Postthrombotic Syndrome: Surgical Possibilities

Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves

Genitourinary Hydatid Disease

Genitourinary echinococcosis is an uncommon cyclo-zoonotic disease. It is caused by Echinococcus species. Kidneys are the common target organs in the genitourinary tract. Clinical presentation is usually non-specific. Pre-operative diagnosis requires a high index of suspicion. It should be considered in differential diagnosis of cystic mass of genitourinary tract, especially in endemic regions. Computed tomography, ultrasonography, and antibody testing aid in diagnosing and classifying the stage of the cyst. Although a number of operative techniques have been described, complete removal of germinal layer with daughter cysts without spillage of viable cyst contents with perioperative medical therapy provides an optimum chance of cure with minimal morbidity. Considering the benign nature of the disease, organ preservation is feasible in majority of the cases. The conventional open surgical treatment has evolved into minimally invasive laparoscopic, endoscopic, and even robotic techniques with concomitant improvement in postoperative and cosmetic outcome. Given the rarity of the disease, no randomized control trial comparing the treatment modalities for genitourinary hydatid exists. Moreover, long-term follow up in many cases is unavailable. Overall, the incidence of local and systemic recurrence is low

Unusual Presentations of Adrenal Masses

With the advancement in imaging technology and pathological evaluation, several unusual adrenal gland lesions have been identified over the years. Presently, the literature consists of case reports or small case series without a comprehensive review on these uncommon adrenal pathologies. The current chapter discusses the epidemiology, pathogenesis, pathology, imaging features and management principles of uncommonly reported infectious and neoplastic adrenal masses

Coverage-based Example Selection for In-Context Learning

In-context learning (ICL), the ability of large language models to perform novel tasks by conditioning on a prompt with a few task examples, requires demonstrations that are informative about the test instance. The standard approach of independently selecting the most similar examples selects redundant demonstrations while overlooking important information. This work proposes a framework for assessing the informativeness of demonstrations based on their coverage of salient aspects (e.g., reasoning patterns) of the test input. Using this framework, we show that contextual token embeddings effectively capture these salient aspects, and their recall measured using BERTScore-Recall (BSR) yields a reliable measure of informativeness. Further, we extend recall metrics like BSR to propose their set versions to find maximally informative sets of demonstrations. On 6 complex compositional generation tasks and 7 diverse LLMs, we show that Set-BSR outperforms the standard similarity-based approach by up to 16% on average and, despite being learning-free, often surpasses methods that leverage task or LLM-specific training

Structurally Diverse Sampling for Sample-Efficient Training and Comprehensive Evaluation

A growing body of research has demonstrated the inability of NLP models to generalize compositionally and has tried to alleviate it through specialized architectures, training schemes, and data augmentation, among other approaches. In this work, we study a different approach: training on instances with diverse structures. We propose a model-agnostic algorithm for subsampling such sets of instances from a labeled instance pool with structured outputs. Evaluating on both compositional template splits and traditional IID splits of 5 semantic parsing datasets of varying complexity, we show that structurally diverse training using our algorithm leads to comparable or better generalization than prior algorithms in 9 out of 10 dataset-split type pairs. In general, we find structural diversity to consistently improve sample efficiency compared to random train sets. Moreover, we show that structurally diverse sampling yields comprehensive test sets that are a lot more challenging than IID test sets. Finally, we provide two explanations for improved generalization from diverse train sets: 1) improved coverage of output substructures, and 2) a reduction in spurious correlations between these substructures.Comment: Accepted at Findings of EMNLP 202

CLINICO-CYTOLOGICAL AND HISTOPATHOLOGICAL CORRELATION OF LYMPHADENOPATHY IN PEDIATRIC PATIENTS

Objective: The aim of the present study was to evaluate the cytomorphological and histopathological (wherever possible) patterns of lymph node (LN) lesions along with clinical correlation in the pediatric population. Methods: This was a prospective study conducted on 100 pediatric patients (aged <12 years) who presented with lymphadenopathy (LAP). Fine-needle aspiration cytology (FNAC) was performed on all cases out of which only 22 underwent surgical excision and histopathological examination. Aspirated material was stained with May-Grunwald Giemsa, Papanicolaou, Z-N stain (wherever required) and for histopathology, Hematoxylin and eosin stain was used. Results: Majority number of patients was in the age group of 5–8 years (44%). Cervical LN s were most commonly involved (71%). Out of the total 100 cases, 91% were benign, 3% were malignant and 6% were inadequate. Most common cytologically diagnosed entity was non-specific reactive lymphadenitis (68%). There was one case of reactive lymphadenitis on cytology that proved to be Hodgkin lymphoma on histopathology. Two cases of generalized LAP given as atypical lymphoproliferative lesion on cytopathology proved to be acute lymphoblastic leukemia/lymphoma on further investigation. The cytomorphological findings were found to be concordant with histopathology in 21 cases out of 22 with a diagnostic accuracy rate of 95.45%. Conclusion: FNAC is especially helpful as LN biopsy is a difficult and invasive procedure in children. Although excision biopsy is the gold standard, FNAC is preferred as first-line investigation. Along with cell block analysis and ancillary techniques, it provides an excellent diagnostic accuracy

FATAL PROGNOSIS OF H1N1 INFLUENZA IN LATE TRIMESTER OF PREGNANCY: DESCRIPTIVE ANALYSIS OF FOUR CASES

Influenza infection in late trimester associated with complications is attributable risk factors for critical illness among pregnant women. We have analyzed the medical records of four pregnant women retrospectively who were admitted in a medical intensive care unit of tertiary care center with influenza-like symptoms of breathlessness, fever, headache, myalgia and cough. Their mean age was 26.5 (19-30). They were confirmed to have H1N1infection by real-time reverse transcriptase polymerase chain reaction assay. Chest x-ray of all patients showed abnormalities like pulmonary edema and suggestive of acute respiratory distress syndrome. Arterial blood gas analysis of all four patients shown severe hypoxia and all of them was mechanically ventilated. Oseltemivir was started for all four from the day of admission. Pipracillin-tazobactum combination along with other antibiotics was given as prophylaxis and treatment of different infections. Midazolam and morphine were given together to reduce the restlessness and ventilator-associated distress. Furosemide was given to all for breathing problems and pulmonary edema. Despite of all the management provided none of the patients survived due to the progression of H1N1 into septic shock and multiple organs dysfunction syndromes.Â

Robot-assisted “Santosh-Post Graduate Institute tubularized flap pyelovesicostomy” in a solitary functioning kidney with giant hydronephrosis: A minimally invasive salvage procedure

We describe a case of a solitary functioning kidney with giant hydronephrosis secondary to ureteropelvic junction obstruction in a young girl who underwent successful robot-assisted tubularized flap pyelovesicostomy. The aim of this report was to highlight the feasibility and efficacy of this technique in salvaging such renal moieties and to present a brief review of the surgical options available for the management of giant hydronephrosis