A Rare Case with Absent Second Rib, Bifid Costal Cartilages and Bifid Xiphoid Process.

Thoracic cage is made up of twelve thoracic vertebrae, twelve pairs of ribs and costal cartilages (CC) and a sternum. Ribs articulate anteriorly with sternum through CC which are flattened bars of hyaline cartilage considered as unossified anterior part of embryonic cartilaginous ribs. Numerical and structural variations of ribs are well documented. In the present study, we observed both structural and numerical variations of thoracic cage, bilaterally. On both the sides, eleven pair of ribs were present, instead of seven, six true ribs were found and second rib with CC was absent. Second and third CC and third CC of right and third CC of left side were bifid. Cartilaginous bridges were present between various CC on both sides. In the midline xiphoid process was found to be bifid. These variations are of immense help to the physicians, surgeons and radiologists.

Accessory Sulci of Liver in the Population of Haryana.

Aims and objectives: Research on segmental anatomy of liver has been extensively done but very little work is done on Accessory Sulcus (AS). Participants: Present study was carried on 36 cadaveric livers with mean age ranging between 30-60 years. Main outcome measures: Although, variation in surface of liver are reported but very few studies are there which reports their presence on inferior surface, on caudate lobe, in gall bladder fossa and right lateral surface of liver. Result:We found AS in 13 livers (36.1%) out of 40 livers. These Sulci were transverse, vertical as well as curved in shape. Out of these in nine liver a single sulcus was present (25%) while in five livers the sulci were multiple (13.88%). Conclusion: This study highlights the occurrence of variations on the liver surface. The finding of this studymay be utilized by imaging specialists & surgeons respectively to avoid errors in interpretations & subsequent misdiagnosis.

Sickle Children Vs Normal Children: A Transcranial and Extracranial Doppler Study.

A prospective hospital based study was carried out to evaluate the role of transcranial Doppler in sickle cell anemia for period of 2 yrs (July 2009- August 2011). A total of 100 children, 50 normal individuals in control group and 50 diagnosed sickle cell disease patients in sickle group were evaluated in the age group .Children were from Newborn to15 years of age, of which 62% were males and 38% were females. Common Carotid Artery (CCA), External Carotid Artery (ECA), Internal Carotid Artery (ICA), Vertebral Artery,Middle Carotid Artery (MCA), Anterior Carotid Artery (ACA), Posterior Carotid Artery (PCA) was evaluated by Transcranial and Extracranial Doppler on both sides in sickle cell patient. The mean velocities in all the vessels were higher in sickle group patient as compared to normal group patients. Evaluation of Extracranial carotid vessels has not been done in previous published studies. Our study can act as benchmark in extracranial Doppler studies of sickle cell patients. We have not followed the patients of sickle cell disease till stroke, but we can say with certainty that increased values of velocity >200 cm/sec is an absolute indication for blood transfusion to prevent stroke, which was observed in 10% of sickle cell patient in our study where velocities reduced by 20-25 cm/sec after blood transfusion.

A Rare Case of Prolapsed Omphalomesenteric duct with ruptured Umbilical Hernia.

Strangulated ileal intussusceptions into the Meckel’s diverticulum (which is caused by an incomplete obliteration of omphalomesentric duct) and coming out through ruptured umbilical hernia is an extremely rare presentation. A 3- months- old male child presented with low grade fever, refusal to feed and episodes of discomfort often alternating with long period of sleepiness and lethargy. On abdominal examination loops of intestine were seen at the site of ruptured umbilical hernia. The abdomen was opened under general anaesthesia by transverse incision. Proximal ileal intussusception into the Meckel’s diverticulum, which was gangrenous, was noted. A resection with end to end ileo-ileal anastomosis was undertaken. The prolapsed bowel was replaced back and double breasting of umbilical defect was done with vicryl 2-0. The patient was completely asymptomatic and healthy.

A Rare Case With Multiple Variations Of Liver And Associated Arteries.

Variations of liver, its arterial supply and branching pattern of coeliac trunk are not uncommon as separate entity but this case presents several variations. During routine dissection, a multi-lobular liver, with irregular inferior margin, was observed occupying only right upper quadrant of the abdomen. An extra (accessory) lobe was hanging from its inferior surface. Common hepatic artery was giving eight branches, six on left side and two on right side. Five of the left branches were entering liver but none was passing through porta hepatis. Coeliac trunk showed tetrafurcation; the additional branch was supplying pancreas and transverse colon. Knowledge of these variations or combinations is important in open access surgeries, endoscopic surgeries and diagnostic and interventional radiology of the region.

Blood stream infection by an emerging pathogen Oligella ureolytica in a cancer patient: Case report and review of literature.

Oligella ureolytica is an emerging bacteria rarely implicated as a human pathogen. It is infrequently recovered from clinical specimens probably because of inadequate processing of non-fermenting oxidase positive Gram negative bacilli. We present here a case of a 30 year old male suffering from right lung adenocarcinoma (moderately differentiated) with multiple abdominal lymph node metastasis with Syringohydromyelia whose blood culture yielded Oligella ureolytica in pure culture. Oligella ureolytica isolation in pure culture and the patient’s response to targeted treatment supported that Oligella ureolytica was the true causative agent of the blood stream infection. Early suspicion, diagnosis and treatment with potent antibiotics are needed to prevent further complications resulting from infection with this emerging pathogen.

An elucidatory review of the association between thyroid disorders and diabetes.

Thyroid disease and Diabetes (type 1 and type 2) are known to be pathophysiologically associated. The implications of the associations have clinically relevant implications for insulin sensitivity and adequate management requirements. Interconnectedness of common signalling pathways forms the pathophysiological basis of this association. In the case of type 1 diabetes and autoimmune thyroid disease, linked genetic susceptibilities may be involved. Interactions between thyroid hormone and the basal mechanisms controlling appetite, energy expenditure and insulin sensitivity regulation / secretion governance are also significant to understand. A clearer understanding of the interactions between diabetes mellitus and thyroid hormones has the potential to assist in optimization of treatment in a select group of diabetic patients.

Usefulness of automated cell counter in detection of malaria in a cancer set up-Our experience.

Background: Malaria diagnosis presents a challenge to all laboratories. In malaria-endemic areas, there is a need for rapid, sensitive and cost-effective method to effectively screen all samples, especially when the workload is very high. Various hematology analyzers have been investigated for detection of malaria in the past. Here, we present our experience of malaria detection in a cancer hospital where a large number of complete blood count requests are received either before or during chemotherapy. Fever, being a very common symptom in cancer patients, causes a suspicion of malaria. Aim: This study was conducted to assess the usefulness of hematology cell counter, viz. WBC-DIFF and WBC/BASO scatter plots and the flaggings generated in malaria-positive cases. The occurrence of pseudoeosinophilia as reported by previous studies was also assessed. The parasitic index was determined and its correlation with the abnormalities found on the Hematology analyzer was also studied. Materials and Methods: Blood samples were collected from 80 out-patient department and inpatients with various solid as well as hematological malignancies, who presented with acute febrile illness during September 2010 and January 2012, and for whom complete blood cell analysis and peripheral smear for malaria parasite had been requested. Results: Of the 80 patients who presented with fever and suspicion of malaria, 29 patients were positive for malaria and 10 cases were diagnosed incidentally by the findings on the cell counter and were confirmed by Giemsa-stained blood smears. The sensitivity and specificity of the abnormalities detected in the WBC-Diff channel in detecting malaria is 82% and 100% respectively. Using WBC-BASO channel abnormality for initial diagnosis the sensitivity and specificity is 50% and 92.5% respectively. The sensitivity and specificity with respect to pseudoeosinophilia is 18% and 100% respectively. The most common WBC and PLT flags were leukopenia, atypical lymphocytes, lymphopenia, WBC abnormal scattergram, platelet clumps, thrombocytopenia, platelet abnormal distribution flag. Conclusion: The instrument provides significantly valuable diagnostic parameters in detecting acute Plasmodium vivax malaria; however, it is not very useful for acute falciparum malaria infection. It is suggested that the laboratories using the hematology analyzers should be aware of such specific parameters, even in the absence of a clinical request.

AML1-ETO positive AML: first report from India.

Translocation (8;21) is associated with few typical morphological features and favorable prognosis. All patients of AML and MDS with increased blasts (N = 35) according to FAB criteria, presenting (between Jan 2004 to June 2005) to the Department of Hematology, AIIMS were studied. RT-PCR was done for the AML1-ETO fusion transcript in all cases. Overall incidence of AML1-ETO was 28.57% and no correlation was found between AML1-ETO positivity and clinical or hematological parameters except for a direct correlation with absolute blast count (ABC) (a lower ABC in the AML1-ETO positive cases). Interestingly, 1/3 MDS cases were positive for the same fusion transcript and thus, it appears worthwhile to look for AML1-ETO in all cases of MDS with increased blasts. Objective morphological evaluation using a scoring system based on morphological features was not helpful in predicting positivity for AML1-ETO. The effect of this translocation on long-term survival could not be determined by the present study.