Choledocho duodenal fistula? Iatrogenic

Dr.Kanakambaran (General Surgery, )

BaMeal xray showing the common bile duct well imaged. Patient underwent? endoscopic sphincterotomy. Details not available

Small intestinal intussusception in anadult

Dr.Kanakambaran (General Surgery, )

Forty two year old woman presented with colicky abdominal paln and vomiting. On abdominal examination a firm mass in the supra umbilical area She was put on nasogastric aspiration and iv fluids initially and BaMeal xray was done which showed typical watch spring appearance suggestive of intussusception. Laparotomy done and jejunojejunal intussusception due to submucous lipoma.

another reason to stay away from mosquitos in Cochin

Dr.Jobi (Laparoscopy, )

a 45 yr old lady presented with a 2 cm subcutaneous inflammatory swelling over manubruim sterni of 3 weeks .It responded to antibiotic therapy , but the swelling persisted with itching. She is diabetic and gives a H/O carcinoma right breast treated 10 yrs back. since the swelling persisted , she underwent an excision biopsy which revealed Dirofilaria worm in subcutaneous fat nodule. Dirofilaria is a vector-borne parasitic disease of dogs and cats and is transmitted by mosquitoes. human are accidental hosts and can present with subcutaneous nodules or occualr filariasis

Thrombocytopenia-simple causes

Dr.Shyamala (Medicine, )

4o year old referred with isolated TCP. History of epistaxis 1 month back-no active treatment. Recurrence of epistaxis and menorrhagia since few days.Investigations revealed platelet count of 30000 with normal rbc and wbc count.ana mildly positive, anti-aiv _ve.referral for sle. On thorough perusal, MCV-110,MPV high.patient vegetarian. Vit.b12 low normal.treated with Vit.b12 and folic acid and marked response noted in 7 day"s time.

Diagnostic Conundrum

Dr.George (Medicine, )

In Dec we saw 2 similar cases with 1 common funny lab result-1st was a 48 yr old lady who had a thyroidectomy for multinodular goitre in 1986-with 2ry hypoparathyroidism & b/l abductor palsy on long term oral calcium & activated vitamin D supplements –at the last visit a serum 25OH vit D was done was 148 ng/ml(30-100)..seeing this her rocaltrol was stopped ..she promptly developed tetany 3 days later needing iv Ca gluconate & settled after restarting rocaltrol 2nd - 48 yr old lady, post op thyroidectomy 2005 with identical clinical picture & Rx-she came 4 days later very alarmed about a vitamin D level done outside which was >150 mng/ml since local GP had said “vitamin D toxicity”-

Content validity of a Fetal Radiology Assessment and Diagnostic Score-India (FetRADS- India) for early identification of at-risk pregnant women

Dr.Praveen (Public Health, )

Non-invasive radiology imaging techniques can be used to identify pregnant women at risk for adverse fetal and maternal events. The FetRADS-India categories have been developed, using content validation, for the risk stratification of pregnancy to help initiate appropriate early management for high risk pregnant women including referral to advanced care or tertiary care units.  The FetRADS-India score has six levels with increasing scores for higher risk of adverse fetal events and subset scores based on fetal structure, growth and environment. Read at:

Advanced carcinoma of male breast

Dr.Kanakambaran (General Surgery, )

Case of advanced carcinoma of male breast. He is from most literate region of Kerala, not from remote highrange Village where health care facilities were not adequately available in the 1990s.

Fistulated Colonic carcinoma

Dr.Kanakambaran (General Surgery, )

A 65 year old man with bowel symptoms underwent Ba Enema. Colonoscopy was not available in our hospital during that time. Ba Enema examination revealed a growth in the transverse colon fistulating into tye stomach, contrast was clearly visible in his stomach. He was treated surgically followed by post operative chemo therapy.