Hakim Irfan Showkat

Hydatid lung cyst in a 5-year-old boy presenting with prolonged fever

Cystic echinococcosis is the larval cystic stage (echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally. Pulmonary hydatid cysts are typical, involving one lobe in 72% of cases, usually at the lung base. In the paediatric age group, boys are affected more commonly than girls. We present a case of isolated hydatid cyst of the lung in a 5-year-old boy from a nomadic cattle-rearing tribe.

Duodenal Perforation with an Unusual Presentation: A Case Report

A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation.

Hyponatremia in Postoperative Patients

Object: This study was done to evaluate the adverse effect of hyponatremia in post-operative patients, the clinical spectrum of complications and comparative study of these complications between the elderly patients (age > 50 years) and relatively young patients (age <50 years). Methods: The present’s study of clinical co-relation of hyponatremia in post-operative patients was carried out in 60 patients. The patients were taken from Department of Surgery. Patients were randomly selected and divided into two groups on the basis of age. Group 1, 50 years of age. All selected patients were asked for detailed history of illness and a complete physical and systemic examination was done. All baseline and other relevant investigation were done for confirmation of diagnosis and as pre-operative work up. Serum sodium and potassium was checked in all patients pre-operatively and only serum sodium was checked 24 hours and 48 hours post-operatively. Results: Significant number of patients post operatively developed hyponatremia (30%) and complications (30%) related to hyponatremia ranging from headache, nausea to altered sensorium. (p<0.05, statistically significant). The number of patients who developed post-operative hyponatremia as well as complications of hyponatremia was observed more in the patients who were more than 50 years of age (39.3%). Post-operative hyponatremia and related complications was observed more in patients who were having abdominal pathology like peritonitis and abdominal trauma, (33.3%) which was not statistically significant. Patients who were operated under general anesthesia (72.2%) developed more hyponatremia as compared to patients who were operated under local anesthesia or regional anesthesia (27.8%), which was statistically significant. Conclusion: We conclude that post- operative hyponatremia is not an uncommon post-operative complication and its progression to severe neurological manifestations like seizures, coma and eventual death can be prevented by anticipating hyponatremia in high risk patients, not confusing early manifestations with normal post-operative sequelae and treating hyponatremia as earlier as its symptoms appear.

Leksell Gamma Knife : An Effective Non Invasive Treatment for Rare Case of Nelson’s Syndrome

Nelson’s syndrome nowadays a rare entity results from an adrenocorticotropin (ACTH)–secreting pituitary adenoma in patients with refractory Cushings disease after a therapeutic bilateral adrenal gland removal. We report a case of 25 year old female with cushing’s disease who was initially managed with medical treatment, but in view of severe persistent hyper cortisol state was subjected to bilateral adrenalectomy following which she developed Nelson’s syndrome after a gap of six years, which was difficult to diagnose because of limited investigations available. Patient was managed with stereotactic radiosurgery (gamma knife surgery).

Pneumomediastinum, pneumorachis, subcutaneous emphysema: An unusual complication of leukemia in a child

Pneumorrhachis (PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.

Human born with a tail: A case report

Context. The dorsal cutaneous appendage, or so-called human tail, is often considered to be a cutaneous marker of underlying occult spinal dysraphism. Human tails have always elicited curiosity. A unique case of human dysraphism is described. Case report. An interesting case of a child with a tail-like caudal appendage that had been present since birth is reported. Surgical excision of a pseudo-tail was done together with repair of a meningocele. Conclusion. Before any form of treatment for a caudal appendage is undertaken, the patient must be evaluated carefully in case it coexists with a lesion of the intraspinal component.