MRC Scale as grades 1-5. Baseline FEV1 was measured by spirometer . Spirometry was performed as per the general guidelines of American Thoracic Society. Each patient then received two puffs (200mcg) of salbutanol delivered by a metered dose inhaler with spacer. 15 minutes later forced expiratory maneuver was repeated as described in the guidelines of American Thoracic Society and the best FEV1 was recorded. Those patients who showed reversibility of 12% or more were excluded from the study. Results: The age of the study group ranged from 35-83. Out of the 260 patients studied, most of them had MRC grade 4 (40.38%) and only 15 (5.76%) patients had dyspnoea of grade 5. Strong correlation between MRC dypnea grade and post-bronchodilator % predicted FEV1 was noted[P=0.0001]. Conclusion: MRC dyspnoea scale correlated well with FEV1 post spirometric indices. The MRC scale can be used as an effective tool for screening in rural set up and it is also a convenient and comprehensive tool for respiratory therapists in planning the rehabilitation programs. Keywords - COPD, Dyspnoea, MRC scale, Percentage predicted FEV1(FEV1%). Spirometry,

[1]. McKay AJ, Mahesh PA, Fordham JZ et al. Prevalence of COPD in India: a systematic review. 2012 Sep;21(3):313-21.
[2]. Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003; 163: 1180-6.
[3]. J.F. Murray & J.Nadel. Text Book of Respiratory Medicine 1994. Chronic bronchitis & Emphysema P.1342.
[4]. Gold, 2006. Guidelines for chronic obstructive pulmonary Disease. Thorax 2006, 61: 189-95.
[5]. M.Cazzola B. Celli, R. Dahl, S. Rennard therapeutic strategic in COPD, 2005 - Dyspnoea , MRC Scale P.No.40.
[6]. Alfred P. Fishman, Jack A Elias, Jay A. Fishman, Michael A. Grippi, Fishman's Pulmonary Diseases & Disorders. Fourth Edition, 20088. Chronic obstructive Pulmonary Disease: Epidemiology Pathophysiology & Pathogenesis – Proposed Risk factors for COPD P.No.660, 680.
[7]. Douglas Seaton, Anthony Seaton, Leitch, Crofton & Douglas's Respiratory Diseases: 5th Edition Chronic bronchitis & Emphysema – Pathology P.No.627-632.
[8]. The latest set of guidelines from the American Thoracic Society (ATS) website: http.//www.thoracic.org.
[9]. Kylie Hill PhD Richard Hodder et al. Identifying adults at risk of COPD who need confirmatory spirometry in primary care. Vol 57: february 2011 ;57:e51-7
[10]. Ray D, Abel R, Selvaraj K.G. A 5 years prospective epidemiological study of chronic obstructive pulmonary disease in rural South India. Indian J. Med. Res. 1995; 101: 258-44.

Abstract: Thyroid disorders are known to cause a wide range of skin manifestations. Hypothyroidism causes changes in the skin, hair and nails. The aim of our study was to evaluate the skin manifestations in patients with hypothyroidism. A total of 100 patients with hypothyroidism attending the General Medicine and Dermatology of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences over a period of one year were included in our study, and the skin lesions have been recorded after a detailed history and clinical examination. Out of 100 patients, 63 patients had skin manifestations. Xerosis (acquired ichthyosis) and diffuse hair loss were the common skin manifestations which were seen in 38.09% and 34.8% of patients respectively. Melasma(14.28%), chronic urticaria(14.28%) and generalised pruritus(11.1%) were the other common manifestations. Tinea corporis, vitiligo, alopecia areata, lichen planus and xanthelasma palpebrarum were the other skin disorders associated with hypothyroidism.We therefore conclude that a better understanding of the skin lesions helps in the early detection of the underlying hypothyroid state.

Keywords – Hypothyroidism, Skin changes, Xcrosis

[1]. Goolamali SK. Thyroid disease and sebaceous gland function. Br. Med J. 1979; 1 :432-440.
[2]. Khurram Irfan M, Choudary Kiran, Muhammad Khan, Islam Najmul. Clinical presentation of hypothyroidism in central part of Iran.Pak J Med Sci.2008 Jan-Mar;24(1):44-7.
[3]. Dogra A, Dua A, Singh P. Thyroid and skin. Indian J Dermatol 2006; 51: 96-99.
[4]. Joan Felicita Samson, P.S. Mathew, G .K. Libu, B. Jayakumar. Astudy of cutaneous manifestations of hypothyroidism and hyperthyroidism. Kerala Medical Journal 2011; 52-54
[5]. Means MA, Dobson RL. Cytologic changes in the sweat gland in hypothyroidism. JAMA 1963; 186: 113-5
[6]. Feingold KR, Elias PM. Endocrine Skin Interactions. J Am Acad Dermatol 1987; 17: 920-940.
[7]. Leznoff A, Sussman GL. Syndrome of Idiopathic chronic Urticaria and angioedema with thyroid autoimmunity: A study of 90 patients. J Allergy Clin Immunol 1989;84: 66-71.
[8]. Heymann WR. Chronic urticaria and angioedema associated with thyroid autoimmunity; Review and therapeutic implications. J Am Acad Dermatol1999; 40: 229-232.
[9]. Lufti RJ, Fridmanis M, Misiunas AL, Pafume O, et al. Association of melasma with thyroid autoimmunity and other thyroid abnormalities and their relationship to the origin of melasma. J Clin Endocrinol Metab 1985; 61: 28-31.
[10]. Niepomniszcse H, Amad RH. Skin disorders and thyroid. Endocrinol Invest 2001; 24: 628-38.

Abstract: To report the experience in diagnosis, management and outcome of 2 cases of malignant melanoma of vagina. Case Reports: the report concerns two postmenopausal patients with vaginal melanoma treated by radical surgery with bilateral inguinal pelvic lymphadenectomy. The first patient presented with a 4cm pigmented brownish mass located in the posterior wall of the lower third of the vagina with a satellite nodule of 1cm in the upper third of the vagina. The second patient had a 10cm pigmented and ulcerated mass in the upper two third of posterior vaginal wall and an ulcer of 1.5 cm in the middle third of anterior vaginal wall. The first patient did not receive any adjuvant therapy after surgery and expired after one and half years because of local recurrence and distant metastasis. The second patient received radiotherapy after surgery and is alive for more than 2 years without any evidence of disease. An adjuvant external radiotherapy at dose of 50Gy was delivered to the second patient and she was well 26 months later, with no sign of local or distant recurrence.

Conclusion: Though radical surgery is the treatment of choice for malignant melanoma of vagina adjuvant radiotherapy may improve survival by preventing recurrence.

[1]. Greggi, S., S. Losito, C. Pisano, S. Desicato, and C. Scaffa, Malignant melanoma of the vagina: report of two cases and review of the literature. Int Surg 2010; 95: 120-5.
[2]. Gupta, D., A. Malpica, M.T. Deavers, and E.G. Silva, Vaginal melanoma: a clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol 2002; 26: 1450-7.
[3]. Tcheung, W.J., M.A. Selim, J.E. Herndon, 2nd, A.P. Abernethy, and K.C. Nelson, Clinicopathologic study of 85 cases of melanoma of the female genitalia. J Am Acad Dermatol 2012; 67: 598-605.
[4]. Frumovitz, M., M. Etchepareborda, C.C. Sun, et al., Primary malignant melanoma of the vagina. Obstet Gynecol 2010; 116: 1358-65.
[5]. Gungor, T., S.O. Altinkaya, M. Ozat, H. Bayramoglu, and L. Mollamahmutoglu, Primary malignant melanoma of the female genital tract. Taiwan J Obstet Gynecol 2009; 48: 169-75.
[6]. Mihajlovic, M., S. Vlajkovic, P. Jovanovic, and V. Stefanovic, Primary mucosal melanomas: a comprehensive review. Int J Clin Exp Pathol 2012; 5: 739-53.
[7]. Gokaslan, H., A. Sismanoglu, T. Pekin, H. Kaya, and N. Ceyhan, Primary malignant melanoma of the vagina: a case report and review of the current treatment options. Eur J Obstet Gynecol Reprod Biol 2005; 121: 243-8.
[8]. Nigogosyan, G., S. Delapava, and J.W. Pickren, Melanoblasts in Vaginal Mucosa. Origin for Primary Malignant Melanoma. Cancer 1964; 17: 912-3.
[9]. Reid, G.C., R.W. Schmidt, J.A. Roberts, M.P. Hopkins, R.J. Barrett, and G.W. Morley, Primary melanoma of the vagina: a clinicopathologic analysis. Obstet Gynecol 1989; 74: 190-9.
[10]. Geisler, J.P., K.Y. Look, D.A. Moore, and G.P. Sutton, Pelvic exenteration for malignant melanomas of the vagina or urethra with over 3 mm of invasion. Gynecol Oncol 1995; 59: 338-41.

Abstract: Different neoplasms and infections are known to involve the masticator space, but pathological diagnosis and treatment of these lesions are not always simple due to anatomical complexity. We treated a 65-year-old woman with an abscess in the masticator space suffering from trismus and swelling over left cheek region and left-TMJ pain, which was initially diagnosed as a superficial cheek abscess. Masticator space abscesses have been reported more frequently in recent years. They are usually secondary to extractions of the first and second mandibular molar teeth Therefore, Successful aspiration of pus was followed by an instantaneous improvement in the ability to open the mouth for a period of at least 24 hours. The infection had spread upward along the mastication muscles, resulting in an abscess in both the upper masseter muscle and the lower temporalis muscle. Based on a review of the literature, most abscesses in the masticator space originate from the mandibular molar, while the most impressive physical finding varied between the submandibular region and temporal fossa, as did its acute or chronic clinical course. We emphasize diagnostic significance when assessing findings for each masticator muscle and mandibular bone depicted using computed tomography.

Key Words: abscess, CT scan, masticator abscess, trismus

[1] Bratton TA, Jackson DC, Nkungula-Howlett T, et al. 2002, Management of complex multi-space odontogenic infections. J Tenn Dent Assoc; 82(3): 39-47.
[2] Chong VF, Fan YF. 1996, Pictorial review: radiology of the masticator space. Clin Radiol; 51(7): 457-65.
[3] Chow AW, Roser SM, Brady FA. 1978, Orofacial odontogenic infections. Ann Intern Med; 88(3): 392-402
[4] Duran-Reynals F. 1942, TISSUE PERMEABILITY AND THE SPREADING FACTORS IN INFECTION: A Contribution to the Host:Parasite Problem. Bacteriol Rev; 6(4): 197-252.
[5] Endicott JN, Nelson RJ, Saraceno CA. 1982, Diagnosis and management decisions in infections of the deep fascial spaces of the head and neck utilizing computerized tomography. Laryngoscope; 92(6 Pt 1): 630-3.
[6] Hardin CW, Harnsberger HR, Osborn AG, et al. 1985, Infection and tumor of the masticator space: CT evaluation. Radiology; 157(2): 413-417.
[7] Spilka CJ. 1966, Pathways of dental infections. J Oral Surg; 24(2): 111-24
[8] Welsh LW, Welsh JJ, Kelly JJ. 1991, Massive orofacial abscesses of dental origin. Ann Otol Rhinol Laryngol; 100(9 Pt 1): 768-773