Online ISSN: 2515-8260

Current Issue
Volume 9, Issue 4

Volume 9, Issue 4, Summer 2022


A Clinical Study and Ultrasonography Diagnosis in Clinically Suspected Cases of Acute Appendicitis

Dr. Janardhan Jakkula, Dr. Ramesh Lingala, Dr. Shekhar Goud S, Dr. Sridhar Matta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1-11

Background: Acute appendicitis is the most prevalent cause of acute abdomen and
subsequent surgery. Misdiagnosis is a common and critical problem in general surgery
because the diagnosis is primarily based on clinical grounds. Maximum incidence observed
in the second and third decades of life, with male preponderance. Graded compression
ultrasonography is one of the diagnostic procedures that has been shown to reduce the need
for unfavourable surgical treatments, particularly in females.Objectives: Objectives of the
study were to study the clinical features of acute appendicitis, Utility of USG in supporting
the clinical diagnosis of acute appendicitis. Methods: This study included one hundred and
Twenty Five patients with history of RLQ pain where clinical diagnosis of acute appendicitis
was made. The study period was of 18 months between November 2019 to May 2021.
Routine bloodinvestigations and abdominal USG were done in all cases. All ultrasound
positive cases were subjected to surgery. Some ultrasound negative cases were also taken to
surgery on the high clinical suspicion of acute appendicitis. The ultrasound findings were
compared with clinical findings and histopathological examination reports.

A CLINICOPATHOLOGICAL STUDY OFBREAST LUMPS

Dr. P. Swarnalatha, Dr. R.Swarupa Rani , Dr. S.Rajasekhar Reddy , Dr. Shaik. Raja Husne Kalam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 12-39

Breast cancer affects women more than men. From puberty to death, breasts go through
constant physical and physiological changes related to menstruation, pregnancy, and
menopause. The goal was to classify different types of breast lesions and conduct a
clinicopathological study on them.Methodology: In the present study carried out at the
department of Pathology of ACSR Govt Medical College, Nellore AP during the period
from January 2019 to June 2021 (18 months) a total number of 150 FNAs were performed
on patients with breast lumps. Results: The youngest patient in this study was 12 years
and the oldest 79 years. Majority of the patients were in the age group of 21-40 years. In
majority of the patients i.e. From 150 aspirates, 65 were from the right breast and 70 from
the left. 15 cases involved both breasts.Upper outer quadrant of right and left breast had 39
and 35 cases of breast lumps, respectively. Lower outer quadrant of the right breast had 11
cases and upper medial had 11 cases. Two breast cases showed diffuse all-quadrant
involvement. 2 of the 45 cases were clinically suspected of malignancy and 1 of
fibroadenosis, but FNAC showed fibroadenoma. Three clinicocytologically discordant cases
lacked excision biopsy. 15 cases of breast cancer were in the right breast and 9 in the left.
Upper outer quadrant is most common for breast lumps. Side and quadrant distribution are
shown below. All 20 cases were confirmed by excision biopsy. FNAC diagnosed 18 IDC
NOS cases and 2 IDC Mucinous cases.CONCLUSION: FNAC is the procedure that is most
commonly used since it is an initial outpatient procedure that is straightforward, risk-free,
quick, and dependable. Additionally, it contributes to an early preoperative diagnosis of any
lump in the breast.

DIFFUSION WEIGHTED VERSUS CONVENTIONAL MRI IN DIAGNOSIS AND CHARACTERISATION OF INTRACRANIAL SPACE OCCUPYING LESIONS

Dr. Shubham Gupta, Dr. Suresh A, Dr. Kotha Vinay Kumar Reddy, Dr. Soham Shrivastava, Dr. Sourav Tripathy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 40-59

Background information -Non-invasive and accurate differentiation of brain mass lesions
are important for determining the correct treatment plan and in some cases, may avoid the
necessity of performing a biopsy. Now MRI is being currently used to determine the tumor
nature and extent that is helpful in planning surgery and radiotherapy, even for post therapy
monitoring for tumor recurrence or progression. 30-90% MRI can correctly diagnose
intracranial space occupying lesions of various types. It is clinically very important to
differentiate brain infections from brain tumors, as their plan of management is completely
different.
Materials and Methods - All clinically suspected patients of intracranial space occupying
lesions and already diagnosed patients with intracranial space occupying lesions, who were
referred to the department of Diagnostic Radiology in VIMS and RC underwent MRI. The
images of MRI were evaluated to characterize the space occupying lesions by conventional
and diffusion weighted sequences. Further the study was reviewed by the experienced
radiologist, only after which the data was analyzed and recorded.
Results - All cases (100%) of epidermoid and neuroblastoma showed true diffusion
restriction. 100% GBM cases showed true restricted diffusion while none of the low- grade
tumours showed diffusion restriction. All cases of arachnoid cysts showed low signal on DWI.
And none of benign meningioma and schwannoma showed restriction diffusion. Positive
correlation was found in the comparison of mean ADC values for high-grade gliomas
(1.02×10-3 mm2/s±0.2) and metastasis (0.881×10-3 mm2/s±0.2), low-grade gliomas (1.20 ×
10-3 mm2/s ± 0.2), and medulloblastomas (2.09×10-3 mm2/s ± 0.075).
Conclusion - Presence of diffusion restriction is a useful method of differentiating abscesses
from necrotic or cystic neoplasms. Highly cellular tumors may show restricted diffusion.
Arachnoid cysts can be differentiated from epidermoid cysts by presence of low signal on
DWI. ADC is useful in the differentiation of various brain mass lesions and in grading brain
tumours. The combination of routine image interpretation and ADC had a higher diagnostic
predictive value in characterizing brain lesions.

CLINICO-RADIOLOGICAL CORRELATION OFSHOULDER PAIN

Dr.KothaVinay Kumar Reddy, Dr.Madan Mohan Babu L, Dr. Suresh A, Dr.Shubham Gupta, Dr.Devamani VKH Chalavadi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 60-69

Background - Shoulder pain is one of the commonest conditions encountered in our
orthopedic department. Accurate diagnosis is a must before undertaking any treatment. Since
clinical diagnosis cannot make an accurate diagnosis, radiological investigation is necessary
to know the exact cause of shoulder pain. There are a wide range of invasive and noninvasive
modalities that can be used to investigate these patients. Ultrasound examination is a
highly specific and sensitive modality in comparison with MRI. High-resolution real-time
USG has shown to be a cost-effective means of investigation of rotator cuff pathologies. With
recent advances with USG, results of imaging of shoulder joint pathologies are as similar or
in some cases more precise in the diagnosis than MRI.
Methods - Prospective analysis of 52 patients presenting with shoulder pain were included in
our study. A pre-formed written consent is also taken. All patients underwent a thorough
clinical examination, USG of the affected shoulder with comparison of the opposite side and
MRI of the affected shoulder for comparison.
Results - Ultrasound is equivalent in detection of rotator cuff tears in comparison with MRI.
MRI outscores ultrasound in detection of labral tears, cartilaginous lesions and subtle bony
lesions. USG examination can be used as the first line of investigating a case of shoulder pain
as it is inexpensive, real time and allows for comparison with the opposite side. MRI can be
used as a confirmatory tool.

Hippocampal sparing in radiation therapy to primary brain tumors - and impact on memory function in adults

Dr.Veda Varshne D Nath, Dr.Geeta S.N, Dr.SalmanKhurshid Shah, Dr.BhaskarVishwanathan, Dr.Richa Tiwari, Dr. Sowmya Narayan, Dr.Shubham Gupta, Dr.KashyapMalleshappa, Dr. Natasha Laishram

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 70-81

Introduction - Sparing the hippocampus during cranial irradiation poses important technical
challenges with respect to contouring and treatment planning.Purpose of this study was to assess
if sparing the hippocampaus region during the planning of radiotherapy using IMRT technique
without compromising the dose conformity to tumour, and to compare memory function of
patient, before the start of irradiation and retention after radiation therapy in both the arms using
the Hopkins verbal learning test.
Materials and Methods -Patients presenting with Primary brain tumours were chosen for the
study. Age 18 to 65 years, diagnosis as per WHO Grading, ECOG performance status {0-2}
were selected. All the types of Primary brain tumours were included.

TO STUDY THE MORPHOMETRIC ANALYSIS OF ABDOMINAL AORTA AND ITS BRANCHES

K D V Santhi Priya, Dr. Nageswara Rao Gutti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 82-89

Introduction: Knowing the morphology of abdominal aorta (AA) and its branches are important as
regards to diagnosis and surgical treatments. Despite that, data on morphometry of abdominal aorta
branches and abdominal viscera are lacking.
Aim: To investigate this subject authors performed a morphometric study on 80 adult fresh and
embalmed Asian cadavers and examined abdominal aorta branches to make morphometric
measurements of AA and its branches, to investigate sites of the origins of the branches and their
relationships and variations and to compare the results with literature. We believe that our results add
knowledge on abdominal aorta branches and viscera morphometry and are valuable for new radiologic
and clinical applications including stent grafts and chemoembolisation materials and surgical
applications including visceral arteries' aneurysms investigation, treatment, and transplantation
precedures.
Materials and Methods:
The study was conducted on 80 AA specimens that were obtained from human cadavers during
autopsies Guntur General Hospital from March 2020 to October 2021. These specimens of AA and
its branches were measured with a metal scale morphometrically to determine diameter of Aorta and
distances between branches
Result: The mean diameter of AA was studied at various levels and recorded. The study showed a
decrease in caliber from above to below. In both sexes, diameter of Aorta is more in > 40yrs age group
than age group < 40yrs. The average distance from CT-AB, CT-SMA, SMA-IMA and IMA-AB were
measured as 10.99cm, 0.76cm, 4.89cm, 3.54cm, respectively in males with average age and height was
38.26 and 158.2 respectively. Similarly, in females the average distance from CT-AB, CT-SMA, SMAIMA
and IMA-AB were measured as 10.12cm, 0.68cm, 4.69cm, 3.32cm, respectively with average age
and height was 36.24 and 145.9 respectively. Numerous variations were observed during the study
which include absence of renal artery, origin of renal arteries one above the other, 3pairs of lumbar
arteries etc.
Conclusion: Knowledge of morphology of AA and its branches is important in regards to the diagnosis,
surgical treatment and endovascular interventions of these vessels. We think our study will contribute
to the medical education and clinical medicine.

A Retrospective assessment of the histo-morphological diversity of various lesions of the uterus, cervix and adnexa

Dr. Vani H Patel, Dr. Maulik K Mehariya, Dr. Vishal S Patel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 90-95

Aim: To study the histo-morphological diversity of various lesions of the uterus, cervix and adnexa.
Materials and Methods: A Retrospective Histopathological study of 609 cases of nonneoplastic and neoplastic lesions of hysterectomy specimens was conducted in Department of Pathology, over the period from June 2015- May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Atrophic changes were seen in 13.46% cases. Endometrial hyperplasia was seen in 26 cases. Among the neoplastic lesions 2.46% cases were endometrial polyps with only 3 cases of malignancy forming 0.49%. Among the histologic types of lesions of myometrium, majority were Leiomyoma (27.59%). Leiomyoma and Adenomyosis were seen in 55 cases (9.04%). Adenomyosis was seen in 22.00%. Chronic cervicitis was seen in 36.07% cases and chronic cystic cervicitis in 6.21% of cases. Nabothian cyst were seen in 124 cases (20.80%). 19.80% cases showed Squamous metaplasia. Out of 188 Ovarian lesions, 167 (88.83%) were non-neoplastic lesions and 21 (11.17%) were neoplastic lesions. Fallopian tube pathology included chronic salpingitis in 2 cases, paratubal cyst in 07 cases. 69.4% of cases show unremarkable fallopian tubes.
Conclusion: The present study provides awareness into the wide range of histopathological patterns of lesions in uterus and cervix in hysterectomy specimens. It aids to appropriate management in the postoperative period.

EDTA INDUCED PSEUDOTHROMBOCYTOPENIA(PTCP): A PROSPECTIVE STUDY AT TERTIARY CARE HOSPITAL

P.Geetha Vani, T.Rayapa Reddy, G. Rajeswari, C.Padmavathi Devi, L. Padma Priya Priya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 96-102

Background -Spurious thrombocytopenia or pseudothrombocytopenia (PTCP) is a well
known in vitro phenomenon that occurs when the anticoagulant used while testing the blood
samples causes clumping of platelets which results in spuriously low platelet count with
automated haematology analyser. It occurs most often in EDTA anticoagulated blood,
however other anticoagulants though to a lesser extent have also been implicated in several
reports. Clinical consequences include unnecessary platelet transfusions, bone marrow
aspiration and inappropriate treatment like administration of steroids.
Material and methods –This is a hospital based prospective study in department of clinical
pathology for one year duration from January 2021 to December 2021.
Results – A total of 82 were found to have EDTA induced pseudothrombocytopenia in the
study period. The total case load during the study period was 2581 cases. The incidence of
PTCP in our study being, 3.1%. Males accounted for 45% and females accounted for 55 %
with male to female ratio of 2.5: 3.
Mean platelet count in EDTA anticoagulated samples with PTCP was 39,333/mm3 mean
platelet count in sodium citrate sample was 1,78,666/mm3, and mean platelet count manually
was 2,10,552/mm3. Citrate anticoagulated samples showed higher values as compared to
EDTA.
Conclusion -EDTA-PTCP is a common pre analytical error encountered in routine clinical
laboratory practise. EDTA-PTCP should be suspected in all cases with a low platelet count
but without any clinical bleeding manifestations. Platelet counts should be reviewed in all
such cases to prevent unnecessary clinical interventions and treatment. Simple, inexpensive
and diagnostic method of peripheral smear examination remains gold standard.

An Autopsy Based Study of Chest Injuries in Fatal Road Traffic Accidents Conducted at IGIMS, Patna, Bihar

Nikhil Goel, Aman Kumar, Sanjeev Kumar, Mukesh Prasad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 103-109

Background: Thorax (chest) is one of the most important cavities of the human body. Thoracic trauma constitutes 10 to 15% of mortalities in the world wide population. Road Traffic Accident (RTA) is like an endemic disease, which affects mainly young people. According to a study, death related trauma rank third after cardiovascular diseases and cancer. 90% of RTA take place in low and middle income countries.
Objective: To study the pattern and type of chest injuries in fatal road traffic accidents.
Materials and Methods: The present study was done on medicolegal autopsies conducted at the department of Forensic Medicine and Toxicology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna from 25th July 2017 to 24th July 2019 to study the pattern and type of chest injuries in fatal road traffic accidents.
Inclusion Criteria 1. All those who died after road traffic accidents and brought to mortuary of Indira Gandhi Institute of Medical Sciences, Patna with some history of the road traffic accident.   Exclusion Criteria 1. The bodies found on the road side with injuries, where road traffic accident is suspected, but not confirmed. 2.            Cases other than that of road traffic accident. 3.        Decomposed bodies in which the organs are liquified and injuries could not be appreciated.
Result: Out of total 223 autopsies done in the study period, 61 (27.35%) cases had chest injuries.  Majority of the cases were observed in Winter season. Males were affected more than females. Male of 31 – 45 years age group were most vulnerable age group for chest injuries in fatal road traffic accident. Injuries over chest and abdomen together were found in maximum number of victims (32 cases; 52.46%).  Haemorrhage and shock was the most common cause of death in 80.33% of the victims. Fracture of ribs were found in 39 victims. Haemothorax was found in 88.52% of the cases. Lung alone was the commonest involved thoracic viscera in victims of chest trauma in 75.41% cases.
 Conclusion: Improving the design of roads and vehicles, enforcing emergency medical services could be used to control the increasing toll of death due to RTA. There needs to be intensification of current educational programmes and law enforcement with regards to traffic rules and road safety measures. Pre-hospital emergency medical system should be implemented. Also High-tech trauma centre should be established at every district head-quarter and on highways at definite intervals.
 

Insight into the Management of Non-traumatic Perforation of the Small Intestine at a Tertiary Care Hospital, Bihar

Dr. Sumeet Kumar, Dr. Chandrakala Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 110-115

Background: Management of non-traumatic perforation of the small intestine has always been a consideration for surgeons because of associated enormous morbidity and mortality. There is a paucity of data on the management of non-traumatic perforation of the small intestine.
Material and Methods: A retrospective study was conducted which involved analysis of 192 patients treated for non-traumatic perforation of small intestine at a tertiary care hospital at Bihar from 2018-2019. The clinical profile and management of the patients were studied.
Results: The most common cause of non-traumatic perforation of small intestine was typhoid (46.4%), followed by non-specific inflammation (39.2%), tuberculosis (12.8%) and malignant neoplasm (1.6%). Primary repair was the most frequent procedure (44.0%), followed by ileostomy (25.5%) and resection-anastomosis (19.3%). Superficial wound infection was the most frequent postoperative complication (46.8%), followed by wound dehiscence (31.3%). The wound infection rate was reduced significantly following delayed primary closure of skin incision. Enterocutaneous fistula/leak developed in 11.5% patients. Salvage ileostomy for post-operative intestinal leak resulted in a better survival rate as compared to conservative treatment (85.7% vs. 50.0%). The overall mortality rate was 16.6%.
Conclusion: Operative procedures undertaken for the management of non-traumatic perforation of small intestine can be classified into two groups: procedures that leave an intestinal suture line inside the peritoneal cavity and procedures that do not. The no suture line-in procedure seems to be better option in adverse patient conditions.