A profile of abdominal and pelvic injuries in medico-legal autopsy.

Abdomino-pelvic region is vulnerable to injury in various forms of trauma. This study was undertaken with objectives to study the pattern and type of external and internal abdominal and pelvic injuries and to identify the risk organs in abdomen and pelvis susceptible to trauma among the medico-legal autopsies at the mortuary of a referral centre in eastern Nepal during the period of one year (n = 80). Males constituted 80% of the cases and the mean age of the victims was 30.76 years. The cause of trauma was Road Traffic Accident in 82.5%. The manner of death was accidental in 87.5% and homicidal in 11.25% cases. Liver (57.5%) was the most common organ injured followed by spleen in 37.5% cases. Multiple organs injury was seen in 67.5% and absence of any external injuries was noted in 31.25% cases. Autopsy can play a role in establishing the missed injuries and be helpful to widen the knowledge of the medical faculty in early diagnosis and management of such injuries.

Caecal volvulus: a twisted tale.

Caecal volvulus is an uncommon cause of acute intestinal obstruction caused by axial twisting of the caecum along with the terminal ileum and ascending colon. Early diagnosis is essential in order to reduce the high mortality rate, though the condition is rarely diagnosed correctly at the time of presentation. We report a series of four cases describing their presentation, management and subsequent outcome.

Isolated pancreatic tuberculosis mimicking as carcinoma: a case report and review of the literature.

INTRODUCTION: Pancreatic tuberculosis is a rare disease even in endemic countries for tuberculosis. Here, we report a case of pancreatic tuberculosis from tuberculosis endemic zone presenting as obstructive jaundice mimicking pancreatic cancer. CASE PRESENTATION: A 41-year-old male presented with features of malignant obstructive jaundice. Ultrasonography and computed tomography scan showed mass in the pancreatic head and uncinate process. He underwent a pancreatoduodencetomy. Histological examination showed typical features of tuberculosis. Antitubercular drugs were started and he remains well six months after surgery. CONCLUSION: Tuberculosis should be considered as a differential diagnosis to an obscure pancreatic mass in younger or middle aged patient residing in tuberculosis endemic zone.

Comparison of aspiration-sclerotherapy with hydrocelectomy in the management of hydrocele: a prospective randomized study.

BACKGROUND: Hydrocelectomy is practiced as the gold standard technique for the treatment of hydrocele worldwide. Aspiration and sclerotherapy is cheap, less invasive and safe compared to hydrocelectomy. However, the outcomes are inconsistent because of lack of uniformity in methods and sclerosing agents used. MATERIALS AND METHODS: This was a randomized controlled study conducted in a university hospital for a period of one year. Sixty symptomatic adult males without fertility concern or coexisting scrotal pathology were enrolled. Aspiration and sclerotherapy and hydrocelectomy were performed in 30 each. PRIMARY OUTCOME MEASURES: incidence of complications, loss of working days, cost involved, recurrence rate and patient's satisfaction. Patients were followed up till 6 months after the procedures. RESULTS: Eight patients (26.7%) after hydrocelectomy developed fever which was significantly more (p<0.05) than 2 patients (6.7%) following sclerotherapy. Four patients (14%) with hydrocelectomy had infection (p<0.05). The incidence of pain and haematocele between the two groups were comparable. Nine patients (34.6%) after sclerotherapy developed recurrence at 3 months. All patients developed recurrence after repeat aspiration and sclerotherapy. The level of satisfaction was more in hydrocelectomy 19 (95%) versus 13 (61.9%) patients in sclerotherapy (p<0.05). The cost involved was fivefold and the loss of working days sevenfold in hydrocelectomy (p<0.01) as compared to sclerotherapy. CONCLUSION: Although aspiration and sclerotherapy had less complications, morbidity and was cheaper, it had lower success rate and less patient's satisfaction than hydrocelectomy.

Anorectal tuberculosis coexisting with adenocarcinoma: an unusual association.

INTRODUCTION: Tuberculosis affecting the anorectum is an uncommon extra-pulmonary form of the disease, and its association with malignancy is highly unusual. CASE REPORT: A 35 year lady presented with lower gastrointestinal bleed, altered bowel habit and significant weight loss. On examination, she had nodular stricture in the lower rectum, with friable mucosa, bleeding easily on touch. With the diagnosis of carcinoma lower rectum, she underwent abdomino-perineal resection of the growth. The histopathological examination revealed carcinoma rectum with coexisting tuberculosis. CONCLUSION: The aetiological association between the tuberculosis and anorectal cancer is a matter of debate. However, the treating surgeon should be aware of this association, to avoid confusion and delay in the management.

Crohn disease in Nepal: true rarity or gross underdiagnosis?

Gross and histopathological examination of a resected segment of ileum in a 72-year-old man with the preoperative diagnosis of small intestinal perforation peritonitis revealed the first-ever diagnosed case of Crohn Disease (CD) at the B P Koirala Institute of Health Sciences, Dharan, Nepal. In view of the recent reports on rising incidence of CD in neighbouring Asian countries, it was decided to perform an exhaustive literature search to find out the documented prevalence of CD in Nepal. It was surprising to find only a single case of CD from Nepal, occurring in the year 1980, to be documented in English literature. Further, the index case of CD presenting with acute abdomen is of interest since only about 100 cases of CD with small intestinal perforation have been so far reported worldwide.

Hydride generation activity of arsenosugars and thioarsenicals.

The major arsenosugar compounds have been reported to be hydride-generation-active, however to a lesser extent in comparison with the inorganic arsenicals. We report here for the first time the identity and quantity of the volatile arsenicals generated by As-sugar-SO(3), As-sugar-SO(4), dimethylarsinoyl acetic acid and dimethylarsinoyl ethanol. Only one major volatile compound was identified for all four compounds studied: dimethylarsine. This means that the As-C bond to the longer carbon chain was cleaved during the hydride-generation process. Theoretical calculations at the RHF/6-31G(d,p) ab initio level confirm that this As-C bond is much weaker than the As-CH(3) bonds. Furthermore, it was revealed that the sulphur analogue of dimethylarsinic acid (DMAS ) is hydride-generation-active at pH 7 in contrast to dimethylarsinic acid, despite the fact that arsenic is also pentavalent. This has been substantiated by the calculation of the change in susceptibility of the arsenic towards nucleophilic attack when oxygen is replaced by sulphur. Hence, DMAS can easily be mistaken for a trivalent arsenic species.

Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis.

OBJECTIVE: To study the role of fine needle aspiration cytology (FNAC) and ancillary studies in the diagnosis of tubercular epididymitis or epididymo-orchitis. STUDY DESIGN: Forty patients with tubercular epididymitis or epididymoorchitis diagnosed on FNAC underwent a detailed clinical workup, imaging and microbiologic studies before being started on antitubercular treatment (ATT). One patient underwent orchiectomy. RESULTS: Clinically, the disease presented in patients of all ages usually as a scrotal swelling or rarely as a scrotal sinus (3) or abscess (3) or as part of disseminated tuberculosis (2). Three patients gave a history of previous tuberculosis. Scrotal sonography confirmed the involvement of the epididymis, testis or spermatic cord in each case. FNAC was diagnostic in 27 aspirates (epithelioid cell granulomas with caseation) but nondiagnostic in the rest. Tubercular etiology was confirmed directly by detection of acid-fast bacilli (AFB) on FNA smears in 24 (60%) patients and urine samples in 11 and indirectly in 9 patients with negative AFB by using a combination of a positive Mantoux test (5 of 9), presence of caseating granulomas on FNA smears (7 of 9) and therapeutic response to ATT (9 of 9). CONCLUSION: FNA as a minimally invasive technique plays a prime role in the diagnosis of tubercular epididymitis and epididymoorchitis. It provides adequate material for cytologic and microbiologic examination and helps to avoid unnecesary orchiectomy.