Cleidocranial dysplasia: Radiological mimic of pyknodysostosis – A case report

Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disorder with predominant membranous bone involvement. It may also occur as a sporadic mutation. The diagnosis of this condition is based on the clinical, radiological and genetic findings. It is characterised by hypoplasia or aplasia of the lateral thirds of the clavicles; craniofacial and dental anomalies; and hypoplastic iliac bones. Pyknodysostosis is a close radiological mimic of this entity. Definite diagnosis is based on the genetic analysis. A 36-year-old short-statured female was referred for computed tomography of the paranasal regions for complaints of a deviated nasal septum and midline depression in her forehead. Skeletal screening demonstrated an open metopic suture, wormian bones, maxillary hypoplasia, maldentition and aplastic lateral thirds of both clavicles. In this article, we report a case of CCD, discuss various overlapping features between CCD and pyknodysostosis and attempt to differentiate them radiologically

Successful Early Non-Operative Management of Congenital Knee Dislocation: Demonstration via a Case Report

Congenital knee dislocation (CKD) is a deformity in which unnatural hyperextension is possible at the knee much beyond the normal 0° full extension while the flexion is severely restricted. Incidence of this rare congenital malformation is 1/100,000 live births. We present a clinical case of unilateral CKD in a 2-week-old female child and our approach of treatment using serial casting. We have been able to demonstrate that if initiated early, within first few weeks of life, the congenital deformity of knee can be managed conservatively without any surgical intervention even in higher grades

RETROSPECTIVE MULTICENTRIC STUDY ON THE POST-SURGERY SYMPTOMATIC AND OBJECTIVE IMPROVEMENT OF BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objectives: To evaluate patients of benign prostatic hyperplasia (BPH) preoperatively and identify those who would benefit from surgery, to evaluate outcome of surgery for BPH with respect to symptomatic and objective improvement of patients, and to compare the results of different surgeries for BPH being done different hospitals at Bhopal, which included transurethral resection of the prostate (TURP), transurethral incision of prostate (TUIP)/bladder neck incision (BNI), and Freyer’s prostatectomy? Methods: The present study was carried out at different hospitals of Bhopal. Patients presenting to the surgery outpatient department with symptoms of obstruction, namely, weak urinary stream, frequency hesitancy, intermittency, urgency, nocturia, etc., were included in the study. Some of the subjects included were patients presenting during emergency timings with complaints of retention of urine or occasionally other symptoms. The American Urological Association (AUA) Symptom Index questionnaire was administered to all such patients. They were also evaluated by ultrasound examination and patients having BPH on ultrasound (USG) were further evaluated by uroflowmetry. Results: Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship. Both maximum and average urinary flow rates (Q max and Qav) were improved by all the three surgeries However, TURP and Freyer’s prostatectomy showed greater improvement as compared to TUIP/BNI. Combination of AUA scoring, USG, and uroflowmetry helped us document improvement in our BPH patients and compared it favorably with other studies. Conclusion: Uroflowmetry was a simple assessment tool easy to learn and use. It was also inexpensive and formed a useful extension to clinical examination providing objective evidence of obstruction. It also helped to indirectly quantity the severity of obstruction. Symptom severity did not correlate with prostate size. Small prostates caused symptoms in the severe range also while even large prostates sometimes caused little symptoms. Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship

Unusual Renal Tumors — Report of Four Cases

Collecting duct carcinoma, plasmocytoma and malignant fibrous histocytoma are rare but aggressive tumors of the kidneys. We present four cases we have recently encountered in our practice. In most of the cases imaging did not help in the pre-operative diagnosis. Surgery is the mainstay of treatment when recognized early. Clinician should be aware about these rare varieties of renal tumors whose prognoses may be worse than that of renal cell carcinoma. The Annals of African Surgery, Volume 6, 201

Is thoracic facet joint arthritis over-reported? It’s time to review CT grading parameters - An analytical cross-sectional study

Background: In the absence of any exclusive classification for dorsal FJA, there is a lot of confusion while labelling grade 1 FJA in thoracic spine based on decreased FJ space. Purpose: The purpose of this study was to know the facet joint space measurements in thoracic spine of asymptomatic and symptomatic participants and to comment whether the lower cut-off of 2 mm used in lumbar FJA classification can be safely applied in thoracic spine too. Materials and Methods: This cross-sectional study was done from December 1, 2018 to November 30, 2019. Patients above 18 years of age in this study who underwent CT thorax for causes unrelated to dorsal spinal pain were included. IBM SPSS Statistics v 26 was used for statistical analysis. Results: We measured and analysed 1512 thoracic facet joints in 63 patients (30 females and 33 males) in both axial and sagittal plane on CT scan. Mean age of the entire sample was 59.19 ± 15.19 years, ranging from 33 to 97 years and a standard error of mean 1.365 years. Overall mean thoracic facet joint space was measured to be 1.270 mm ± 0.3416 mm, ranging from 0 to 3.1 mm and a standard error of mean 0.0088 mm and a variance of 0.117 mm. The median was 1.300 mm while mode was 1.1 mm. Conclusion: The popular lumbar FJA classification by Weishupt et al. cannot be applied in its present form in thoracic spine, without the modification in parameters of grade 1 FJA. The lower cut-off of normal thoracic facet joint space probably lies around 1 mm. MeSH Terms: Zygapophyseal joints, dorsal, thoracic, facet joint, arthritis, classificatio

A study of paediatric percutaneous nephrolithotomy in a tertiary care center

Aims: To evaluate the technique of Paediatric Percutaneous Nephrolithotomy in terms of safety, outcome and efficacy in age group 1 to 14 years. Material & Methods: The observational study was done from October 2011 to October 2014 in Chirayu Medical College Bhopal. 25 cases of renal stone in paediatric age group were admitted in our hospital and evaluated for size of the stone, number of stones, associated congenital anomalies and complications. PCNL was done by standard technique. Results: A total number of 25 children were operated. Sex distribution in our study was male 15 and female 10, most of the patients were of age group 10-14 years 15(60%). Most of the children15(60%) had large stones >2cm stones and small stone was seen in 6(24%) cases. Malrotated kidney having stone was seen in 8(32%) cases. Complications as fever and haematuria was observed in 1 (4%) case. The maximum sheath size used inchildren was 24 F. Out of 25 children, only one patient required blood transfusion. Conclusion: Paediatric PCNL is safe procedure in expert and experienced hands. Minimal invasive procedures are beneficial in paediatric age group because of longer life expectancy andmore riskof recurrence

Synchronous primary cancers of urinary bladder and kidney and prostate

Synchronous occurrence of two or more than two primary cancers of the urinary tract is quite rare, and poses a difficult treatment challenge. Here, we present a case of syn-chronous renal cell carcinoma, transitional cell carcinoma of urinary bladder and adenocarcinoma of prostate diagnosed within a short period. To the best of our knowledge, this is the first case reported from India and the youngest patient reported in the literature having this combination of urinary cancers

Fixation of an ipsilateral bicondylar Hoffa's fracture via medial para patellar approach using multiple screws - A case report

Background: An ipsilateral bicondylar Hoffa's fracture having the simultaneous involvement of both the medial and the lateral femoral condyle on the same side is very rare. Choosing a surgical approach with limited access to fix Hoffa's fracture may lead to a non-anatomical reduction, ultimately ending up with sub-optimal results like malunion, non-union, knee stiffness, and early osteoarthritis. Case report: We herein discuss the successful management of an ipsilateral bicondylar Hoffa's fracture having a metaphyseal spike in a 37-year-old male with AP screws via the Medial Para Patellar approach (MPPA). We limited the fixation to only two 6.5 mm screws with washers through each condyle to minimize the damage to the intra-osseous blood supply. An apical screw was used instead of adding a plate posteriorly to minimize the iatrogenic damage to the extra-osseous blood supply of the condyles. The whole procedure was done without a tourniquet. The entry point of all the screws was from an extra-articular area anteriorly so there was no need to countersink the screw heads. The benefit of MPPA is that if arthroplasty of the knee is ever required, it can be performed through the original incision without damaging the skin's vascularity. Conclusion: Computed Tomography (CT) scan is indispensable for the exact fracture characterization of Hoffa's fracture, planning of surgical approach, and screw trajectory. In our experience, the medial parapatellar approach is dependable to deal with such fractures and provides adequate exposure for fracture fixation even if it is accompanied by a metaphyseal spike