Rizwan Ahmad Khan

Children with significant cervical lymphadenopathy: clinicopathological analysis and role of fine-needle aspiration in Indian setup

OBJECTIVE To study the clinicopathological profile of children from India with cervical lymphadenopathy and the role of fine-needle aspiration cytology with special emphasis on tuberculosis as a cause. METHODS A total of 89 children in the age group of 10 months to 12 years, presenting to our hospital from April 2004 to March 2005, were included. All the patients underwent thorough clinical and investigational assessment vis-à-vis cervical lymphadenopathy. Outcome measurements included clinical status and ability of conventional tests to categorize different types of lymphadenopathy and their utility in diagnosing tubercular lymphadenitis. Interobserver variability was analyzed measuring kappa test and was found to be in agreement. RESULTS Reactive hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen staining, histopathology and culture in combination were able to perform the diagnosis in 85.7% of cases affected with tubercular etiology. CONCLUSIONS Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is non-diagnostic.

Reliability analysis of TLP tethers under impulsive loading

In the present study, reliability assessment of Tension Leg Platform (TLP) tethers against maximum tension (i.e. tension exceeding yield) has been carried out under combined action of extreme wave and impulsive forces. For this purpose, a nonlinear dynamic analysis of TLP has been carried out in time domain. A limit state function for maximum tension (i.e. tension exceeding yield) has been derived employing Von-Mises theory of failure. Using this derived limit state function and responses obtained after dynamic analysis under sinusoidal, half-triangular and triangular impulsive forces, reliability assessment of the TLP tethers has been carried out. Design point, important for probabilistic design of tethers, has been located on the failure surface after solving a constrained optimization problem. To study the influence of various random variables on tether reliability, sensitivity analysis has been carried out. Effects of angle of impact; effect of variable submergence; and effect of material yield strength on tether reliability have also been studied on parametric basis. Effect of uncertainty on overall tether reliability has also been discussed to show the importance of quality control in the various design parameters.

Macrodystrophia lipomatosa: four case reports

AimMacrodystrophia lipomatosa is a rare cause of gigantism of limb which can be confused with other common causes like congenital lymphedema. It presents usually with loss of function and cosmetic problems. Four cases are described with emphasis on clinical presentation, differential diagnoses, imaging and treatment options.Methods & ResultsFour patients of macrodystrophia lipomatosa were thoroughly examined and subjected to investigations.ConclusionBesides diligent clinical examination, imaging and histopathology are crucial in clinching the diagnosis.

Left-sided strangulated Amyand’s hernia presenting as testicular torsion in an infant

The finding of an appendix in the hernial sac is termed Amyand’s hernia. There have been a few reports of perforated appendix in the hernial sac (right-sided) mimicking testicular torsion. We report an extremely rare case of a left-sided inguinal hernial containing sac containing perforated appendix which was never thought of in the preoperative assessment.

Isolated retroperitoneal hydatid cyst in a child: a rare cause of acute scrotal swelling?

Hydatidosis affects almost every region of the body. Although adults are mostly affected, children also suffer from the disease especially in endemic areas. The usual affected location is the liver, lung, spleen, brain, and kidney. We report a hydatid cyst located in a retroperitoneal location presenting with a sudden scrotal extension in a 7-year-old child. The finding presented a diagnostic dilemma vis-à-vis obstructed inguinal hernia.

Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning

OBJECTIVE To evaluate the role of cranial sonography and computed tomography in the diagnosis of neonatal intracranial hemorrhage and hypoxic-ischemic injury in an Indian set-up. METHODS The study included 100 neonates who underwent cranial sonography and computed tomography (CT) in the first month of life for suspected intracranial ischemia and hemorrhage. Two observers rated the images for possible intracranial lesions and a kappa statistic for interobserver agreement was calculated. RESULTS There was no significant difference in the kappa values of CT and ultrasonography (USG) for the diagnosis of germinal matrix hemorrhage/intraventricular hemorrhage (GMH/IVH) and periventricular leucomalacia (PVL) and both showed good interobserver agreement. USG, however detected more cases of GMH/IVH (24 cases) and PVL (19) cases than CT (22 cases and 16 cases of IVH and PVL, respectively). CT had significantly better interobserver agreement for the diagnosis of hypoxic ischemic injury (HII) in term infants and also detected more cases (33) as compared to USG (18). CT also detected 6 cases of extraaxial hemorrhages as compared to 1 detected by USG. CONCLUSION USG is better modality for imaging preterm neonates with suspected IVH or PVL. However, USG is unreliable in the imaging of term newborns with suspected HII where CT or magnetic resonance image scan is a better modality.

The Role of MRI in the Management of Cases of Mayer-Rokitansky- Kuster-Hauser (MRKH) Syndrome

Mayer- Rokitansky- Kuster- Hauser (MRKH) syndrome is a rare entity characterized by congenital aplasia of the uterus and the upper part of 2/3rd of vagina in normal karyotype females with normal development of secondary sexual characteristics. The incidence rate is about 1 in every 4500 females. We report a case series of three different patients who presented with different clinical picture to various outpatient departments of our hospital. Magnetic Resonance Imaging of the pelvis was done in all these patients.

Congenital rectovestibular fistula associated with rectal atresia: A rare occurrence

We report a rare variety of anorectal malformation, rectal atresia associated with rectovestibular fistula. The case was successfully treated by posterior sagittal repair. The fistula was mobilized and the continuity of the rectum was established by circumferential anastomosis.

Nonlinear dynamic and bilinear fatigue reliability analyses of marine risers in deep offshore fields

ABSTRACT Depleting oil reserves in shallow water are opening the avenues of new ventures in deep sea conditions. India is no exception; deep sea explorations are highly recommended and exercised. As part of the design process, there are requirements of structural failure criteria, such as rupture by over loading, fatigue failures, buckling or an unstable fracture. Three-dimensional nonlinear dynamic analysis of riser is obtained in time domain using finite-element solver ABAQUS/Aqua. The response histories so obtained are employed for the study of fatigue reliability assessment of risers. Fatigue model is based on a bilinear relationship that gives the crack growth linked failure criterion to describe the interaction between fracture and plastic collapse. Uncertainty modelling, especially fatigue crack growth parameters, is undertaken with the help of recently published data in support of bilinear crack growth relationship. Results pertaining to fatigue reliability and fatigue crack size evolution are presented using Monte Carlo simulation. The bilinear crack growth model is found to lead to higher fatigue life estimation as compared to linear fracture mechanics model. Sensitivity behaviour pertinent to limit state adopted has been thoroughly investigated. These findings implicate inspection schemes for components of the marine structures to ensure minimisation of the surprises due to wide scatter of the fatigue phenomenon in marine environment.

Neonatal Intestinal Obstruction: When to Suspect Duplication Cyst of Bowel as the Cause

Background: Duplication cyst is a rare cause of neonatal intestinal obstruction. Their most common location is the small intestine. The clinical presentation is extremely variable depending upon its size, location and type and the age of the patient and are mainly encountered during infancy or early childhood. The diagnosis is very difficult in neonates. This study was undertaken to study their presentation, diagnostic modality of choice and further management in neonatal age group. Materials and Methods: This was a retrospective study performed at the Department of Paediatric Surgery, J .N Medical College Hospital, AMU Aligarh from July 2008 to June 2014. The data was analyzed with respect to demographic profile of the neonates, their initial clinical presentation, radiological features and subsequent event leading to intervention, operative features and outcome. Results: There were a total of seven neonates between ages of 3 days and 21 days who were diagnosed as cases of intestinal obstruction due to duplication cyst. The majority of the patients were having ileal duplication cyst (n=4). Ultrasonography played important role in majority of the cases for diagnosis. There was one patient in which the diagnosis was confused with ileal atresia. All the patients underwent excision with restoration of bowel continuity. Conclusion: The diagnosis of intestinal obstruction in neonate due to duplication cyst is difficult. It has varied presentation and preoperative diagnosis at times may be challenging. Surgery is the mainstay of the treatment.