Showing papers in "The Southeast Asian Journal of Case Report and Review in 2014"

Primary thyroid Schwannoma Masquerading as a thyroid nodule: A case report with review of literature -

Abstract: INTRODUCTION: The thyroid gland is a very rare site for head and neck schwannomas (1) . Till date there have been only 19 reported cases in English literature (2). Only 25 % of Schwannomas occur in the head and neck region (2) , most of them arising in relation to the peripheral nerves and cervical sympathetic chain(3),(4) . CASE PRESENTATION: We report a similar case, with clinical and sonological features of a benign thyroid nodule. The diagnosis of schwannoma was established on the final histopathology report and a review of the slides and the imaging available was done to confirm the site of origin . A thorough review of earlier reported cases ( only 15 completely reported cases in English literature ) showed the entity to mimic a benign thyroid nodule in most cases. CONCLUSION AND RELEVANCE: We report this case along with a review of earlier reports to summarise the existing knowledge on the entity , emphasising its radiological appearance , the importance of IHC in pre operative diagnosis on FNAC slides as well the adequacy of a hemithyroidectomy being the treatment standard .

A study of laboratory profile of fever with thrombocytopenia in adult patients at C.U. Shah Medical College, Surendranagar -

Abstract: Background and objectives: Infection is the commonest cause of thrombocytopenia. Thrombocytopenia associated with fever helps to narrow differential diagnosis and management of fever. It also helps to know the various complications of thrombocytopenia and its management. Methods: 500 patients aged >18 years with fever and thrombocytopenia between July 2013 – October 2013 were included for this study. Results: Infection was the commonest cause of thrombocytopenia and malaria was the commonest infections. Bleeding manifestations were seen. Petechiae/ purpura as the commonest bleeding manifestation followed by spontaneous bleeding. Conclusion: Infections, particularly malaria was the commonest cause of fever with thrombocytopenia. In majority of patients thrombocytopenia was transient and asymptomatic but in significant number of cases there was bleeding manifestations. Spontaneous bleeding was noted in platelet count of < 20,000 in majority of patients, petechiae/purpura was seen in platelet count in range of 50,000-1, 00, 000. On treating the specific cause drastic improvement in platelet count was noted during discharge and further follow –up.

Multifocal abscess in a neonate: Neonatal chronic Granulomatous disease- Case report -

Abstract: Chronic Granulomatous Disease (CGD) is a genetically heterogeneous condition characterized by recurrent life-threatening bacterial and fungal infections and granuloma formation. CGD is the most common of the inherited disorders of phagocytic function and is characterized by susceptibility to recurrent severe infection. Although this disease is rarely seen in neonates. Case Report: We have encountered a baby with unusual multiple abscesses in various parts of the body. Because the hallmark of the clinical presentation of CGD is recurrent infections at epithelial surfaces in direct contact with the environment such as the skin, lungs and gut, we took steps to diagnose this disease, too. Conclusion: Ultimately it is true that this disease is rarely seen in neonates but in any case, that the neonate has multiple abscesses must be thought to have this condition and it should be treated.

Apert’s Syndrome- A Rare Craniofacial Anomaly -

Abstract: Introduction: Apert’s Syndrome is a rare autosomal dominant disorder characterized by craniosynostosis, craniofacial anomalies, and severe symmetrical syndactyly (cutaneous and bony fusion) of the hands and feet. Other craniosynostosis syndromes such as Carpenter syndrome, Crouzon disease (craniofacial dysostosis), Pfeiffer syndrome and Saethre-Chotzen syndrome have clinical features that are similar to Apert’s syndrome. Case Presentation: The case of a 10 month old infant with Apert’s syndrome is presented here. The characteristic features of Apert’s Syndrome are discussed. Conclusion: A multidisciplinary team approach comprising of neurosurgeons, craniofacial surgeons, plastic surgeons, otolaryngologists, orthodontists, orthopaedic surgeons ophthalmologists, radiologists, geneticists, paediatricians, clinical psychologists, speech and language pathologists is needed for the effective management of this condition.

FNAC and Histopathology of Salivary Gland Tumors

Abstract: Accounting for less than 2% of all human neoplasm, salivary gland tumours are relatively uncommon. This is a retrospective study of all salivary gland tumor biopsies received at our referral teaching hospital in Ahmadabad from January 2007 to October 2008. It will be noted that the most common benign neoplastic lesion during the present study as pleomorphic adenoma in the age group of 3nd decade of life (28 cases) followed by 4th decade (20 cases) Malignant lesions are common in age group of 5th decade of life (8 cases) Graphical presentation showing number of benign and malignant cases with their age distribution. Out of 100 cases, histopathological correlation was done in 60 cases. Most of the patients presented between 3rd and 5th decade of life. Males were predominantly affected with Male: Female ratio was 1:04. The commonest benign lesion was pleomorphic adenoma (74%) and the commonest malignant lesion was mucoepidemoid carcinoma (6%), In the present study, the incidence of benign and malignant lesion was 83% and 17% respectively. In the present study, FNAC had 100% accuracy rate for malignant lesion false negative result was obtained in 2(3.33%) cases. Thus, FNAC, in comparison to other methods of biopsy, is readily available, no anaesthesia is required, is a short procedure, reports are rapidly in one or two hours. It is cheap and cost effective, is an O.P.D. Procedure, least traumatic and has 100% patient compliance. It is highly reliable and accurate in expert hands.

Lymphangioma of small bowel wall: A rare case report -

Abstract: Introduction: Lymphangiomas are benign lesions of vascular origin that show lymphatic differentiation. They occur in many anatomic locations and may have a paediatric or adult clinical presentation. Case presentation: We herein describe the case of a 15-year old female who presented to the emergency of our hospital with abdominal distension and pain. At laparotomy, a giant multicystic tumor of jejunum was found which was leading to volvulus with gangrene of distal jejunum and whole of ileum. Histologically, the tumor was diagnosed as lymphangioma arising from the wall of jejunum. Conclusion: Intra-abdominal lymphangiomas are rare and most commonly are mesenteric in origin but in our case it was arising from the wall of jejunum which is a very rare phenomenon.

A Rare case of Giant retroperitoneal uterine Leiomyoma with cystic degeneration mimicking huge ovarian cyst

Abstract: Introduction: Leiomyomas are the most common benign tumors of the uterus. Retroperitoneal uterine leiomyomas with cystic degeneration are very rare. They can pose diagnostic dilemma and can mimmick ovarian cysts. Case report: We report the case of a 34 yrs old para 5 who presented to our hospital with complaints of distention whole abdomen, heaviness lower abdomen & decreased appetite. On examination a huge abdomino-pelvic cystic mass was felt. Clinically provisional diagnosis of ? Ovarian cyst was made.CT scan showed a huge retroperitoneal cystic mass. Laprotomy and proceed was planned. Intraoperatively a huge retroperitoneal cyst attached with uterus just below the left fundal structures by a pedicle and extending upto xiphisternum was found.Uterus was of normal size and both the ovaries and tubes were distinctly separate from the mass .left ovary was slightly enalarged and unhealthy in appearance. Cyst excision followed by total abdominal hysterectomy and left sided salpingooopherectomy was done. Histopathological examination revealed degenerated leiomyoma with immunohistochemistry positive for smooth muscle actin.To the best of our knowledge this case is the largest retroperitoneal uterine leiomyoma with cystic degeneration in literature. Conclusion: Retroperitoneal uterine leiomyoma with cystic degeneration are rare. They can pose diagnostic difficulty preoperatively and even peroperatively. As in our case the retroperitoneal leiomyoma with cystic degeneration was mimicking a huge ovarian cyst. Though CT scan was guiding towards retroperitoneal lesion but its cystic nature created diagnostic dilemma.

An Analysis of osteomyelitis in Diabetic Foot using Amit Jain’s Classification of Diabetic foot osteomyelitis -

Abstract: Aim: Analyzing osteomyelitis in the foot of the diabetic patients using Amit Jain’s classification for diabetic foot osteomyelitis Materials and Method: A retrospective analysis was carried from March 2011 to February 2014 in Department of Surgery of St Johns medical college, Bangalore, India Results: 21 patients with diabetic foot osteomyelitis were included in this study 9523% patients had unilateral osteomyelitis Most common type of diabetic foot osteomyelitis was type 1 osteomyelitis with 5714% of the patients being affected with this type 9048% patients with osteomyelitis had underlying ulcers and they belonged to type 3 diabetic foot complications 3333% of the patient had Subtype C and it was the most common subtype seen Type 3 osteomyelitis was the commonest cause for major amputation Conclusion: Diabetic foot osteomyelitis is one of the most frequent complications of ulcers In this study, most cases of the osteomyelitis belonged to type 3 diabetic foot complications Type 1 diabetic foot osteomyelitis was the most common type of osteomyelitis seen in this study This new Amit Jain’s classification for diabetic foot osteomyelitis helps in specifying the type of osteomyelitis occurring in clinical practice and also the type of osteomyelitis commonly responsible for the major amputations

Isoniazid Induced Hepatitis and Psychosis in a Single Patient – Case report -

Abstract: A 22-year-old female who was a known case of tubercular meningitis on anti-tubercular therapy, presented to the emergency room with complaints of recurrent vomiting, markedly reduced appetite, yellowish discoloration of eyes, abnormal behaviour and delusion of reference. There was no prior history of psychiatric illness or hepatitis like illness. Her liver enzymes were elevated more than 3 times of reference value and mental status examination revealed features of acute psychosis. Hepatitis resolved completely after isoniazid was discontinued and psychosis resolved fully only after treatment with amisulpride was begun. The patient was later rechallenged with isoniazid successfully and remained symptom-free 3 months after discharge from the hospital. This is an unusual presentation where both hepatitis and psychosis due to isoniazid occurred together simultaneously.

Histo-pathological changes of placenta in normal and pregnancy induced hypertension -

Abstract: Introduction: Placenta is the most important and vital organ of intrauterine life.Hypertension is one of the common complication met within pregnancy and contributes significantly to maternal and fetal morbidity and mortality. Objectives: This study is undertaken to assess the morphology of placenta in pregnancy induced hypertension and compare the same with that of normal pregnancy. Material and method: Fifty mothers with uncomplicated pregnancy and fifty mothers with pregnancy induced hypertension were selected randomly from in-patients of Obstetrics and Gynecology Department, Sir Takhtasinhji General Hospital,Bhavnagar, Gujarat. Gross and microscopic histopathological examination was carried out on placenta. Comparative study was done between two groups. The data were statistically analyzed using Chi square test by using EPI INFO 7 software. Results: Microscopic examination of placenta in Pregnancy induced hypertension show excessive syncytial knots, increased fibrinoid necrosis, increased villous stromal fibrosis and increased basement membrane thickening of the Villi along with decreased vasculosyncitial membrane as compare to normotensive group. Conclusion: Pregnancy Induced Hypertension alters the placental histomorphology. The histopathological changes among PIH group were statistically significant as compared to Normal. This will contribute to the better understanding, treatment and finally optimal management of the problem.

Carotico clinoid foramen and interclinoid bars - A case report -

Abstract: We have observed one skull with bilateral carotico clinoid foramen and interclinoid bars formed by fusion of carotico clinoid ligaments between the anterior, middle and posterior clinoid processes. The incidence of the complete type of bilateral carotico clinoid foramen in our study was 1 out of 20 human dry skulls (5%). The bilateral formation of interclinoid bars and carotico-clinoid foramen have high significance due to their rare occurrence. Carotico clinoid foramen may cause changes in the internal carotid artery in clinoid segment which may cause compression of cavernous sinus due to its medial position. Our study provides a guide to neurosurgeons in surgical approaches to prevent fatal complications while performing regional surgeries.

Assessment of Lung Functions and Factors Affecting in Chronic Obstructive Pulmonary Disease (COPD) Patients

Abstract: Introduction: COPD is a major cause of chronic morbidity and mortality throughout the world. Its prevalence & mortality due to it are increasing day by day. Current prevalence in India is not well understood but condition is worsening. So the aim of present study is to compare and to assess the severity of lung dysfunctions in the patients with COPD & to study the effects of various factors like BMI, BSA, smoking, residence etc. on lung dysfunctions in COPD patients in rural & urban areas of Jamnagar district, Gujarat. Material and Method: Lung functions of 50 COPD patients of various age groups were measured by doing spirometry (Spiro-Analyzer St90) in stable phase of disease & spirometric parameters are compared with their predicted values. Effects of smoking, BMI, BSA, residence, seasons etc. on severity of COPD were measured. The various data were collected; compiled, statistically analyzed and valid conclusions were drawn. Observation and Results: Study results showed the mean values of FVC, FEV1, FEV1/FVC%, FEF25-75, PEFR and MVV were greatly decreased in COPD patients (more profound in smokers) as compared with their predicted value, which were statistically significant. There was positive correlation of spirometric parameters with BMI and BSA. Majority of patients were in severity grade 2 (46%) and grade 3 (46%) (suggested by ATS). Conclusion: All spirometric parameters were greatly reduced in COPD patients. COPD was more prevalent in urban area and disease was more severe with smoking history & patients with low BMI & BSA values and worsens in winter. So by maintaining proper nutrition we can reduce the severity of the disease.

Primary lymph node Plasmacytoma: Presenting as a solitary neck mass -

Abstract: Introduction: Primary plasmacytoma of lymph node is a rare neoplasm. Primary lymph node plasmacytoma represents 2% of all extramedullary plasmacytomas, and only 0.08% of all plasma cell malignant neoplasms. There have been fewer than 20 reported cases worldwide. Case Report: We hereby report a case of primary lymph node plasmacytoma (PLNP) in a 41 year old man, who presented with a solitary subcutaneous nodule on lateral aspect of his neck, which turned out to be a primary plasmacytoma of the lymph node on histopathological examination. No evidence of the systemic involvement of plasma cell dyscrasia was discovered and thus, the diagnosis of primary lymph node plasmacytoma (PLNP) was made. Discussion: Plasmacytoma involving lymph node is a rare entity and can occur as a manifestation of regional lymph node involvement in extramedullary plasmacytoma or even more rarely as a primary lymph node plasmacytomas (PLNPs), a complete clinical, radiological and laboratory work up needs to be done to rule out metastatic multiple myeloma and metastatic upper respiratory tract plasmacytomas. Conclusion: Primary lymph node plasmacytomas (PLNPs) are rare malignant neoplasms representing 0.08% of all plasma cell malignant neoplasms. A diagnosis of plasmacytoma should prompt further clinical, biochemical and radiologic evaluation to determine whether the lesion is purely solitary or a localized presentation of multiple myeloma.

Fine needle aspiration cytology of soft tissue tumours, its accuracy and pitfalls--our institutional experience -

Abstract: Background: Soft tissue tumours are extremely rare neoplasms. Fine needle aspiration cytology (FNAC) is being increasingly used for diagnosing soft tissue tumours inspite of its poor sensitivity, specificity and inadequacy. Aims: The aim of this study is to study the usefulness of fnac in diagnosing and sub grouping of soft tissue lesions. Methods and Material: FNAC smears of 92 cases of soft tissue lesions with adequate cellularity (at least 5 clusters of 10 unobscured cells) were reported under the following cytomorphological headings- spindle cell, round cell, pleomorphic, myxoid and lipomatous type, along with benignicity or malignant nature of the lesion. Immunocytochemistry (ICC) was performed wherever feasible. Results: Out of the 92 cases, 61(66.3%) were benign, 21 (22.8%) malignant and 10 (10.9%) inconclusive on fnac. Benign lesions occurred in 2nd to 4th decade of life with a predilection for extremities (54%), whereas malignant tumours occurred in all age groups and at all sites. Males had a higher incidence than females. 87 %( 53 cases) of benign soft tissue lesions and 62 %( 13 cases) of malignant soft tissue lesions could be diagnosed by fnac alone, while ICC helped in 6 cases(out of 15). Lipomatous tumours (46%) were most easy to diagnose, whereas round cells, spindle cells and myxoid lesions were most difficult. False positive diagnosis was made in only 1% of adequate smears. Conclusion- In spite of its limitations, FNAC can be an useful cost-effective tool for preoperative diagnosis of soft tissue lesions, with low morbidity, high compliance and acceptable accuracy. Ancillary techniques like ICC can help in improving the accuracy of fnac diagnosis.

Giant orbital foreign body mimicking as orbital cellulitis: A Rare case report

Abstract: Introduction: Intra-orbital foreign bodies are notorious for presenting a confusing clinical picture. Wooden foreign bodies may remain quiescent for a long time, before presenting with a variety of complications. Case report: 25-year-old male presented to ENT-OPD with history of left eye pain for last 14 day with history of fall from motorbike 14 days back with left eye swelling. Patient was asymptomatic for 3-4 days and then again started having left eye swelling and fever. There was history of upper eye lid laceration which healed by itself. Radiology was suggestive of intra-orbital foreign body, which was subsequently removed surgically. Conclusion: We report an unusual case of a missed wooden intra-orbital foreign body mimicking as orbital cellulitis. Keywords: Foreign body, orbit, organic. 1,2 Senior Resident, 3 Associate professor Department of Otolaryngology & Head-Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Corresponding author mail: karan_gupta86@yahoo.com Conflict of interest: None INTRODUCTION:

A study of incidence of interparietal bones in adult human dry skulls

Abstract: Introduction: The inter-parietal part of squamous occipital bone which lies above the highest nuchal line develops from membranous ossification. The failure of fusion of ossification centres in this region leads to the development of interparietal bones. These bones are very rare in occurrence as compared to the other sutural bones. In this study, the objectives were to find the incidence of interparietal bones in adult human dry skull of Gujarat region. Materials and method: The study included a total number of 250 human adult dried skulls from various medical colleges and dental colleges of Gujarat region. The skulls were studied for the gross incidence, number, size, shape, position and number of fragments of the interparietal bones. Observation and Results: in present study Out of 250 skulls were examined by us, 24 skulls show the presence of interparietal bone. The incidence of interparietal bones in present study was 9.6%. Conclusion: The study has provided information on the squamous part of occipital bone, the interparietal bones, their incidence, and morphology. The knowledge of these variants is of importance to the neurosurgeons, radiologists and morphologists and forensic expert for comparison of skull bone.

Significance of Glycosylated Haemoglobin (Hb) in Diabetic Patients

Abstract: In normal, non-diabetic control group subjects, mean glycosylated haemoglobin concentration is 6.68% and range is 5.02 to 7.93.In present study mean glycosylated haemoglobin concentration is 12.90. Glycosylated haemoglobin correlates significantly with the fasting, post prandial levels. Mean of fasting and post –prandial blood sugar level are 178.68 and 226.28 mg /dl respectively. Glycosylated haemoglobin value found higher in female -13.01 compare to make -12.86 Glycosylated haemoglobin values were higher in Juvenile onset diabetes (IDDM) – 14, 20 than Maturity onset diabetes (NIDDM) 12.26. A Glycosylated haemoglobin value has no relation with the long complication of diabetes mellitus. Glycosylated haemoglobin concentration was found high in Insulin taking 15.26 than patients on oral hypoglycaemic agents 12.25 and on dietary restriction 7.81. Single Haemoglobin A1c measurement reflects the mean blood sugar concentration of the patient for the previous two to three months. Therefore, the glycosylated haemoglobin assay provides information about the degree of long term glucose control that is otherwise obtainable in the usual out patients setting. ION EXCHANGE RESIN method can be used routinely to estimate HbA1c in non-diabetic and diabetic patients. Periodic monitoring of HbA 1c should allow the assessment of chronic diabetic control on an out patients basis in a more objective manner than is now possible and enable one to evaluate various forms of therapy and the relationship between carbohydrate control and the progression of various diabetic sequele.

Xeroderma pigmentosum with tongue cancer and neurological manifestations in a 5-year-old child: a case report

Abstract: Xeroderma pigmentosum is an extremely rare inherited disorder caused by a nucleotide excision repair (NER) defect leading to defective DNA repair after UV radiation- induced DNA damage. The condition is associated with increased risk of cutaneous malignancies, and the manifestations vary across different complementation groups of the disease. Neurologic abnormalities are more frequent in complementation group A, whereas group C has the highest incidence of oral cavity cancer. We describe a case of xeroderma pigmentosum where a 5-year-old child presented with squamous cell carcinoma of tongue and skin, together with neurological and ocular involvement, a constellation of clinical features

Fulminant hepatic failure due to combined infection with Plasmodium falciparum and hepatitis A virus

Abstract: Acute viral hepatitis due to hepatitis A and malaria are very common diseases in India. Both malaria and acute hepatitis A virus infection can each present with fulminant hepatic failure. Literature on concurrent infections leading to fulminant hepatic failure is scanty. Forty nine years old male, coal mine worker, presented with history of fever followed by yellowish discoloration of eye and urine and irrelevant talk, drowsiness. Patient had Ig M anti HAV antibody positivity. Patient was treated with standard measure for fulminant hepatic failure. Patient did not improve. Patient had disproportionate anemia, mild elevation of transaminases and mild derangement of prothrombin time. Rapid malarial antigen test was positive for plasmodium falciparum though peripheral blood smear was non-contributory. Antimalarial treatment was started and patient improved. FHF related to malaria and hepatitis A virus infection has similar clinical presentation. Patient with malaria simulating FHF may have significant anemia, mild derangement of prothrombin time compared to viral FHF. This case teaches us that co-infections with two hepatotropic pathogens require immediate attention with early intervention which may lead to survival of patient. Keyword: Falciparum malaria, Fulminent Hepatic Failure (FHF), Hepatitis A virus

Carcinosarcoma of Breast: A Rare tumor with Triple Positive Phenotype -

Abstract: Primary sarcomas of the breast are rare and constitute 0.6% to 1.2% of the total number of malignant tumors of the breast. Clinically, these are aggressive tumors and majority of them do not express the estrogen and progesterone receptors and do not over express the Her2/neu oncogene. A 35 years female presented with a mass in her right breast. Physical examination and radiological findings were consistent with malignancy. Patient underwent surgery and modified radical mastectomy was performed. Histological examination revealed carcinosarcoma of the breast. On immunohistochemistry, tumor cells were positive for hormone receptors Estrogen Receptor (ER), Progesteron Receptor (PR) and Her2/neu gene, which is a rare entity. The patient is on chemotherapy and hormonal therapy and is under follow up. There was no axillary lymph node involvement or distant metastasis. The present case merits presentation because of its rarity.

Hydatid Cysts Presenting in Uncommon Sites – An uncommon case series -

Abstract: Hydatid cysts are commonly seen in the lung and liver. In the last 3 years in our institute we had a total of 25 patients of Hydatid cysts which included 13 cases of liver, 3 lung, 2 intramuscular, 1 submandibular gland, 1 recurrent intraperitoneal hydatid cyst (with history of previous liver hydatid surgery 6 years prior) and one case each of hydatid cysts at six uncommon intra abdominal sites- pancreas, kidney, ovary, mesentery, spleen and appendix.

Plexiform Neurofibroma of Submandibular gland: A Case Report in Young Adult

Abstract: Background:-Tumours of neurogenic origin are rare in submandibular gland. Plexiform neurofibroma of the salivary glands is a rare benign tumour of submandibular salivary gland. Case report: - We present a rare case plexiform neurofibroma of submandibular gland. This patient presented with history of right side facial swelling for last 10 years .Initially ultrasound was done. A provisional diagnosis of salivary gland tumour was made. Later on Fine needle aspiration cytology (FNAC) was reported as chronic sialadenitis. An excisional biopsy was done and case diagnosed as plexiform neurofibroma of submandibular gland. Conculsion: - Clinicians have an important role in early diagnosis and alerting the patient about its future complications.

Effect of Smoking on Lung Volume and Capacity

Abstract: Tobacco smoking is highly prevalent all over the world. Tobacco smoke affects almost all the systems of the body. This study aimed to see the effects of smoking on the respiratory system. For this study we selected 30 control and 30 cases and divided cases into mild, moderate and heavy smokers according to no. cigarettes they were smoking daily. Pulmonary functions tests were performed by medspior instrument in a standing posture. We found that difference between predicted value and observed actual value is increased from mild smoker to heavy smokers in all the parameters like FVC, FEV1, PEFR, FEV1/FVC ratio. It suggests that tobacco smoking starts obstructive changes in the respiratory system before the onset of respiratory symptoms. Prolonged tobacco smoking may lead to respiratory diseases like emphysema, asthma and even lung cancer.

Disseminated Cryptococcosis in a Pregnant Woman- Case report -

Abstract: Introduction: Disseminated cryptococcosis remains a significant life threatening opportunistic fungal infection in AIDS patients. The clinical presentation of disseminated cryptococcosis is variable and depends on the organ systems involved. Generalized lymphadenopathy and characteristic skin lesions usually precede the onset of more severe disseminated cryptococcosis. Case presentation: A 25-years old pregnant woman presented with fever without lymphadenopathy or cutaneous manifestations or manifestations pertaining to any other organ system. She was investigated to detect the cause of fever. The patient died before a diagnosis of disseminated cryptococcosis could be made. Conclusion: A high index of suspicion is required in patients who do not present with skin or central nervous system manifestations.

Traumatic Tracheal Transection: Surgical Challenges and Management -

Abstract: Complete tracheal transection is relatively rare. Also most of the patient of tracheal injury does not survive long enough to refer to trauma centre. Timely intervention and airway management is lifesaving. This is a case report of 32-year-old man injured in a motor vehicular accident at high speed sustained a crush injury of the neck and face with complete transection of the cervical trachea. He was aphonic, severely dyspnoeic with wound over neck on anterior aspect with bleeding and visualised tracheal transection. There was associated multiple injuries. The patient was taken to emergency surgery. Small tracheostomy tube was directly inserted into open tracheal wound after suctioning. Treatment was by primary closure of the tracheal wound with tracheostomy. These potentially lethal injuries are saved with early initiation of the advanced trauma life support protocol. Such patient requires urgent ventilatory support.

Clinical and Bacteriological Profile of Hospitalised Community Acquired Pneumonia (CAP)

Abstract: Community acquired pneumonia[CAP] occurring in a hospital or long term care facilities remains a common and serious illness, despite the availability of potent new antimicrobials and effective vaccines Objectives: To find out the most common bacteria causing CAP in hospitalized patients and to study the clinical profile of CAP Methodology: The present study was carried out in 50 patients of community acquired pneumonia admitted to Civil Hospital, Ahmedabad, from March1998 to Nov 2000 The diagnosis was based on acute illness of fever and cough with clinical signs of crepitation and/or bronchial breathing along with radiological evidence of pulmonary consolidation Results: After studying the 50 cases of adult community acquired pneumonia following conclusions was drawn Streptococcus pneumonia is still the most common cause of community acquired pneumonia (22%) Next common cause in the present study is Gram- negative bacilli (22%) and Staphylococcus aureus (12%) Among Gram-negative bacilli Klabasiella and E-coli were common ( 8% each) Inspite of all possible diagnostic methods like sputum gram-stain, culture, blood culture and invasive procedure like bronchoscopic aspirate, no organism were detected in 44% of cases Pleural effusion were noted in 7 cases ie 14%Streptococcus pneumonia is the causative agent in 3 cases out of 7 ie 428% Conclusion- The mortality in the present study was 8% The decrease in mortality is due to early hospitalization and vigorous therapy with broad spectrum antibiotics 80% of the patients were improved 8% were expired and 12% had slow resolving pneumonias