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   2014| April-June  | Volume 3 | Issue 2  
    Online since June 20, 2014

 
 
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ORIGINAL ARTICLES
Ultrasonographic study of anatomical characteristics of internal jugular vein in relation to common carotid artery
Saya Raghavendra Prasad, Jarad Sudheer Kumar, Chennareddy Kailashnath Reddy, Matam Uma Maheshwar
April-June 2014, 3(2):97-101
DOI:10.4103/2277-8632.134847  
Context: Cannulation of internal jugular vein (IJV) by using the anatomical landmarks is associated with a significant complication rate of up to 15%. Aim: The aim of our study was to determine the anatomical characteristics of IJV in relation to common carotid artery (CCA) using ultrasonography (USG). Materials and Methods: This prospective observational study was carried out in a tertiary care teaching hospital. A total of 120 healthy volunteers aged between 20 and 60 years were enrolled in our study. The subjects were placed in the supine position with 15° trendelenberg tilt and neck rotated 30° to the contralateral side. Ultrasound probe was placed at the apex of the clavicle-sternocleidomastoid triangle. Location of IJV was recorded as lateral, anterolateral, anterior, anteromedial, medial and posterolateral, posteromedial and posterior. Diameter and depth of IJV was recorded. Any position other than lateral and anterolateral was defined as dangerous position. Maximum diameter of IJV ≤7 mm was defined as small sized. Statistical Analysis Used: Data was analyzed using GraphPad prism software 6.03 (GraphPad software, Inc. USA). P < 0.05 was considered to be significant. Results: The most common position of IJV in relation to CCA was anterolateral; 81.66% on the right side and 78.33% on the left side. Dangerous position of IJV was found in 13.33% on the right side and 15% on the left side. Mean transverse diameter of IJV was 13.2 (3.1) mm on the right side and 10.4 (2.9) mm on the left side of neck (P < 0.0001). Small sized IJV was found in 1.6% on the right side and 4.16% on the left side. Conclusion: Due to the anatomical variations found in a significant number of the population, we recommend using USG for IJV cannulation.
  2 4,329 380
CASE REPORTS
Rare gingival odontoma: Report of a case and review of literature
Anila Koneru, M Vanishree, R Surekha, A Hamsini, Santosh Hunasgi
April-June 2014, 3(2):133-135
DOI:10.4103/2277-8632.134889  
Peripheral odontogenic tumors are rare with mostly single case reports or a small series of case reports. Odontoma is the most common central odontogenic tumor, but odontomas arising in the extra-osseous soft-tissue, also known as peripheral odontoma (PO), are extremely uncommon. To the best of our knowledge, very few cases of POs have been previously reported. Here, we report an additional case of PO occurring in the gingiva with review of literature on clinical features. A 15-year-old male patient complained of two tiny, asymptomatic, white masses in the left upper labial gingiva. On gross examination, specimens were oval in shape, measuring 0.3 cm, white in color and hard to firm in consistency with a smooth surface. Hematoxylin and eosin stained decalcified sections revealed enamel matrix and dentinal tubules in cross-section with entrapped core of pulpal tissue. All tissues were arranged in a disorganized pattern. A final diagnosis of peripheral complex odontoma of gingiva was given. Clinical features of previously reported cases, together with the current case were reviewed. Features of this interesting odontogenic entity add to our knowledge and are of special relevance to pediatric health-care providers, since PO of gingival origin usually occurs in young children.
  1 1,552 204
An interesting case report of ulcerated proliferating pilar tumor (PPT) mimicking squamous cell carcinoma
Ramesh Uppada, Sudhasmita Rout, Neelima Bora, Ramalakshmi VB Pullela
April-June 2014, 3(2):111-113
DOI:10.4103/2277-8632.134858  
Proliferating pilar tumor (PPT) is a rare neoplasm arising from the isthmus of the outer root sheath of the hair follicle, commonly called a proliferating trichilemmal cyst. It is described as a well-circumscribed dermal or subcutaneous neoplasm with squamoid cytologic features and trichilemmal type of keratinization. PPTs most commonly occur on the scalp during the 4 th -8 th decades of life with distinct predilection for women. They typically undergo slow but progressive enlargement over several months to years, yielding lobulated and exophytic masses that occasionally ulcerate mimicking squamous cell carcinoma both grossly and microscopically; posing a diagnostic challenge to young surgeons, dermatologists, and pathologists. Here we report an interesting case of an ulcerated PPT which was diagnosed cytologically as benign adnexal tumor and confirmed histopathologically as benign PPT. Ulcerated PPT is an important differential diagnosis of ulcerated scalp swellings and needs to be differentiated from squamous cell carcinoma.
  1 2,676 206
Alkaptonuria with review of literature
Onteddu Joji Reddy, Jamkhana Abdul Gafoor, Balla Suresh, Polysetty Obuleswar Prasad
April-June 2014, 3(2):125-129
DOI:10.4103/2277-8632.134884  
Alkaptonuria, a metabolic disorder characterized by a triad of homogentisic aciduria, arthritis, and ochronosis is one of the first conditions in the group of inborn errors of metabolism proposed to have Mendelian recessive inheritance. It is due to the deficiency of the enzyme homogentisic acid (HGA) oxidase which catalyzes the conversion of HGA to maleylacetoacetic acid in the catabolism of tyrosine. HGA thus accumulates in cells and body fluids and its oxidized polymers bind to collagen, leading to progressive deposition of grey to bluish black pigment resulting in degenerative changes in cartilage, intervertebral disc, and other connective tissues, leading to arthritis which is the only disabling effect in an affected older individual. However, the diagnosis can be made in neonates when blackish stain is noticed in an unwashed diaper. In this report we describe a 46-year-old male patient who presented with typical features of alkaptonuria.
  1 4,782 310
Pedunculated osteoma; a rarity
B Rajsekhar, Ramisetty Sabitha Devi, S Balamurugan, Ninad J Moon
April-June 2014, 3(2):130-132
DOI:10.4103/2277-8632.134888  
Osteomas are benign tumors that consist of mature, compact, or cancellous bone. Osteomas that arise on the surface of bone are referred to as periosteal osteomas; whereas, those that develop centrally within bone are endosteal osteomas. Osteomas are rare benign tumors of bone commonly occurring in the maxillofacial skeleton. Most jaw osteomas occur in young adults and are generally asymptomatic, sessile, and solitary lesions. There is seldom any pain associated with this tumor. We herewith report a case of pedunculated osteoma arising from angle of mandible in an elderly lady.
  - 1,502 173
Late ileocutaneous fistula due to onlay mesh fixation after incisional hernia repair
Varun Raju Thirumalagiri, Ramakrishna Satwalekar, Ramachandra Polisetti, Tokala Hemachandra
April-June 2014, 3(2):107-110
DOI:10.4103/2277-8632.134851  
It is a well-known established fact about the low recurrence rate after mesh repair as compared with anatomical repair of the incisional hernia. Hernioplasty with polypropylene onlay fixation is now widely popular all over the world and being practiced routinely in many centers. This is a case of ileocutaneous fistula that occurred lately due to a stitch (polypropylene) gone through the underlying small bowel wall at the time of previous onlay mesh repair after a long postoperative gap. Although many techniques were described (open and laparoscopic) for the mesh fixation to the abdominal wall, in cases of gross obesity with thinned out abdominal musculature, extreme care must be taken to fix the mesh to the anterior abdominal wall for prevention of rare delayed postoperative complications. Different techniques are discussed to prevent the above said complication.
  - 2,128 189
Focal palmoplantar keratoderma with mutilating arthropathy: An interesting case report
Bendapudi Venkata Ramachandra, Krishna PV Rao, V Hithyshi, Lakshmi S Jhansi
April-June 2014, 3(2):114-117
DOI:10.4103/2277-8632.134860  
Vohwinkel syndrome, characterized classically by a triad of diffuse honeycomb hyperkeratosis of palms and soles; star-shaped hyperkeratosis on the dorsa of hands, feet, knees, and elbows; and pseudoainhum is a rare type of hereditary form of palmoplantar keratoderma (PPK) which can present as two classical variants: Deafness associated variant and ichthyosis associated variant. Here we report a rare variant of hereditary PPK in a 22-year-old male patient presenting as focal PPK with striate hyperkeratosis on elbows and knees and mutilating arthropathy in addition to deafness and prognathism, the diagnosis being supported by histopathology, X-rays, and genetic mapping showing connexin defect. There are umpteen numbers of genetically inherited PPK syndromes associated with closely mimicking cutaneous features, autoamputation, and a wide range of systemic manifestations, where the differentiation of specific entities is always a difficult task. The present case is probably the first of its kind being reported from India.
  - 2,361 170
Rosai dorfman syndrome with extranodal presentation
Garimella Venkateshwara Rao, Gummadi Purnima, Gayathri Devi Bakuru, Divya Lakshminarayan, Pavani Garnpudi
April-June 2014, 3(2):118-121
DOI:10.4103/2277-8632.134862  
Rosai-Dorfman disease (RDD) also known as sinus histiocytosis with massive lymphadenopathy is a rare idiopathic and non-neoplastic disorder of histiocytes, resembling the sinus histiocytes of lymph nodes. The most common presentation of RDD is painless cervical lymphadenopathy in a young patient. The typical clinical features of this disease include bilateral painless lymphadenopathy, fever, and polyclonal hyperglobulinemia. However, in about 25% of cases there is no lymph node involvement and the disease presents as a mass in skin, soft-tissue, nasal cavity, eye, bone, or in other extranodal sites (extranodal type). The condition may present with extranodal involvement in 43% of cases, and cutaneous lesions are the most common form of extranodal disease. This can pose a diagnostic challenge if RDD is not considered in differential diagnoses. Isolated extranodal RDD is relatively uncommon. We report this rare case of extranodal RDD in a 32-year-old female who presented with erythematous tender subcutaneous plaques on lower extremities with left periorbital swelling. Histopathological examination demonstrated lymphophagocytosis (emperipolesis) consistent with a diagnosis of RDD.
  - 1,950 182
Spinal actinomycosis
Chennamaneni Vikas
April-June 2014, 3(2):122-124
DOI:10.4103/2277-8632.134882  
Actinomycosis is a subacute to chronic bacterial infection caused by Actinomyces species. Most common form of actinomycosis is cervicofacial type. We report a rare case of spinal actinomycosis with subcutaneous abscesses illustrated by magnetic resonance imaging and computed tomography findings.
  - 2,185 186
Management of bimaxillary dento alveolar protrusion with lingual appliance
Anilkumar Katta, Navaneet Krishnan Kurunji Kumaran, Adusumilli Sai Prakash, Revathi Peddu
April-June 2014, 3(2):136-139
DOI:10.4103/2277-8632.134891  
Adult orthodontics in today's contemporary world is focused mainly on esthetics. Lingual orthodontics has evolved as an adjunct while exploring esthetics. Assuring esthetics and functional balance is the current concept of invisible orthodontics. It is almost as successful as labial orthodontics and has good three-dimensional control over the dentition. As the brackets are placed near to the center of resistance of the tooth, anchorage value is higher in lingual orthodontics than labial orthodontics. With the appliance in mouth, the patient overcomes the social barriers of appearing in public and augments his own level of confidence. Proper knowledge on biomechanics ensures success with lingual appliance. The following case report presents the usage of lingual technique in closing generalized spaces by following proper biomechanics in achieving ideal occlusion and thus enhancing esthetics.
  - 2,712 296
LETTERS TO THE EDITOR
Retrograde jejunogastric intussusception: Review of two cases
Haricharan Perigela, Kotireddy Maramreddy, Varaprasad Bangi, Sivaraj Nagabhushigari
April-June 2014, 3(2):140-142
DOI:10.4103/2277-8632.134894  
  - 1,265 114
Congenital myasthenic syndrome: A common disease; in rare age group
Nagarjunakonda Venkata Sundarachari, Amalakanti Sridhar, Blessy Manohar
April-June 2014, 3(2):142-143
DOI:10.4103/2277-8632.134897  
  - 896 107
Foreign body granuloma mimicking a soft-tissue tumor
Hari Charan Perigela, Koti Reddy, Vara Prasad Bangi, Narahari Janjala
April-June 2014, 3(2):143-145
DOI:10.4103/2277-8632.134899  
  - 2,884 224
Oral mucormycosis: Need for early diagnosis!!
Sridhar Gontu Reddy, Kiran K Kumar, Chandhra P Sekhar, Ramana B. V. Reddy
April-June 2014, 3(2):145-147
DOI:10.4103/2277-8632.134900  
  - 1,413 182
ORIGINAL ARTICLES
Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: A three year study at tertiary center
Atul Shrivastav, Harsh A Shah, Neeru M Agarwal, Pravina M Santwani, Geetika Srivastava
April-June 2014, 3(2):86-91
DOI:10.4103/2277-8632.134834  
Background: Lymphadenopathy is a common presenting symptom in various diseases. Objective: The present study was undertaken to evaluate the usefulness of fine-needle aspiration cytology (FNAC) as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies. Materials and Methods: The present study was conducted in the department of pathology, Shri M.P. Shah Medical College, Jamnagar from June 2008 to July 2011. FNAC of the enlarged lymph nodes was performed with informed consent of the patient. Totally 1022 patients of lymphadenopathy who underwent FNAC were divided into three groups: Group I (0-20 years), Group II (21-50 years) and Group III (>51 years). Results: Maximum number of patients with lymphadenopathy was in Group II: 502 (49.11%), followed by Group I: 378 (36.98%) and in Group III there were 142 (13.90%) cases. Most common causes of lymphadenopathy in different groups were found to be: In Group I: Reactive hyperplasia 198 cases (52.38%), Group II: Tubercular lymphadenitis 232 cases (46.21%) and Group III: Metastatic carcinoma 80 cases (56.33%). Conclusion: It was concluded that different etiological factors play a role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy.
  - 4,141 533
Why do medical students under-perform? A cross-sectional study from Kempe Gowda Institute of Medical Sciences, Bangalore
Chitra Nagaraj, BS Pradeep
April-June 2014, 3(2):92-96
DOI:10.4103/2277-8632.134841  
Context: Globally, it is an accepted fact that training to become a medical professional is rigorous and needs a lot of hard work. In Kempe Gowda Institute of Medical Sciences, Bangalore on an average 15-25% of each year's student intake have difficulty in completing the medical course in the prescribed duration of 4½ years. There are many factors which influence the academic performance of the students. Identification of these factors could help to establish a support system to help the students to improve their academic performance. Objective: This study was designed with the objective of evaluating the factors affecting the academic performance of medical students. Materials and Methods: This cross-sectional study included all currently enrolled and willing undergraduate students and interns. A general information questionnaire and the Denis Congo Study Skills Inventory were used to collect data. Secondary data on each student's/interns marks were collected using the University marks sheet. Statistical analysis was carried out using STATA- Intercooled version 10.1 for windows (Stata Corp, Texas, USA). Results: A total of 205 girls and 162 boys provided complete information. Univariate (odds ratio = 1.06, 95% confidence interval [CI]: 1.00-1.13) and multivariate (adjusted odds ratio = 1.09, 95% CI: 1.02-1.16) analysis revealed that note taking skills was significantly associated with good performance. Every unit increase in note taking skills increased the odds of success by 9%. Conclusion: This study has identified poor study skills, note taking in particular to be a statistically significant cause for poor academic performance.
  - 2,073 292
Comparison and evaluation of tensile bond strength of two soft liners to the denture base resin with different surface textures: An in vitro study
Kuncha Venu Gopal, Brahma Josyula Indira Padmaja, Nagam Raja Reddy, Budigi Madan Mohan Reddy, Nagumalla Suresh Babu, Motupalli Sunil
April-June 2014, 3(2):102-106
DOI:10.4103/2277-8632.134850  
Introduction: Debonding of soft liners from the denture results in localized unhygienic conditions and often causes functional failure of the prosthesis. Aims: The purpose of this study is to evaluate and compare of the bond strength of the two permanent soft denture liners to a denture base resin with different surface preparations. Subjects and Methods: All the specimens were prepared by stainless steel dies which are duplicated and wax patterns were fabricated, which are then flasked and dewaxed. Heat cure denture base resin was mixed and trial packed into the mold. The specimens are recovered and divided into four sub-groups based on the surface to be prepared. The soft denture lining material, Super-soft (G.C. America Inc., USA) and Molloplast-B (Detax Gmbh and Co., KG, Germany) was packed and cured in between the two specimens. All the specimens were subjected to tension, until failure, in a Universal Testing Machine. Statistical Analysis Used: Analysis of variance using a Fischer's F test, unpaired t-test. Results: The tensile bond strengths of the four groups of both the soft liners were found to be very highly significant. The comparison between each group was made using a student's unpaired t-test for equality of means. It was found that when statistical analysis was made for Super-soft between group I and group II, group I and group IV the results were not significant whereas between group I and group III, group II and group III were strongly significant. The statistical analyses of the four groups of Molloplast-B soft liners were found to be very highly significant. Conclusions: Under the conditions of this in vitro study, conclusions were, sand papering the surface of the heat polymerized denture base resin increased the bond strength of the soft liner. Preparing holes on the surface of the denture base resin increases the bond strength because increase in the surface area and mechanical inter locking. Super-soft denture liner had the highest bond strength on all the surfaces than Molloplast-B.
  - 2,824 408
REVIEW ARTICLES
Congenital brain anomalies: Neuroimaging findings
Thangjam Gautam Singh, Vaibhav Srivastav, Pooja Singhania, Shital Mala Devi
April-June 2014, 3(2):77-85
DOI:10.4103/2277-8632.134827  
Congenital brain anomalies are rare among the congenital anomalies of various organ systems. It is important to diagnose these conditions at the earliest due to its far reaching neurological deficit and detrimental outcome. Most of the congenital brain anomalies can be reliably diagnose by neuroimaging (computed tomography or magnetic resonance imaging) of brain. Radiologist and treating physician should be aware of various specific imaging appearances and unique signs of these anomalies to avoid delay in diagnosis and thereby further treatment. A widely accepted classification of brain anomalies with each representative radiological image are illustrated with its distinctive findings.
  - 9,048 1,145
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