iosr-JDMS   Volume-14 ~ Issue-4 ~ April-2015

Abstract: Breast cancer can metastasize anywhere in the body but the primary metastatic sites are the bones, liver, lymph nodes, liver and pleura. The current case report is an unusual entity which represents a case of breast cancer metastasis to rectum. A 66 year old woman presented with constipation and bleeding per rectum. Investigations were done accordingly in which histopathology revealed rectal malignancy. The patients past history revealed that she was operated for infiltrating duct cell carcinoma. Immunohistochemical evaluation on the rectal biopsy confirmed a breast primary. Surgery, chemotherapy and radiotherapy were the therapeutic modalities done. Rectal metastasis from breast cancer is seldom seen and this possibility must be kept in mind in a patient with history of breast cancer.

Keywords: Infiltrating duct cell carcinoma, Estrogen receptors, Progesterone receptors, Metastasis, Pleomorphism, Rectum.

[1]. R. E. Schwarz, D. S. Klimstra, and A. D. M. Turnbull, ―Metastatic breast cancer masquerading as gastrointestinal primary,‖ American Journal of Gastroenterology, vol. 93, no. 1, pp. 111–114, 1998.

[2]. K. Washington and D. McDonagh, ―Secondary tumors of the gastrointestinal tract: surgical pathologic findings and comparison with autopsy survey,‖ Modern Pathology, vol. 8, no. 4, pp. 427–433, 1995.

[3]. E. Caramella, J. N. Bruneton, and P. Roux, ―Metastases of the digestive tract. Report of 77 cases and review of the literature,‖ European Journal of Radiology, vol. 3, no. 4, pp. 331–338, 1983.

[4]. Borst MJ, Ingold JA: Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast.1993, 114:637-641.

[5]. Harris M, Howell A, Chrissohou M, Swindell RI, Hudson M, Sellwood RA: A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating duct carcinoma of the breast. Br J Cancer 1984, 50:23-30.

[6]. Lamovec J, Bracko M: Metastatic pattern of infiltrating lobular carcinoma of the breast: an autopsy study. J Surg Oncol 1991, 48:28-33.

Abstract: Chest injuries are one of the leading causes of morbidity and mortality in trauma patients. Significant morbidity can result from pain and respiratory distress in patients of blunt trauma chest.A prospective randomized controlled study was conducted at our institute on patients suffering from blunt trauma chest. A total of 36 patients were studied. Patients were randomized to two groups of 18 each. The first group were treated with intercostal nerve blocks for pain relief. The second group of patients were administered parenteral analgesics.Pain intensity at identified hours was measured in both the groups using the visual analog scale.the outcomes were compared.Pain relief was found to be significantly better with intercostal block compared to parenteral analgesia. Conclusion:intercostal nerve block is a simple and effective method for pain relief in patients with blunt trauma chest.

[1]. Mayberry JC, Trunkey DD. The fractured rib in chest wall trauma.ChestSurgClin N Am. 1997;7:239–261.
[2]. Ziegler DW, Agarwal NN. The morbidity and mortality of ribfractures. J Trauma. 1994;37:975–979.
[3]. Wimpy R, Hubbard L, McCormick M, Fortune JB. The treatment ofpatients with multiple rib fractures using continuous thoracic epidural narcotic infusions. RegAnesth 1987; 12:48
[4]. Manoj K. Karmakar, Anthony M.-H. Ho. Acute Pain Management of Patients with MultipleFractured Ribs. J Trauma. 2003;54:615–625
[5]. Murphy DF. Intercostal nerve block for fractured ribs and postoperative analgesia.Regional Anesthesia. 1983; 8:151-3

Abstract: Introduction: Papillary thyroid carcinoma (PTC) accounts for 70–80% of thyroid cancers and of good prognosis with very minimal rate of metastasis. Till date no single cytological feature is pathognomonic of PTC. Hence we have looked into criterion- Cellular swirls described by Sozoporn for the diagnosis of papillary carcinoma on FNA. Materials and methods: 30 cases of PTC & 30 cases of colloid goitre FNA were reviewed for the cytological features. Cytological features evaluated are papillary structure formations, nuclear grooves (NG), intranuclear cytoplasmic inclusions (INCI), nuclear pleomorphism, nuclear chromatin, psammoma bodies, cellular swirls, multinucleated giant cell (MGC) and colloid. All 60 cases in the study had confirmatory diagnosis on histopathology. Cellular swirls consisted of concentrically organized aggregates of about 50–200 tumor cells, in which most of the peripherally situated cells have ovoid nuclei, the long axes of which were oriented perpendicular to the radius of the swirl and did not contain any colloid. Pathologists were blind folded for final diagnosis while reviewing the cytology smears.

[1]. Ravetto C, Colombo L, Dottorini ME. Usefulness of fine needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer2000;90:357-63.
[2]. Cramer H. Fine-needle aspiration cytology of the thyroid: an appraisal. Cancer2000;90:325-9. [3]. GagnetenCb, Roccatagliata G, Lowenstein A, Soto F, Soto Re. The role of fine needle aspiration biopsy cytology in the evaluation of the clinically solitary thyroid nodule.ActaCytol1987;31:595-8.
[4]. Busnardo B, DeVido D. The epidemiology and etiology of differentiated thyroid carcinoma. Biomed Pharmacother 2000;54:322–6.
[5]. Szporn AH, Yuan S, Wu M, Burstein DE. Cellular swirls in fine needle aspirates of papillary thyroid carcinoma: A new diagnostic criterion. Mod Pathol 2006;19:1470-3.
[6]. Schlumberger MJ: Papillary and follicular thyroid carcinoma. N Engl J Med 1998;338:297-306.

Abstract: Dermoid cyst is a rare tumor of the testis with less than 20 previously reported cases. It is more commonly observed in ovary. A 56 years old male patient presented with a non tender, soft cystic to firm right testicular mass of eight months duration. Serum alpha fetoprotin, human chorionic gonadotrophin levels were within normal limits. Left testis was normal. Subsequently right orchidectomy was done. On gross examination the mass measured 7.4cm x 6.2cm x5cm. Cut section showed near-total replacement of testicular architecture by a multiloculated cyst containing whitish pultaceous materials and tufts of hair. Microscopically, stratified squamous epithelial lining of skin, dermal adenexal structure, glandular tissues, fibro-adipose tissue, cartilage and bone were identified. Immature tissue or any other germ cell components or foci of intratubular germ cell neoplasia (ITGCNU) was not seen. The patient is asymptomatic in the two years follow up period. In most of the reports, the cyst tended to be diagnosed in a younger age group. This case is being reported because of its rarity especially in the older age group.

Keywords: Testis, dermoid cyst, germ cell tumor, mature cystic teratoma.

[1]. Eble J.N., Sauter G., Epstein J.I., Sesterhenn I.A. (Eds.): World Health Organization. Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press: Lyon 2004

[2]. Crankson J, Shabra S, Al Hawashim N. Dermoid cyst of the testis. Ann Saudi Med 1997;17:634-35.

[3]. Mostofi FK, Sesterhenn IA, Davis CJ Jr. Developments in histopathology of testicular germ cell tumors. Semin Urol 1988;6:171-88.

[4]. Mostofi FK, Sobin LH. Histological typing of testis tumors. In: International Histological Classification of Tumors, No.16. Geneva: World Health Organisation; 1977.
[5]. Christopher D.M. Fletcher, Diagnostic Histopathology of Tumors (Fourth Edition, Elsevier 2013) 968-970

[6]. Assaf G, Mosbah A, Homsy Y, Michaud J. Dermoid cyst of testis in five-year-old-child. Urology 1983;22:432-4

Abstract: Thyroid disorders are the most common endocrine disorders affecting the women of reproductive age group and hence constitutes the common endocrine disorder in pregnancy also. It has long been recognized that maternal thyroid hormone excess or deficiency can influence the outcome for mother and fetus at all stages of pregnancy as well as interferes with ovulation and infertility.

[1]. Kim E Barrett, Barman SM et al. The thyroid gland. Ganong's Review of medical physiology, 23rd edition, 2010: 301-340.
[2]. Kasper DL. Brauwald E et al. Disorders of Thyroid Gland. Harrison's Principles of Internal Medicine, 16th edition, Vol. 2, 2005 : 2104-2126.
[3]. ChowdarySujit, The Thyroid, Medical Physiology 6th edition, 2008: 276-281.
[4]. Guyton & Hall, Thyroid Metabolic Hormones. Textbook of Medical Physiology, 11th edition, 2006: 931-943.
[5]. Cunningham, Thyroid and other endocrine disorders. Williams obstetrics, 23rd edition, 2010: 1126-1144.
[6]. John Studd, Thyroid Hormones in pregnancy and foetus, 15th edition, 75-102.
[7]. Glinoer D, De Bayer P, Bourdoux P et al. Regulation of maternal thyroid during pregnancy. J. Clin. Endocrinol. Metab. 1990:71(2): 276-287.

Abstract: T.I.V.A can be an effective alternative to inhalation anaesthesia.This study was conducted to compare the two T.I.V.A techniques Propofol-Ketamine and Propofol-Fentanyl in terms of haemodynamic variables and recovery characteristics in minor surgeries. Materials and Methods: 100 patients undergoing short surgical procedures less than 30 minutes, of ASA grade I and II, 20 to 50 years of age were randomized into two groups. Group A – Patients received Injection ketamine 0.5 mg/kg followed by I/V propofol 1% . Group B -Patients received Injection fentanyl 1.5 microgram/kg I/V followed by I/V propofol 1% . Monitoring for HR, SBP, DBP, RR ,SpO2 was done and recovery was also assessed. The results were tabulated and analyzed statistically with student unpaired 't'test and Chi square test. P value(<0.05) was considered significant.

[1]. Matsuki A , A review of recent advances in total intravenous anaesthesia, Masui , 40 (5),1991, 684-91.
[2]. Dunnihoo M, Wuest A, Meyer M , The effects of T.I.V.A. using propofol, ketamine & vecuronuim on cardio-vascular response and wake up time, AANA J , 62(3)1994, 261-6.
[3]. Wylie & Churchill- Davidson's , A practice of anaesthesia 7th Edition (London:Arnold,2003).
[4]. Ghabash M, Matta M & Kehhaleh J, Depression of excitatory effects of propofol induction by fentanyl, Middle East J Anaesthesiol , 13(4),1996, 419-25.
[5]. Reich DL, Silvay G, Ketamine - An update on the first 25 yrs of clinical experience, Canadian Journal of Anaesthesia , 36,1989, 186-9.
[6]. BaidyPL,EganTD,StanleyTH,Non barbiturate intravenous anesthetic Ketamine, in Ronald D Miller(Ed), Miller anesthesia ( London:Churchill Living Stone Co, 2001)240-245.

Abstract: Uterus Didelphys, a Congenital anomaly of uterus with a soft vertical vaginal septum reported to the Gynec OPD with complaint of irregular post menopausal bleeding and offensive vaginal discharge. On examination, found to have two uterus and two cervices with a soft vertical vaginal septum and endocervical polyp of 5x3 cm size, was found in one of the cervix which was pedunculated and bleeding on touch. Surprisingly she had 4 children, all of them were full term normal deliveries conducted by local dai at home. She was subjected to ultra sound abdomen which confirmed Uterus Didelphys with endocervical polyp. She does not have any renal abnormalities. She was put on antibiotics to control the infection, Polypectomy was done followed by TAH + BSO after 3weeks. Management of the case is discussed. Keywords: Uterus Didelphys, Mullarian duct, Endo cervical polyp, Vertical vaginal septum, Chronic non specific cervicitis, Polypectomy, TAH + BSO.

[1]. American Fertility Society classification of mullerian anomalies (1988) Fertile Steril 49: 952.
[2]. Peeti Nisture, Niranjan N Chavan, "Vaginal delivery in a case of longitudinal vaginal septum- an interesting case report " Bombay hospital journal, Vol 51,no2,2009.
[3]. Keller.B.(1967): Bull.Fed.Soc.Gynec.Obstret.Franc., 19.371.
[4]. Jarcho.J.(1946):Amer.J.surg:,71,109.
[5]. B Haddad, C Louis, "Longitudinal vaginal septum a retrospective study of 202 cases" European journal of obstetrics and
gynecology and reproductive biology vol 74 pp 197-199, 1997.

Abstract: Asymptomatic subcutaneous penile tract of Non venereal origin is very rare. We are presenting a case of Asymptomatic subcutaneous penile tract in a 50 year old healthy male, who attended to our OPD. The possibilities of such a penile tact were discussed here along with review of literature. Introduction: Sinus by definition is a blind tract, usually lined by granulation tissue and connects cavity to the surface. Penile sinuses are most commonly seen as complications of Sexually Transmitted Infections, like untreated Gonococcal urethritis, Lympho Granuloma Venereum [ LGV] and trauma, apart from congenital anomalies of genitalia. Tract by definition has two openings in a system of body part [1]. We are presenting a case of Asymptomatic subcutaneous penile Tract in an 50 year old male patient without any evidence of any STI's. we are presenting this case in view of its rarity. Keywords: Asymtomatic, Subcutaneous, Penile tract.

[1]. Mantyh C. American society of colon and rectal surgeon (ASCRS). 2004 Core Subjects. Anal fistula / abscess.
[2]. Theerapol A, So BY, Ngoi SS. Routine use of Setons for the treatment of anal fistulae. Singapore Med J. 2002 Jun; 43(6):305 -7

Abstract: Background: Acute colonic pseudo-obstruction/Ogilvie syndrome presents as massive colonic dilatation without a identifiable cause. Hypothyroidism is a rare cause of colonic pseudo-obstruction. Here we present a case of Ogilvie Syndrome in a previously undiagnosed hypothyroid patient. Case Report: A 45 year old female presented with features of intestinal obstruction clinically and radiologically. She underwent laparotomy and there were no features of mechanical obstruction. On retrospective analysis of her thyroid profile, she was found to be hypothyroid and was frankly started on thyroid supplementation. Bowel motility was regained subsequently. A retrospective analysis of literature for hypothyroidism as a cause for colonic pseudo-obstruction was done and here we present the case report

[1]. Zur Ätiologie des Megaduodenums by Willi Weiss. Deutsche Zeitschrift für Chirurgie, Leipzig, 1938, 251: 317-330
[2]. Sabistons textbook of surgery 18th edition, page 1317 [3]. Harrisons Principles of Internal Medicine 18th edition page 2919 [4]. Ganongs review of medical physiology 23rd edition clinical box 20-1 [5]. Ogilvies syndrome in a case of myxedema coma by Uday Yanamandra et al. Indian Journal of Endocrinology and Metabolism, May-June 2012, volume 12, issue 3 [6]. A case of subacute intestinal obstruction with overt hypothyroidism in stupor scheduled for emergency laparotomy by Anand T. Talikoti et al, Indian Journal of Anaesthesia, vol 58, issue 3, May-June 2014

Abstract: sub aortic stenosis is an important cause of left ventricular outflow tract ( LVOT ) obstruction in young adult . They usually present with angina, syncope or dyspnoea during the second decade of life. Surgical resection is the intervention of choice for treatment of SAS. Surgical mortality is low, and complications are generally minimal.

Keywords: subaortic stenosis, LVOT, Discrete subaortic membrane , Tunnel.

[1]. Newfeld EA, Muster AJ, Paul MH, Idriss FH, Riker WL. Discrete subvalvular aortic stenosis in childhood. Am J Cardiol 1976;38:53–61.
[2]. Oliver JM, Gonzalez A, Gallego P, Sanchez-Recalde A, Benito F, Mesa JM. Discrete subaortic stenosis in adults: increased prevalence and slow
[3]. rate of progression of the obstruction and aortic regurgitation. J Am Coll Cardiol. 2001;38:835– 842.
[4]. Erentug V, Bozbuga N, Kirali K, Goksedef D, Akinci E, Isik O, et al. Surgical treatment of subaortic obstruction in adolescents and adults: long-term follow up. J Card Surg 2005;20:16–21.
[5]. Talwar S, Bisoi AK, Sharma R, Bhan A, Airan B, Choudhary SK, et al. Subaortic membrane excision: mid-term results. Heart Lung Circ 2001; 10:130–5.
[6]. Tentolouris K, Kontozoglou T, Trikas A, Brilli S, Chlapoutakis E, Exadactylos N, et al. Fixed sub-aortic stenosis revisited. Congenital
[7]. abnormalities in 72 new cases and review of the literature. Cardiology 1999;92:4–10.
[8]. 6 ) Brauner R, Laks H, Drinkwater D, Shvarts O, Eghbali K, Galindo A. Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll

Abstract: The objective of this study is to describe the MRI features in various traumatic and non traumatic lesions causing painful knee joint. Materials and methods: 140 consecutive patients with painful knee joint were selected for the study from October 2012 to April 2014. Clinical examinations, MRI knee (within 4 days of referral) & in selected cases arthroscopy was performed and the findings were compared. Results: Out of 140 patients MR images were normal in 4 patients. It was positive for meniscal tears in patients with maximal involvement of the medial meniscus and the posterior horn. These tears were classified into grades with maximum number of tears belonging to grade 3. In ligament tears more number of tears were seen in ACL. Secondary signs associated with ligament tears were also assessed. Other chronic causes of painful knee joint were minimal.

[1]. Stoller DW, Martin C, Crues JV, Kaplan L, Mink JH. Meniscal tears: pathologic correlation with MR imaging Radiology 1987; 163:731-5.
[2]. Hall FM. Arthrography of the discoid lateral meniscus. AJR Am J Roentgenol 1977; 128:993-1002.
[3]. Wright DH, De Smet AA, Norris M. Bucket handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments. AJR Am J Roentgenol 1995;165:621-5.
[4]. Vahey TN, Broome DR, Kayes KJ, Shelbourne KD. Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging. Radiology 1991; 181:251-3.
[5]. Robertson PL, Schweitzer ME, Bartolozzi AR, Ugoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology 1994; 193:829-34.
[6]. Weber WN1, Neumann CH, Barakos JA, Petersen SA, Steinbach LS, Genant HK. Lateral tibial rim (Segond) fractures: MR imaging characteristics. Radiology 1991; 180:731-4.

Abstract: Backgroundand Aim: Concern about the grim nature of acid aspiration syndrome grew among the anaesthesiologist over the years warranting pre-emptive intervention. The aim of study to compare efficacy of ranitidine, omepazole, pantoprazole, and esomeprazole on gastric pH and volume in adults undergoing elective surgery. Method: This prospective parallel group controlled randomdized single blind study was conducted after permission from ethical committee. 250 patients of either sex between ages 15-60 years of ASA-I and II posted for elective surgeries were divided into 5 groups. In group A [n=50] participants received tablet Ranitidine , in group B[N=50] received tablet omeprazole, group C[N=50] tablet pantoprazole , group E[N=50] tablet esomeprazole received and their gastric pH and volume estimated.

[1]. James Simpson: The alleged case of death from chloform.Lancet,i: 175[1848].
[2]. Hamelberg W. and Bosomworth P.P.: Aspiration Pneumonitis-experimental studies and clinical observations. Anaesth.Analg.,43:669[1964].
[3]. Mendelson C.L. : Aspiration of stomach contents into lungs during obstetric anaesthesia. Amm.J.Obstetric Gynaecol., 52 : 191 [1946].
[4]. David H. Morison, Geoffrey L. Dunn : A double blind comparison of cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome. Anaesthe. Analg. 1982, 61,1988-92.
[5]. Sachin Sadawarte, Priya Vaidyanathan, Raman Sareen : The efficacy of single dose intravenous esomeprazole and pantoprazole on gastric pH and volume ; A double blind study. J. Anaesthesia Cli.Pharmacology 2009 ; 25[2] ; 217-220.
[6]. Hussein A, Al-Saeed AH, C HabibSS : Esomeprazole as a prophylactic agent for acid aspration syndrome in adult patients undergoing elective surgery : A triple blind placebo controlled clinical trial. SAJAA 2008 ; 14[5] : 39-42.

Abstract: It is not uncommon in medical practice to diagnose a disorder which after investigations turns out to be a totally different disease necessitating a complete change in our approach to treatment. Cancer is one such disorder which is being encountered with alarming incidence and due to its dreaded nature accorded a high index of suspicion by the treating physicians. We present one such case where the patient with a pathological fracture was initially suspected as a case of malignancy; but on further investigations turned out to be a case of secondary Hyperparathyroidism. In the following article we discuss the anaesthetic management of a Patient with Secondary Hyperparathyroidism.

Keywords: Calcium, Hyperparathyroidism, Malignancy, Pathological Fracture, Vitamin D

[1]. Aguilera M, Vaughan RS. Calcium and the anaesthetist. Anaesthesia 2000; 55: 779-90.
[2]. Stoelting RK, Dierdorf SF. Endocrine diseases. Stoelting RK, Dierdorf SF (Eds). Anaesthesia and Coexisting disease, 4th ed. Philadelphia: Churchill Livingstone; 2002: 421-5.
[3]. Mihai R, Famdon JR. Parathyroid disease and calcium metabolism. BrJAnaesth2000; 85: 29-43.
[4]. Kearns AE, Thompson GB. Medical and surgical management of hyperparathyroidism. Mayo Clinic Proc 2002; 77: 87-91.
[5]. R Bhanu , V Shrihari, M Lakshmi.Parathyroid Adenoma in a young male with Multiple Fractures and Varied Clinical Features. Indian Journal of Otolaryngol Head Neck Surg 2014; 66(1)114-117.
[6]. A Hussain, H Mahmood, E Geddoa, M Hamish, A H Reda. Parathyroid adenoma and hypercalcaemia in a patient presenting with multiple pathological fractures of the long bones.International Journal of Surgery 2008; 6: 465-468.

Abstract: A variety of tumours and tumour like conditions occur in hand, which are usually benign. Malignant neoplasms in hand are rare. Giant cell tumours (GCT) in the bones of the hand comprise only less than 1% of all giant cell tumours. Though GCT of metacarpals,scaphoid, tendon sheath and soft tissue of hand have been reported1,2,3,4,5,6,GCT of phalanges are very rare.We have come across only one or two scattered cases of GCT of the phalanges during our worldwide literature search but we got no reference of any bilobular GCT involving a phalanx.Keeping in mind the raritywe present a case ofbilobularGCT of index finger proximal phalanx treated with ray amputation.

Keywords: Bilobulartumour,GCT, index finger, proximal phalanx, ray amputation

[1]. Plate AM, Steiner G,Posner MA. Malignattumors of the hand and wrist. J Am AcqdSurg 2006: 14(12):680-692

[2]. Athanasian EA. Malignant bone & soft tissue sarcomas of the hand. J Am SocSueg Hand 2004;4:60-72

[3]. Biscaglia R et al

[4]. SzendzoiM.Giant cell tumor of bone. J Bone Joint surg, Br 2004;86:5-12

[5]. Athanasian EA, Wold LE,AmadioPC.Giant cell tumor of bones of the hand. J hand surgAM 1997; 22: 91-8

[6]. Dahlin DC. Caldwell Lecture. Giant cell tumor of bone : highlight of 407 cases. AJR Am Roentgenol1985 : 144 : 955-60

[7]. UnniKK, editor. Dahlin's bone tumors: general aspects and data on 11087 cases. 5th edition. Philadelphia: Lippincott-Raven,1996: 263–83.

Abstract: Lymphadenopathy is a very common clinical manifestation of many diseases, defined as an abnormality in the size or character of lymph nodes, caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. Objective: To evaluate the diagnostic efficacy of the fine needle aspiration cytology of cervical and axillary lymphadenopathy as compared to open biopsy for histopathological examination. A comparative study of diagnostic efficacy of FNAC cervical and axillary lymphadenopathy as compared to open biopsy for histo-pathological examination was carried out on the patients with cervical and axillary lymph adenopathy coming to OPD. All patients selected as per inclusion and exclusion criteria underwent FNAC of lymph node followed by open biopsy of same lymph node. The results revealed that, the overall diagnostic accuracy was 82.00% with accuracy of 91.70% for tuberculous lymphadenitis and 80.00% for metastatic carcinoma with positive predictive value of 100.00%. In 50.00% of the patients, enlarged tuberculous lymph nodes were matted.

[1]. Bielamowicz SA, Storper IS, Jabour BA. Spaces and triangles of head and necek. Head Neck 1994; 164: 383-8.
[2]. Rouviere H. Anatomy of the Human Lymphatic System. Ann Arbor MI: Edward Bros. Inc; 1948.
[3]. Fisch V. Lymphography of the Cervical Lymphatic System. Philadelphia: WB Saunders Co; 1968.
[4]. Reede DL, Bergeron RT. The CT evaluation of the normal and diseased neck. Sermin Ultrasound CT. MR. 1986; 7: 181-201.
[5]. Shah JP, STrang E, Spiro RH. Neck dissection, current and future possibilities. Clin. Bull. 1981; 11: 25-33.
[6]. Robins KT, Medina JE, Wolfe GT. Standardizing neck dissection terminology. Official report of the academy's committee for head and neck surgery and oncology. Arch Otolaryngol Head and Neck Surg. 1991; 117: 601-5.

Abstract: An unfortunate absence or loss of an eye may be caused by a congenital defect, irreparable trauma, a painful blind eye, Sympathetic opthalmia or the need for histologic confirmation of a suspected diagnosis.[1] The disfigurement associated with the loss of an eye can cause significant physical and emotional problems. Two surgical procedures are generally used, one is evisceration, which is the removal of the contents of the globe, leaving the sclera and on occasions the cornea in place, and the other procedure is enucleation where the eyeball is completely removed.[2][3]. The prosthetic eye includes:

[1]. Siddesh Kumar Ch. and Chandra Shekar Sajjan Prosthetic management of an ocular defect Contemp Clin Dent. 2010 Jul-Sep; 1(3): 201–203. [2]. ArtopolouI,Mountgomery P,Lemon J ,Digital imaging in fabrication of orbital prosthesis.J Prostho Dent 2006,95:327-30
[3]. Colen, TP; Paridaens, DA; Lemij, HG; Mourits, MP; Van Den Bosch, WA (2000). "Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants". Ophthalmology 107 (10): 1889–94. doi:10.1016/S0161-6420(00)00348-1. PMID 11013194.
[4]. 3rd Millennium BC Artificial Eyeball Discovered in Burnt City, December 10, 2006
[5]. London Times (February 20, 2007). "5,000-Year-Old Artificial Eye Found on Iran-Afghan Border". foxnews. Retrieved December 14, 2
[6]. Frequently asked questions, American Society of Ocularists

Abstract: The effect of green tea extracts on the sporulation of oocysts of 3 species of Eimeria was investigated. The unsporulated oocysts were exposed to 0%, 5% and 10% of green tea extracts (1 and 2% strengths, w/v). A new sporulation inhibition bioassay was designed to evaluate the anticocccidial activity of the tea extracts. The results showed for the first time that water-soluble extracts from green tea have anticoccidial activity as evidenced by their ability to significantly decrease (P< 0.0001) the sporulatuion of the oocysts of three species of Eimeria, namely Eimeria tenella, E. maxima and E. acervulina under laboratory conditions. Incubation of unsporulated oocysts of these parasites in water containing 10% and 25% of tea extract resulted in inhibition of sporulation of these oocysts by about 28-84% relative to the oocysts in the control incubations (no tea extract added). In addition, the sporocysts in about 5-30% of the sporulated oocysts of the three species of Eimeria recovered from incubations containing the tea extract were abnormal in their shapes and sizes. In conclusion, water-soluble extracts of selenium-rich green tea demonstrated anticocidial activity as evidenced by their ability to decrease the sporulation process and via interference with the development of the sporocysts.

Keywords: Selenium-rich green tea, Eimeria oocysts, sporulation assay, new assay

[1]. Allen, P. C. and Fetterer, R. H. (2002). Recent advances in biology and immunobiology of Eimeria species and in diagnosis and control of infection with these coccidian parasites of poultry. Clinical Microbiology Reviews 15, 58-65.
[2]. Al-Quraishy, S., Delic, D., Sies, H., Wunderlich ,F., Abdel-Baki, A. A. and Dkhil, M. A. (2011). Differential miRNA expression in the mouse jejunum during garlic treatment of Eimeria papillata infections. Parasitology Research 109, 387-394.

Abstract: Approximately 50% of human infertility is attributable to male defects with the clinical presentation of abnormal sperm production, such as oligospermia, asthenospermia, teratospermia, or azoospermia. Numerous factors have been implicated in spermatogonial development. Several alternative hormonal mechanisms regulate the mitotic and meiotic dynamics of spermatogonia. Apoptosis is an important process in the context of germ cells since they undergo both mitosis and meiosis, and this process is affected by interleukins (IL6 and IL2). The aims of this study wasto assess the effect of sex steroidal hormones, seminal antiapoptotic factor soluble fibroblast associated surface antigen (sFas) and inflammatory markers Interleukin(IL-2, IL-6), with conventional semen parameters in infertile men.

[1]. Who.int. 2013-03-19. Retrieved2013-06-17.)
[2]. LD. Russell, H. Chiarini-Garcia, SJ. Korsmeyer, and CM. Knudson. Bax-dependent spermatogonia apoptosis is required for testicular development and spermatogenesis. BiolReprod, 66, 2002, 950-958.
[3]. R. Singh, SR.Deepa, S. Madhavi, NJ. Gupta, B. Chakravarty, L. Singh, and K.Thangaraj. Male Infertility: No Evidence of involvement of androgen receptor gene among Indian men. J Androl, 27, 2006: 102-105.
[4]. J.Tesarik, E.Greco, P. Cohen-Bacrie, and C. Mendoza, Germ cell apoptosis in men with complete and incomplete spermiogenesis failure. Mol Hum Reprod,4, 1998,757-762.
[5]. L.Gandini, F. Lombardo, D. Paoli, L. Caponecchia, G. Familiari, C. Verlengia, F. Donde, and A. Lenzi. Study of apoptotic DNA fragmentation in human spermatozoa. Human Reproduction, 15, 2000: 830-839.

Abstract: Vulvar carcinoma is rare, accounting for less than 5% of all vulvar neoplasms and less than 1% of all neoplasms. Vulvar SCCs are usually diagnosed late because they are often asymptomatic and tend to grow at slow rates. They may be invasive and destructive if neglected or improperly treated. Nevertheless, they have a very low propensity for metastatic spread, but frequently recur after simple excision. We report a 45 year-old woman presenting with the complaint of painful vulvar ulceration ,small swelling at vulvar region and vaginal bleeding. The physical examination revealed a 3 × 2 cm indurated nodulo-ulcerative lesion involving the clitoris, both labia minora and left labia majora. The histopathology was consistent with the "non keratinizing squamous cell carcinoma" that invaded the subcutaneous tissue without lymph node metastasis on left side and with lymph node metastasis on 2 nodes on the right side. The patient underwent wide local excision with clitoral amputation and remained disease free at post-surgical follow-up after 6 months. Keywords: squamous cell carcinoma, clitoris, vulva

[1]. Olbricht S, Noe JM. Cutaneous carcinomas. In: Georgiade GS, Riefkohl R, Barwick W, editors. Textbook of plastic, maxillofacial and reconstructive surgery. 2nd ed. Baltimore: Williams Wilkins; 1992. pp. 141–7.
[2]. Giorgi V, Salvini C, Massi D, Raspollini MR, Carli P. Vulvar basal cell carcinoma: retrospective study and review of literature. GynecolOncol. 2005;97:192–4. [PubMed]
[3]. Mulayim N, Silver DF, Ocal IT, Babalola E. Vulvar basal cell carcinoma: Two unusual presentations and review of the literature. GynecolOncol. 2002;85:532–7. [PubMed]
[4]. Finan MA. Bartholin's gland carcinoma, malignant melanoma and other rare tumours of the vulva. Best Pract Res ClinObstet Gynecol. 2003;17:609–33. [PubMed]
[5]. Piura B, Rabinovic A, Dgani R. Basal cell carcinoma of the vulva. J SurgOncol. 1999;70:172–6. [PubMed]
[6]. Benedet JL, Miller DM, Ehlen TG, Bertrand MA. Basal cell carcinoma of the vulva: Clinical features and treatment results in 28 patients. Obstet Gynecol. 1997;90:765–8. [PubMed]

Abstract: Aim: To report the outcome of treatment of Severe Blount's disease in late-onset type by gradual correction using Ilizarov and multi-axial devices in Delta State University Teaching, Hospital, Oghara. Patients And Method: A three-year retrospective study of five knees in five patients with late-onset Severe Blount's disease treated by gradual method of correction between 12th of January 2012 and 31st of December 2014 was done. They were managed in a single step, by a gradual method of correction, using the Ilizarov device in four patients and multi-axial correction (MAC) device in one. The procedure comprised of medial tibial plateau elevation, varus deformity and limb length discrepancy (LLD) correction all by distraction osteogenesis after osteotomy. The tibial torsion was corrected acutely after osteotomy. The age range of the patients was 9-35 years (mean=15.8 years), the range tibiofibular (TFA) angle was 300-500 (mean=450) and LLD was 4-8cm (mean=6cm). MPTA range was 35-500. Outcome was assessed by Schoenecker criteria.

[1]. Blount WP. Tibia vara osteochondritis deformans tibiae. J. Bone Joint Surg 1907;19: 1-29
[2]. Thompson H, Carter JR. Late-onset tibia vara (Blount's disease) Current concepts. Clin Orthop Relat Res 1990; 255;24-35
[3]. Lagenskiold A, Riska GB. Tibia vara (osteochondritis deformans tibiae): a survey of seventy one cases) J. Bone Joint Surg Am.1964; 46:1405-20
[4]. Sabharwal S, Lee JJr, Zhao C. Multiplanar deformity analysis of untreated Blount's disease. J.Pediatr. Orthop. 2007; 27(3):260-5
[5]. Langenskiold A. Tibia vara; (osteochondrosis deformans tibiae); a survey of 23 cases. Acta Chir Scand. Mar 26 1952;103(1):1-22. [Medline].
[6]. Gordon JE, Hughes MS, Shepherd K, Szymanski DA, Schoenecker PL, Parker L. Obstructive sleep apnoea syndrome in morbidly obese children with tibia vara. J Bone Joint Surg Br. Jan 2006;88 (1):100-3. [Medline].

Abstract: Aim: To report outcome of treatment of significant limb length discrepancy (LLD) associated with non-union and mal-union using soft tissue distraction by Ilizarov technique and interlocked nailing of the reduced fracture after fibrous tissue interposition excision and osteoclasis at the fracture site respectively in DELSUTH, Oghara, Delta state. Method: A retrospective study of 10 patients who completed soft tissue distraction and interlocked nailing of their overlapping non-union and osteoclased mal-union with significant LLD (>5cm) between 12th of January 2011 and 31st of December 2014. Information obtained from their case notes were age, sex, phone numbers, diagnosis, LLD, duration of problem before presentation for treatment, blood loss at surgery, outcome of procedure, complications.

[1]. Stuart AG. Ilizarov- type of Treatment of Non-union, Mal-union and Post-traumatic Shortening. Operative Orthopaedics 2nd Edition, edited by M.W. Chapman.1993; 64:985-1000.
[2]. Howard R. Treatment of Non-union. General Principles. Operative Orthopaedics 2nd edition. 1993. Chap 51. Pg.751
[3]. Omololu AB, Ogunlade SO, Gopaldasani VK. The practice of traditional bone setting: training algorithm. Clin. Orthop Relat Res 2008; 466:2392-8

Abstract: Introduction: Bowels are frequently used in reconstructive urology for ureteral substitution, bladder augmentation and urinary bladder replacement done for various indications. Materials and methods: A prospective study of incorporation of bowel segments in various urological procedures was done in King George Hospital, Visakhapatnam between August 2009 and March 2012 Results: Total number of 40 patients were studied for whom bowel segments were used for various indications. Patient age group 24 to 67years included. Out of 40 cases , 21 cases were done after cystectomy for benign and malignant causes. In 10 cases Mitrofanoff procedure was done for failed stricture urethra. Augmentation cystoplasty was done in 6 cases of tuberculous bladder disease. Ileal ureter replacement was done in 3 cases.

[1]. Historical perspective of the use of bowel in urology Urologic Clinics of North America, Volume 24, Issue 4, Pages 703-713 W. Hardy Hendren
[2]. Campbell walsh urology 10th edition
[3]. The Kelalis-King-BelmanTaxtbook of Clinical Pediatric Urology Fifth edition
[4]. Gillen water adult and pediatric urology 4th edition
[5]. Simon J. Extropiavesicae , Operation for directing the orifices of the ureters into the rectum: Lancet 1852;2:568
[6]. Yeates WK. A technique of ileocystoplasty, Br J Urol 1956;28:410.

Abstract: Responsible, productive and competent health workforce is an essential pre-requisite for effective health outcomes and favourable health indicators. Existing on geographical and organizational periphery of the formal health care delivery system, Auxiliary Nurse Midwives (ANMs) operate from subcentres, catering 5000 population in plains and 3000 in hills. Darjeeling district has wide geographical variations, thus finding the difficulties faced by ANMs in the area are of utmost necessity, so that these issues are addressed and productive outcome of health workforce ensured. Objective: To assess performance and satisfaction of ANMs working in the two studied blocks of Darjeeling district.

[[1]. Park K.PARK'S Textbook of Preventive and Social Medicine. 21st.ed. Premnagar, Jabalpur: M/s BanarsidasBhanot Publishers; 2011.p.826-51
[2]. Borooah VK. Gender bias among children in India in their diet and immunisation against disease. SocSci Med. 2004; 58:1719–31.
[3]. Registrar General of India. Census of India. New Delhi: Registrar General of India;2001.Population tables. Availablefrom: http://www.censusindia.gov.in [Last accessed on 2008 Nov 23]
[4]. A State Bureau of Health Intelligence — Health on the March. Government of WB (2004-2005). Kolkata: Government of West Bengal, 2005: 3-6.
[5]. WHO. Not Enough Here… Too Many There…Health Workforce in India. World Health Organization Country Office for India 2007. pp.1. Available from: http://www.whoindia.org/LinkFiles/Human Resources Health Workforce in India-Apr07.pdf [last accessed on 2010 Nov 23]
[6]. Taneja DK. Demographic and health information of India. In:TanejaDK,editor. Health Policies and Programmes in India, 10thed.New Delhi: Doctors publications; 2012. pp.38-48.

Abstract:The mandibular second premolar is usually described as a single rooted tooth with a single root canal. However, two root canals may be found but the occurrence of two roots is extremely rare. The reported studies have shown 0.3% prevalence of two roots in mandibular second premolars. This report describes an unusual case of a thirteen year old female patient with bilateral two rooted mandibular second premolars. The patient reported for root canal therapy of decayed mandibular first permanent molar and the presence of bilateral two rooted mandibular second premolars was detected coincidently. The clinicians should be aware of the presence of anatomical variations in the teeth during endodontic treatment.

Keywords - Mandibular second premolar, number of roots, root morphology, root canal morphology.

[1]. Ingle J, Bakland I. Endodontics. 5th ed. Hamilton: BC Decker, 2002.
[2]. Ash M, Nelson S. Wheeler's dental anatomy, physiology and occlusion. 8th ed. Philadelphia: Saunders, 2003.
[3]. Vertucci FJ. Root morphology of mandibular premolars. J Am Dent Assoc 1978;97:47-50.
[4]. Cleghorn BM, Christie WH, Dong CC. The root and root canal morphology of the human mandibular second premolar: a literature review. J Endod 2007;33:1031-1037.
[5]. Goswami M, Chandra S, Chandra S, Singh S. Mandibular premolar with two roots. J Endod 1997;23;187.
[6]. Mukhaimer RH. Bilateral mandibular second premolars with three separate roots. Saudi Endod J 2012;2:156-160.