cme conducted on july
TRANSCRIPT
Contents :
*Academics and Achievements
*National Level Workshop / CME / Conference / Medical Education
*Activities of Academic Body
*Graduation day celebration
*Case reports
J. J. M. Medical College, Davangere.
NEWS LETTER COMMITTEE
Patrons :
Dr. Shamanur Shivashankarappa MLA,
Hon. Secretary, BEA., Chairman, JJMMC
Sri S. S. Mallikarjun.Joint Secretary, BEA
Advisory Board :
Dr. H. Gurupadappa, Director, P. G. Studies & Research
Dr. M. G. Rajasekharappa, Director, General Administration
Chairman :
Dr. Manjunath AlurPrincipal
Editor :
Dr. K. RavindraProfessor of Dermatology
Associate Editor :
Dr. C. S. Santhosh Associate Prof. of Forensic Medicine
Scientific Committee :
Dr. G. GuruprasadProfessor of Paediatrics
Dr. M. G . UshaProfessor of Microbiology
Dr. C. Y. SudarshanProfessor of Psychiatry
Executive committee :
Dr. K. R. Chatura, Professor of Pathology
Dr. M. G. Dinesh, Professor of Surgery
Dr. J. Raghukumar, Professor of Orthopaedics
Dr. G. R. Veena, Professor of Obst. & Gynaecology
Dr. B. R. Uma, Reader in Anaesthesia
Dr. A. R. Suresha, Associate Professor of Ophthalmology
Dr. M. S. Anurupa, Professor of Community Medicine
Dr. B. K. Bharathi, Professor of Biochemistry
Dr. M. Sunitha, Assistant Professor of Physiology
Dr. N. S. Prakash, Reader in Otorhinolaringalogy
Dr. M. B. Siddesh, Associate Professor of Radio-diagnosis
Dr. S. Narendranath, Associate Professor of Pharmacology
Dr. T. V. Pradeep, Assistant Professor of Medicine
"The greatest disease in the West today is not TB or
leprosy ; it is being unwanted, unloved, and uncared for. We can cure
physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love. There are many in the world who are dying for a piece of bread but there are many more dying for a little love. The poverty in the West is a different kind of poverty - it is not only a poverty of loneliness but also of spirituality. There's a hunger for love, as there is a hunger for God."
- Mother Teresa
The Chairman / The Principal,
J. J. M. Medical CollegeDavangere - 577 004.
Ph : +91-8192-231388, 253850-59 Ex. 101 / 104Fax : +-1-8192-231388, 253859 www.jjmmc.org
Disclaimer : Views and openions expressed in this newsletter are not directly that of the editor or the editorial board. For any clarification,
author of the article is to be contacted.
ACADEMICS AND ACHIEVEMENTS
02 JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013
ollowing are the academic activities and
achievements of our college faculty from various
departments.F1) Dr.Chatura K. R. presented "Cyto-histo-correlation of
ischemic fasciitis" in Slide seminar at the Launch of
Karnataka Chapter of Indian academy of cytologists, st
SDMMC, Dharwad on 31 March.
2) Dr. Chatura K. R. delivered a lecture on "Impact of
2001 Bethesda system of Cervical Cytology
Reporting" in the CME "Update of Diagnostic
Cytology" Department of Pathology , Sri Devaraj Urs thMedical College on 5 of April 2013.
3) Dr. Chatura K. R. has been nominated to the Executive
council, Karnataka Chapter of Indian Academy of
Cytologists 2013 -14.
4) Dr. Akshi Katyal, first year postgraduate, won the third
place for the poster "Cytomorphology of
myxofibrosarcoma - A see and learn experience"
guided by Dr. Chatura K. R., at Launch of KC-IAC,
SDMMC, Dharwad on 31-03- 2013.
5) Dr. S. S. Hiremath was faculty for Workshop on
"Histotechniques" at SSIMR, Davangere, conducted
by KC -IAP(ID) and delivered a lecture on
"Connective tissue stains" on 14-04-2013.
1) Department of Medicine celebrated the 82nd Birthday
of Dr. H. Gurupadappa, Director for Post graduate
studies, known as Teacher of Teachers, one of the
eminent senior faculty member of J.J.M. Medical
College, Davangere and Karnataka.
2) Dr. Pradeep T. V. Asst. Prof. of Medicine "Serum lipid
profile and Electrocardiographic changes in young
smokers" IJPHS vol.2/no.1/march 2013;2(1): 33 - 38.
Academic Activities of Dr. Sudarshan C. Y.
Delivered a lecture on "Coping Physical and
Psychological changes in Adolescent Males," to high
DEPT OF PATHOLOGY
DEPARTMENT OF MEDICINE
DEPARTMENT OF PSYCHIATRY
school and preuniversity students of Aditya Birla
Educational Institutions Harihar on 1-2-2013. About 300
students with their parents participated in the program
which featured a lively question and answer session at the
end.
Participated in a Mental health Awareness Program
organized by the taluk administration of Jagalur taluk , for
anganwadi workers, ASHA workers, Relatives of
psychiatrically ill patients on 3-2-2013. Delivered a talk on
Mind and Mental Illness - Common myths and Treatment
facilities available.
1) Dr. B. Vidyasagar, delivered the following lectures :-
Diagnosis of tuberculosis beyond sputum examination thand chest x-ray ,on May 13 , at Kapicon 2013,
Mangalore.
Selection of antibiotics for respiratory tract th
infections.0n 25 May, for family physicians,
Davangere.thCOPD acute exacerbation interactive session, on 26
May for physicians, Davangere.
2) Dr. B. P. Rajesh-delivered the lecture on "Reliability of th
chest Xrays in the diagnosis of tuberculosis", on 5
June 2013, for Physicians of Chitradurga.
3) Dr. Arun B. J. delivered the lecture on "Inhaled th
medications in Asthma & COPD". On 7 June, at IMA,
Harapanahalli.
The Department of Neonatology, JJMMC & SSIMS under
the auspices of NNF in association with department of
Peadiatrics, JJMMC, IAP-Davangere District Branch,
Dr. Nirmala Kesaree Paediatric Academic Trust &
Department of Health & Family Welfare conducted its first
novel one-day CME with the theme "President's vision -
Reach the Unreached" for PHC & MHC Medical Officers thof Davangere district on 27 April, 2013. It was conducted
in Bapuji Child Health Institute Auditorium.
DEPARTMENT OF PULMONARY MEDICINE
NATIONAL LEVEL WORKSHOP / CME /
CONFERENCE NEONATOLOGY CME
"Let food be thy medicine and medicine be thy food"- Hippocrates
JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013 03
ACADEMICS AND ACHIEVEMENTS
Dr. Manjunath Alur, Principal, JJMMC & Dr. Sumitra
Devi, District Health Officer were the chief guests while
Dr. P. S. Suresh Babu presided over the CME. The
dignitaries inaugurated the CME by giving an artificial
breath to the Mannequin baby with the concept "Give a
breath, save a life " . Dr. G. Guruprasad read "Brief report"
about CME. This was followed by release of the "CME
Resource Book". Dr. Munavar, District RCH officer & Dr.
Prabhu Patil, District Malaria Officer also participated. Dr.
S. S. Prakash, President, IAP-DDB proposed the Vote of
Thanks. The CME had an attendance of 150 delegates of
which majority were Medical Officers of PHC / MHC's.
Topics chosen dealt with the common Neonatal problems
faced in day to day practice.
The CME began with the delegates being given an
"Overview of Neonatal Resuscitation" by Dr. G.
Guruprasad, Prof., & HOD, Department of Neonatology,
JJMMC as a practical demonstration with all the necessary
equipments. This was followed by talk & demonstration on
the "Art of Newborn Examination" by Dr. Ashwini R. C.,
Asst. Professor Department of Neonatology, JJMMC,
Davangere.
Dr. B. S. Prasad, Professor of Pediatrics & Vice Principal,
SSIMS & RC gave a talk on "Approach to Respiratory
Distress in Newborns".
Dr. Girish G., Asst. Professor of Neonatology, JJMMC,
enlightened the participants about the "Myths & Facts of
Neonatal Jaundice". Dr. P. S. Suresh Babu, Professor of
Pediatrics & Past President IAP-Karnataka State Branch
spoke on "Feeding of LBW infants". The post lunch session
began with an interactive Panel discussion on NEONATAL
SEPSIS with Dr. Guruprasad as Moderator and Dr. Girish
G., Dr. Ashwini R. C. & Dr. Jayalakshmi (Fellow in
Neonatology, JJMMC ) as the Panelists. The risk factors of
Neonatal Sepsis, diagnostic dilemmas and practical tips in
the management of neonatal sepsis were discussed.
Dr. Harsha B. M., Professor of Pediatric Surgery, JJMMC,
spoke on "Surgical Neonate-when and how to transport"
and answered queries of participants on practical aspects
involved during transport of neonate with surgical
problems from periphery to a tertiary referral centre.
This was followed by a session on "Mixed Bag
of Neonatology" in which common neonatal emergencies
were discussed. Dr. Madhu Pujar, Associate Professor
gave a talk on "Neonatal Seizures" & Dr. Ramesh H.,
Professor of Pediatrics spoke on "Management Protocol of
Hypoglycemia in Newborn" .
The concluding talk was given by Dr. Chaitali R. Raghoji
on the" Danger signs in Newborn"- How to identify, when
to start treatment and refer patient to higher centre.
This was followed by an Open House discussion on various
aspects like Neonatal colic, Identification of seizures,
intramuscular injection for Neonatal sepsis, sunlight
therapy for Neonatal Jaundice and timing of surgery for
Esophageal Atresia / Tracheoesophageal Fistula.
Role play "Ruchigintha Schuchi Mukhya" by the nursing
staff of Bapuji Child Health Institute depicted in a hilarious
and entertaining manner the importance of hygiene. It was
well appreciated by the CME delegates.
The CME ended with the award of certificates to the
participants and high tea.
A CME was conducted by the department of Dermatology
on 7-4-2013 in the Library Auditorium. Dr. Prabhakar M.
Sangolli, Consultant Dermatologist & Former Associate
Professor, Department of Dermatology, Dr. B. R.
Ambedkar Medical College Bangalore delivered enriching
talks on:
1. Urticaria: an update
2. Acne: an update
3. Dry skin
Senior Dermatologist and Professor Emirates Dr. K.
Sidappa inaugurated the function. The gathering was
welcomed by Dr. S. B. Murugesh, Professor & HOD,
Department of Dermatology. Dr. K. Ravindra, Professor,
Department of Dermatology, thanked the gathering. A total
of around 100 delegates attended the CME.
DEPARTMENT OF DERMATOLOGY
"Declare the past, diagnose the present, foretell the future"- Hippocrates
04 JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013
ACADEMICS AND ACHIEVEMENTS
DEPARTMENT OF MEDICINE
ACTIVITIES OF DEPARTMENT OF
MEDICAL EDUCATION
thA CME on "Diabetes in Children" organized on 14 April
2013 and following guest lectures were delivered: -
1. "Epidemiology of diabetes in children - global / Indian
scenario" Dr.K.M.Prasanna kumar. Endocrinologist,
MS Ramaiah medical college, Bangalore.
2. "Diagnosis and classification of DM in children" Dr.
Chandrashekar S. Professor, J.J.M. Medical College.
3. "Management of DM in children with insulin" Dr.
Surendra E. M., Professor, J.J.M. Medical College.
4. "Nuts and bolts of monitoring children with diabetes"
Dr. Manjunath Alur, Principal, J.J.M. Medical College.
5. "CGMS and insulin pump in type 1 diabetes" Dr. K. M.
Prasanna Kumar, Endocrinologist, MS Ramaiah
Medical College, Bangalore.
6. "Chronic complications of type 1 diabetes" Dr.
Gurushanthappa S. Professor, J.J.M. Medical College.
7. "Management of DKA" Dr. Vinaya Swami P. M.
Professor, J.J.M. Medical College.
8. "Psychosocial aspects of DM" Dr. K. Sriharsha,
Professor, J.J.M. Medical College.
9. "Auto immunity in Type 1 DM" Dr. U. R. Raaju,
Reader, J.J.M. Medical College.
st1 Basic Course Workshop on Medical Education
Technologies (MET) was conducted for 3 days for our th th
college faculty from 25 to 27 April,2013 in which 27
members participated. This programme was MCI (Medical
Council of India) approved as it was conducted under the
consensus of MCI & MCI's Regional Training Centre,
JNMC, Belgaum. Dr. Manjunath Alur, Principal, JJMMC
inaugurated the programme. Dr. Sunitha Y. Patil, Associate
Professor of Pathology, FAIMER Fellow, Assistant /
Coordinator, DOME, JNMC, Belgaum was the observer &
external resource person. Following faculty of our college
were the resource persons :-
1. Dr. Usha M.G., Prof. of Microbiology & Coordinator
of DOME
2. Dr. Nagamani Agarwal, Prof. of Pediatrics
3. Dr. Deepak G.Udapudi, Prof. of Surgery
4. Dr. Rajini S., Asso. Prof. of Biochemistry
5. Dr. Preethi B. P., Asso. Prof. Biochemistry
6. Dr. Veena M., Asso. Professor of Microbiology
7. Dr. Suneel Reddy, Asso. Prof. of Pharmacology
8. Dr. Jayalakshmi M. K., Asst. Prof. of Physiology
9. Dr. Sunitha M., Asst. Prof. of Physiology
10. Dr. Varadendra Kulkarni, Asst. Prof. of Pathology
11. Dr. Renuka B. G., Asst. Prof. of General Medicine
Dr. Santhosh C. S., Asso. Prof. of Forensic Medicine,
Dr. Sunil Kumar K. B., Asso. Prof. of Pathology,
Dr. Anurupa M., Prof. of Community Medicine took
active role in conduction of programme, in Role plays
& Video shows.
Case discussion on the following topics were organized by
the academic body "Multimodality imaging finding and
clinical aspect in tuberous sclerosis" Department of
Radiology on 16-5-13
"Oesophageal stricture and management" Dr. Siddesh,
Gastroenterologist
"Lumbo-costal vertebral syndrome" by Dept. of
Neonatology
All the faculty members took part actively in the case
discussion.
Guest Lecture on "Infectious disease control" on 5-6-13
Dr. Chetan Jinadatha, M.D., MPH, USA
Guest lecture on "Pain Management" Dr. Naren Raj,
Consultant Anesthetist, Manchester, UK
Case discussion on "Intestinal Obstruction"- surgery C
unit, Bapuji Hospital
ACADEMIC BODY
"The art is long, life is short, opportunity fleeting, experiment dangerous, judgment difficult"- Hippocrates
JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013 05
The graduation day started at 5.30 pm after the arrival of the
guests with a march from the Mother Theresa block to the
Bapuji auditorium with the band on the red carpet. There
was a photo session for the whole batch. After the photo
session, all the students gathered inside the auditorium .The
program started with invocation. Dr. Shukla Shukla Shetty,
professor, department of OBG welcomed the gathering.
This was followed by lighting the lamp. Dr. Prasanna
Anaberu, professor, department of orthopaedics,
introduced the chief guest Dr. C. V. Manjunath,
cardiologist, director of SJICR, Banglore. Dr. C. V.
Manjunath inspired the students with the stories from his
medical experience about compassion, logic, common
sense and how to deal with all aspects of patient care. Sri S.
S. Mallikarjun, Joint Secretary, BEA, Chairman of SSIMS
and former youth and sports minister addressed the
gathering. Dr. Alur Manjunath, our beloved principal also
spoke on the occasion. Junior doctor's association president
Dr. Sumeeth Kumar read out the batch report containing the
academic, cultural and sports achievements of the batch.
Dr. Kavya Reddy, treasurer, JDA gave an outlook of the
undergraduate life experience of the batch. Also present on
stage were Dr. Gurupadappa, Director of PG studies, Dr. M.
G. Rajashekarappa, Director general Administration,
JJMMC, Dr. Shivswamy Sosale, cardiologist, BMC heads
of all the departments.
th thGraduation Day Celebration of Batch 2007 on 24 and 25 March 2013
The graduation of the students began with the distribution
of certificates and the medals to the students. Dr. Belgundi
Preeti received gold medal from the Apollo group of
hospitals Banglore by the representatives Dr. Sahana
Govindaiah, deputy medical superintendent and Mr.
krishnamurthy, senior manager-admn & HR for being the
best outgoing student of the batch. Dr. Prashanth R. R. was
awarded gold medal from the Alur Trust for scoring the
highest marks in medicine.
The fresh graduates took the Hippocratic Oath under the
guidance of Dr. Ravindra Banakar, senate and syndicate
member of RGUHS. Dr.Belgundi Preeti, vice-president,
JDA thanked the gathering with the vote of thanks. The
parents of all the fresh graduates participated in the
function. Grand dinner was arranged after the ceremony. thOn 25 march a cultural program was arranged by the batch
of 2007.
Name of the Topic Name of Presenter
Name of the Guide / Other Authors
Venue & DateSl.No.
A cyto- histomorphological correlative study of endometrium
Granuloma in testis- A dilemma
FNAC spleen in diagnosing primary myelofibrosis
Malignant testicular germ cell tumour
Angioimmunoblastic T-cell lymphoma
Gaucher's disease
Leukemic lymphadenopathy
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Dr. Boobalan S.
Dr. Ananthvikas J.
Dr. Nagalakshmi D. N.
Dr. Ajit Pratap Singh Panayach
Dr. Shweta Puri
Dr. Ranjana R.
Dr. Neethu R.
Dr. S. S. Hiremath
Dr. Chatura K. R.Dr. Sunilkumar K. B.
Dr. Hiremath S. S.Dr. Suresh Hanagavadi
Dr. Hiremath S. S.Dr. S. B. Patil
Dr. Hiremath S. S.
Dr. Hiremath S. S.
Dr. Hiremath S. S.Dr. Suresh Hanagavadi
Karnataka chapter of Indian Academy of CytologistsSDMCMS, Dharwad on31-03-2013
Postgraduate Section: Dept. of Pathology: Posters presented by postgraduates
ACADEMICS AND ACHIEVEMENTS
"Cure sometimes, treat often, comfort always"- Hippocrates
06 JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013
Name of the Topic Name of Presenter
Name of the Guide / Other Authors
Venue & DateSl.No.
Bronchioloalveolar carcinoma -The mystery lung cancer
Left supraclavicular lymphnode metastasis of ovarian carcinoma - an uncommon presentation
Myxofibrosarcoma- A see and learn experience
Cytological diagnosis infiltrating squamous cell carcinoma of buccal mucosa
Cytomorphology of Anaplastic large cell lymphoma
Intraoperative cytology of mixed germ cell tumor ovary
Cytological evaluation of polymorphous low grade adenocarcinoma- parotid
Malignant melanoma on FNAC-Two case reports
Recurrent soft tissue tumour - A case report
Salivary duct carcinoma - A Pitfall on FNAC
Dr. Sreelekha B. V.
Dr. Priya C.
Dr. Akshi Katyal
Dr. Suchetha K. R.
Dr. Geetha D. H.
Dr. Trupti Deshpande
Dr. Prashanth R.
Dr. Abhijit Kalita
Dr. Rama Reddy Tetali
Dr. Bhuvana T.
Dr. Hiremath S. S.
Dr. Hiremath S. S.Dr. Nikethan B.
Dr. Chatura K. R.Dr. Hiremath S. S.
Dr. Hiremath S. S.
Dr. Hiremath S. S.
Dr. Hiremath S. S.
Dr. Hiremath S. S.Dr. Nikethan B.
Dr. Hiremath S. S.Dr. Arijit Roy
Dr. Hiremath S. S.Dr. Nikethan B.
Dr. Chatura K. R.
Karnataka chapter of Indian Academy of CytologistsSDMCMS, Dharwad on31-03-2013
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Oral Presentation : Dr Abhijit Kalita : Penile neoplasia: OLD wine in a NEW bottle of morphology, stGuided by Dr. Chatura K. R. at 61 Annual conference of IAPM, APCON 2012, Jamnagar, Gujarat, December 2012
DEPT. OF MEDICINE
Name of the Topic Name of the Guide / Other Authors
Venue & DatePresen-tation
Sl.No.
Name of Presenter
Acute ischemic Infarct in MCA territory following Russell's Viper bite
Thyroid functions in chronic Renal failure patients
Congenital heart disease single ventricle with malposition of great vessels with pulmonary stenosis
Study of Carotid Intima media Thickness among Type-2 DM, HTN & Diabetic hypertensive patients
Poster
Platform
Poster
Platform
Dr. Shardulkumar Dubey
Dr. Shardulkumar Dubey
Dr. P. VamseeKrishn
Dr. P. Vamsee Krishna
Dr. K. Sriharsha
Dr. P. E. DhananjayaDr. Shrinivas A. Patil
Dr. K. Sriharsha
Dr. Vinayswamy P. M.Dr. Ashok K.
KAPICON - 2013th th
26 to 28 April 2013 Mangalore.
1
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3
4
ACADEMICS AND ACHIEVEMENTS
"Natural forces within us are the true healers of disease"- Hippocrates
ACADEMICS AND ACHIEVEMENTS
JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013 07
Name of the Topic Name of the Guide / Other Authors
Venue & DatePresen-tation
Sl.No.
Name of Presenter
Alexia without Agraphia
Sturge weber syndrome - case report
Endoscopic esophageal stricture dilatation without Fluoroscopy
Clinical and Histopathological study of Nephrotic syndrome in adults
Brain Metastasis from Hepatocellular carcinoma (HCC)
A Study of Coronary artery involvement in Diabetics & non-Diabetics with Acute coronary sysndrome
Eight and Half Syndrome
To assess the prevalence of hyperglycemics with RCBG in rural community of South India.
Pneumatic balloon dilatation of achalasia cardia
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Poster
Poster
Poster
Platform
Poster
Paper
Poster
Platform
Platform
Dr. Deepak S. V.
Dr. Basavanagowda G. M.
Dr. Shankargouda Patil
Dr. Shankargouda Patil
Dr. Chirag D.
Dr. Chirag D.
Dr. Manjunath P. R
Dr. Manjunath P. R.
Dr. Prashanth D. C.
Dr. L. KrishnamurthyDr. S. M. YeliDr. Vishwakumar S. N.
Dr. L. Krishnamurthy
Dr. E. R. SiddeshiDr. S. N. Vishwakumar
Dr. Rajeev Agarwal Dr. Aditya Lajami
Dr. S. M. Yeli
Dr. Srinidhi M. S.Dr. P. Mallesh
Dr. L. KrishnamurthyDr. S. M. Yeli
Dr. Vishwanath B. M.
Dr. E. R. SiddeshiDr. S. N. VishwakumarDr. S. R. HegdeDr. SrinivasDr. Keshav
KAPICON - 201326th to 28th April 2013 Mangalore.
Organophosphate induced delayed polyneuropathy
Isolated systolic Hypertension in elderly ; evaluation of cardiac status and study of co-existing cardiovascular risk factors
Spreading vasculitis of unknown etiology - a case report
Dyke Davidoff masson's syndrome
Poster
Paper
Poster
Poster
Dr. Prashanth D. C.
Dr. Suresh S. R.
Dr. Suresh S. R.
Dr. Phiji Mathews Philipose
Dr. Manjunath AlurDr. Chandrashekar S.Dr. Surendra E. M.
Dr. Thippeswamy A. P. Dr. Rahul S. Patil
Dr. S. M. Yeli
Dr. B. D. ChavanDr. Malathesha M. K.
"It's far more important to know what person the disease has than what disease the person has"-Hippocrates
08 JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013
ACADEMICS AND ACHIEVEMENTS
Dr.Shankargowda Patil Final Year Post Graduate Student in General Medicine received the Best Paper award in
Nephrology section for "Clinical and Histopathalogical Study of Nephrotic syndrome in adults" at KAPICON - 2013 in
Mangalore, Karnataka, under the Guidance of Dr.Rajeev Agarwal. Prof. of Medicine.
DEPARTMENT OF PSYCHIATRY
Name of the Topic Presen-tation
Sl.No.
A Clinical study of microvascular complications - in a newly diagnosed Type 2 DM
Clinical Spectrum of Pulmonary Tuberculosis in HIV sero positive persons with reference to CD4 count
Paper
Paper
Name of the Guide / Other Authors
Venue & DateName
of Presenter
Dr. Suman G. R.
Dr. Jairaj
Dr. Manjunath Alur Dr. Mohan R.
Dr. Rajasekharappa G.Dr. S. Rajakumar
KAPICON - 2013th th
26 to 28 April 2013 Mangalore.
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19
Name of the Topic Presen-tation
Sl.No.
Name of the Guide / Other Authors
Venue & DateName
of Presenter
Psychiatric morbidity in students
Study of Psychosocial profile in suicide attempters in tertiary care hospital
Psychiatric morbidity in prisoners
Temperament & emotional problems in children with specific learning disability-Teacher's perceptio
Emotional quotient & coping skills in junior doctors
Psychiatric morbidity in students & non-student population-A comparative study
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Dr. Karthik U. M.
Dr. Nivedita
Dr. Mruthyunjaya Dr. Anupama M.Dr. GangadharDr. RoopeshDr. Raghu
Dr. Mruthyunjaya
Dr. Harish Kulkarni
Dr. Karthik U. M.
Dr. Shamshad Begum
Dr. M.Anupama
Dr. Anupama M.
Dr. Sudarshan C. Y.Dr. Shamshad Begum
Dr. K. Nagraj Rao Dr. Shamshad Begum
KANCIPS held at Mangalore Dec 2012
Poster
Poster
Poster
Paper
Paper
Poster
ANCIPS 2013 held at Bangalore January 2013
"Extreme remedies are very appropriate for extreme diseases"-Hippocrates
JJMMC VoiceJuly 2013JJMMC VoiceJuly 2013 09
Introduction
Case Report
Discussion
Urothelial carcinoma is the most common malignancy of the urinary tract and is the second most common cause of death among genitourinary tumors. Bladder cancer is related to age and exposure to environmental carcinogens, 3 times more common in men than in women, rare in persons less than the age of 40 years and typically nonaggressive and well differentiated.
We gave a brief insight into the WHO 2004 grading scheme which has replaced the 1973 and 1998 WHO classification system of urothelial neoplasia.
A 15yr boy presented with the history of hematuria for past 6 months. He was evaluated thoroughly and found to have a bladder growth on ultrasound. There was no metastasis found on metastasis work up. He underwent TURBT under spinal anaesthesia (Fig1). The growth was completely removed (Fig 2) and sent for histopathology examination. The histopathology report gave an impression as Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP), (Fig 3, 4). The boy was relieved of symptoms and is on regular follow up for past 2 months.
PUNLMP, short for papillary urothelial neoplasm of low malignant potential, is an exophytic (outward growing), (microscopically) nipple-shaped (or papillary) pre-malignant growth of the lining of the genitourinary tract (the urothelium).
PUNLMP is pronounced pun-lump, like the words pun and lump.
PUNLMP is a papillary growth with minimal cytological atypia that is more than seven cells thick and is generally solitary and located on the trigone and is composed of thin papillary stalks, where the polarity of the cells is maintained and the nuclei are minimally enlarged. PUNLMP has a low proliferation rate and is not associated with invasion or metastases. PUNLMP is different from a benign papilloma in that a PUNLMP has a thicker cell layer and large nuclei with occasionally mitotic figures. The male to female ratio for PUNLMP is 5:1, and the mean age is 65. PUNLMP can recur within the bladder in 35% of cases, but progression is rare, occurring in less than 4%. PUNLMP is relatively rare with a prevalence of 0-3.5%
PUNLMPs are exophytic lesions that appear friable to the naked eye and when imaged during cystoscopy. They are definitively diagnosed after removal by microscopic
PAPILLARY UROTHELIAL NEOPLASM OF LOW MALIGNANT POTENTIAL (PUNLMP) - CASE REPORT
examination by pathologists. Histologically, they have a papillary architecture with slender fibrovascular cores and rare basal mitoses. The papillae rarely fuse and uncommonly branch. Cytologically, they have uniform nuclear enlargement.
They cannot be reliably differentiated from low grade papillary urothelial carcinomas using cytology, and their diagnosis (vis-a-vis low grade papillary urothelial carcinoma) has a poor inter-rate reliability.
The WHO 2004 grading scheme is used routinely and has replaced the 1973 and 1998 WHO classification system. The elimination of the grade 1, grade 2, and grade 3, 1973 WHO system is collapsed into low grade or high grade in the 2004 WHO classification. This system lacked reliability in terms of recurrence, invasion, metastasis and therefore failed to stratify tumors accurately .In 1998, the International Society of Urological Pathology (ISUP) developed a new nomenclature to better reflect the recurrence and progression rates of urothelial cancer. In 2004, the WHO adopted the ISUP recommended staging system and is the standard histologic nomenclature for urothelial carcinoma.
WHO grading scheme for urothelial malignancy
2004 World Health Organization Classification of Nonivasive and Invasive Urothelial Neoplasia
Noninvasive Urothelial Neoplasiahyperplasia (flat and papillary)Reactive atypiaAtypia of unknown significanceUrothelial dysplasia (low-grade intraurothelial neoplasia)Urothelial carcinoma in situ (high-grade intraurothelial neoplasia)Urothelial papilloma Urothelial papilloma, inverted typePapillary urothelial neoplasm of low malignant potential Noninvasive low-grade papillary urothelial carcinoma Noninvasive high-grade papillary urothelial carcinoma Invasive Urothelial NeoplasiaLamina propria invasionMuscularis propria (detrusor muscle) invasion
From Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladdertumors : a summary and commentary. Int J Surg Pathol 2005 ; 13 (2) : 143-53
"Whereever the art of medicine is loved, there is also a love of humanity"-Hippocrates
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Clinical Significance of Different Non-Muscle_invasive Urothelial Cancer Categories in WHO 2004 Grading System
CIS, carcinoma in situ; N/A, not applicable ; WHO, World Health Organization.From Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors : a summary and commentary.Int J Surg Pathol 2005 ; 13 (2) : 143-53.
PapillomaPapillary Neoplasm of Low
Malignant PotentialLow-grade Papillary
CarcinomaHigh-grade Carcinoma
(Papillary and CIS)
Recurrence (%)
Grade progression (%)
Stage progression (%)
Survival (%)
0-8
2
0
100
27-47
11
0-4
93-100
48-71
7
2-12
82-96
55-58
N/A
27-61
74-90
Special thanks to, Dr. K. K. Suresh, Department of Pathology, JJMMC, Davanagere.
Figure 1: Intra operative picture of the papilloma
Figure 2: Specimen after resection.
Figure 3: (1) Low-power view of tumor of Figure 4: (2) High-power view of the same tumor. lowmalignant potential (LMP). The cellular polarity is retained
and the superficial umbrella cell layer is intact.Dr. Naveen H. N. Asst. Prof, Urology, Bapuji Hospital
Dr. Deyonna Fernandes (Surgery Post graduate)
Histologic Characteristics of Noninvasive Papilary Urothelial Tumors of the Bladder According to the WHO
From Montironi R, Lopez-Beltran A. The 2004 WHO classification of bladder tumors : a summary and commentary. Int J Surg Pathol 2005 ; 13 (2) : 143-53.
PapillomaPapillary Neoplasm of
Low Malignant Potential (PUNLMP)
Low-grade PapillaryCarcinoma
High-grade Papillary Carcinoma
Architectural Features Papillae
Organization of cells
Cytologic Features Nuclear size
Nuclear shape
Nuclear chromatin Nucleoli
Mitoses Umbrella cells
Delicate
Identical to normal urothellum
Identical to normal urothellum Identical to normal urotheliumFine Absent
AbsentUniformly present
Delicate, Occasionally fused, not branchingOrdered, Polarity Identicalto normal urothellum any thickness, cohesive
May be enlarged but uniformElongated, round to ovaluniformFineAbsent to inconspicuous
Rare, basalPresent
Fused, branching
Predominately ordered ,minimal crowding and minimal loss of polarity ; any thickness, cohesive
Enlarged with variation in sizeRound to oval, slight variation in shape and contourmild variationUsually inconspicuous
Occasionally at any levelUsually present
Fused branching
Predominately disordered with frequent loss of polarity, variable thickness, discohesive
Enlarged with variation in size ready visible moderate to marked pleomorphismModerate to marked variation. Hyperchromasia.
Multiple prominent nucleoli maybe present Usually frequent, at any level Usually absent
"Walking is man's best medicine"-Hippocrates
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JUVENILE NASOPHARYNGEAL ANGIOFIBROMA - RARE CASE REPORT
ABSTRACT
A 12 year old male, presented with left sided progressive nasal obstruction and recurrent epistaxis since 5 months. History, clinical examination and imaging pointed to the diagnosis of Juvenile Nasopharyngeal Angiofibroma (JNA).
JNA is a relatively uncommon neoplasm occurring almost exclusively in adolescent males.It is histologically benign, but locally aggressive vascular tumor. It is the most common benign neoplasm ofnasopharynx. Surgery is the main modality for management of this tumor.
INTRODUCTION
JNA is a rare high risktumour of adolescent males.It accounts for less than 0.5% of head and neck tumours.The most common presenting symptoms are severe recurrent epistaxis with persistent nasal obstruction.As disease progresses,facial deformities,proptosis,blindness and cranial nerve palsies may occur.Diagnosis is based on a careful history, clinical features and radiological examination.Different treatment modalities are available-the definitive being surgical extirpation and most recent is endoscopic excision.
CASE REPORT
A 12 year old male patient came with complaints of left sided progressive nasal obstruction and recurrent bouts of epistaxis and voice change(nasal intonation) since 5 months. Medical, family and personal history were noncontributory. General physical examination revealed a moderately built and nourished adolescent male with swelling on left side of cheek. Anterior rhinoscopic examination revealed blood stained mucoid discharge and deviated septum to left. Posterior rhinoscopy revealed a pinkish mass in the nasopharynx. Oropharyngeal examination was normal.
Figure 1-pre op picture of the patient
CT-PNS showed an intensely enhancing lobulated mass of 2.5x2.1 cm arising from posterior choana extending into left sphenopalatine foramen and laterally to pterygopalatine fossa causing remodelling, deviation of
septum to right and expansion of left pterygopalatine fossa. Routine examination of blood, urine, CXR, ECG revealed no abnormalities. Based on clinical features and radiological evaluation, it was diagnosed as a case of Juvenile nasopharyngeal angiofibroma-Stage II b. Angiography and embolisation were not done due to unavailability.
Figure 2-axial,sagittal and coronal cuts showing mass in nasopharynx
Surgical excision under GA through lateral rhinotomy approach was planned. After sufficient pre-op measures(including 4 units of fresh blood)patient was operated using hypotensive anaesthesia, in supine and 15 degree head up position. Through left lateral rhinotomy the tumour was approached by medial maxillectomy with exposure of left maxillary antrum and sphenopalatine foramen from where the tumour has originated.Tumour was pushed to the nasopharynx with digital pressure, dissecting subperiosteally. Whole mass was removed along with its extensions. Post nasal and anterior nasal packing done. Incision was closed in layers. Per operative bleeding was around 1L.So 2 units of blood transfusion was done intraoperatively.
Figure 3- Intraop images
Nasal packs were removed after 48 hours and there was no bleeding. Mild soft tissue swelling was present on left side. No visual disturbances or epiphora. Patient is doing well.
"Whenever a doctor cannot do good, he must be kept away from doing harm"-Hippocrates
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DISCUSSION
JNA is a highly vascular, benign, yet locally invasive neoplasm seen in adolescent males. Its exclusive occurrence in males suggests a hormonal influence. The site of origin is most likely near sphenopalatine foramen. It expands laterally via pterygopalatine fossa to infratemporal fossa, medially to anterior nasal cavity and related sinuses. It can have intracranial extension into anterior and middle cranial fossa via preformed pathways or by destroying bone.
Gross pa thology usua l ly showed a sess i le , lobulated,rubbery dark red to tan grey unencapsulated mass, composed of an admixture of vascular tissue and fibrous stroma.
JNA usually presents with unilateral nasal obstruction and recurrent epistaxis. Other features include facial swelling, proptosis, diplopia, conductive hearing loss, mucopurulent rhinorrhoea, headache, nasal speech, anosmia etc,10-20% can have intracranial extension at time of presentation.
Plain lateral X-ray of skull showed anterior bowing of posterior wall of maxillary sinus. CT with contrast shows an enhancing soft tissue mass arising from nasopharynx, widening of sphenopalatine foramen and expansion of pterygopalatine fossa. MRI showed a vascular tumour with flow voids within the sinus. Biopsy is contraindicated due to risk of haemorrhage. Diagnosis is based on its typical presentation, clinical examination and radiological investigations..
Definitive diagnosis is established by angiography, characteristic angiographic appearance in JNA is tumour blush and absence of venous filling. Major arterial supply is ipsilateral internal maxillary artery and in 1/3rd cases ascending pharyngeal artery. If there is infra-temporal or intracranial extension, contralateral ECA, ICA and CCA also contribute.
There are various staging systems for JNA-Chandler's, Session's, Fisch's, Radkowski's etc. Various treatment modalities are-Surgical, Radiotherapy, Hormonal, Chemothe rapy, C ryo the rapy, Sc l e ro the rapy, Electrocoagulation and Gamma knife surgery. Surgical excision is the treatment of choice for extracranial lesions. Choice of surgical approach is determined by pre op imaging revealing the site and extent of lesion. Various approaches include transpalatal, medial maxillectomy approach via lateral rhinotomy or midfacial degloving, Le-Fort I osteotomy, maxillary swing, trans-mandibular, trans-hyoid etc. Trans-nasal endoscopic tumour resection is the mainstay of surgical resection in present era.
Radiotherapy has been used for reccurence after surgery and those with intracranial extension. External beam radiation is given as 30-35 Gy in 15-18 fractions for 3 weeks. Hormonal therapy with diethyl stilbesterol and flutamide (non steroidal androgen antagonist) has been used as an adjuant therapy to primary surgical treatment.
CONCLUSION
JNA is an uncommon, benign and extremely vascular tumour seen exclusively in adolescent males. Diagnosis is based on history, physical examination and radiographic findings. CT scanning is invaluable for evaluating tumour extent. Angiography combined with embolisation aids surgeons in identifying the main feeding vessels and decreasing intraoperative blood loss. Surgery is the main stay of therapy with radiation therapy reserved for inoperable masses.
REFERNCES
1. Scott-Brown's Otorhinolaryngology $ Head and Neck Surgery(7th edition)
2. Cumming's Otorhinolaryngology & Head & Neck Surgery(5th edition)
3. Eugene Myer's Operative Otolaryngology(2nd edition)
4. Otolaryngologic Clinics of North America-Nov.86
5. Indian Journal of Otolaryngology & Head and Neck Surgery(July-Sept 2012)
6. Journal of Laryngology & Otology 2008;122;1185-9 endoscopic approach to JNA
7. Laryngoscope 2005;115:1201-7 endoscopic versus traditional approaches for excision of JNA
Figure 4-specimen post op Figure 5-patient post op
Dr. K. P. Basavaraj, Professor, of E.N.T
Dr. K. B. Chandrappa, Professor, of E.N.T
Dr. Lakshmi Prasenajith, PG in E.N.T
"A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses"
-Hippocrates
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INTRA ORAL RECONSTRUCTION IN ADENOID CYSTIC CARCINOMA WITH EXTENDED NASOLABIAL
SKIN FLAP - A RARE CASE
ABSTRACT
INTRODUCTION
CASE REPORT
Facial reconstruction relies on creativity of surgeons as well as clear understanding of local flaps. Large defects following resection of head and neck tumors can present as a challenge for reconstructive surgeon. We present a case of adenoid cystic carcinoma of face and oral cavity managed by combined wide excision and extended nasolabial rotation flap reconstruction. Proper planning and staging of surgical procedure and use of local flaps gave us good aesthetic and facial outcome.
KEY WORDS : adenoid cystic carcinoma (ACC), nasolabial rotational flap, intra oral reconstruction.
The adenoid cystic carcinoma is a rare malignant tumor of head and neck affecting both minor and major salivary glands along aero-digestive tract. It includes approximately 10% of all salivary neoplasms and 30% of minor salivary glands. It is well known for its slow progression, perineural invasion, delayed direct distant metastasis. The goals of management in cases of carcinoma of head and neck include preservation of life by surgical ablation with combined radiotherapy and focussing on better facial aesthesis and oral function to improve quality of life. Quality of life has been found to be improved in those who have undergone vascularized nasolabial flap reconstruction. The subcutaneous pedicled nasolabial flap appears to have been originally described in works of Susruta in 600 BC in India. For centuries there after nasolabial flap was used primarily in external nasal reconstruction, but several authors have reported favourable outcome when this flap was used to cover oral cavity defects.
Here we report a case of adenoid cystic carcinoma of minor salivary glands managed with wide excision of tumor and intra oral reconstruction using extended nasolabial flap, first of its kind to be reported in India.
A 60 Year old female patient, tobacco chewer, presented with a recurrent swelling over right cheek since 5 years, progressively increasing in size since one month, associated with pain on chewing and difficulty in opening mouth since one month. She had been operated for same complaint 5 yrs back at private hospital. On examination of cheek and oral cavity, a diffuse solitary swelling over right
side, with bosselated surface inside oral cavity and smooth surface over right cheek, hard in consistency, superior border was ill defined due to extension of tumor into infratemporal fossa and inferior border was well made out and the swelling decreased in size on clenching of teeth. Skin over swelling was pinchable (Fig1,2,3). There was weakness of the buccal branch of facial nerve. No lymphadenopathy. On X-ray PNS soft tissue opacity noted around right maxillary region extending into pterygo palatine fossa with no underlying bony erosions. Fine needle aspiration cytology showed features suggestive of adenoid cystic carcinoma. On Chest X-ray showed no metastasis to lungs.
Based on above findings a clinical diagnosis of ACC of minor salivary gland T4a N0 M0, Stage 4b and patient was taken for wide excision of tumour with extended nasolabial rotational skin pedicle flap for reconstruction of oral cavity.
Under general anaesthesia with nasal intubation, incision was outlined on the right cheek for raising inferiorly based extended nasolabial flap with keeping in consideration tumor location, medial incision of flap precisely followed nasolabial fold in superior two thirds and inferior third 2-3mm medial to fold, apex 1 cm below medial canthus up to angle of mouth lateral to the commissure (Fig4). This design allowed the length of 7-8 cm and width about 4 cm maximum at base with pedicle, and hence less distortion after flap transfer and allowed improved arc of rotation. Incision at base of pedicle was further deepened medially into oral cavity upto 3rd molar including tumor and laterally up to upper border of ramus of mandible for dissecting the tumor. Tumor was dissected along with few masseter fibers laterally and buccal mucosa medially along the extension. Superiorly while dissecting the tumor in inferior temporal fossa, pterygoid plexus of veins were injured and packs were placed in situ just below orbital plate to achieve haemostasis. Skin flap was rotated at base of pedicle and placed inside oral cavity (Fig5). After placing the flap, donor site over right cheek was closed by primary suturing of medial and lateral limb upto angle of mouth bringing the scar in line of nasolabial fold. A small triangular area was left inferiorly at the base of the flap to preserve vascularity of flap pedicle and was planned to be divided after two weeks. On third week patient will be subjected to radiotherapy. Post operatively packs were removed on 3rd post operative day and postoperatively uneventful. (Fig7, 8)
"Healing is a matter of time, but it is sometimes also a matter of opportunity" -Hippocrates
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DISCUSSION
Adenoid cystic carcinoma accounts for 60% of all minor salivary gland neoplasms, most common occurrence of ACC is palate and presents as submucosal swelling .ACC is well known for its prolonged clinical course, perineural invasion with tendency of delayed distant metastasis and multi local recurrence rate of 42% .It is commonly seen in 5th to 6th decade of life. Histopathologically ACC is categorized into three growth patterns solid, cribriform and tubular. Loco-regional recurrences are more common in cribriform forms and poor prognosis in solid forms. Fine needle aspiration cytology is preliminary diagnostic tool for malignancies of head and neck, a safe procedure well tolerated with no tumor seeding to surrounding tissue and histopathology of biopsy specimen being confirmatory diagnosis. The optimal therapy for ACC of the head and neck has not been established. The choice of therapy is affected by site, stage, histologic grade, and biologic behaviour of the ACC. There are a number of publications that address the efficacy of surgery and radiation therapy in the treatment of ACC of the head and neck.
In above case ACC was managed surgically with extended nasolabial skin flap. Several methods are described for reconstructing of oral cavity defects either pedicled or free flap. The pectoralis major flap a pedicled flap is commonly used for this purpose. However, this flap is bulky associated with donor site morbidity. Likewise the forearm free flap has also become more preferable reconstruction method .It offers a large surface of thin pliable skin that allows for complex reconstruction but unfortunately donor site morbidity rates are quite high. This makes nasolabial flaps ideal for reconstruction of large intraoral defects. The nasolabial region is well known donor site for variety of flaps and provides an excellent texture and colour. The nasolabial flaps are superior and inferiorly based. An inferiorly based flap is useful in reconstruction of oral lip, oral commissure and anterior aspect of floor of mouth while superiorly based flaps used for reconstruction of ala and tip of the nose, lower eyelids and cheek .The choice of pedicle is based on site of defect and thickness of donor tissue. The nasolabial flaps are raised with skin and subcutaneous tissue to ensure good blood supply, although remaining superficial to facial muscles. The base of the flap is above the level of angle of the mouth, as just below several branches of from facial artery and inferior labial artery
which passes into subcutaneous tissue and skin of nasolabial region further assuring abundant blood supply and lymphatic drainage to and from the flap so less chances of flap edema and flap necrosis. The terminal branches of facial nerve lie deep to facial muscles and are not endangered by flap elevation. The skin flap length and breadth are adjusted in ratio of 4:1 to fill the defect without tension and permit safe closure of donor site in two stage procedure; pedicle will be separated from the flap by 14 to 21 days .The scar line lie along nasolabial fold giving good cosmetic outcome. Radiation therapy in cases of ACC is by photon irradiation therapy which will recur locally with time and usually doses of 60 Gyc or more may be beneficial in minimal residual microscopic disease. The conclusion is that neutron radiotherapy is effective treatment compared with neutron and photon irradiation, for patients with gross residual disease and achieves excellent loco regional control in patients without evidence of gross disease.
PICTURES
Fig. 1 & 2: Adenoid Cystic Carcinoma Right Side of Face and Oral Cavity.
Fig.3 : Acc Extending into Oral Cavity from 1st Upper
Molar to 3rd Molar
Fig. 4 : Incision Outlined Over Right Cheek for Raising
Extended Naso Labial Flap and Tumor being Lateral
Fig.5: Rotation of Nasolabial Flap at base and Placing
inside Oral Cavity
Fig. 6 : Acc Specimen at Recipient Site.
"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health"
-Hippocrates
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Fig.7: On Postoperative 2nd Week - Operated Scar in line of Nasolabial fold with Pedical Seperated from flap.
Fig.8: Skin Flap Placed at Recipient Site inside Oral Cavity at 2nd Week.
Dr. K. C. Shivamurthy, Prof. & Head of Plastic Surgery.
Dr. Deepak K. Post-graduate, Dept. of General Surgery.
MULTIMODALITY IMAGING AND CLINICAL ISSUES IN TUBEROUS SCLEROSIS- A CASE STUDY
A 38 year old female patient was referred for ultrasound examination of the abdomen to evaluate the cause of abdominal pain. Patient stated that she experienced pain of mild to moderate severity in the upper part of the abdomen which improved with analgesic use but did not completely subside. She said she first noticed her complaints two years before this hospital visit.
Ultrasound examination of the abdomen revealed grossly enlarged kidneys that were highly echogenic. The parenchyma of both kidneys was observed to be replaced by multiple echogenic masses. Structural disorganization of the kidneys was highly evident.
The enlarged kidneys obscured visualization of other structures. A diagnosis of bilateral renal angiomyolipomas was made.
Ultrasound examination disclosed bilateral renal echogenic masses.
Renal angiomyolipomas can occur in isolation. However multiplicity, bilaterality and gross renal distortion raise suspicion for tuberous sclerosis. Furthermore, the characteristic facial lesion of adenoma sebaceum as shown in the photograph prompted a search for other lesions.
Following a diagnosis of renal angiomyolipomas, additional imaging was considered to evaluate the presence
of other lesions of Tuberous Sclerosis.Patient underwent Roentgenologic Studies of the head, CT scan of the brain and abdomen and MRI examination of the Brain.
CT scan images of the abdomen in axial and coronal views shows multiple fat density masses in bilateral kidneys with marked renal enlargement and architectural distortion with mechanical effects on the pelvicalyceal system as shown in the third image.
R e f o r m a t t e d Sagittal and coronal CT sections of the abdomen viewed in the bone window reveal multiple bony i s l a n d s i n t h e lumbosacral spine.
CT slice through the lower part of the thorax reveals a cystic lucency in the right m i d - l o b e w i t h f e w traversing septations within the same, suggesting cystic lymphangioleiomyoma.
"Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed" -Hippocrates
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he submission for the next issue (October 2013) thTof the News Letter should be done before 10
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well as hard copy to the department Co-ordinator.
X-ray studies of the skull show a calcific focus in the left para-sagittal region.
Axial sections of brain CT revealed multiple subependymal nodular calcifications.
Post-contrast CT brain shows few enhancing subependymal nodules.
Left to right : T1 weighted axial brain MRI, T2 axial, gadolinium enhanced and FLAIR axial sections
T1 axial sections show few enhancing subependymal nodules
T2 section shows presence of nodules along with a small white matter cystic lesion in the right parieto-occipital white matter. FLAIR image shows multiple cortical tubers.
DIAGNOSIS: On the basis of the radiological findings of bilateral renal angiomyolipomas, lung cystic lymphangioleiomyomatosis, subependymal calcifications, nodules and cortical tubers in the brain, a diagnosis of Tuberous Sclerosis was made.
DISCUSSION:
TS is an autosomal dominant disorder characterized by the tendency to form multiple hamartomatous lesions in various tissues of the body.
TS is caused by mutations in either TSC1 or TSC2. TSC2 mutations are seen in 75% cases, more so in de novo cases. They tend to be much more severe.
TS1 maps to chromosome 9 whereas TSC 2 maps to 16. The proteins encoded are hamartin and tuberin respectively
The disease has an incidence that varies in different studies from 1 in 10000 to 1 in 50000
The classical clinical triad of facial adenoma sebaceum, seizures and mental retardation is seen in less than fifty percent of the cases and therefore the radiologic hallmarks of this disease have universally been accepted as sufficient evidence for diagnosis
DIAGNOSTIC CRITERIA
MAJOR CRITERIA
Facial angiofibroma or forehead plaque, Non-traumatic ungual or periungual fibroma, Hypomelanotic macule (three or more), Shagreen patch, Cortical tubers, SEN, SEGA, Cardiac Rhabdomyoma/s, LAM, Renal angiomyolipomas, Nodular retinal Hamartomas
MINOR CRITERIA
Dental pitting, Hamartomatous rectal polyps, Bone cysts and islands, Cerebral white matter migration lines, Gingival fibromas, Retinal achromic patch, Confetti lesions, Renal cysts, Non-renal hamartomas
DEFINITE TS - 2 major or 1 major and 2 minor criteria
PROBABLE TS - 1 major and 1 minor criteria
POSSIBLE TS - 1 major or 2 or more minor criteria
Adapted from Roach ES, Gomez MR, Northrup H: tuberous sclerosis complex consensus conference - revised clinical diagnostic criteria. Journal of child Neurology 13:624, 1998
Dr. Rohith G. R., Junior Resident
Dr. Pramod Setty J., Prof. and Head, Dept. of Radio - Diagnosis.
"What medicines do not heal, the lance will ; what the lance does not heal, fire will" -Hippocrates