Inferior vena cava leiomyosarcoma with liver metastasis at presentation in a young male: A challenging diagnostic quandary

Leiomyosarcomas of vascular origin are very rare tumors, predominantly affecting the inferior vena cava (IVC). Although vascular leiomyosarcomas are slow-growing, their non-specific and late presentation results in delayed diagnosis which portends a very poor prognosis. Here we report a case of a 24-year-old man who presented with abdominal pain since 15 days and was found to have unresectable metastatic leiomyosarcoma of the inferior vena cava at initial diagnosis.

Lymphoepithelial carcinoma of the maxillary sinus: A case report

Lymphoepithelioma-like carcinoma or lymphoepithelial carcinoma (LEC) of the maxillary sinus is an extremely rare malignancy. It is a rare type of undifferentiated carcinoma, consisting of atypical epithelial cells surrounded by reactive lymphoplasmacytic infiltrate. The paper reports the case of a 76-year-old male patient, with complain of swelling on the hard palate and epistaxis. Biopsy from the hard palate mass showed features consistent with LEC, with contrast-enhanced computed tomography nasopharynx and neck showing soft-tissue lesion in the right maxillary sinus. The patient is currently under treatment with external beam radiotherapy.

Incidence of Stillbirth in a Tertiary Medical College in North- Eastern India and its Associated Maternal and Foetal Factors

Background: Perinatal mortality still continues to be high in India. The most important reason is that 60% of perinatal deaths are constituted by stillbirths and reducing stillbirth rate has always been a challenge to obstetricians for decades. In order to reduce the stillbirth rate it is mandatory to ascertain the various determinants of it. Studies regarding this in the north-eastern part of India are almost non-existent. Objectives: The objectives of the current study were to estimate the magnitude of stillbirth and also to ascertain the association between stillbirth and maternal and foetal factors. Methods: A hospital-based prospective study was done in the Department of Obstetrics and Gynaecology of RIMS, Imphal, Manipur in the year 2003. Data regarding socio-demographic backgrounds, detailed obstetric history, examination and investigative findings and pregnancy outcome was collected from 5,588 mothers who gave to 5,672 deliveries. Results: The stillbirth rate was found to be 17.6 per 1,000 births. The statistically significant determinants of stillbirth were rural residency, low educational level, age than 40 years, high parity, un-booked cases, anaemia, hypertension, high parity, twin delivery, presence of risk factors, breech delivery, preterm delivery and low birth weight. Conclusion: Stillbirth rate continues to be high in the north-eastern part of the country. And many of the determinants of stillbirth found out were preventable factors.

Maternal, Foetal And Placental Conditions Associated With Stillbirth: An Exploratory Study

Background: Stillbirth constitutes about 60% of the perinatal deaths. And this is an event which has always challenged the obstetricians for decades. Various maternal, foetal and placental factors may result to stillbirths. Yet, in spite of the modern facilities available and advances made in the medical field, many times no contributing factors can be attributed to the exact cause of stillbirth and refusal of autopsy examination seals the chapter, with the cause of stillbirth remaining unexplored. Objective: The objective of the current study was to explore the maternal, foetal and placental conditions associated with stillbirth and to ascertain the common causes of stillbirth. Methods: A hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical College, Imphal, Manipur in the year 2003. At the time of admission, after obtaining informed verbal consent, a detailed history was taken followed by thorough physical examination and routine investigations were dome for all the admitted patients in the antenatal ward. After delivery, all the women who had stillbirth were approached again to undergo special investigations like blood sugar estimation, VDRL test, urine examination for culture and sensitivity, ELISA for HIV and TORCH antibodies, Widal test, liver function tests and kidney function test. Based on the above findings, the stillbirths were analysed as macerated stillbirths and fresh stillbirths. Results: Only 43 women out of all the 100 women who had stillbirths could be investigated for TORCH antibodies. Out of these 43 women, 4 (9.3%) women were positive for Ig M toxoplasma antibody, 3 (7.0%) women were positive for Ig M Rubella antibody, 10 (23.3%) women were positive for Ig M CMV and 9 (20.9%) women were positive for Ig M HSV I & II indicating present infection. Ig G antibody alone was positive in 25 (58.1%) women for toxoplasmosis, 29 (67.4%) women for Rubella, 31 (72.1%) women for CMV and 20 (67.4%) women for HSV I & II indicating past infection (Table 1). Forty-eight women underwent VDRL testing and 08 (20%) women were found to be positive. Only 20 women gave consent for their placenta to undergo histopathological examination. Among these the commonest histological finding was syncytial knots (70%). Maternal anaemia (78%) was by far the commonest medical condition associated in women who either had macerated or fresh stillbirth. And accidental haemorrhage with or without placenta previa and prolonged/obstructed labour were the common conditions associated with stillbirth. The most probable causes of stillbirth assigned for all the 100 stillbirths, made after careful clinical consideration were intra-partum asphyxia (59%), foetal asphyxia (19%), unexplained intra-uterine deaths (15%) and congenital malformations (7%). Conclusion: Proper antenatal care for screening high risk factors and management thereof and educating the women to overcome the fear for hospital delivery are the needs of the hour. Also, a constant supervision by the senior staffs and their availability for consultation while conducting deliveries in the medical institutions may prevent a sizeable number of stillbirths. Vaginal delivery of difficult and breech delivery may be avoided as far as possible. Instead, Caesarean section should be opted.

A Rare Clinical Presentation of Primary Pulmonary Hypoplasia with Tuberculous Pleural Effusion.

Primary pulmonary hypoplasia is rare in adulthood. It is characterized by decreased number or size of bronchi, vessels and alveoli. We present a case of unilateral pulmonary hypoplasia in 44-old-year male smoker who presented with right pleural effusion. His chest X-ray revealed an inhomogenous opacity on the left side with bronchiectatic changes and right minimal pleural effusion. Fiberoptic bronchoscopy revealed blind end bronchi in left upper lobe and computed tomography pulmonary angiography revealed hypoplastic lung with cystic bronchiectasis on the left side and hypoplastic left pulmonary artery. It was not associated with any other congenital anomalies. In addition to symptomatic management, he was started on anti-tuberculous treatment for tuberculous pleural effusion and kept under follow-up.

Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of low risk Pulmonary Embolism in Emergency Department.

A diagnosis of Pulmonary Embolism (PE) is difficult that may be missed because of non specific clinical presentation. However, early diagnosis is fundamental, since immediate treatment is highly effective. Thus, with the availability of ultrasound machine in Emergency Department (ED) can help Emergency Physician to diagnose PE by using Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of PE in low risk patient before proceed with the gold standard investigation which is CT Pulmonary Angiogram (CTPA). We believed this case was likely to be repeated on some readers' clinical practice and this procedure is an appropriate option to consider in such cases.

Neural stem cells & supporting cells - The new therapeutic tools for the treatment of spinal cord injury.

Stem cells play important role in the development and in the maintenance of specific tissues. They have been identified in majority of the organs like liver, blood, skin and intestine. Role of stem cells in regenerative medicine have been implicated in many chronic diseases. Stem cell research is a new opportunity to those patients whose organs are damaged or diseased. The discovery of stem cells in central and peripheral nervous system is relatively recent. Spinal cord injury is one of the major neurological disaster affecting mostly young lives. Stem cell transplantation in spinal cord injury patients have shown encouraging results. Different sources of stem cells are being exploited for spinal cord injury as well as other neurological disorders.

Maternal and neonatal anthropometric and hematological parameters in Manipuri population.

One hundred and sixty five women admitted in the Regional Medical College Hospital, Manipur, for delivery and their newborns were studied for some anthropometric and hematological parameters. The mean weights of mothers and infants were 50.94 +/- 0.86 kg and 2.86 +/- 0.07 kg, respectively. The mean hemoglobin levels were 11.05 +/- 1.57 g/dl in mothers and 15.05 +/- 0.27 g/dl in cord blood. Statistically no correlation existed between hemoglobin levels and between weights of mothers and infants.