Chronic Lymphocytic Leukaemia Complicated by Cranial Diabetes Insipidus - A Case Report

Here we describe a case of 55-year-old lady who was admitted in hospital for evaluation of recurrent anaemia, polyuria and polydipsia with history of splenectomy 9 months back. Physical examination revealed anaemia, dehydration and scar mark of splenectomy. Initial laboratory tests were suggestive of chronic lymphocytic leukaemia (CLL) and further bone marrow examination & immunophenotyping confirmed the diagnosis. At the same time Polyuria & polydipsia was evaluated by water deprivation test and diabetes insipidus was diagnosed.

MANAGEMENT OF RELAPSE CLUBFOOT BY PERCUTANEOUS TENDON RELEASE WITH APPLICATION OF CORRECTIVE CAST AND ANALYSIS OF RESULT THROUGH PIRANI SCORE, PODOGRAPH FOOT BIMALLEOLAR ANGLE, RADIOLOGICAL FOOT ANGLES AND FUNCTIONAL FOOT SCORE.

Aim:-The aim of our study to evaluate the effectiveness of percutaneous tendon release and application of corrective cast in children who had undergone serial corrective cast but had some Residual deformity Material and method :-We have included total 18 patient of Relapse clubfoot (with 22 clubfeet) in our study.The age group of patient between 6 month to 36 month.All these patient treated by percutaneous tendon release procedure and application of corrective cast.then result analysis by pirani score, podograph foot bimalleolarangle,and radiological foot angles at follow up of 1,6,12 month. Result:-pirani score result excellent in 10 feet (score<0.5),good in 10 feet(score<1.5),and fair in 2feet (score<2). Podograph foot bimalleolar angle(FBA) in 19 feet (87%)[angle >75°],FBA in 2 feet (9%)[angle70-74°],FBA in 1 feet (4% ) [angle 65-69°]. Radiological foot angleApTalocalcaneal angle mean change(7.42°) ,lateral Talocalcaneal angle mean change(7.09°) ,AP Talorst metatarsal angle mean(7.0°) , Tibiocalcaneal angle meanchange(18.66°) , Talocalcaneal index meanchange (14.65°) Laaveg ponseti and Cummings functional score excellent (85-100) in 4feet(18%),Good (70-84) in 12feet(54%), fair(60-69)in 3feet(14%), Poor (below 59)in 3feet(14%). Conclusion:-Percutaneous tendon release with application of corrective cast is safe and easy method for correction of Relapse clubfoot with less risk of wound complications,neurovascular injury and post operative scar mark.

Sulfated Polysaccharides from Marine Algae as a Basis of Modern Biotechnologies for Creating Wound Dressings: Current Achievements and Future Prospects

Wound healing involves a complex cascade of cellular, molecular, and biochemical responses and signaling processes. It consists of successive interrelated phases, the duration of which depends on a multitude of factors. Wound treatment is a major healthcare issue that can be resolved by the development of effective and affordable wound dressings based on natural materials and biologically active substances. The proper use of modern wound dressings can significantly accelerate wound healing with minimum scar mark. Sulfated polysaccharides from seaweeds, with their unique structures and biological properties, as well as with a high potential to be used in various wound treatment methods, now undoubtedly play a major role in innovative biotechnologies of modern natural interactive dressings. These natural biopolymers are a novel and promising biologically active source for designing wound dressings based on alginates, fucoidans, carrageenans, and ulvans, which serve as active and effective therapeutic tools. The goal of this review is to summarize available information about the modern wound dressing technologies based on seaweed-derived polysaccharides, including those successfully implemented in commercial products, with a focus on promising and innovative designs. Future perspectives for the use of marine-derived biopolymers necessitate summarizing and analyzing results of numerous experiments and clinical trial data, developing a scientifically substantiated approach to wound treatment, and suggesting relevant practical recommendations.

Endoscopic thyroid lobectomy vs Conventional open thyroid lobectomy

Background and Objective: Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery. Methods: Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019.The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study. Results: Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches. Conclusions: The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group. doi: https://doi.org/10.12669/pjms.36.4.1604 How to cite this:Imran M, Mehmood Z, Baloch MN, Altaf S. Endoscopic thyroid lobectomy Vs Conventional open thyroid lobectomy. Pak J Med Sci. 2020;36(4):831-835. doi: https://doi.org/10.12669/pjms.36.4.1604 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Management of Ganglion: Comparative Study between Surgical Excision and Aspiration followed by Intralesional Steroid Injection

Introduction: Ganglions are tense, smooth, cystic transilluminant swellings. They are the commonest soft tissue swelling of the hand and most commonly found on the dorsum of the wrist. At present aspiration or surgery are the management options of Ganglion. To improve the outcome of treatment some advocated aspiration combined with steroid injection into the cyst. Objectives: To compare pain relief, cosmetic results and recurrence rate in the management of ganglion with aspiration followed by intralesional steroid (triamcinolone acetate) injection and surgical excision. Materials and Methods: Prospective interventional control trial was performed from October 2016 to October 2017. Fifty patients were treated in two groups in group A (33 patients), aspiration followed by intralesional steroid (triamcinolone acetate) injection and group B (17 patients) surgical excision was performed on. Follow up of patients were done on at one, three and six months after treatment up to 1 year. Results: In group A out of 33 patients, pain relief was in all 33 (100%) patients, there was no scar mark and only in 4 (12.12%) patients there was recurrence which was managed by repeating the procedure. In group B, out of 17 patients, pain relief was in 15 (88.23%), 17(100%) patients had linear scar mark, 1(5.8%) patient had hypertrophic scar and 02 (11.76%) patients had recurrence which was managed with intralesional steroid as group A. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 190-192

CRB modification to retromandibular approach for management of subcondylar fractures.

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular subcondylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was carried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was recorded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of retromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome.

LAPAROSCOPIC APPENDECTOMY;

Background: Minimal invasive surgery (MIS) is a modern and safe improvement in field of laparoscopic surgery. Single incision laparoscopic appendectomy (SILA) is a major breakthrough in MIS and has become standard procedure for acute appendicitis in place of conventional three port laparoscopic appendectomy (CTLA). Objectives: To see the potential advantages in terms of operative time, duration of hospital stay, post-operative pain and cosmetic results in SILA and CTLA groups. Study Design: Randomized control study. Setting: Department of General Surgery in Allama Iqbal Medical College/ Jinnah Hospital Lahore. Period: July 2016 to June 2017. Materials and Methods: 48 patients were divided in two groups; group SILA (cases) and CTLA (control). Each group comprised 24 patients. All cases were performed by consultant who were competent enough and trained in MIS. Results: We found that there was statistically no difference in operative time (p>0.05) and post-operative pain (p>0.05) of both procedures but statistically significant outcome was observed in duration of hospital stay (p<0.005) and cosmetic result (p< 0.005). Post-operative analgesia usage was same in both groups with similar outcome of control. Surgical wound healed in all patients of both groups without complication but noticeably had shown no scar mark on three months follow up in patients of SILA group. Almost all patients in SILA group were discharged on same day on oral diet. Conclusion: This study showed that results of SILA are better in terms of cosmoses and less duration of hospital stay in the presence of non-significant operative time of two procedures. Staying with promise of minimizing in MIS to SILA, cosmetic satisfaction and minimal hospital stay are its comprehensible advantages.

Treatment of Morell Lavallee Lesion (MLL) with Arthroscopy

Background: Previous approval for treatment of persistant Morell lavallee soft tissue degloving lesion has included open debridement or simple compression or serial aspiration under USG guidance or insertion of surgical vacuum or sclerodesis with tetracycline/doxycycline. None of them had proven the minimally invasive surgical technological effect of arthroscopy. Purpose of study: This study evaluates the minimally invasive surgical effectiveness and use of radio frequency ablation under arthroscopy for treatment of persistant Morell lavallee soft tissue degloving lesion. This technique provides satisfactory cosmetic and functional effect as overall outcome. Methods: We treated 7 cases of persistant Morell lavallee lesion between Nov 2010 to March 2013. These lesions developed in 5 male and 2 female patients (Mean age 36.57yr, Range 23-48 yrs) due to various mode of trauma. The lesion involved the thigh region in 3 patients with gluteal, distal leg, knee and forearm being other region involved. An area of palpable fluctuance was the most coherent examination finding. MRI and Ultrasonography confirmed the diagnosis with clinical evidences. Treatment was achieved by placement of arthroscope, aspiration of fluid and radio frequency ablation of inner layer of capsule and proceed with compressive elastic bandaging. Healing was defined as the loss of fluctuation with complete absence of fluid on ultrasonography (USG). Result: The average duration of the persistence of the lesion was 3 month. All lesions were evacuated arthroscopically and found to be negative on culture. The mean follow up period was 11 month (Range 6-24 month). All patients showed complete resolution of fluid collection and no contour deformity at final follow up. All the lesions healed exclusive of any infections or other complication. No recurrences were detected during the follow up period. A persistent feeling of tightness was the most common problems faced on long term follow up. Conclusion: The persistant closed degloving lesion can be managed easily, conveniently and effectively with radio frequency ablation under arthroscopy. Patients were satisfied with cosmetic problems like contour deformity, tightness of skin, rough scar mark, diminished sensation and skin mobility at site of lesion.

Tubercular lymphadenitis presenting with facial palsy: a rare case report

<p class="abstract"><span lang="EN-IN">India has a very high prevalence of tuberculosis (TB). Incidence of extrapulmonary tuberculosis is on the rise and at times it presents with uncommon features. We reported a case of 27 year old female presented with an irregular scar mark in the submandibular region along with an asymmetric smile. She was on treatment for tuberculosis as diagnosed by an earlier aspiration cytology report. Examination showed irregular non tender scar along with an underlying 2×2 cms swelling. Repeat fine needle aspiration was inconclusive and the patient was thus taken up for excision biopsy. Final report turned out to be tubercular lymphadenopathy and treatment was thus started accordingly. We conclude that tubercular lymph nodes presenting with facial nerve paresis are extremely rare entity. A high degree of suspicion should be maintained in a country like India where prevalence of TB is significantly high.</span></p><p class="abstract"> </p>

Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon

ABSTRACT Aim To present a case of recurrence of giant cell tumor of the tendon sheath (GCT TS) and its management. Background The GCT TS is a solitary benign soft tissue tumor of the limbs. It usually appears as an enlarging painless mass and has a synovial origin. The GCT TS is approximately 1.6% of all soft tissue tumors. The GCT TS of tibialis posterior is very rare, and recurrence has not been reported. Case report A 21-year-old male patient presents with complaint of swelling over right ankle since 3 years. Patient was operated for swelling 10 years back, and histological examination revealed GCT TS. Patient was asymptomatic for 3 years after operation and then developed swelling since last 3 years. On local examination, hypertrophic scar mark 1 × 4 cm was present at right medial malleolus. Ultrasonography of right medial malleolus and magnetic resonance imaging were done for further evaluation. Under spinal anesthesia and tourniquet control, medial approach was taken extending from 7 cm above the medial malleolus posterior to the tibia up to the talar head. Tissue was cleared and was sent for histopathology, which confirmed the diagnosis of GCT TS. Patient is on regular follow-up since then, and there has not been any recurrence. Conclusion Though rare, recurrence of GCT TS can occur, and it should be properly investigated and completely excised. Clinical significance Though recurrence of GCT TS is rarely reported, it needs to be dealt with a high index of suspicion and treated aggressively. How to cite this article Choudhry KR, Mandlewala VN. Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):45-48.