Parasitic twin with major cardiac defect: a case report

Parasitic twins are an extremely rare form of asymmetrical conjoined monochorial monoamniotic twins where one of them has a mostly intact body that is able to survive and which is referred to as 'autosite', while the counterpart, referred to as 'parasite', is only rudimentarily developed being physically attached to and nourished by the other twin. Our case is a baby boy with Single Ventricle Heart defect with a thoraco-abdominal mass (epigastric heteropagus twin) attached to the anterior abdominal wall near the umbilicus with minimal visceral sharing. The twins had two external genitalia both in host and parasite micturating separately. After high risk surgery the parasite could be separated completely from the host and postoperative recovery was uneventful.

Outcome and clinical efficacy of bleomycin and doxycycline percutaneous sclerotherapy for treatment of paediatric lymphatic malformations in a limited resource setting

Background: The aim was to study the role of bleomycin and doxycycline as a cheap and readily available sclero-therapeutic agent in the treatment of lymphatic malformations in paediatric populations of poor resource setting.Methods: It was a longitudinal study. A total of 23 paediatric cases with distinct types of lymphatic malformations were treated with injection sclerotherapy. Bleomycin and doxycycline used for microcystic and macrocystic lesion type respectively. The patient was followed up to complete remission. The level of evidence was Level II and type of evidence was prognosis study.Results: Commonest site of lesion was neck (78.3%), followed by cheeck (8.7%), chest, shoulder and suprapubic region. Only 21.7% of patients had good reduction (50-89%) in their lesion volume on first follow up. Overall 43.4% of patients showed a reasonable reduction in lesion volume during the follow-up period. Almost 3/4th of patients improved symptomatically on the first follow up visit. Macrocystic lesion showed an excellent response to treatment (50-89% volume reduction) in 33.3% of cases while only 16.7% of microcystic ad 12.5% of the mixed lesion showed a similar response to treatment.Conclusions: Doxycycline sclerotherapy can be a primary treatment modality in macrocystic and mixed macrocystic lesions. It is inexpensive and widely available and has minimal side effects. In contrast, bleomycine as a sclero-therapeutic agent showed an inadequate response in size reduction of microcystic lesions.

Rapidly Fatal Silicosis Among Jewellery Workers Attending a District Medical College of West Bengal, India.

Background. Silicosis is a slowly progressive chronic occupational lung disease, developed after a prolong period of exposure to high concentration of silica dust. Methods. In this longitudinal study, we enrolled old and new silicosis patients (n=19; 8 jewellery polishers, 11 from other occupations) seen at our Pulmonary Medicine Department from June 2009 to December 2012 to document the course of illness as per their occupational exposure. Results. Six of the eight jewellery polishing workers had developed silicosis within five years of exposure, while six of the 11 other workers with other occupational exposure had developed silicosis after exposure of 10 years or more. Mean duration of exposure was significantly less among jewellery polishing workers compared to other workers (3.4±1.7 versus 9.3±4.1; p=0.001). Mean duration of illness (months) (14.9±5.8 versus 28.5±16.5; p=0.040) were significantly less among the jewellery polishing workers compared to other workers. At the end of the study period, all eight jewellery polishing workers with silicosis had died while four of the 11 patients with other occupational exposure had died. Conclusion. Silicosis among jewellery polishing workers was found to be more severe and progressive compared to silicosis due to other occupational exposures, in our study.

Simultaneous isolated bilateral facial palsy : A rare vincristine-associated toxicity.

We describe a case of a 15-year-old boy with vincristine-induced simultaneous isolated bilateral facial palsy. The boy presented with superior vena caval syndrome (SVC syndrome), right-sided pleural effusion and anterior mediastinal lymphadenopathy. Histopathological examination of left axillary lymph node was suggestive of lymphoblastic lymphoma. We started chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone. SVC syndrome disappeared completely after the 1st cycle, and he achieved remission after the 3rd cycle of chemotherapy. He noticed that he could not close his eyes. Neurological examination revealed bilateral lower motor neuron facial palsy. Findings from examination of other cranial nerves and peripheral nerves were normal. Results of MRI of brain and cerebrospinal fluid examination were normal. He received 6 mg vincristine before developing toxicity.