Axillary artery thrombosis with anteroinferior shoulder dislocation: a rare case report and review of literature / 中华创伤杂志(英文版)

A very rare and serious complication of shoulder dislocation is a lesion to the axillary artery in the elderly population, whose vascular structures have become less flexible. Axillary artery injury secondary to anteroinferior shoulder dislocation is much rarer, especially in the young people. Proper recognition and treatment of this entity offers a full recovery to the patient. Present report highlights the possibility of axillary artery injury with anteroinferior shoulder dislocation. A few case reports and small case series of this injury have been reviewed. And recommendations for management have been brought up to date, in line with current thinking.

Simultaneous bilensectomy and endothelial keratoplasty for angle-supported phakic intraocular lens-induced corneal decompensation.

A 40-year-old lady presented with severe endothelial cell loss in both eyes 14 years after angle-supported phakic intraocular lens (AS PIOL) implantation. The left eye had severe corneal edema with bullous keratopathy. The right eye had markedly reduced endothelial cell count (655 cells/mm2) although the cornea was clear. She underwent simultaneous bilensectomy (AS PIOL explantation and phacoemulsification) and Descemet's stripping and endothelial keratoplasty (DSEK) in the left eye. Explanted AS PIOL was identified as ZSAL-4 (Morcher, Stuttgart, Germany) model. Corneal edema cleared completely in 2 months with a best corrected visual acuity (-2.25 D sph) of 20/60. No intervention was done in the right eye. The present case illustrates that AS PIOL-induced endothelial decompensation can be effectively managed by simultaneous bilensectomy and endothelial keratoplasty.

Renal angiomyolipoma, a diagnostic dilemma: a case report.

Angiomyolipomas are the most common benign mesenchymal tumours of the kidney. Most of the angiomyolipomas in adults are asymptomatic and discovered incidentally. We report a case in a symptomatic 55 yrs old male who had a huge retroperitoneal mass abdomen and in whom diagnosis and organ of origin remained unclear until operation and histopathological study was performed. Radiological and fine needle aspiration cytology (FNAC) report of a malignant retroperitoneal tumour was given, but histological examination of the respective tumorous mass showed a benign renal tumour - angiomyolipoma. Our emphasis by reporting this case is to make cytopathologists and radiologists aware of such kind of diagnostic pitfall encountered while reporting retroperitoneal masses.

A clinical profile of shock in children in Punjab, India.

This prospective study was conducted to determine the frequency, etiology, type and outcome of shock in hospitalized children in the age group of 1 month to 15 years. There were 98 cases of shock, constituting 4.3% out of total admissions. Mean age was 2.8 +/-3.4 years. Maximum number of patients (39) was seen in infancy. Hypovolemic shock due to acute diarrheal disease was the commonest type (45.9%) followed by septic, cardiogenic and distributive shock. Compensated stage was common in hypovolemic shock (88.9%) whereas majority of patients with septic shock (73.5%) presented in decompensated stage. Overall survival was 73.6%. The survival rate was best in hypovolemic shock (97.7%;) followed by septic(53.3%) and cardiogenic shock(43.7%). Inotropes and ventilatory support were required in 46% and 23% patients, respectively. Diagnosis and management of shock in compensated stage carried better prognosis than in uncompensated shock irrespective of the age of the patient.

Histological spectrum of ependymomas and correlation of p53 and Ki-67 expression with ependymoma grade and subtype.

BACKGROUND: Clinical and histological criteria for ependymoma prognosis are well recognized. Recently few studies have been done based on Immunohistochemistry for prognostication of these tumours. In this study we have correlated the histological spectrum with immmunoexpression of p53 and Ki67 in these tumors. AIMS: To know the incidence of ependymomas; study their morphological spectrum and to evaluate expression of P53 and Ki 67 in different morphological subtypes. MATERIAL AND METHOD: A retrospective study was preformed on 70 ependymomas received in a period between 1994 and 2001. Entire tissue received was processed for routine paraffin embedded H&E stained sections. Immunocytochemistry was performed using antibodies to GFAP, EMA, Pancytokeratin and synaptophysin, to differentiate papillary ependymoma from choroid plexus papilloma; clear cell ependymoma from oligodendroglioma and central neurocytoma; ependymoblastoma from other embryonal tumours. p53 and Ki-67 immunohistochemistry was performed to correlate their expression with various tumour grades and subtypes. RESULTS: There were 3 cases (4.2%) of Grade I ependymoma (2 cases of myxopapillary ependymoma and 1 case of subependymoma); 57 cases (81.5%) of ependymoma grade II (43 of these were of classical variety, 11 of clear cell ependymoma, 2 of papillary and 1 case of cellular ependymoma). There were 9 cases (12.8%) of anaplastic ependymoma (one of these was a clear cell ependymoma and 1 case (1.5%) of ependymoblastoma CONCLUSION: p53 and Ki67 indices can be used in routine diagnostic laboratories to supplement the tumor grade on histology and more studies with follow up should be performed to analyse the prognosis of different subtypes. The expression of Ki 67 and p53 was significantly higher in anaplastic ependymomas. 4 out of 11 cases of clear cell ependymomas showed higher Ki 67 indices as compared to classical grade II ependymomas, thus further highlighting the importance of differentiating the various subtypes.

Impact of bed side communication with fathers on their anxiety about newborn.

This study assessed the impact of bedside communication with fathers (N = 100) on their anxiety about sick neonates admitted in SCNU. The control group consisted of fathers of 100 sick babies communicated outside the unit. Anxiety was measured in both the groups on day 1 (at admission) and day 7, by using 5 point Likert Scale. At the time of admission there was no difference in the level of anxiety between the study group and controls (p >0.05; Mann Whitney test). There was a statistically significant difference (p <0.01; Mann Whitney test) in the level of anxiety between the study and control group at 7 days. When compared within the group, the anxiety in the fathers of study group was significantly less (p <0.01) at 7 days than at admission. In the control group there was no such significant difference. To conclude, bed side communication with fathers of admitted neonates reduces their anxiety significantly.

Intracranial hemorrhage in late hemorrhagic disease of the newborn.

This study was conducted to evaluate the clinical profile and outcome in late hemorrhagic disease of the newborn (HDN) with particular reference to intracranial hemorrhage. Infants (n = 42) presenting with late HDN from January 1998 to December 2001 were studied. Majority (76%) were in the age group of 1-3 months. All were term babies on exclusive breast-feeding and none received vitamin K at birth. 71% patients presented with intracranial hemorrhage, commonest site being intracerebral and multiple ICH. Visible external bleeding was noted in 1/3rd of patients only. Three patients expired. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Isolated intracranial hemorrhage is a common mode of presentation.

Response to hepatitis B vaccine in preterm babies.

INTRODUCTION: A well-accepted vaccination schedule for preterm babies is not available. We therefore studied the response to hepatitis B vaccine in preterm babies. METHODS: 60 babies born to HBsAg-negative mothers were studied. Group I (n=20) consisted of term babies with birth weight >2.5 Kg, group II (n=20) included preterm babies with birth weight between 1.8 and 2.49 Kg, and group III (n=20) included preterm babies with birth weight between 1.2 and 1.79 Kg. Mean gestational age in the three groups was 38.5 (1.1), 33.5 (1.4) and 32.7 (2.1) weeks, respectively. All babies received 3 doses (10 microg/0.5 mL) of a recombinant HBV vaccine within 3 days of birth, and at 6 weeks and 6 months of life. Anti-HBs levels were measured one month after the 2nd and 3rd doses each; the immune response was categorized as good responders (anti-HBs >100 mIU/mL, low responders (anti-HBs 10-100 mIU/mL) and non-responders (anti-HBs <10 mIU/mL). RESULTS: Good antibody response after the second dose was seen in 95% of babies in group I, 60% of those in group II and 10% of those in group III. This increased to 100%, 90% and 45%, respectively after the third dose. The response was influenced by gestational age (r=0.73); 94% of babies with gestational age 34-36 weeks attained good antibody response compared to only 55% of babies with gestational age of 31-33 weeks. Birth weight had no independent influence on the antibody response. CONCLUSION: The response to hepatitis B vaccine is influenced by gestational age. Hence, in preterm babies, it is advisable to check antibody titers one month after the third dose to assess the need for a booster dose.

Chronic/recurrent cough in rural children in Ludhiana, Punjab.

OBJECTIVE: To determine the prevalence, age distribution and common causes of chronic/recurrent cough in rural children. DESIGN: Prospective study. SETTING: Pediatric population in five villages of Dehlon Block of Ludhiana, Punjab. METHODS: 2275 children in the age group of 1 to 15 years were screened by house to house survey for chronic/recurrent cough using defined criteria. A detailed work up of selected cases was carried out. Underlying etiology was determined using clinical and laboratory parameters. Five hundred children in the study population formed the control group. Variables associated with chronic/recurrent cough were analyzed in cases and controls. RESULTS: Twenty four children were diagnosed with chronic/recurrent cough showing a prevalence rate of 1.06 percent. The most common cause was bronchial asthma (66.7 percent) followed by postnasal drip syndrome (25 percent). Family history of allergy/asthma was noted in 11 (45.8 percent) children as compared to 52 (10.4 percent) in the control group (p < 0.01). Family history of smoking was recorded in 16.7 percent of cases in contrast to 6.4 percent in controls (p = 0.05). There was no significant association with overcrowding, pets and kind of cooking fuel used. CONCLUSIONS: The most common cause of chronic/recurrent cough was bronchial asthma. There was a significant association with family history of allergy/asthma and smoking.

Histological analysis of cystic tumour like lesions of central nervous system.

True cysts of the central nervous system (CNS) are rare lesions. A retrospective study of patients with symptomatic non-neoplastic cystic lesions of CNS operated in the Department of Neurosurgery, G.B. Pant Hospital, New Delhi between Jan 1994 and Feb 2001 was conducted. Parasitic cysts, cystic transformation of hemmorhages, vascular malformations and cystic tumours were excluded from the study. A total of 109 cases were reviewed. There were 34, 27, 17, 16, 8, 3 and 2 cases of epidermoid, arachnoid, dermoid, colloid, neurenteric, Rathke's and ependymal cysts and 1 case each of choroid plexus and glial cysts. The clinical presentations, locations, incidence and pathogenesis of these cysts is discussed.