Bilateral cervical chondro-cutaneous remnants

Cervical chondro-cutaneous brachial remnant [CCBR] is a developmental anomaly presenting at birth and are usually seen on the lateral aspect of neck, anterior to sternocleidomastoid muscle. Bilateral appearance of this lesion is extremely uncommon. These lesions are painless and lack any inflammation or discharge. Since there is no connection with underlying deeper structures, complete surgical excision is the standard treatment in such cases. It is associated with several other congenital anomalies in 70-80% of cases. Hence, thorough evaluation of patients [clinical and investigation] becomes mandatory in such cases to detect any additional anomaly. We report a case of a 6-year-old female with bilateral cervical chondro-cutaneous remnant located at the lower third of lateral aspect of neck, anterior to sternocleidomastoid muscle, and discuss the embryologic and diagnostic aspects considering the common differential for this lesion at this site

Enhancing laboratory turnaround time performance by combining the implementation of a laboratory instrumentation interfacing solution with six sigma methodology

Six Sigma is considered to be an important quality improvement tool in the industry. This paper outlines the application of six sigma methodology along with the implementation of a laboratory instrumentation interfacing solution in bringing down turnaround time [TAT] failures in the hospital laboratory sample collection, testing and reporting cycle at GMC Hospital Ajman. This was implemented since the GMC Hospital laboratory was facing numerous client complaints due to TAT failure in reporting of diagnostic test results. To address the problem of high TAT failures the following steps were taken 1. Bar coding of all samples was facilitated and all samples barcoded 2. Random access analyzers interfaced through R5232 ports with HIMS 3. TAT defined for all in-house tests 4. Barcoded samples were scanned and time points noted automatically at collection, receipt in lab, testing on bench, initial technical verification, secondary verification and printing of report. This data was monitored for adherence to the pre-analytical, analytical and post analytical phases. 5. Three cycles of the DMAIC process was used to decrease defect rate and enhance adherence to TAT. a. In the first cycle analytical Issues, b. in the second cycle pre-analytical issues and c. in the third cycle post-analytical issues were defined, measured, analyzed, intervention carried out and changes consolidated [DMAIC]. The interventions in three phases of two months each, over a six months period, sequentially brought down TAT failures 45% [pre-intervention] to 33%, 13%, 11%, 4%,3% and 1% [post-intervention] respectively. A barcode enabled laboratory equipment interfaced HIMS system combined with Six Sigma Tools was able to significantly enhance adherence to TAT, improve services to physician, resulted in better staff utilization and improve the quality and value of the report by ensuring timely reporting. To consolidate gains and for continual improvement it is now proposed to improve performance by further reduction of TAT by introducing POCT, introducing a dedicated LIMS and auto-verification of samples

disc as the basis of treatment for glaucoma

The goal of the treatment of patients with glaucoma is to prevent disability or, if disability already exists, to repair the disability or at the least to prevent further disability from developing. To achieve these goals requires knowing what will happen if there is no treatment and what will happen if there is treatment. That is, one must know the possible benefits from the therapy in comparison to the damage caused by the therapy. As we will demonstrate, the classic risk factors do not provide accurate estimates of the development of disability and do not answer these two questions. The most helpful clues are provided by what the patient says, by whether the disc is damaged and by whether the disc is deteriorating. The severity of disease is best estimated by the nature of the optic disc and how it changes. This report is primarily focused on increasing the skill of the physician in being able to estimate the nature of the optic disc and how that changes. This does not, however, lessen the tremendous importance of careful history-taking and of gonioscopy. In this report, however, we focus on the evaluation of the disc. Currently disc evaluation is often not adequate because of poor examination techniques, reliance on cup/disc ratios, and reliance on the results of image analyzers. We will present here the Disc Damage Likelihood Scale, which is a user-friendly method which correlates accurately with visual field changes

Pulmonary function tests in three wheeler diesel taxi drivers in Bikaner city

Pulmonary Function Tests [PFTs] including spirometry give an important clue in terms of respiratory chronic airway disorders and can predict early damage to pulmonary system. The present study was carried out in 100 diesel taxi drivers [Study group] of Bikaner city and compared it with 100 healthy medicos [control group] in the age group of 20 to 50 years by computerized spirometer. The pulmonary function tests included FVC, FEV[1], FEV[1]/FVC, FEF[25-75%] and PEFR. All subjects were divided into non-smokers and smokers so that influence of smoking on lungs can be studied. The restrictive impairment was found in 87% of study group, of which 50% were smokers and 37% were non-smokers, mixed pattern [both restrictive and early obstructive impairment] was found in only 13% of study group, of which 7% were smokers and 5% non-smokers. When all the above five parameters were taken together, they were indicative of mixed pattern [both restrictive and obstructive] lung impairment

Role of magnetic resonance imaging in the assessment of perianal fistulas

This study was carried out to evaluate the role of magnetic resonance imaging [MRI] in preoperative assessment of fistula-in-ano. Subjects and Twenty-six patients [21 male and 5 female, age 19-65 years] were prospectively studied from July 1999 to December 2001 using a 1.0-tesla superconducting magnet. T1-weighted fast spin echo [T1W FSE] images before and after gadolinium injection and fat suppressed T2-weighted fast spin echo [T2W FSE] images were obtained in transverse and coronal planes. MRI findings were correlated with surgical findings. Twenty-one of the 26 patients demonstrated active fistulas. The MRI findings were in accordance with the examination findings under anesthesia and/or surgery in 15 of 16 cases. Both coronal and transverse planes were useful in assessing the location and direction of tracts and abscesses. Both contrast-enhanced T1W FSE and fat-suppressed T2W FSE images were useful in assessing the activity of lesions and the course of tracts. MRI showed accurate correlation with surgical findings and aided in preoperative management and planning for surgery

Pain during mammography: impact of breast pathologies and demographic factors

The aim of this study was to systematically assess the pain experienced by patients undergoing mammography for various clinical presentations. Subjects and Two hundred and twenty-five patients aged 25-85 years [45.43 +/- 8.25 years] presenting for mammography were included in the study. Presenting symptoms and clinical diagnosis were provided by the referring physicians and demographic information was obtained from self-reported questionnaires. Mammography results were recorded by the radiologist. Two different but reliable and valid measures of pain - Visual Analog Scale [VAS] and Pain/Discomfort Rating Scale [DRS] - were used to assess pain during mammography and data were statistically analyzed to examine the possible predictors of pain. Forty-nine% of the patients reported pain during mammography when cut-off level of VAS score was 40; however, when the cut-off level was raised to 60 [considering the preexisting pain as presenting symptom in some patients] only 23% reported pain. With DRS, 7% reported pain, 27% discomfort and 66% neither pain nor discomfort. Biserial correlation between the VAS and DRS scores suggested strong positive agreement between the two measures of pain [r = 0.56, d.f. = 90, p < 0.01]. Patients presenting with coexisting breast lumps and preexisting breast pain and those diagnosed with inflammatory conditions of the breast and fibrocystic changes experienced more pain during mammography. Preexisting breast pathologies and demographic factors such as age and educational level of the patient were important in reporting pain during mammography. This finding indicates that proper assessment of pain using standard measures and its association with breast pathologies and demographic factors is important for planning pain management in women undergoing mammography

Evaluation of pregnacies complicated by intrauterine growth retardation

The intrauterine growth retardation [IUGR] of the fetus is a common and serious complication of pregnancies across the world. The incidence of IUGR reported in the literature varies according to the cut off point. Our study was undertaken to assess the outcome of the pregnancies complicated by IUGR at SQU Hospital. One hundred and eighty four patients were diagnosed as having IUGR babies and were followed up in the special clinic. These patients were evaluated retrospectively. Diagnosis of IUGR was confirmed post-natally by assessment of babies' weight for gestational age. We have noticed surprisingly good condition of the newborns, measured by Apgar score at 5 minutes after birth. There was one case of perinatal mortality in this group. The number of IUGR patients who required antenatal intervention was high but the overall Caesarian section rate was relatively low

Primary subcutaneous sarcoidosis of the face

A rare case of sub-cutaneous sarcoidosis of face mistaken as Neurofibroma is reported along with relevant review of literature

Pattern of malignant tumors in Kerman province

From March 1980 to March 1989 a total number of 2254 [7.6%] new malignant cases from Kerman province were diagnosed by examination of surgical specimens, blood films and bone marrow smears. The crude relative frequency of cancers was studied and compared with other areas of Iran. Gastric [11.36%] and urinary bladder [7.01%] carcinomas were significantly more common in Kerman province than other parts of Iran. Esophageal malignancy was also common in this area. No significant difference was found in the pattern of lymphomas and leukemias. Frequencies of cancer of the cervix [3.24%] and oral cavity [3.73%] were less as compared to other parts of Iran

Intramural tracheobronchial remnants: a misdiagnosed cause of congenital esophageal stenosis

In cases of congenital esophageal stenosis due to tracheobronchial remnants, symptoms of partial esophageal obstruction appear at the time of weaning or during early childhood. In the absence of esophagitis, esophagram combined with cinefluoroscopy demonstrates fixed stenosis of distal esophagus and appears to be diagnostic. Dilatation of rigid stenosis is invariably unrewarding and surgical resection is mandatory. Pathologically, the presence of cartilage or respiratory seromucinous glands in the esophageal wall are pathognomonic features. Other congenital anomalies may be encountered in some cases [30%]