Introduction: We retrospectively evaluated our experience with modified Cantwell-Ransley epispadias repair at our center to determine the complications and long-term results. Materials and Methods: We retrospectively reviewed the case records of 43 male children with a mean age of 9.13 ± 1.94 years who underwent primary epispadias repair at our center. The results of epispadias repair were assessed by both physical and endoscopic examination. All children who were old enough to opine as well as all parents/guardians were interviewed during the follow-up visits. Results: Urethrocutaneous fistulae occurred in 17.85% (5/28) children of the classic bladder exstrophy group and in 13.33% (2/15) children with penopubic epispadias. Postoperative cystoscopy done 12 weeks after repair revealed a smooth urethral tube in 81.39% (35/43) of children. With the patient in a standing position, the penis was dangling downward or in a horizontal position in 88.37% (38) of children, 85% of the patients ≥18 years of age were satisfied with both the functional and cosmetic outcome, as assessed by short form 36 and 93.02% (40/43) of the patients were continent during the daytime with voided volumes of more than 200 ml. Conclusion: In our experience, Cantwell-Ransley repair creates a functionally and cosmetically acceptable penis and produces a reliably tubularized neourethra with acceptable complication rates.

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Acral erythema (AE) is a swelling and numbness of the hands and feet that is observed in viral infections such as hepatitis C, HIV, and toxic drug induced skin reactions (chemotherapy). Patients with undifferentiated connective tissue disease (UCTD) may present with various symptoms. The most common symptoms at presentation include Raynaud's phenomenon (48-59%), arthralgia (37-81%), arthritis (22-71%), mucocutaneous symptoms such as photosensitivity, malar rash, alopecia and oral ulcerations (23-52%), fever (15-23%), sicca symptoms (12-42%) and central nervous system symptoms (8.5%). There is no literature available on patient presenting with AE as a symptom of connective tissue disease who are not on any treatment. In this particular patient icterus, multiple oral ulcers, bilateral pitting edema feet and reddish discoloration of palms and soles were present. Nervous system examination revealed weakness in muscles of shoulder and pelvic girdle (power grade 3/5). Laboratory investigations showed conjugated hyperbilirubinemia, raised liver enzymes and albuminuria. HIV and hepatitis C serology was negative. Electromyography showed mixed neurogenic and myogenic pathology. Autoantibody testing revealed that the patient was positive for the following: Antiribonucleoprotein (RNP) antibody, anti-Smith antibodies, anti-double-stranded DNA antibody, antihistone antibodies, antinucleosomal antibodies, antiribosomal P antibody thereby suggesting UCTD. This case is unique for the fact that AE was the sole cutaneous manifestation of connective tissue disorder without any history of drug intake.

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As life expectancy increases overall incidence of distal humeral fractures is increasing worldwide. Objectives: To evaluate the results of JESS External fixator in the management of supracondylar fracture with or without intercondylar extension in adults. Materials and Methods: This prospective study was conducted on thirty adults in a tertiary care Hospital of eastern India after obtaining permission from Institutional ethical committee and consent of the patients in a time span of one year. JESS external fixator was applied within 3 days of admission. Results: According to AO classification 16 cases has C1 fractures and 14 cases had C2 fractures. Among 16 C1 fractures 10 were open injury and 6 were close injury and among 14 C2 fracture 8 were open injuries and 6 were close fractures. The mean duration of JESS application was 16 week. The mean follow-up was 10 months. The functional outcome was evaluated by use of Cassebaum's functional rating system. C1 closed fractures (6 cases) showed excellent results and C2 closed fractures (6 cases) showed good to fair results. Irrespective of injury pattern (open/close) among 16 C1 fracture 12 cases (75%) showed excellent to good results and 4 cases(25%) showed fair result in contrast to 14 cases of C2 fracture where only 2(14%) cases showed good result and rest 12 cases(86%) showed fair to poor results. Irrespective of fracture pattern among 12 close fracture 8 cases (67%) showed good to excellent results and 4 case (33%) showed fair results. Among 18 open cases 6 cases (33%) showed good results and 12 cases (67%) showed poor to fair results. Conclusions: JESS-external fixation technique represents a viable option in the management of open as well as close intercondylar fractures of the distal humerus.

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Background: Until recently, perimenopause has been little understood and ignored especially in developing the country like India. It is a distinct entity from menopause and in terms of symptomatology, it may be even more important than postmenopause. Aims and Objectives: (1) To ascertain the cause of abnormal uterine bleeding in perimenopausal women (40-55 years). (2) To study the spectrum of morphological changes in perimenopausal bleeding with high-risk factors predisposing to endometrial hyperplasia and malignancy. Materials and Methods: The study was undertaken in a large tertiary care teaching hospital over a period of 3 years. All the outdoor and indoor patients presenting with abnormal uterine bleeding with or without other clinical features in the perimenopausal age group (40-55 years) were included in the study. Women with menstrual cycles of 21-35 days with a duration of flow of 2-6 days were considered normal and were excluded from the study. Specimen considered for histopathological study included endometrial biopsy, dilation and curettage, fractional curettage, cervical biopsy, and or hysterectomy with or without salpingo-oophrectomy done for diagnostic or therapeutic purposes. Statistics Used: Totally, 100 cases were selected on the basis of simple random sampling and analyzed. Results: Most of the patients were in the age group of 40-45 (45%) with menorrhagia as the chief complaint. The bulk of the specimens were of total hysterectomy with bilateral salpingo-oophrectomy (43%). Functional endometrial changes were the most common cause in 40-50 years age group but endometrial carcinoma was the main cause of bleeding in the 51-55 years group indicating heightened occurrence of malignancy with increasing age.

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Steatocystoma multiplex is a rare disorder of the pilosebaceous unit, which presents as multiple sebum containing subcutaneous cysts. Usually, the involvement is generalized;however, localized forms of the disease have been described. In exceptional cases, acute episodes occur associated with fever and suppuration when the term "steatocystoma multiplex suppurativum" is used. In some cases, the inflamed cysts rupture forming sinus tracts, which may undergo scarring. This clinical presentation with discharging sinuses may be easily mistaken for tuberculosis, especially in endemic countries. We herein report a patient with localized form of steatocystoma multiplex suppurativum where initially a diagnosis of scrofuloderma had been considered. Cytological and histopathological examination allowed a correct diagnosis to be established.

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We report a case of a 17-year-old male with precursor B acute lymphoblastic leukemia who presented with erythematous palpable rash over all extremities and trunk following initiation of linezolid for febrile neutropenia. This rash resolved on discontinuation of linezolid. We report this case with emphasis on review of the literature to highlight this unusual adverse effect and make clinicians aware and create a high index of suspicion in such a situation.

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Background: Triple negative breast cancers (TNBC) are defined by absence of estrogen and progesterone receptors (ER and PR) and absence of overexpression of human epidermal growth factor receptor 2 (Her2). They are associated with poor prognosis. The purpose of this study is to study the clinicopathologic parameters of TNBC such as age, tumor size, stage, grade, and lymph node involvement and compare them with nonTNBC tumors. There are many studies which have shown that TNBC are similar to basal-like breast cancers (BBC). We have found the proportion of BBC in the TNBC group using surrogate immunohistochemical (IHC) markers cytokeratin5 (CK5) and epidermal growth factor receptor (EGFR). Materials and Methods : This is a retrospective study of 102 cases of carcinoma breast. Clinical records of the cases were retrieved. Histopathology slides and the IHC slides (ER, PR, Her2) were reviewed. Thus, two groups of patients were made TNBC and nonTNBC. Using the software SPSS version 16 statistical significance of the difference between clinicopathologic variables of the two groups was calculated. TNBC group was later studied for the presence of basal markers CK5 and EGFR using tissue microarray. Results: Statistically significant difference was found between the two groups in the variables such as mean age at diagnosis, mean tumor size, tumor grade, and the presence of lymphovascular invasion. Conclusions: TNBC formed 23.5% of total cases. Overall, TNBC were high grade tumors with larger size at diagnosis, presenting in younger women and showing lymphovascular invasion in a higher number of cases. 87.5% of TNBC were BBC.

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As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. Vesicouterine fistulas (VUF) are a pathological and uncommon connection between the uterus and the bladder. Patients with VUF may have various clinical presentations. The main symptoms are urinary incontinence, which may be associated with hematuria. Vesicouterine fistulas are usually associated with psychological distress and have a negative effect on quality of life. The accurate and early diagnosis of VUF can be difficult. There are multiple ways to investigate VUF and several examinations may be required to confirm the diagnosis; these examinations may include a cystoscopy, a retrograde cystography, methylene blue test, and a computed tomography scan. We report a case of vesicouterine fistula.

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Gallbladder cancer is a common malignancy in Northern India, and it accounts for 2-4% of all malignant gastrointestinal tumors. It is an aggressive tumor with early dissemination to liver and lymph nodes and associated with poor prognosis. Systemic metastases from gall bladder carcinoma (Ca) frequently occur; however, metastatic involvement of the central nervous system is rare and late manifestation and remains an ominous sign. Initial presentation of gall bladder Ca with brain metastasis is rare. We report a case of 65-year-old women who initially presented with a solitary brain metastasis from an adenocarcinoma of the gallbladder, which was diagnosed incidentally when the patient presented with headache, vomiting, and right temporal region swelling. Palliative chemotherapy and cranial radiotherapy were prescribed. She is symptom-free from 3 months after the completion of the treatment.

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Multiple schwannomatosis, is defined as two or more, pathologically proven schwannomas, without radiographic evidence of vestibular nerve tumor, below 18 years, or absence of VIII nerve dysfunction beyond 30 years with absence of stigmata of neurofibromatosis 2 (NF2). The plexiform schwannoma (PS) is a rare tumor. The gross appearance is an important diagnostic criterion for diagnosis of PSs. It is associated with NF2, which was ruled out in this case. Here we present a 50 year female patient with two nonintradermal schwannomas, in the supraclavicular and infraauricular deep soft tissues. One was plexiform, diagnosed on cytology and confirmed by histopathology. She also had multiple pulmonary and pleural lesions. Fine needle aspiration cytology smears from both supraclavicular and infraauricular lesions as well as the lung lesion sampled, showed spindle cells in a myxoid background, having wavy nuclei with pointed ends. Verocay body - like palisading of nuclei was noted.

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Solitary plasmacytoma (SPC) of the skull (SPS) is rare, and only a few cases have been reported in the literature so far. Plasmacytoma of the skull has a wide spectrum of pathology, including a quite benign, SPC, and an extremely malignant, multiple myeloma at the two ends of the spectrum. SPC of bone including SPS is characterized by a radiologically solitary bone lesion, neoplastic plasma cells in the biopsy specimen, fewer than 5% plasma cells in bone marrow, <2.0 g/dl monoclonal protein in the serum when present and negative urine test for Bence Jones protein (monoclonal light chain). For diagnosing, a comprehensive examination and analysis, which includes radiological examination, immunoglobulin, biochemistry, test for Bence Jones protein in the urine and bone marrow is needed.

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Lymphangioleiomyomatosis (LAM) is a rare disease of unknown etiology that traditionally affects young women of childbearing or premenopausal age. It is characterized by proliferation of atypical smooth muscle cells, preferentially along bronchovascular structures that cause progressive respiratory failure. Owing to its unusual and nonspecific presenting symptoms, patients often receive missed or delayed diagnosis. This disease occurs sporadically or in association with the genetic disease-tuberous sclerosis complex. Recurrent pneumothorax is the hallmark of LAM. We present a 16-year-old young female having recurrent pneumothorax with LAM.

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Sebaceoma is a benign adnexal tumor. Face and scalp are the most common locations of sebaceoma. Ripple pattern sebaceoma is an unusual histological variant of sebaceoma, with scalp being the most common site of presentation. We report a case of giant, ripple pattern sebaceoma in an 80-year-old male, presenting in an unusual location of the back side of the neck and associated with grade 2 fatty liver. The patient also presented with incidental prostatomegaly. The presence of giant size, unusual location, histopathological ripple pattern and association with fatty liver make this case a very unique one.

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Introduction: Human brucellosis is clinically indistinguishable from other infectious diseases such as tuberculosis, typhoid, leptospira, and malaria. Laboratory diagnosis remains a mainstay in the diagnosis of brucellosis. This study was carried out to find out the prevalence of brucellosis among high risk group by Brucella immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) testing to assess the magnitude of the problem. Materials and Methods: A total of 130 blood samples collected from high risk group, another 130 samples from general population as control group were tested for Brucella IgG ELISA using smooth-lipopolysaccharide antigen. Results: Among the 130 high risk group, 19 (15%) were positive for Brucella IgG antibody. The duration of exposure of more than 25 years was observed in 10 (53%) seropositive cases. 21 (16%) handled Brucella vaccine for animals. Of this, 13 were seropositive for Brucella IgG. Among the 130 control group, none were positive for Brucella IgG antibody. Conclusion: Since vaccine is not available for human, awareness of transmission of brucellosis, vaccination of livestock, protective measures like barrier protection, while handling animal vaccines and isolation of infected animals can reduce the prevalence.

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Context: Early detection and optimal treatment of type 2 diabetes mellitus (T2DM) are shown to prevent or delay the complications of the disease. In resource poor settings we need sensitive, specific and inexpensive screening tool to detect people with T2DM. Tools involving point of care blood glucose testing have shown the superiority over others where only history and anthropometry were used. Aims: This study aims to compare the specificity and sensitivity of Indian diabetes risk score (IDRS) and Tabaei and Herman equation based risk score model in a rural community of Northern Karnataka. Materials and Methods: Diabetes prevalence study conducted in rural North Karnataka is used for the present study. All the variables required for calculating IDRS and Tabaei and Herman equation are available from the prevalence study. Instead of random capillary blood glucose, 2 h post 75 g plasma glucose value is used in the equation. And self-reported postprandial time is taken as 2 h. Statistical Analysis: The MedCalc-version 11.3.0 is used for the statistical calculations. DeLong method used to compare the area under receiver operating characteristics (ROCs) of the two risk scores. Results: Three hundred and eighteen participants completed the study and were considered for analysis. In this study optimal, cut-off value for IDRS found to be 40 and for Tabaei et al. equation 0.09. Area under ROC for IDRS was 0.755 (95% CI: 0.680-0.819), and for Tabaei et al. equation it was 0.979 (95% CI: 0.943-0.995). Conclusion: Sensitivity and specificity of T2DM screening tool can be improved by including a point of care blood glucose testing.

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