Pulmonary artery catheter knotting in a coronary artery bypass surgery patient

A fifty seven years old female patient came to operating room for coronary artery bypass grafting (CABG) surgery. After induction, invasive monitoring lines were placed. Pulmonary artery catheter (PAC) floated after three attempts and it was wedged at 60cm. Intra operative course was smooth and patient transferred to cardiac intensive care unit (CICU). First chest X-ray revealed PAC knotting in the right ventricle. Vascular surgeon was involved and he removed it through right internal jugular vein under fluoroscopic guidance. Pulmonary arterial catheterization is an invasive procedure. Knotting usually occurs due to excessive advancement of the pulmonary artery catheter beyond the normally expected distance. The removal of a catheter should never be forced when resistance is encountered. PA catheter knotting is a rare complication but it should be suspected whenever there is excessive length of catheter required to reach pulmonary artery

A Study of Cervical Pap Smears in central India: a city based study

Introduction: The most common cancer of women in our country is cervical cancer (24/100,000) followed by breast cancer (21/100,000). Some inflammatory lesions like Trichomonas and Human papiloma virus are forerunners of malignancy underlining the importance of diagnosing these conditions early. Methods: The material for the present study comprised of examination of 500 cervical/vaginal smears taken from patients attending OPD. Papanicolaou staining was used for staining. Cases were reported according to The Bathesda System. Result: In the present study low grade squamous intraepithelial lesion were found in 35 cases (7%). High grade squamous intraepithelial lesion was found in 25 cases (5%). Invasive carcinoma cervix was found in 7 cases (1.4%). Atypical epithelial cells of uncertain significance were found in 65 cases, of which 50 cases were reported as ASCUS and 15 cases were reported as AGCUS. In the present study significant number of patients with history of early age at marriage (34 cases) and first child before 18 years of age (37 cases) presented with squamous intraepithelial lesions (LSIL + HSIL). Carcinoma cervix was found to be correlated with early age of marriage and first child birth before 18 years of age. Conclusion: Cervical cancer can be detected at a very early stage by simple technique of exfoliative cytology. Early stage detection is important because early stage is 100% curable, reducing the morbidity and mortality from invasive cancer cervix

Syringoma of the Palate-A Rare Presentation

Syringoma is a benign adenexal neoplasm formed by well differentiated ductal elements. They are tumors of eccrine origin commonly found over upper part of cheek, lower eyelid, axilla, chest, abdomen, penis and vulva. A 40 year male reported in the OPD with an asymptomatic swelling over the hard palate for the past 15 year. The tumor was excised and sent for histopathological examination. Histological examination showed clusters of eccrine ducts lined by doubled layer epithelial cells. Lumen showed keratinous accellular eosinophillic material suggestive of Syringoma. The case of Syringoma is being reported for its unusual presentation over the palate suggesting it should be considered in the differential diagnosis of various swelling of the palat

Analysis of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, in patients with alcoholic liver disease (ALD) and alcoholic chronic pancreatitis (ACP)

Introduction: Cystic fibrosis (CF) is an autosomal recessive disorder affecting multiple organs. A defective CFTR gene leads to inadequate transport of Cl ions between intra- and extracellular environment of cells in affected organs. Susceptibility to alcoholic chronic pancreatitis (ACP) could be genetically determined. Mutations in cystic fibrosis transmembrane conductance regulator (CFTR) genes have been variably associated with both hereditary and idiopathic form of chronic pancreatitis (CP). Our aim was to analyze these genes in ACP patients. Mutational screening was performed in 05 unrelated ACP patients and 05 patients with alcoholic liver disease (ALD). Method: Patients with ACP and ALD, were admitted in Bundelkhand Medical College hospital, Sagar, and enrolled for genetic analysis. Genomic DNA was extracted from whole blood according to the established protocols using the DNA Isolation Kit for Mammalian blood (Genei Bangalore). Results: Mutation analysis of CFTR was performed in all ACP and ALD patients. In three ACP patients, ΔF508 mutation was detected in heterozygous state with a prevalence rate of 8.88%. R117 H was another mutation detected in ACP patients in heterozygous state. Conclusion: Present study was performed to determine whether patients with ACP and ALD had mutations in the CFTR gene and to explore whether non coding sequences that produce low levels of CFTR mRNA (the 5T allele) was responsible for above mentioned abnormalities. Our hypothesis was that the pancreatic damage due to high alcohol intake could be due to abnormal allele or a combination of multiple mutations occurring in the two alleles in CFTR gene

An unusual case of a very large Ameloblastic fibroma

Ameloblastic fibroma is usually seen in children and teenagers. It is a rare mixed odontogenic tumor; it is found predominantly in children and therefore is an important diagnostic consideration. A female patient of age 13 years reported to the hospital with complaint of mass in her mouth since two years. The microscopic examination revealed strands and buds of ameloblastic epithelium embedded in cellular neoplastic fibrous stroma suggesting of ameloblastic fibroma. The case of ameloblastic fibroma is being reported for its unusual presentation which involved two third of mandible. The high recurrence rate of the tumor emphasizes the need of early diagnosis; adequate excision and a long term follow up

Study of the clinical and cytological spectrum of Granulomatous Mastitis: A Retrospective Study in Bundelkhand Medical College Sagar MP

Background: Granulomatous mastitis (GM) is a benign condition, and therefore its early diagnosis is essential to avoid invasive surgery. The fine needle aspiration cytological (FNAC) features of GM have rarely been discussed in the literature.Aims and objectives: To study the various clinical and cytological presentations of GM and its differentiation from neoplastic lesions of the breast, thus avoiding time-consuming histopathological workup of cases.Materials and methods: Fifty-two cases of GM diagnosed on FNAC were studied between 2017 to 2021 retrospectively. The patient history, clinical findings, and the cytology slides of all the cases were retrieved and studied. Patient details including age, sex, presenting symptoms, obstetrics and lactational history, relevant past medical history, and treatment history were collected. The radiological diagnoses when present were also recorded. The patient's age, sex, history of recent childbirth or lactation, duration of symptoms, laterality of lump,nature of lump whether well-defined or diffuse, presence of discharging sinus,presence or absence of nipple retraction, and axillary lymph nodes were noted and analyzed. Cytological findings include the presence of epithelioid cells, as granulomas or in singles, multinucleated giant cells and their morphology, necrosis, caseous and non-caseous, and type of background inflammation of neutrophils, lymphocytes, and macrophages were also studied from the cytology slides.Results: All patients with GM except one were females (98.08%) with a mean age of 38 years. The majority had left side lump (69.23%) and the size of lump <5 cm (88.46%). 48 (92.3%) patients had a palpable lump, and 8 (15.38%) had axillary lymphadenopathy. In USG, 28.85% had an abscess, 21.15% had irregular hypoechoic mass, and 15.38% had increased vascularity. On fine needle aspiration, blood mixed aspirate was obtained in 65.38% cases, whereas in 34.62% cases, pus was aspirated. On cytological smears, 30.77% of patients showed the presence of ill-formed granulomas, one case had scattered epithelioid histiocytes, and the rest of the cases had well-formed granulomas. Multinucleated giant cells, containing nuclei ranging from 5 to 8, were present in 2 (3.85%) cases, 27 (51.92%) cases also had a predominance of neutrophils among other inflammatory cells forming microabscesses, and 8 (15.38%) cases showed the presence of benign ductal cells of the breast.Conclusion: The common clinical findings include a positive history of recent childbirth or lactation along with results of the firm to hard unilateral palpable lump associated with skinulceration, sinus formation with or without discharge, nipple eversion, or retraction with any associated axillary lymphadenopathy. Epithelioid histiocytes, singly scattered or present as granulomas, multinucleated giant cells along with the background of caseationnecrosis, or neutrophils present in the background are the common cytological features. However, a confident diagnosis requires a multidisciplinary approach based on microbiological investigations, radiological correlation, and histopathological confirmation

Comparative study of Oral Nutritional Supplements vs Intralesional Triamcinolone and Hyaluronidase in Oral Submucous Fibrosis

Introduction: Oral submucous fibrosis (OSMF) is a common premalignant condition found in Indian subcontinent caused by chewing arecanut, betel quid and gutkha with tobacco. A standard treatment to manage this condition is not yet available. The various modalities of treatment are nutritional oral antioxidants, intralesional injections, and surgical removal of bands. We compared the efficacy of intraoral administration of vitamin B combined with lycopene with intralesional triamcinolone acetonide combined with hyaluronidase and oral vitamin B complex with lycopene. Methods: 80 patients suffering from OSMF diagnosed clinically were treated in Bundlekhand Medical College Sagar for 4 months. The patients were divided into two groups randomly. Group A patients received oral administration of vitamin B complex, lycopene and topical triamcinolone for 4 months. Group B received weekly intralesional injections of triamcinolone combined with hyaluronidase for 8 weeks along with vitamin B complex, lycopene and topical triamcinolone for 4 months. Treatment outcome was evaluated on the basis of improvement in mouth opening, decrease in burning sensation and healing of ulceration. Result: Group B patients receiving intralesional injections of triamcinolone and hyaluronidase along with nutritional supplements showed improvement in degree of trismus as well as burning sensation and ulceration as compared to Group A receiving only nutritional supplements. Conclusion: Intralesional injection of triamcinolone combined with hyaluronidase with oral antioxidants is more effective in treating the patients with OSMF than antioxidants alone. No side effects were seen in both the groups though some patients complained of pain during administration of injection