Animesh Mishra

A Classical Image of Dermographism

Clinical Image: A 31year old male presented with complain of itching followed by localised swelling of the part that has been scratched. He also complained of swelling of parts of limb and back on being hold tightly, stroked or rubbed and intermittent swelling of lips. Symptom was worsened by abrasive and tight clothings. The patient had no history of respiratory symptoms suggestive of asthma. General survey and systemic examination was normal other than raised skin within minutes on scratching left arm with a pinhead suggestive of dermographism (Panel A-G). Routine blood count revealed haemoglobin 13 gm/dl, a leucocyte count of 8000/ cumm with increase in the percentage of eosinophils. The absolute eosinophil count was 880/cumm. Serum IgE level was 835 IU/ml. The patient was treated with albendazole (400 mg), levocetrizine (5 mg) for four weeks and with a H2 receptor antagonist with an advice to follow after one month.

Fatal complication of ductal arteritis in a malnourished child

Proper counseling and timely intervention in cases of congenital heart lesions is absolutely essential and vital because rare and potentially fatal complications can arise out of simple lesions like patent ductus arteriosus (PDA). The incidence of infective arteritis in untreated PDA is less than 1%. Pulmonary showering from infected PDA vegetation is not uncommon. Vegetations usually occur on the pulmonary artery end of duct where the high velocity jet strikes and embolic events are usually to the lungs rather than the systemic circulation. The mycotic aneurysm of branch pulmonary circulation is rare but is a recognized entity. Aneurysms occur within the pulmonary circulation in conjunction with infective endocarditis or in association with pneumonia. The pulmonary findings of infective endocarditis in pulmonary computed tomography have a wide range of vascular abnormalities, such as intravascular filling defects, total vascular cut off, vascular enhancement, or enlargement of an occluded vessel. Localized mycotic aneurysm of affected pulmonary artery along with perivascular ground-glass opacities are important ancillary findings. A severely malnourished 7-year-old female child was referred from local healthcare facility for evaluation of high fever. The parents were aware of a hole in the heart. Echocardiography showed a large aneurysmal patent ductus arteriosus with left to right shunt, and a very large vegetation sitting on pulmonary end Article history: Received 22 January 2016 Accepted 1 April 2016 Available online 3 May 2016

Substantive treatment of Lutembacher's syndrome by the trans-septal puncture technique: a case report and review

There are few reports on the primary percutaneous treatment of Lutembachers syndrome for which surgery has been the traditionally accepted modality of treatment. Concerns for percutaneous treatment in this entity are: (1) it is technically demanding and the dual lesion renders negotiation of catheters and balloons difficult; (2) redo valvulotomy in the presence of an atrial septal device would be difficult; (3) it may not be suitable for all patients with the condition. We describe percutaneous treatment by a hitherto undescribed technique of separate low septal puncture and review the existing literature.