Deepak Sundriyal

“Peripherally Inserted Central Catheters: Our Experience from a Cancer Research Centre”

Peripherally inserted central catheter (PICC) is a modern drug delivery system utilised in oncology practice. The purpose of this study was to determine the complications associated with PICCs within a one year study period. PICCs inserted in patients registered at Dharamshila Cancer Hospital and research centre from 1st July 2012 to 30th June 2013 were studied. Data was retrieved from the procedure room records, medical records department, department of radiology and department of microbiology. Data was collected by oncology residents and procedure team. A total of 246 PICCs were inserted during the one year period. Complete data was not available in 23 patients. 223 results were included in the final analysis. USG guidance was required in 14 patients (6.3%). Optimal PICC duration was achieved in 151 patients (67.7%). 28 patient developed culture positive infective complications (12.5%). 44 patients developed mechanical complications (19.7%). Our study shows a relatively higher rate of infective complications. PICC is an acceptable means of drug delivery system.

Multidermatomal herpes zoster

A 37-year-old male patient with acute myeloid leukaemia presented to us with eruptive lesions over the anterior chest and neck for the past 5 days and severe burning pain over the involved areas. He had earlier received consolidation chemotherapy. On examination, he was afebrile. Multiple papular, vesicular and crusting lesions over C2 to C7 and T1 to T3 dermatomes were noted which were consistent with herpes zoster (HZ; figures 1 and 2). No ocular or neurological symptoms were present except the neuropathic pain. Oral …

‘Monod’ and ‘air crescent’ sign in aspergilloma

A 62-year-old male patient presented with a symptom of haemoptysis for 15 days. There was history of pulmonary Kochs for which he took complete treatment 11 years ago. In the CT scan of the chest, there was an irregular-shaped cavity in the right apical zone, with an oval-shaped mass within it (figure 1). The mass was separated from the wall of the cavity by a crescent-shaped airspace; it is known as an ‘air crescent sign’.1 This finding is typical of aspergilloma, but is also found in pulmonary tuberculosis, hydatid cyst, pulmonary abscess, bronchogenic carcinoma and Pneumocystis carinii …

Biliary ascariasis: radiological clue to diagnosis.

Ascariasis is caused by Ascaris lumbricoides. It is the most common helminthic infection seen worldwide. Ascariasis is an endemic disease in our country. This is due to the prevailing poor sanitary conditions and low level of education. Biliary ascariasis is an uncommon cause of obstructive jaundice. We report a case of biliary ascariasis in a young labourer who presented with acute abdominal pain.

“Difficult to Flush Chemoport: An Important Clinical Sign”

A central venous access device is an intravenous device whose internal tip lies in a large central vein. Chemoport is a central venous device which serves various purposes in oncology practice apart from optimum delivery of chemotherapy. Various early and late complications have been frequently reported with the use of these devices. Fracture-embolization of the port catheter is an uncommon but life-threatening complication. Timely recognition and management is important to minimize the morbidity and mortality.

Hypercalcaemia of malignancy: two primaries in the same patient.

Hypercalcaemia of malignancy (HCM) is a grave emergency in a cancer patient. Metastatic breast cancer and multiple myeloma are two of its important causes. Moreover, breast cancer is a predisposing factor for secondary malignancy, multiple myeloma being one of them. We report an interesting case of HCM in which we labelled the first two admissions to metastatic breast cancer. However, on third admission again for HCM, we diagnosed a coexisting multiple myeloma. As early diagnosis is the crux to decrease morbidity and prolong survival in HCM, this case emphasises the fact that more than one malignant cause can exist in the same patient.

Metronidazole-induced fixed drug eruption

A 67-year-old man presented with a history of an itchy, erythematous oval lesion over the right calf (figure 1). He was prescribed metronidazole for dysentery 1 day earlier. He mentioned history of a similar eruptive lesion in the same location, after he was prescribed metronidazole for an episode of diarrhoea about 4 months previously. At that time, the lesion appeared after 3 days of treatment. It was itchy and it healed after stopping the drug leaving a residual hyperpigmentation. Hence, we suspected it to be fixed drug eruption (FDE) due to metronidazole. As oral challenge test is risky and patch test is not available in our clinic, we assessed a causal relation between the drug and the adverse drug reaction (ADR) using Naranjo et al …

Virchow's node

A 57-year-old man presented to us with epigastric pain, decreased appetite, weight loss (8 kg) for 2 months prior to presentation. He noted a lump on the left side of the neck for 15 days. He was a chronic smoker, smoking two packs of bidi per day for about 20 years. On examination, he had a 3.5×4 cm, firm, non-tender lump in the left supraclavicular region between the two heads of the sterno-cleidomastoid muscle, that is, Virchows node (figure 1 …

Terlipressin induced ischaemia of skin

A 47-year-old man presented to the emergency department with haematemesis and melaena for 1 day. He had a 15 year history of heavy alcohol consumption. On examination, he was icteric; spider naevi were seen and ascites was present. Prothrombin time (test) was 16 s against a control of 13.5 s. The platelet count was within normal range. Oesophago-gastro-duodenoscopy was suggestive of actively bleeding oesophageal varices. He was started on terlipressin therapy 1 mg six times a day. On the third day of therapy he developed cold extremities, …

Craniovertebral junction tuberculosis

A 26-year-old woman presented with occipital and upper neck pain, left upper limb weakness and a lump on the left side of the neck for 3 months, followed by weakness in the other three limbs for last 1 month. She was bedridden for 15 days prior to admission. On examination, she had left-sided torticollis: left-sided, multiple, matted cervical and axillary lymphadenopathy. A fluctuant swelling of size 4×3 cm was present in the left upper part of the neck. Neurological examination revealed left-sided lower motor neuron type of 12th cranial nerve palsy, asymmetric spastic quadriparesis more marked on the left, hyper-reflexia, bilateral Babinskis signs, hypoesthesia below C3 dermatome. Higher mental functions, the rest …