Mirizzi Syndrome: An Experience in Laparoscopic Era

Objective:To assess the presentation and surgical management of Mirrizi syndrome patients who underwent LaparoscopicCholecystectomy. Study Design and Setting:Retrospective Descriptive Study was conducted at Surgical Department Combined MilitaryHospital Rawalpindi and Combined Military Hospital Quetta from 1st Jan 2010 to 20th Jan 2016. Methodology:Patients undergoing laparoscopic cholecystectomy during this period were retrospectively reviewed. Allcases of Mirizzi Syndrome (MS) were identified and data analysed. Results:A total of 5500 patients underwent laparoscopic cholecystectomy during this period. Approximately 26(0.47%)cases were identified to be having MS. Out of these 26 cases only 8 (30%) were males while 18 (70%) were females. Ageranged from 25 to 80 years. Three patients (11%) had an endoscopic retrograde cholangiopancreaticography (ERCP) done.Type-I MS was found in 19 cases (73 %), Type-II in 3 cases (11%), Type-III and Type-IV in 2 cases each (7.69 %).Conversion to open surgery was carried out in 15 cases (57.6 %). All type-I MS had cholecystectomy except one casewhere partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly T-tube closure was possible in two cases of type-III while one hadRoux-en-Y hepaticojejunostomy. All cases of type-IV MS had Roux-en-Y hepaticojejunostomy. One patient out of 26 (3.8 %) had carcinoma gallbladder. There was no mortality. Conclusion:Type-I MS can be managed with laparoscopic cholecystectomy in selected patients.Type-II and type-III MS may need placement of T-tube while most of type-IV MS are managed with Roux-en-Y hepaticojejunostomy.

Diagnóstico prenatal de iniencefalia. Reporte de caso.

Iniencephaly is an infrequent and fatal neural tube defect that affects the occiput and neck, this occurs together with the widening of the foramen magnum, rachischisis and marked retro-flexion of the head. This entity belongs to the group of defects of neural tube closure. About 200 reports have been published in the literature. A diagnosis can be made using an ultrasound morphology test that is easy to perform due to the characteristic findings of the condition. Associated anomalies of the nervous system and other systems are frequently present during the ultrasound evaluation. Prenatal diagnosis of a neural tube defect that involves occipital defects and spinal and thoracic spine rachischisis accompanied by retro-flexion of the head should raise the diagnostic suspicion of iniencephaly. The prognosis is particularly bad with only a few cases of survival. Keywords: Iniencefalia, Neural tube defect, Prenatal diagnosis.

Novel Variants of the Sternal Muscle in an Adult and an Anencephalic Infant: Embryological Insights and Clinical Implications

Background The sternal muscle is a supernumerary variant of the thoracic muscles found in 3–8% of the population. When present, it can be unilateral or bilateral, which can produce confusions during surgeries and imagenological examinations. Methods We report the finding of the sternalis muscle in two human cadavers, one adult and one anencephalic infant. The muscles were dissected from the fixed bodies and their morphometry analysed. Results In the case of the adult, we observed two sternal muscles connected in the superior portion by a central tendon. In the case of the anencephalic infant, we found a bilateral sternal muscle, in which the bellies came from the contralateral pectoralis major muscles. The two sternalis muscle variants found here were impossible to categorise according to the current classifications. Conclusions The sternalis muscle displays variants that are still not classified, as observed in the case of the adult and the infant, in which its presence was correlated with anencephaly. We discuss about this muscular variation in the clinical, imagenological and surgical context and propose a developmental link with the occurrence of neural tube closure defects.

Prevalence of Neural Tube Defects (NTDs) In And Around Varanasi Region: Some Observations

Congenital anomalies are one of the primary causes of infant mortality and disability in the world. Neural Tube Defects (NTDs) are the most typical type of birth defect resulting from the failure of Neural tube closure. In this retrospective hospital-based study, the data of the children affected byneural tube defects (NTDs) were analyzed. Prevalence of Hydrocephalous, Myelomeningocele (MMC), Encephalocele, Lipo MMC, Meningocele, Spina Bifida Occulta among children with more or less than one year of age and their occurrence in males and females was studied. The frequency of occurrence of cases of neural tube defects was significantly less among all the congenital disabilities, i.e., 5% of total cases studied. The prevalence of myelomeningocele, hydrocephalous, and Encephalocele was higher than other types of NTDs. This study concludes that the prevalence of hydrocephalous and myelomeningocele in this area raises a concern to have more research of their etiology.

Cats, frogs, and snakes

Disturbed neurulation fascinated scientists of all times. In Egypt, brainless infants were venerated as animal-headed gods. Roman law required them to be killed. The medieval world held the mother responsible, either because of assumed imagination or ‘miswatching’, or because of suspected intercourse with animals or devils. Modern embryology and teratology began with the use of the microscope by Malpighi in 1672. Details of neural tube closure were described by Kölliker in 1861 and His in 1874. From 1822, genetic disease and familiar recurrence due to insufficient nutrition were discerned and lower social class identified as a risk factor. It took a century to define the malnutrition as insufficient folate intake. The mandatory supplementation of folate in staple foods successfully reduced the incidence of neural tube defects in the US, Australia, Canada, and Chile, but it was not adopted by most European countries.