Sanjeev Sharma

Complete androgen insensitivity syndrome with microtia: a rare presentation

Complete androgen insensitivity syndrome (CAIS) is a rare X-linked disorder characterized by a female body habitus and male genotype. The Müllerian duct derivatives are absent or rudimentary, and the testes are undescended. Microtia is characterized by a malformed auricle; and in some cases it is genetically transmitted with a non-sex-linked inheritance pattern. The presence of CAIS with microtia has not been documented previously, and this is the first case to describe the radiological findings of this rare presentation.

Fungal Infection in Thermal Burns: A Prospective Study in a Tertiary Care Centre

INTRODUCTION Burn Wound Infection (BWI) is primarily caused by aerobic bacteria followed by fungi, anaerobes and viruses. There has been a worldwide decrease in incidence of bacterial infections in burns due to better patient care and availability of effective antibiotics. Consequently, the fungal burn wound infection has shown an increasing trend. AIM The aim of study was to assess the frequency of fungal infections in thermal burn wounds with respect to age of wounds, total body surface involved, depth of burns and to assess common fungal pathogens. MATERIALS AND METHODS The study was conducted on 50 patients admitted with thermal burn wounds having 20-60% burns in the surgical unit. Pus swab and scrapings were taken under local anaesthesia from each burn patient. Scrapings were put in a sterile container and sent to Mycology section of Microbiology department and were examined by direct microscopy and culture studies on Sabourauds Dextrose Agar medium in the Mycology section of Microbiology department. RESULTS In our study, the incidence of fungal infection in burn wound patients came out to be 26%. The incidence of fungal infection increased with increase in Total Body Surface Area, (TBSA) increase in depth and age of burn. In our study, the maximum positive fungal cultures were seen in the third week of post-burn period. No positive culture was seen in the first week and 30.76% positive fugal cultures were seen in second post-burn week. Candida albicans was found to be the most common organism followed by Non-albicans Candida and Aspergillus. CONCLUSION It was concluded from the study that incidence of fungal infections in thermal burns increased with increase in post-burn period and with increasing depth and TBSA of burns. Candida albicans was found to be the most common fungus.

Intercostal muscle flap for repair of bronchopleural fistula

A 50-year-old male patient, a known case of chronic obstructive pulmonary disease (COPD), presented with the features of bronchopleural fistula (BPF) on the right side for 1 month. The patient was a chronic smoker and did not give any history suggestive of pulmonary Koch′s. The patient had sudden-onset breathlessness and chest pain 1 month before, which was diagnosed to be due to spontaneous pneumothorax. An intercostal drain was inserted but even after 1 month of all conservative measures, the lung remained collapsed and there was large air leak in the intercostal drain. Computed tomogram (CT) of the chest revealed collapsed and entrapped lung with surgical emphysema of the subcutaneous tissues due to rupture of the emphysematous bulla on the right side along with the presence of emphysematous bullae on the left upper lobe also. Surgical intervention in the form of decortication of entrapped lung and repair of the BPF with intercostal muscle flap was performed. The patient recovered well and was discharged after 10 days.

Rare case of paratesticular rhabdomyosarcoma

Extremities are the usual site of involvement in Rhabdomyosarcomas whereas paratesticular rhabdomyosarcoma is an extremely rare, which is known to be an aggressive variety of paratesticular tumors occurring in first and second decades of life. They usually develop from the tunica, epididymis or the spermatic cord. Precise preoperative diagnosis is seldom established. It can be mistaken as epididymitis, scrotal abscess, hydrocele, testicular tumors, tuberculosis of testis and strangulated or obstructed inguinal hernia, as in our case. Multidisciplinary approach is needed for the management and disease localized to the scrotum has a favorable outcome.

Adenoid type of basal cell carcinoma presenting like a sebaceous cyst: A case report

Introduction: basal cell carcinoma (bcc) is the most common skin cancer seen mostly in the sun exposed parts of the body like over face, head & neck, nose, eyelids but the presence at covered areas is not uncommon. Adenoid type of bcc is the rare form with a very low malignant potential. surgery is the recommended treatment modality. case report: We present a case of 38-year-year old female who presented with a small lesion looking like a sebaceous cyst near the medial epicanthus of the eye. It was excised and proved to be adenoid type of basal cell carcinoma. the patient underwent complete excision and forehead rotation flap was taken to cover the defect. conclusion: Although the basal cell carcinoma is a non-melanocytic skin cancer; adenoid type of bcc is a rare histopathological variant which can morphologically present as pigmented nodule without any site predilection.

Transthoracic Repair of Paraesophageal Diaphragmatic Hernia Presenting with Symptoms Mimicking Cardiac Disease (Chest Pain and Breathlessness)

We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery.

Ilio-popliteal redo bypass extending below knee using composite graft in a case of obstructed femoro-popliteal bypass with rest pain and impending gangrene

There are few reports in literature [1]on use of ilio-popliteal redo bypass extending below knee in the management of Peripheral Vascular Disease(PVD), though ilio-femoral bypass[2] has been reported more frequently. Common procedures done in cases of PVD are femoro-popliteal bypass in above knee or below knee positions using saphenous vein or prosthetic grafts, femoro-femoral bypass, aorto-bifemoral bypass and axillo-bifemoral bypass. Use of composite graft comprising of Polytetrafluoroethylene (PTFE) and great saphenous vein is also not common. Most of the literature is either on use of prosthetic grafts, Dacron or PTFE [3–5] and autologous saphenous vein. There are lot of studies comparing the use of prosthetic grafts with autologous vein grafts[6,7]however there are few studies on the use of composite grafts[8,9]. Results of bypass grafting are better in the above knee positions as compared to below knee positions and that using saphenous vein are better than that of PTFE. Endovascular stenting is increasingly being used in the management of peripheral vascular diseases because of shorter hospital stay, less invasive approach, cosmetically better results and comparable early to midterm patency rates compared to conventional procedures[10]. Case report

New technique for tunneling of reversed saphenous vein graft to prevent kinking and twisting during vascular bypass procedures

We describe a new, simple technique for tunneling of reversed saphenous vein graft to prevent its kinking and twisting thereby avoiding early graft failure during peripheral vascular bypass procedures. The technique is based on the principle of a temporary rigid tube outside acting as tunnel for the delicate, compressible reversed saphenous vein grafts in getting the proper lie without twists and kinks.