Management of a Rare Pathology in Children it is Lipomyelomenengocele about Casis Report

The lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consistent with the presence of lipomatous tissue adhering to the epinetic marrow, which falls through a defect of the vertical colon with the former meninges and the marrow under posture the skin. LMMC is the cause of the most frequent congenital attache between the cadre of the syndrome of the attached cord and causes a neurological deterioration due to the compression of the medical bone and the root system which is superadded. It is therefore about a girl from 6 years ago with a swelling located in the region of Lombardy after the birth of the size of a tangerine which has increased the size gradually with age. He presented the interrogation of the signs of urinary incontinence and the fact that he confirmed that he left us to fellow therapists who sent him to us for support. The local examination of the lumbosacral region revealed a single mass without other distinctive skin signs, spherical in shape, 12 × 10 cm, soft and fixed in consistency. A medullary MRI with effect, which reveals a mass of lipomate consistency at the level of lumbosacral associated with a bone spina extending from L5 to S2. Surgical treatment was indicated as the patient had urinary problems. There were no postoperative complications and after a few months postoperative symptoms improved.

Management of labial adhesion in a developing country—an observational study

Background Labial adhesion is the fusion of the labia minora or majora. The literature reports conservative management. However, the situation may be different in our setup, where management differs due to prevailing circumstances. The present study was conducted to evaluate labial adhesion presentation, management, and outcome in our center. Methods It was a retrospective observational study from January 2015 to January 2020. The patients were evaluated for age at presentation, presenting symptoms, type of adhesions, treatment, recurrence, and follow-up. The treatment included the manual release of labial adhesion and Mupirocin ointment application for 15 days. They were advised to attend the outpatient department after 1 month for evaluation and later on in case of any problem. Results The total number of patients was 150, of which 104 (69.33%) were from rural backgrounds. The complaint was of the absent vaginal opening in all patients. Seventeen (11.33%) were advised ultrasonography of the abdomen elsewhere to look for the presence of internal genital organs. The local examination revealed poor hygiene in 65 (43.33%) patients. The patient with thick adhesions has minor erythema after the release of adhesions. Ten (6.66%) patients had a recurrence managed by repeat release with no recurrence. Conclusion Despite being a benign entity, labial adhesion may be a cause of severe concern. Manual separation and antibiotic ointment may be a viable first option in its management with minimal recurrence. Maintenance of local hygiene may be needed to prevent a recurrence. The overall outcome is excellent.

Xanthogranuloma of nose in an adult: an uncommon presentation

<p class="abstract">Xanthogranuloma is a relatively rare histiocytic cutaneous disorder that typically affects the pediatric age group. Its occurrence in adulthood is still rarer with only a handful of cases on the record. The present case report describes a case of adult-onset xanthogranuloma in a 49 years old lady who presented to the otorhinolaryngology clinic with a 6 months history of a nodule on the left side of the columella. There was no history of associated pain or bleeding from the site. Local examination revealed a 0.6×0.6 cm, non-tender, soft-to-firm, pinkish dome-shaped lesion with rounded edges. No similar lesions were found elsewhere. Excisional biopsy of the lesion was performed and microscopy showed a dermal lesion comprising of sheets of histiocytes admixed with lymphoplasmacytic infiltrate, touton giant cells and few spindle cells. A diagnosis of xanthogranuloma was rendered. A number of lympho-histiocytic lesions comes in the differential diagnosis of xanthogranuloma and hence it is important to be aware of such unusual presentations in order to make correct histological diagnosis.</p>

KEKUATAN PEMBUKTIAN PEMERIKSAAN SETEMPAT (GERECHTELIJKE PLAATSOPNEMING) DALAM PEMERIKSAAN SENGKETA PERDATA

The local examination (gerechtelijke plaatsopneming) is a medium which is provided by the laws and regulations for the judge or the judge panel to clarity a fact or object that is being disputed, in which the local examination or the trial which is conducted by the judge or the judge panel at the object’s spot where is being disputed. The local examination it self is regulated in the Article 153 HIR/Article 180 RBg and also in the circular letter of Indonesia Supreme Court (Surat Edaran Mahkamah Agung/SEMA RI) Number 7 of 2001 on The Local Examination. The local examination has a function to match the plaintiff’s postulates of private lawsuit about the dispute’s object of the private lawsuit which is area just for the land dispute, such as the surface measure, position by mentioning its details as roads, village, sub districts, and then it borders with whose properties. The matters are pointed to ease the judge or the judge panel in deciding the judge decision whether the private lawsuit could be granted or rejected, or whether the private lawsuit itself is obscuur lebel (unclear) so that it is unacceptable.

Management of Non-Healing Ulcer by the Use of Crushed Raw Papaya along with Leeching: A Case Study

The incidence of non-healing ulcer is 1-2 percent in developed countries. In Indian community its prevalence reported in year 2004 was 4.8 per 1000 populations. It may increase many folds in future because of increase in number of old persons, diabetes mellitus and vascular diseases A male patient aged 63yrs. came to surgery OPD Majeedia Unani Hospital, Jamia Hamdard, New Delhi, in October 2019, with the complain of ulcer on antero-medial aspect of right foot. The ulcer was painful and movement was limited on affected side. After required investigations and local examination of wound, treatment was started by local application of meshed papaya and combination of oral Unani drugs formulations along with leech therapy as described in texts of Unani System of Medicine. It was observed that Unani treatment of non-healing ulcer with papaya and leech therapy is an option to avoid amputation and its complications. The ulcer completely healed without any locomotor disturbances. Recovery was very fast and the condition of leg totally resolved without any complications and side effects. Keywords: Non-healing ulcer, Unani medicine, leech therapy, Qurooh-e-Aseeratul Indemal.

Meat Hook Injury Leading to Brain Abscess: A Rare Occurrence

Transorbital orbitofrontal penetrating injury by a nonmissile object is uncommon. The presentation of this injury varies. This injury can be easily missed during the initial clinical presentation, because the foreign body is sometimes not visible on local examination, the wound on the orbital skin is small, and very subtle signs are present. The patient can present with delayed complications of the primary injury. Our patient was a 33-year-old male who presented with an orbitofrontal injury with a meat hook. He had minor symptoms at the time of presentation, which were overlooked. Three weeks later, he developed signs and symptoms of raised intracranial pressure (ICP). Brain imaging revealed a peripheral rim of contrast-enhancing mass lesion in the right frontal lobe, extending into the right orbit with perilesional edema suggestive of posttraumatic brain abscess. Via right frontal craniotomy, pus was drained out and abscess wall was excised. The patient made good clinical recovery. A higher index of suspicion and sound knowledge of occult penetrating injury patterns is required in the cases of orbital injuries. Appropriate radiological imaging can lead to an earlier and accurate diagnosis, and can prevent its delayed sequela like brain abscess.

A rare case of sclerosing polycystic adenosis of parotid gland

The parotid gland tumors are classified according to their morphological and histological patterns. The most common site of presentation of a salivary neoplasm is the parotid gland. Sclerosing polycystic adenosis (SPA) is a rare disease of the salivary glands, first described by Smith et al at 1996. We report a case of 61 year gentleman admitted in KVG Medical college and hospital with complains of swelling in right side of face since 6 months. Local examination of right parotid region showed solitary swelling with ipsilateral mandibular lymphadenopathy. EBV profile was positive. CT head and neck revealed an enlarged right sided parotid gland resembling features of Pleomorphic adenoma. Fine needle aspiration of gland showed features of chronic sialo-adenitis. A provisional diagnosis of Pleomorphic Adenoma was made. Patient underwent superficial parotidectomy. Histopathology of the operated specimen had features suggestive of Sclerosing polycystic adenosis of parotid gland. Patient was followed up for a period of one year and he had no recurrence. To conclude, Sclerosing polycystic adenosis of the parotid gland is a rare benign salivary gland lesion with histologic analogies to sclerosing adenosis of the mammary gland. Complete surgical excision is the reference treatment, to reduce the risk of recurrence and/or evolution.

Frequency and Clinical Presentation of Colorectal Carcinoma among Patients with Lower Gastrointestinal Symptoms

Objective: To determine the frequency and presentation of colorectal carcinoma (CRC) among the patients presenting with lower gastrointestinal (GI) symptoms. Study Design: Observational study Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from January 2013 to February 2014. Methodology: A sample of 105 patients complaining of lower GI symptoms was selected. Data regarding the age, sex, presenting symptoms and signs, local examination and location of lesions were noted in a pre-structured proforma. Patients were examined by digital rectal examination (DRE), proctoscopy, colonoscopy; computerized tomography and biopsy. Data analyzed on SPSS 21.0 at 95% CI (P≤ 0.05). Results: Age of the patients was 53.17±14.90 years (95%CI: 51.28 to 55.05). Of 105 subjects; 65 (61.9%) were males and 40 (38.09%) were females. The CRC was observed in 11 (10.47%) patients of ≤ 40 years, 77 (73.3%) patients of 40 – 59.9 years and 17 (16.19%) cases were ≥60 years of age. Anemia 81 (77.14%), weight loss 74 (70.47%), abdominal pain 60 (57.14%), bleeding per rectum 79 (75.23%), tenesmus 55 (52.38%) and constipation 48 (45.71%) were common presenting symptoms of the CRC patients. Adenocarcinoma was found in 87 (82.85%), carcinoid tumor in 11 (10.47%), lymphoma in 5 (4.76%) and squamous cell carcinoma in 2 (1.9%). Conclusion: Colorectal adenocarcinoma was most common tumor found in males in their sixth decade of life. Anemia, weight loss, abdominal pain and bleeding per rectum were common clinical symptoms and rectum was common tumor site.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years’ experience from a single center in Turkey

Background The aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience. Methods This is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max). Results Overall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %). Conclusions The physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.

Vaginal Rhabdomyosarcoma in a patient with advanced cervical cancer; a case report and review of literature

Rhabdomyosarcoma is very rare in adults accounting for less than 5% of all soft tissue tumours and less than 1% of all malignancies. Vagina is one of the least common sites for occurrence of Rhabdomyosarcoma in the genital tract. We present a case of a 53-year-old woman who is a follow up case of cervical cancer stage IIIB, managed by radiotherapy and chemotherapy. She was doing well till 5 years of her treatment for cervical cancer when she presented with complaints of pain lower abdomen and discharge per vaginum for 10 days. On examination she was found to have an abdominal mass of 18 weeks size and on local examination there was 4X4 cm fixed mass on lower third of vagina arising from left side. MRI abdomen and pelvis was done. Biopsy from the vaginal mass showed features of Rhabdomyosarcoma. Further follow up of the patient was not possible due to lockdown in view of the pandemic. She was last contacted telephonically on 25th March 2020; she said she was waiting for the lockdown to be lifted so that her further management can take place. This is just one patient; there are many more with other medical conditions all over the world who are losing their lives because of not being able to access medical care due to the present pandemic. New growth in the region of local recurrence in a known malignancy cannot necessarily be the recurrence of the primary tumour. It is important to keep our mind open to other differentials apart from the recurrence of primary malignancy, sometimes it can turn out to be a very rare tumour as we encountered in our case.