Cases of split pons and double encephalocoeles in combination with other spinal anomalies are very rare, and to the best of author's knowledge, this is the first case report of these multiple anomalies in world literature.
Terminal myelocystoceles (TMCs) are a rare form of occult spinal dysraphism. They constitute approximately 5% of skin covered lumbosacral masses. The TMC is composed of a low-lying conus medullaris with cystic dilatation of caudal central canal, a surrounding meningocele and a lipoma that extends from the conus to a subcutaneous fat collection. A 6-month-old female child presented with a large lumbosacral mass (14 cm × 12 cm × 10 cm) and weakness at the ankle joints since birth. Magnetic resonance imaging and computed tomography scan revealed a low-lying terminal lipomyelocystocele with holocord syrinx and partial sacral agenesis. The child was operated on successfully. This is an interesting and rare case of giant terminal lipomyelocystocoele with syrinx and a partial sacral agenesis. Terminal lipomyelocystocele should be included in the differential diagnosis of congenital lesions presenting as a lumbosacral mass and operated early.
Background: Percutaneous Nephrolithotomy (PCNL) is the gold standard for endoscopic management of large renal stones. Various modifications have been done to bring down the morbidity of this procedure. Ambulatory PCNL (APCNL) defines PCNL as day-care procedure, avoiding overnight hospital stay which is less than 24 hours. Totally tubeless makes faster recovery without the need for double J stent or nephrostomy tubes. This study aimed at exploring the feasibility and safety of APCNL in selective patients. It also aimed at improvising the procedure to facilitate early recovery and discharge of patients within 24 hrs. Materials ands Methods: In this study, 12 patients underwent APCNL under general anaesthesia with endotracheal intubation from April 2016 to March 2017. All the procedures were done by a single surgeon. The inclusion criteria were stone size of less than 2cm, without any co-morbidities, Computed Tomography (CT)/Retrograde Pyelogram(RGP) evidence of normal pyelocalyceal anatomy, patient staying within the radius of 15km, well informed patient. All patients underwent totally tubeless PCNL i.e. without nephrostomy, DJ stent and catheter. Skin infiltration was given with 0.25% Bupivacaine. Post operatively analgesia was given on demand (intramuscular Aceclofenac / oral Acetaminophen plus Tramadol). All patients were followed up after 2 weeks. Results: Twelve patients underwent prone PCNL. All patients had single puncture (10 lower calyx, 2 middle calyx), Amplatz size was less than 30F, size of the stone (1.3cm to 2cm) with a mean size- 1.7cm, saline used around 300ml. But, two patients were discharged after 36hrs and 48hrs due to pain. None of them returned to hospital with haematuria, pain or urinary tract infection. Conclusion: APCNL is a safe procedure in well informed selective patients. These are the patients with small burden of stone and staying close to the hospital. APCNL reduces the hospital stay, expenses and results in early return to work.
Fibroadenomas are benign solid tumor associated with aberration of normal lobular development. Giant fibroadenoma is usually single and >5 cm in size /or >500 gms in weight. Their rapid growth, associated with skin congestion and ulceration, and tendency to recur, gives rise to a suspicion of malignancy.[1,2]. Important differential diagnoses are: phyllodes tumor and juvenile gigantomastia. These tumours are almost always benign and should be treated with breast conserving surgery. We present a case of 40year old female who presented with a large lump in the right breast. The diagnosis was made on fine needle aspiration cytology, mammography and ultrasonography. Simple excision of the lump was done. The diagnosis was confirmed on histopathology. Patient again presented twice with similar complaints with no evidence of malignancy of histopathology. CASE REPORT: A 40 year old female presented to surgical opd with complaints of large lump in the right breast since 2months.It was insidious in onset and rapidly progressive in nature, pt also complained of associated pain since 15 days, dragging type nonradiating type. No history of discharge or ulcer over the skin. No history of fever, weight loss loss of appetite. On examination there was a large mass measuring 8*10cm occupying all the four quadrants of the right breast. Surface was bosselated. Dilated veins were noted over the lump. The lump was tender to palpate and margins were irregular. Lump was mobile .Skin was pinchable. Axillary nodes were not enlarged. Left breast and axilla was normal. All routine blood investigations and urine examinations were within normal limits. Fine needle aspiration cytology revealed-features suggestive of benign lesion, s/o giant fibroadenoma. USG of the right breast showed a solid mass with features suggestive of fibroadenoma. Patient was posted for surgery and simple excision of the lump was done. Post operative histopathology revealed it as a benign lesion of right breast. After 3 years patient presented with similar complaints again on the right breast. On examination, there was large lump occupying all the four quadrants of the right breast measuring 8*8cm. Surface was bosselated and dilated veins were noted .The lump was tender to palpate with variable consistency. Skin was pinchable and lymph nodes were not palpable in the right axilla. Left breast and axilla were normal. FNAC and ultrasonography showed features suggestive of fibroadenoma which had recurred. Mammography also revealed features suggestive of fibroadenoma Patient was operated again and simple excision of the lump was done. Histopathology of the specimen showed pericanalicular and intracanalicular type of fibroadenoma. No features suggestive of malignancy. Patient presented again with similar complaints after 5 years of initial presentation. The lump was excised for the third time and the histopathological specimen showed no evidence of malignancy.
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