Ananthakrishnan Ramesh

A Comparison of the Different Methods of Using Jatropha Oil as Fuel in a Compression Ignition Engine

Different methods to improve the performance of a jatropha oil based compression ignition engine were tried and compared. A single cylinder water-cooled, direct injection diesel engine was used. Base data were generated with diesel and neat jatropha oil. Subsequently, jatropha oil was converted into its methyl ester by transesterification. Jatropha oil was also blended with methanol and orange oil in different proportions and tested. Further, the engine was modified to work in the dual fuel mode with methanol, orange oil, and hydrogen being used as the inducted fuels and the jatropha oil being used as the pilot fuel. Finally, experiments were conducted using additives containing oxygen, like dimethyl carbonate and diethyl ether. Neat jatropha oil resulted in slightly reduced thermal efficiency and higher emissions. Brake thermal efficiency was 27.3% with neat jatropha oil and 30.3% with diesel. Performance and emissions were considerably improved with the methyl ester of jatropha oil. Dual fuel operation with methanol, orange oil, and hydrogen induction and jatropha oil injection also showed higher brake thermal efficiency. Smoke was significantly reduced from 4.4 BSU with neat jatropha oil to 2.6 BSU with methanol induction. Methanol and orange oil induction reduced the NO emission and increased HC and CO emissions. With hydrogen induction, hydrocarbon and carbon monoxide emissions were significantly reduced. The heat release curve showed higher premixed rate of combustion with all the inducted fuels mainly at high power outputs. Addition of oxygenates like diethyl ether and dimethyl carbonate in different proportions to jatropha oil also improved the performance of the engine. It is concluded that dual fuel operation with jatropha oil as the main injected fuel and methanol, orange oil, and hydrogen as inducted fuels can be a good method to use jatropha oil efficiently in an engine that normally operates at high power outputs. Methyl ester of jatropha oil can lead to good performance at part loads with acceptable levels of performance at high loads also. Orange oil and methanol can be also blended with jatropha oil to improve viscosity of jatropha oil. These produce acceptable levels of performance at all outputs. Blending small quantity of diethyl ether and dimethyl carbonate with jatropha oil will enhance the performance. Diethyl ether seems to be the better of the two.

Gossypiboma Presenting as Coloduodenal Fistula – Report of a Rare Case With Review of Literature

The term gossypiboma is used to describe a mass of cotton matrix left behind in a body cavity intraoperatively. The most common site reported is the abdominal cavity. It can present with abscess, intestinal obstruction, malabsorption, gastrointestinal hemorrhage, and fistulas. A 37-year-old woman presented with pain in the right hypochondrium for 2 months following open cholecystectomy. As she did not improve with proton pump inhibitors, an esophagogastroduodenoscopy (EGD) was done, which showed a possible gauze piece stained with bile in the first part of the duodenum. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an abnormal fistulous communication of the first part of duodenum with proximal transverse colon, with a hypodense, mottled lesion within the lumen of the proximal transverse colon plugging the fistula, suggestive of a gossypiboma. Excision of the coloduodenal fistula, primary duodenal repair, and feeding jejunostomy was done. The patient recovered well and is now tolerating normal diet. Coloduodenal fistula is usually caused by Crohns disease, malignancy, right-sided diverticulitis, and gall stone disease. Isolated coloduodenal fistula due to gossypiboma has not been reported in the literature so far to the best of our knowledge. We report this case of coloduodenal fistula secondary to gossypiboma for its rarity and diagnostic challenge.

Infantile Nephrotic Syndrome with Microcephaly and Global Developmental Delay: The Galloway Mowat Syndrome

The authors present the first case of Galloway Mowat Syndrome (GMS), a rare disorder comprising of nephrotic syndrome in association with microcephaly, from India. An 11-mo-old girl with microcephaly, developmental delay and nystagmus presented with nephrotic syndrome. The perinatal and neonatal periods had been uneventful. The renal biopsy revealed mesangial proliferation with IgM deposition, while MRI of the brain showed hypomyelination. Molecular diagnosis by polymerase chain reaction (PCR) did not reveal any pathogenic sequences in the exons and the flanking intronic regions of the NPHS2 gene and LAMB2 gene. The infant responded to prednisolone. GMS must be suspected whenever microcephaly and global developmental delay occurs in association with nephrotic syndrome, as this is important for prognostication and genetic counseling. The genetics of GMS remains an enigma and further research is required to delineate the pathogenesis of this disorder.

Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series

Objectives: To describe Magnetic Resonance Urography (MRU) appearances of the circumcaval ureter, a rare congenital cause of hydronephrosis. Materials and Methods: Seven cases of circumcaval ureter, suspected on intravenous urography (IVU), underwent subsequent static MRU using heavily T2-weighted sequences. Results: The various appearances of circumcaval ureter on IVU and MRU were studied and compared. The circumcaval portion of the ureter was especially well seen on axial MRU sections, though this portion was routinely not visualized on IVU. In one case with a ureteric calculus, MRU also depicted a circumcaval course of the ureter, thus providing a complete diagnosis. In yet another case, where a circumcaval ureter was suspected on IVU, MRU proved the actual cause of ureteric obstruction to be a crossing vessel. Conclusion: Static MRU using heavily T2-weighted coronal and axial sequences can make or exclude the diagnosis of circumcaval ureter unequivocally.

Kartagener syndrome associated with mesangioproliferative glomerulonephritis

Abstract An 11-year-old girl with clinical features of Kartagener syndrome presented with signs of acute glomerulonephritis. Blood urea and creatinine were mildly elevated and anti-streptolysin O and C3 levels were normal. Renal biopsy demonstrated mesangial proliferation and direct immunofluorescence showed IgM and C3 deposits. This appears to be the first report of Kartagener syndrome in association with mesangioproliferative glomerulonephritis. The literature is reviewed and the possible mechanisms for this association are discussed.

An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study

OBJECTIVES This study aimed at determining the frequency of abnormal finger flexion, Hoffmans and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients. METHODS Patients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffmans and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed. RESULTS The frequency of the reflexes in healthy controls were finger flexion - 1%, Hoffmans - 0.3% and Babinski sign - 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression. CONCLUSIONS A combination of finger flexion, Hoffmans and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals.

Teaching Neuroimages: Snake eyes appearance in MRI in patient with ALS

A 17-year-old girl presented with 6 months of progressive asymmetrical distal weakness of upper limbs with fasciculation. There were no bulbar symptoms, weakness in lower limbs, or sensory symptoms. There was no history of neck injury or pain. Deep tendon reflexes were all brisk. MRI of cervical spine revealed symmetrical T1 hypointense, T2 hyperintense signal in the anterior horns (“snake eyes” appearance) (figure, A and B) without evidence of extradural compression. EMG showed diffuse denervation changes in both upper and lower limb muscles. Sensory nerve action potentials were normal. A diagnosis of amyotrophic lateral sclerosis (ALS) was made. Snake eyes appearance has been described in disorders like ALS, cervical spondylotic amyotrophy, Hirayama disease, and ossification of posterior longitudinal ligament.1,2

Trans-ciliary minimally invasive keyhole craniotomy for skull base and vascular lesions

Sir, Conventional approaches to the anterior and lateral skull base would necessarily include a large craniotomy and possibly an orbitozygomatic osteotomy.[1,2] Approach-related complications include visible scars, increased blood loss during surgery, facial and orbital ecchymosis, and long-term problems such as temporalis muscle atrophy and painful jaw opening.[2] Many skull base lesions can be easily accessed via a minimally invasive keyhole craniotomy using an eyebrow incision. This approach is effective in minimizing surgical trauma, hospital stay, and long-term morbidity.[3,4]

Hematomyelia due to ruptured intramedullary aneurysm associated with arteriovenous malformation masquerading as demyelination.

An 18‐year‐old female presented with sudden onset of weakness and parasthesiae of all 4 limbs. She also complained of non‐radiating neck pain. On evaluation (at another hospital), she was found to have flaccid paralysis of all 4 limbs with complete loss of sensation below C4. She had shallow respiration and was intubated and electively ventilated. Magnetic resonance imaging (MRI) cervical spine T2W images revealed diffuse hyperintensity of the cord extending from the pontomedullary junction till the lower dorsal spine [Figure 1a]. T1W images revealed an ill‐defined focal hyperintensity at C4 with cord expansion [Figure 1b]. A diagnosis of acute demyelination was made and she was administered corticosteroids and subsequently IV immunoglobulins. She recovered gradually and power improved to 3/5 in the upper limbs and 2/5 in the lower limbs. Repeat MRI one month later revealed partial resolution of the T2 signal changes and multiple flow voids at C4‐5 [Figure 2]. She was then referred to our institute. A spinal angiogram with cannulation of the left thyrocervical trunk revealed aperimedullary AVM at C4‐5 level with a large intranidal aneurysm [Figure 3a and 3b]. MRI confirmed the position of aneurysm to be intramedullary with surrounding hemosiderin deposition suggestive of old rupture [Figure 4a and 4b].

Sporadic bilateral synchronous multicentric papillary renal cell carcinoma masquerading as bilateral multifocal pyelonephritis

Pyelonephritis is defined as an inflammation of the kidney and renal pelvis. The diagnosis is usually clinical. Acute multifocal bacterial nephritis is a rare form of pyelonephritis that is more severe and sepsis is more common. We report a patient who presented with fever and right-sided abdominal pain associated with right flank tenderness, suggesting right acute pyelonephritis. Bilateral multifocal pyelonephritis was diagnosed on ultrasonography, radionuclide renal scintigraphy and computed tomography. However, owing to non-resolution of symptoms, a biopsy was performed, which showed bilateral papillary renal cell carcinoma (PRCC). PRCC is known to exhibit multicentricity. To our knowledge, a case of bilateral multicentric PRCC masquerading as bilateral multifocal pyelonephritis has not been reported in the English literature. This case highlights the need to be vigilant while treating patients with focal lesions of the kidney as an inflammatory condition lest a malignancy should be missed.