Majid Mushtaque

Atypical Localizations of Hydatid Disease: Experience from a Single Institute

Introduction: The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepatico-pulmonary hydatid cysts are rare and only a few sporadic cases have been reported. Materials and Methods: Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7%) patients had isolated involvement of the atypical sites, while six (2.4%) also had a primary involvement of liver. Results: The cysts were present in gall bladder (0.4%), peritoneum (1.6%), spleen (1.6%), ovary (0.4%), subcutaneous (0.8%), seminal vesicle (0.4%), spinal (0.4%), pancreas (0.4%), kidney (0.4%), mediastinal (0.4%), muscle (0.4%), and brain (0.8%). Discussion and Conclusions: Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

Outcome of bilateral ureteroscopic retrieval of stones in a single session

Aim: Evaluation of bilateral ureteroscopic retrieval of stones as a single-stage procedure in terms of clearance of the stones, complications of the procedure and duration of hospital stay. A successful outcome was considered when both ureters were free of stones without any major complications. Materials and Methods: A total of 60 patients with bilateral ureteric stones were treated ureteroscopically from March 2006 to September 2009 in the department of Surgery (Urology unit). Majority of the patients were in their third and fourth decade of life with 38 males and 22 females. A single session bilateral ureteroscopic retrieval of stones was done using a 7.8 Fr semirigid ureteroscope. A 0.038-inch guide wire was used and advanced under direct vision, and monitored by C-arm X-ray image intensifier. Balloon dilatation of the intramural ureters was required in 82 renal units. The stones were either extracted directly or disintegrated into small pieces by lithotripsy (pneumatic) before extraction. Ureteric stenting was required in 39 patients. Patients were followed for a period of 3-12 months. Results: A total of 60 patients (120 renal units) with bilateral ureteric stones were treated ureteroscopically. The stone size in the treated patients was in the range 6-20 mm. The stones were radio-opaque in 47 patients and radiolucent in 13 patients. Single stone was present in all except two patients. Operative time ranged between 40 and 120 minutes. Stones were completely removed in 51 (85%) patients following single-session procedure of which 39 (76.4%) were stonefree intraoperatively and another 12 (23.5%) were cleared of the stones in 4 weeks follow-up. Six patients were stonefree unilaterally. Failed procedures were managed with repeated ureteroscopy, DJ stenting and ESWL or open ureterolithotomy. Intraoperatively false passage or minor ureteric perforations were seen in six patients. Postoperative complications included abdominal pain in 10, persistent fever in 4 and hematuria in 2 patients. No long-term complications were observed. Most of the patients were discharged in 2 days. Conclusion: Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. The results are comparable to unilateral or staged bilateral procedures.

Giant Intrapulmonary Teratoma: A Rare Case

Teratomas are tumors composed of tissues derived from more than one germ cell line. Pulmonary teratomas are rare and commonly involve the upper lobe of the left lung. Criteria for pulmonary origin are the exclusion of a gonadal or other extragonadal primary site and origin entirely within the lung. We report a case of a giant pulmonary teratoma in a 2-year-old male child and review the relevant literature.

Pellet gunfire injuries among agitated mobs in Kashmir

BACKGROUND Pellet gunfire injuries inflicted while controlling agitated mobs has been studied. METHODS A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes. RESULTS 72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed. CONCLUSION While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.:

Tubercular mastitis – A rare presentation

Breast Tuberculosis is a rare form of tuberculosis even in tuberculosis endemic countries like India and its identity is often mistaken with breast cancer and pyogenic breast abscess. A 22-year-old married female, with history of child birth one month back, lactating, presented at peripheral hospital with progressively increasing pain and redness in the upper outer and central portion of her right breast. She was diagnosed as breast abscess and incisional drainage of abscess was carried out. However, patients symptoms progressed and an ulcer began to appear on upper outer quadrant of her right breast which rapidly progressed to involve almost whole breast destroying nipple-areola complex. She was referred to our institution for further management. Debridement of the lesion was carried out and tissue sent for histopathological examination which revealed chronic granulomatous inflammation with caseating necrosis. Patient was put on anti-tubercular treatment for a period of six months. The whole ulcer healed up and she is doing well at present.

Papillary carcinoma thyroid with metastasis to ectopic cervical thymus

Papillary carcinoma of thyroid is the most common type of thyroid neoplasm which is usually confined to the thyroid and tends to metastasize to regional lymph nodes. Distant metastasis occur in up to 15% of cases. Thymic metastasis from any malignant carcinoma is extremely rare with only four cases reported in medical literature. We report a case of papillary carcinoma of thyroid metastasizing to ectopic cervical thymus which has not been previously reported.

Pre‑operative staging of rectal cancer using multi‑detector row computed tomography with multiplanar reformations: Single center experience

BACKGROUND Technical advancement in imaging has helped to stage and plan treatment modality for carcinoma rectum with still some objectives controversial. AIMS The aim of our study was to evaluate the accuracy of multidetector row computed tomography (MDCT) with multiplanar reformations in the pre-operative staging of rectal carcinoma and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to the depth of tumor invasion (T-staging), lymph node metastasis (N-staging) and mesorectal fascia (MRF) involvement. MATERIALS AND METHODS The study was a prospective one and consisted of 52 patients with biopsy proved rectal carcinoma. MDCT studies were performed on a 64-slice computed tomography system. Images were reconstructed in axial, coronal and sagittal planes. MDCT findings were compared with intraoperative and pathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were assessed. RESULTS The diagnostic accuracy of MDCT for T1/T2, T3 and T4 lesions was 77%, 86.5% and 100%, respectively. For perirectal lymph node metastasis (N+), the diagnostic accuracy of MDCT was 84.1%. The diagnostic accuracy of MDCT for MRF involvement was 91%. CONCLUSION MDCT is a reliable radiological tool for local staging of rectal cancer with excellent accuracy rates for T and N-staging of rectal cancer.

Primary isolated echinococcal cyst of the seminal vesicle: A rare case.

Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography (abdominal and trans-rectal), and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole (10 mg/kg/day) for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

Spontaneous hemo-pneumothorax in a patient with Ehlers–Danlos syndrome

Spontaneous hemo-pneumothorax is one of the pulmonary complications of connective tissue disorders such as Ehlers–Danlos syndrome (EDS). Most thoracic surgeons overlook this fact and they consider it as primary. In the following report, we describe a unique case of spontaneous recurrent hemo-pneumothorax in a young patient with undiagnosed EDS. The aim of this presentation is to raise a high index of suspicion of every thoracic surgeon to include in his differential diagnosis, the connective tissue disorders in any case of spontaneous hemo-pneumothorax.

Giant calculus formation after migration of an intrauterine device into the urinary bladder

A foreign body in the urinary bladder acting as a nidus for calculus formation is an uncommon occurrence. Calculi have been reported to form over sutures, drains, stents, staples, needles, pieces of catheter, hair pins, and candle pieces [1]. In addition, intrauterine devices (IUDs) maymigrate to the urinary bladder, leading to calculus formation [2,3]. A 60-year-old woman (gravida 6, para 6—all normal vaginal deliveries), who was 15 years postmenopausal, presented to the Sheri-Kashmir Institute ofMedical Sciences, Kashmir, India, with suprapubic pain, having been unable to pass urine for 8 hours. She had last given birth 20 years earlier and an IUD had been inserted 6 months subsequently. On initial examination, the woman had suprapubic tenderness and a full bladder. Vaginal examination was normal. Catheterization was attempted in the emergency room but was not successful. The woman underwent pelvic ultrasound, which revealed a large urinary bladder calculus obstructing the outflowof urine. An X-ray of the kidney, ureter, and bladder region indicated a large calculus containing an IUD (Fig. 1). An introducer, which displaced the calculus, was used to aid catheterization. When asked, the woman revealed that she had had an IUD inserted by a trained Dai (midwife) 20 years earlier, and had forgotten about it after her menopause. She had a history of recurrent urinary tract infections and vaginal discharge requiring frequent treatment, and had repeatedly been prescribed antibiotics and urinary alkalinizers; however, she had no history of urinary incontinence or hematuria. The woman underwent open cystolithotomy under spinal anesthesia. A calculusmeasuring 8×4×4 cmwas stuck to the posterior bladder wall; itwas freedusingfinger dissectionand extracted togetherwith the IUD. The bladder wall was examined for defects and none was found. The bladder was closed in layers and an indwelling catheter was inserted. The postoperative period was uneventful and the woman was discharged; the catheter was removed 7 days postoperatively.