Reverse Foster Kennedy Syndrome Caused by an Intra-axial Tumor.

We present a case of a 23-year-old male complaining of painless loss of vision in right eye for 1 year and rapidly progressing vision loss in left eye with bilateral lateral rectus palsy. His fundoscopy revealed optic atrophy on the right side and papilledema on the left. Magnetic resonance imaging (MRI) showed intra-axial contrast-enhancing left frontal tumor. We discuss this first case of reverse Foster-Kennedy syndrome in the English literature with emphasis on the clinico-radiological and clinico-histopathological correlation.

Isolated pancreatic tail injury: A rare presentation.

INTRODUCTION: Pancreatic injuries occur in up to 10% of all major blunt abdominal trauma events. Due to the retroperitoneal location of the pancreas, isolated pancreatic injury occurs in less than 5% of cases. PRESENTATION OF CASE: A 12 year old male child was brought to the emergency department with epigastric pain 12 days after alleged history of fall from bicycle. On admission, he had tenderness in the epigastrium. CT scan revealed a transection through the tail of the pancreas with no injury to any other organ. As there was no evidence of duct injury, he was treated conservatively. DISCUSSION: Morbidity and mortality rates for isolated pancreatic trauma are directly related to the presence of damage to the pancreatic duct. Helical multislice CT scan represents the best noninvasive diagnostic method for the detection of pancreatic injury. Hyperamylasemia should at least be considered as a sign of probable pancreatic injury in the setting of blunt abdominal trauma. CONCLUSION: Trauma to the pancreas is not common, and isolated pancreatic trauma is even less common. An isolated pancreatic injury may be missed or the diagnosis may be delayed because the initial symptoms and signs of pancreatic injury are subtle.

A comparative study of colostrum dressing versus conventional dressing in deep wounds.

INTRODUCTION: Deep wounds are extending deeper, across deep fascia into muscles or deeper structures. Understanding of nutrition, immunology, psychological issues, the physiology and the metabolic interactions require for optimal treatment of deep wounds. Wound dressing plays one of the important roles in wound healing. Newer type of wound dressings - Biological dressings like colostrum powder, collagen granules create the physiological interface between the wound surface and environment which is impermeable to bacteria. AIM: To compare the efficacy and safety of colostrum dressing and conventional dressing in deep wounds. MATERIALS AND METHODS: Data was collected from all patients with deep wounds (stage II-IV), admitted during the period of April 2013 to March 2014, considering the inclusion and exclusion criteria. RESULTS: Less number of dressings, short healing time, rapid healing and decrease pain seen in colostrum dressing group compared to conventional dressing group. CONCLUSION: Colostrum powder dressings are safe, promoter of wound healing, more patient compliance in terms of less pain, less number of dressing required. This treatment though found to be more expensive than conventional dressings; results indicate that colostrum powder dressings may be used as an adjunct in management of deep wound.

Primary adenosquamous carcinoma of ampulla of Vater-A rare case report.

INTRODUCTION: Primary adenosquamous carcinoma (ASC) of the ampulla of Vater (AmV) is extremely rare. Carcinoma of the ampulla of Vater tends to manifest early due to biliary outflow obstruction, as opposed to pancreatic neoplasms that often are advanced at the time of diagnosis. Periampullary carcinomas are treated by pancreaticoduodenectomy (PD). Adenosquamous carcinoma carries very dismal prognosis. PRESENTATION OF CASE: Here we present a case of 58-year-old male who was presented with abdominal pain, jaundice and anorexia with no history of (h/o) pruritus and clay colored stool. All blood investigations were normal except liver function tests (LFTs). Ultrasonography (USG) of abdomen suggestive of periampullary mass with dilated pancreatico-biliary tree. Endoscopic retrograde cholangiopancreatography (E.R.C.P.) demonstrated large deformed and bulky papilla with ulcerated lesion with infiltration in to duodenum. Exploratory laprotomy proceeds Whipple's pancreaticoduodenectomy done. Histopathology revealed adenocarcinoma of the ampulla of Vater. Immunohistochemistry was confirmatory of adenosquamous carcinoma. DISCUSSION: Adenosquamous carcinoma (ASC) is defined as a tumor in which both glandular and squamous elements are histologically malignant. Compared to adenocarcinoma, ASC of the AmV is a rare malignancy. Preoperative diagnosis is difficult because of the lack of defining characteristics in imaging studies and the difficulty in acquiring both malignant components by limited biopsy. Periampullary carcinomas are treated by pancreaticoduodenectomy. CONCLUSION: Adenosquamous carcinoma is a very rare form of cancer of the AmV. Pancreaticoduodenectomy is the treatment of choice though early recurrence and distal metastasis may be encountered after surgery. Follow-up should be more frequent to detect possible early recurrence and distal metastasis.

Multiple giant intra abdominal lipomas: A rare presentation.

INTRODUCTION: Solitary or multiple lipomas, composed of mature fat, represents by far the most common benign mesenchymal neoplasm occurring throughout the whole body, but they rarely originate in the intestinal mesentery. PRESENTATION OF CASE: A 60-year-old male presented with left sided abdominal distension and pain since 4 months, ultrasonography and computerized tomography abdomen was suggestive of multiple well-defined fat density lesions in the lower abdomen and pelvis. USG guided fine needle aspiration cytology was conclusive of a spindle cell lesion. Exploratory laparotomy was performed and multiple major fat tissue swellings were excised. Histopathology confirmed it to be spindle cell type of lipoma. DISCUSSION: Because of the silent nature the exact prevalence of lipomas is unknown. It can arise in any location in which fat is normally present, reported intra abdominal lipomas have been very rare. Clinical manifestations depend on the size and location of the growth. In most patients, symptoms are few or absent. USG and CT scan abdomen are used for the diagnosis. Complete surgical excision being the only treatment. CONCLUSION: Intra abdominal lipoma is a very rare entity, and many cases might be ignored due to their silent nature. They might or might not present with any symptoms. Complete surgical excision being the only treatment, with a very good prognosis.