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   Table of Contents - Current issue
May-June 2021
Volume 54 | Issue 3
Page Nos. 79-117

Online since Saturday, June 12, 2021

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Effectiveness of fine needle aspiration cytology versus excisional biopsy in cervical lymphadenopathy p. 79
Anoop Vasudevan Pillai, Riju Ramachandran, Pallavi Vijay Borkar, Renjitha Bhaskaran
Background: Cervical lymphadenopathy is a common cause of referral to the surgery department. In low-resource countries, fine-needle aspiration cytology (FNAC) has been advocated as an alternative to more expensive surgical excision biopsies. Although FNAC is a simple and effective procedure in many conditions, its sensitivity and specificity still remains a question. The primary aim of our study was to evaluate the sensitivity and specificity of FNAC of head-and-neck lymph nodes using histopathology as the gold standard. Methods: All patients clinically diagnosed with cervical lymphadenopathy were included in the study, and they underwent FNAC followed by surgical excision and histopathology. The results were tabulated and analyzed using IBM SPSS V.20.0 software. To test the statistical significance between benign and malignant groups, Chi-square test was used, and the difference in FNAC and histopathology were analyzed using McNemar's test. Results: The mean age group in our study of 86 patients was 45.20 ± 18.20 years with equal sex distribution. Among 23 male patients with age above 45 years, 15 patients (65.2%) had malignancy in the lymph node. Level V lymph nodes were most commonly involved (n = 31 [36%]), of which 13 were diagnosed as malignancy and 10 as tuberculosis (TB). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of FNAC in comparison to histopathology for diagnosis of malignancy were found to be 79.4%, 98.1%, 96.4%, and 87.9%, respectively, and for TB was 77.8%, 87.5%, 87.5%, and 77.8%, respectively. Conclusion: FNAC of head-and-neck lymph nodes has comparable sensitivity and specificity with histopathological examination. It has a very high (96.4%) PPV in detecting malignancy and 100% for detecting metastatic disease in cervical lymph nodes. In patients with suspected lymphoproliferative disorder and in patients above 45 years of age, open biopsy is recommended. For younger patients and in level V cervical lymphadenopathy, irrespective of age, FNAC should be the first invasive diagnostic tool of choice.
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Functional outcome of type 13 C2 distal humerus fractures treated with precontoured locking plates p. 85
SV Gowtam, Ravindra B Gunaki
Background: Distal humerus fractures pose the most challenging task in treatment, which can lead to poor functional outcomes. Anatomic reduction and internal fixation, along with early mobilization, are predicted to improve the functional outcomes. To evaluate the functional outcome, rate of malunion, and intercondylar fixation of distal humerus fractures treated with anatomically precontoured locking plates. Methods: Thirty patients of either sex admitted with type 13 C2 distal humerus fractures, were included in this prospective study. All patients underwent open reduction and internal fixation with anatomically precontoured locking plates and screws using the modified triceps tongue flap approach. Postoperatively, patients were followed up for 6 months. During follow-up, they were evaluated clinically, radiologically, and functionally by mayo elbow performance score (MEPS). The results were analyzed using Chi-square test. Results: A majority of the injuries were seen in males (66.7% vs. 33.3%). The mean age was 36.9 ± 14.7 years. The common mode of injury was through road traffic accident (66.7%). The right upper limb (76.7%) was the most common side involved. The overall excellent/good scores, according to the MEPS, were observed in 80% of the patients. The average time taken for the radiological union at the fracture site was 10.2 ± 2.1 weeks. The mean arc of extension-flexion at 6th weeks was 32.1°–104.1° and at 6th months was 11.5°–124.2°. The complications were early superficial infection (3.3%), ulnar neuropraxia (3.3%), delayed union (3.3%), malunion (3.3%), and chronic osteomyelitis (3.3%). Conclusion: Distal humerus fractures treated with anatomically precontoured locking plates was effective in preserving the functional outcome of the elbow.
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Laboratory virtual instrument engineering workbench-based semi-automated measurement of cranial asymmetry p. 91
Jui-Ming Sun, Chih-Ta Huang, Cheng-Ta Hsieh
Background: Cranial asymmetry has been associated with the laterality of neurological diseases including chronic subdural hematoma, subdural hygroma, and stroke. Although picture archiving and communication systems (PACS) are commonly used radiologic tools, simple angle or contoured area measurement cannot accurately reflect the actual severity of cranial asymmetry. Therefore, we developed an objective semi-automated image analysis tool based on the Laboratory Virtual Instrument Engineering Workbench (LabVIEW) system and compared its efficacy and variability with those of PACS in measuring cranial asymmetry. Methods: This image analysis software was developed on the basis of the LabVIEW system. Three sizes of plastic water pipes and computed tomographic images of the brain from three patients were used for experimental and clinical validations, respectively. We compared the percent error of the calculated areas of the pipes as well as coefficient of variation (CV) and cranial index of symmetry (CIS) ratio obtained from LabVIEW and PACS. Results: Experimental validation showed the overall mean difference of actual size versus estimated size obtained using PACS and LabVIEW-based image analysis to be 7.51% and 4.68%, respectively. This result indicated that LabVIEW-based image analysis provided an estimated area closer to that of the actual size of the phantom, with significantly low inter- and intraobserver variability (P < 0.001). Clinical validation also showed lower variability in the CVs and CIS ratios of areas estimated using LabVIEW-based image analysis, ranging from 0.01% to 0.13% and from 89.2% to 99.1%, respectively. Conclusion: Our study demonstrated through experimental and clinical validation that LabVIEW-based image analysis is a convenient and effective method for investigating cranial asymmetry. This imaging tool can provide more clues in understanding cranial asymmetry.
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Postoperative outcomes of microphlebectomy and Trendelenburg operation with stripping for saphenofemoral junction incompetence p. 97
Bhuvana Lakshmi, Siddartha Gowthaman, E Elamaran, S Vinoth, M Ramanathan
Background: With more than 10 million cases occurring annually in India, varicose veins can sometimes result in severe discomfort and pain besides disfiguration of skin. The objective of the study was to assess the most viable treatment options for varicose veins between the traditional Trendelenburg procedure and microphlebectomy. Methods: This was an interventional study conducted at a tertiary center in South India. Patients above 18 years of age, presenting with varicose veins due to saphenofemoral junction (SFJ) incompetence and scheduled for surgical management, were included in a sample size of 46. Subjects were randomized into two groups – Group 1 underwent micro phlebectomy and Group 2 underwent Trendelenburg operation with stripping of great saphenous vein (GSV). Postoperative pain was assessed on day of surgery, day after, and postoperative day 7. A venous Doppler ultrasound was conducted 6 weeks after the surgical procedure, to look for reflux at SFJ. Results: Group 1 subjects reported lesser immediate postoperative pain and incurred significantly less cost as determined by an independent sample t-test. Chi-square test found no significant difference in the rate of occurrence of local complications (P > 0.05), and no recurrence was noted among both groups. Conclusion: Microphlebectomy is a more feasible treatment option than Trendelenburg operation with GSV stripping on account of lower costs. It is also a patient friendly alternative due to immediate reduction in pain.
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Lumbar spinal epidural hematoma without vertebral fracture causing cauda equina syndrome p. 103
Tsung-Mu Wu, Tien-Yu Chiang, Po-Chang Huang, Kin-Weng Wong
Spinal epidural hematoma (SEH) is a rare disease and may lead to spinal cord compression. It could be caused by trauma, including iatrogenic procedures such as spinal surgery or spinal anesthesia or by spontaneous events related to coagulopathy or arteriovenous malformation. Once SEH is suspected clinically and confirmed by image modalities, it should be emergently decompressed by surgical intervention. Prognosis depends on the rate of symptoms development, interval from symptom onset to surgery, level of spinal involvement, and degree of neurological deficits. Here, we report the case of a 79-year-old female who sustained a fall months before admission, presented with a 3-day history of back and bilateral lower limbs weakness. Radiography and magnetic resonance imaging demonstrated epidural hematomas at the level of T12 to L2 without associated vertebral fracture. An urgent decompressive laminectomy with blood clot removal was performed immediately. Postoperatively, her neurologic deficits improved significantly except for residual numbness.
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Adenomyomatosis of the gall bladder in an 8-year-old girl p. 107
Tune-Yie Shih, Wei-Yun Hsu, Hong-Lin He
Adenomyomatosis of the gall bladder (AMG), with its characteristic Rokitansky-Aschoff sinuses, is a rare disease in children, and only 13 pediatric cases have been reported in the literature. An 8-year-old girl was diagnosed in our institute with symptomatic gall bladder adenomyomatosis and received cholecystectomy with uneventful postoperative course. The pediatric AMG should be regarded as a special type of AMG with different pathophysiology and natural course from those of the adults. Thus, the surgical indications of AMG in children should be considered meticulously to avoid unnecessary cholecystectomy..
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A diagnostic challenge of invasive sellar neuroaspergillosis in an immunocompetent patient p. 111
Pranita Mohanty, Anasuya Lenka, T Govardhan, Souvagya Panigrahi
The commonest differential for sellar space occupying lesion is tumor, and clinicians would rarely consider aspergillosis at this location in an immunocompetent patient. Hence, a high index of suspicion clinically and histological confirmation are required to reach the diagnosis. Here, we report a case of such, a 28-year-old immunocompetent male presented with headache, vomiting, and diplopia for 7 days without any history of convulsion, unconsciousness or nasal symptoms. His magnetic resonance imaging and computed tomography of the brain and pituitary gland were suggestive of a primary bone tumor or pituitary macroadenoma of the sellar region. He then underwent surgery, and intraoperative squash cytology, frozen section, and fine-needle aspiration cytology of aspirated pus revealed necrotizing granulomatous lesion of fungal etiology. Postoperative histopathology and special stains (periodic acid-Schiff, Gomori methenamine silver) confirmed invasive aspergillosis, and Aspergillus flavus was isolated by pus culture. The surgery was followed by systemic voriconazole therapy, and there were no further complications.
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Retroperitoneal fetiform teratoma in an infant p. 114
Rahul Gupta, Priyanka Mittal, Arpita Jindal, Praveen Mathur, Sunil Jakhar, Anu Bhandari
Fetus in fetu is a rare intra-abdominal mass secondary to abnormal embryogenesis in a diamniotic monochorionic pregnancy. Teratoma, unlike fetus in fetu, does not show the vertebral axis or regional distribution of the organs. We report a 9-month-old male infant who presented with a large abdominal lump. The retroperitoneal mass was excised. On opening the sac, well-formed fetus-like structure was seen. The mass was connected to a yolk sac-like structure. The mass had the rudimentary head, thorax, abdomen, and finger-like buds giving a fetiform appearance but without vertebral column. Histopathological examination confirmed fetiform teratoma. The outcome was favorable.
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