A randomized control trial: To evaluate the effect of continuous infusion of low dose vasopressors in elective Cesarean section under spinal anesthesia

Introduction: A lot of researches have been done to support the role of vasopressors in elective Cesarean section to prevent hypotension in patient under spinal anesthesia resulting in better hemodynamic control in mother and fetus. This study was conducted to compare the effect of low dose ephedrine (60 mg) and phenylephrine (2 mg) on hemodynamic stability and fetal acid base profile in patient posted for elective caesarean section under spinal anesthesia. Materials and methods: Ninety three patients were enrolled in this study and randomly divided into three groups. Group C received ephedrine infusion; group B received phenylephrine infusion while group A were preloaded with crystalloid. Maternal vital signs (blood pressure, heart rate, and arterial oxygen saturation) and fetal APGAR score and acid-base status were recorded. Results: Hypotension was significantly recorded in crystalloid group as compared to phenylephrine and ephedrine group. Apgar scores in newborns were above 8 in all three groups. Umbilical cord blood pH was higher in phenylephrine and ephedrine groups in comparison to crystalloid group. Conclusion: Prophylactic low dose phenylephrine and ephedrine infusion were more effective than crystalloid preloading in prevention of hypotension and fetal acidosis during spinal anesthesia for elective Cesarean section.

Sclerosing adenosis clinically feigning as carcinoma breast: A case report.

Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an “adenosis tumor of the breast” or “nodular sclerosing adenosis” if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA).

Pediatric caecal lymphoma involving ovary in a 12 year old girl – A bad prognostic sign: A rarity.

Primary caecal lymphoma or the colonic lymphoma is a rare tumor of the gastrointestinal (GIT) tract and comprises only 0.2-1.2% of all colonic malignancies, both in adults and pediatric age group. The most common variety of colonic or caecal lymphoma is a on-Hodgkin’s Lymphoma (NHL) which arises from the lymphoid elements of the intestine. GIT is the most frequently involved site, accounting for 50-60% of all extra nodal lymphomas, and most of them are NHL. In adults, the stomach is the most common location of GIT lymphomas, followed by the small intestine, but the most common GI site of NHL in children is the terminal ileum and the ileo-caecal region. Diagnosis is difficult since lymphoma presents with vague abdominal pain with loss of weight and appetite. It may present as lump abdomen with complications such as intestinal obstruction, bleeding, perforation and peritonitis and intussusseption. Histologically it is B or T cell type with small or large cell variation, but frequently encountered is diffuse large B-cell cell lymphoma (DLBCL). DLBCL has low incidence but favorable outcome in young adults, lesions localized to one area or organ and children below 5 years of age, but has an aggressive course in children between 10-15 years of age and also in adults above 55 years of age. DLBCL or GIT Lymphomas in general have male preponderance. We present a rare case of caecal lymphoma (DLBCL) involving appendix and right ovary in a 12 year old girl who presented with vague symptoms of abdominal pain and abdominal mass. Clinically and radiologically, provisional diagnosis of Ileo-caecal tuberculosis with possibility of adhesions leading to a mass lesion was considered. Histopaththological examination (HPE) revealed the diagnosis and prognosis of the case.

Kikuchi-Fujimoto disease in inguinal lymph node – A rare site of occurrence.

Kikuchi-Fujimoto disease (KFD) is also known as histiocytic necrotizing lymphadenitis It is a benign, systemic lymphadenitis, self limiting disease first described independently by Japanese Pathologists Kikuchi and Fujimoto in Japan in 1972. The incidence of KFD is unknown. KFD is up to 4 times commoner in women. It presents as lymphadenopathy mainly involving the posterior cervical region, but can occur in any lymph node and even in extra nodal sites. Fever is associated with lymph node enlargement in half of the cases. Though viral and autoimmune cause is suggested by some studies, the exact etiology remains uncertain. There have also been reports of a relation between KFD and systemic lupus erythematosus. Most of the preoperative diagnostic tests are inconclusive. Definitive diagnosis depends on the histopathological examination of the lymph node biopsy. Clinically it has to be differentiated from other lesions like malignant lymphoma, mononucleosis tuberculosis and SLE as treatment and prognosis differs. Here we submit a case of Kikuchi-Fujimoto disease in an inguinal lymph node in a young adult auto driver.

Bilateral juvenile xanthogranuloma of the buttocks - An unusual location: Case report.

Juvenile xanthogranuloma (JXG) predominantly occurs in infancy and childhood. Juvenile xanthogranulomas (JXGs) are asymptomatic; benign; self-healing; self-limiting red, yellow, or brownpapules and nodules composed of histiocytic cells. Most common site of occurrence is skin of the head and neck region and trunk but occurrence at rare sites such as nasal cavity, limbus of the eye, iris of the eye, anterior abdominal wall and tibia had been reported in literature. JXG is the most common form of non–Langerhans cell histiocytosis. Approximately 35% of cases of juvenile xanthogranuloma (JXG) occur at birth, with as many as 71% of cases occurring in the first year. The mean age at presentation is 22 months. Most JXGs resolve by age 5 years. Despite the term juvenile in the disease name, 10% of cases manifest in adulthood. Most of the lesions are solitary. Juvenile xanthogranuloma is a histiocytic inflammatory disorder capable of presenting as different histological patterns. The classic form consists of sheets of foamy histiocytes and numerous multinucleated Touton-type giant cells containing no to very few mitotic figures. We present a case of large juvenile xanthogranuloma (JXG) in a 7 year old child involving an unusual location and bilateral involvement of both the buttocks.