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July-December 2021
Volume 7 | Issue 2
Page Nos. 53-153

Online since Thursday, December 30, 2021

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EDITORIAL  

Fostering collaborative research partnerships – Lessons learned p. 53
Anil Jacob Purty
DOI:10.4103/jcrsm.jcrsm_29_21  
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ORIGINAL ARTICLES Top

Kidney transplant and its outcomes: Five-year single-center experience from Central India Highly accessed article p. 55
Riteshkumar Krishnanarayan Banode, Piyush D Kimmatkar, Charulata P Bawankule, Vandana P Adamane
DOI:10.4103/jcrsm.jcrsm_61_21  
Background: Kidney transplantation has become the treatment of choice for most patients with end-stage kidney disease (ESKD). However, there is a remarkable disparity in the access and outcome of kidney transplant across the world. We present the clinical and survival data from the nephrology and kidney transplantation center for a period of 5 years in a cost-limited setting from Central India. Materials and Methods: This is a retrospective study of 66 kidney transplants performed in a single transplant center over a period of 5 years from 2016 to 2020. All data of recipients and donors were obtained from hospital records. Kaplan–Meier method was used for survival analysis. Results: Of 66 included patients, 86% were living donor and 14% were cadaveric kidney transplant. The mean age of the recipient was 30.64 ± 10.66 years. Fifty-five (83%) were male recipients and 11 (17%) were female recipients. The most common cause of ESKD in recipients was chronic glomerulonephritis (55%). The mean hemodialysis vintage was 11.04 ± 10.12 months. Seventy-four percent of donors were female and 24% of donors were male. Induction therapy with rabbit antithymocyte globulin was used in 20 (30%) and basiliximab in 21 (32%) recipients. Thirty (45%) recipients underwent graft kidney biopsy in view graft dysfunction. Acute cellular rejection was the most common cause of graft dysfunction seen in 8 (28%) of graft kidney biopsy. Graft survival and patient survival at 1, 3, and 5 years after transplant were 89%, 81%, and 77% and 90%, 84%, and 81%, respectively. Conclusions: Our observation showed that graft survival and patient survival after transplant were lower compared to other studies due to higher rejection rate and mortality due to infections. Hence, attention to immunological risk factors with proper immunologic testing pretransplant and early detection and adequate treatment of rejection episode even in cost-limited settings are suggested. Also after kidney transplant, prevention and prompt treatment of infection would offer the greatest potential to improve the chance of living longer with functioning graft.
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Transarterial chemoembolization of hepatocellular carcinoma: Can intraprocedural DYNA computed tomography serve as a guiding tool for the interventionist? p. 62
Manzoor Hussain, Tahleel Shera, Omair Ashraf Shah, Naseer Choh, Feroze Shaheen, Tariq Gojwari, Gull Mohammad Bhat, GM Gulzar
DOI:10.4103/jcrsm.jcrsm_19_21  
Aims And Objectives: We evaluated the role of Dyna CT in localizing HCC lesions and their selective vascular supply to help guide chemoembolization. We also evaluated the role of Dyna CT in assessing drug deposition within the lesion and predict the need of further drug delivery. Methods: 24 patients with documented HCC were taken up for TACE after a pre-procedural contrast CT and MRI. An intra-procedural Dyna CT was done in all patients to obtain a three dimensional overview of the vascular network. Selective cannulation of the tumor arteries was achieved using a combined digital subtraction angiography and Dyna CT image guidance. Additional lesions and vessels identified on Dyna CT were also treated. Drug deposition within the lesion marking technical success was assessed on completion Dyna CT and the need for additional drug delivery was assessed. Results: Contrast CT identified 36 lesions, DSA 33 lesions and Dyna CT 39 lesions in 24 patients. Dyna CT was the most sensitive for lesions <10 mm (p=0.006). Dyna CT identified 4 additional supplying lesion supplying arteries (2 hepatic, 2 extra hepatic) compared to DSA. In 6(25%) patients DYNA CT helped in improvement in catheter position in the form of more selective catheterization. 35 (90%) lesions showed homogenous Type 1 deposition, two lesions (5%) showed Type 2 and the other two (5%) showed type 3 deposition of lipoidol on completion Dyna CT. The latter two were further treated to achieve type 1 deposition and 100% technical success. Conclusion: Dyna CT can effectively guide TACE procedure by not only identifying the lesions and their vascular supply but also helping in guiding the catheter for selective cannulation and drug deposition. Completion Dyna CT can effectively assess drug deposition and the need for additional treatment in the same setting if needed.
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Effect of left nostril breathing on postexercise recovery time p. 70
U Karthika Jyothish, Subhasis Das
DOI:10.4103/jcrsm.jcrsm_84_21  
Background: The nasal cycle is the alternating congestion and decongestion of the nostrils during normal breathing, marking the shift between the sympathetic and parasympathetic systems, the latter being prominent when breathing through the left nostril. The post-exercise period is characterized by a gradual shift from sympathetic to parasympathetic dominance. It is hypothesized that breathing only through the left nostril will aid in accelerating this shift in the postexercise period. Objectives: The objective of this study is to assess the effect of left nostril breathing on post-exercise recovery times of heart rate and blood pressure (BP). Materials and Methods: A total of 60 young healthy male volunteers were instructed to walk on a flat treadmill, following a fixed protocol. Heart rate and BP were measured at rest and postexercise they were monitored every minute until they reached the baseline. The recovery time was noted. The procedure was the same on the 3rd day, except that during the postexercise period, the participants were instructed to breathe only through their left nostrils. Results: The recovery times of heart rate and BP, when breathing through the left nostril only, was significantly lower than when breathing normally. Conclusion: The left nostril breathing technique lowered the postexercise recovery times of cardiovascular parameters, which can be attributed to improved parasympathetic tone. These findings on the post-exercise state may be extrapolated to pathological states of sympathetic dominance, and left nostril breathing can be used as an adjunct to pharmacological therapy to manage such conditions.
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Diagnosis of endometriosis by detection of nerve fibers using protein gene product 9.5 immunohistochemistry p. 75
Shafqat Bano, Dilleswari Pradhan, Pradeep Kumar Behera, Asaranti Kar, Akruti Mishra, Tushar Kar
DOI:10.4103/jcrsm.jcrsm_25_21  
Introduction: Endometriosis is a benign, chronic, multifactorial, debilitating gynecological disease defined by the presence of ectopic foci of endometrial glands and stroma. Diagnostic laparoscopy and histopathological study of hysterectomy specimens are the definitive tool for diagnosis which carries associated risks. The objective of this study is to analyze the presence of protein gene product 9.5 (PGP9.5) antibody-positive nerve fibers by immunohistochemistry (IHC) in endometrial biopsy samples and endometriotic lesions in suspicious cases of endometriosis. Materials and Methods: This was a case–control study carried out in a tertiary care center. It comprised of cases of endometriosis interna (adenomyosis), endometriosis externa (endometriosis), and age- and parity-matched women without endometriosis taken as control. Clinically/radiologically diagnosed cases of endometriosis and those undergoing laparoscopy for infertility with confirmation after histopathology were included in the study. Endometrial biopsy samples were subjected to IHC using PGP9.5 antibody and examined for The presence of nerve fibers. Statistical analysis was done using SPSS software, and analysis of nerve fibers stained by PGP9.5 was done by the Kruskal–Wallis test. Results: A total of 60 cases are included in this study broadly divided into three groups (30 women with adenomyosis, 10 with endometriosis externa, and 20 women without endometriosis). Majority (26/30 = 65%) belonged to the third to fourth decade of life with pain being the most specific symptom. Small nerve fibers were noted in endometrial foci of the endometriosis cases but not in women without endometriosis (P = 0.001). Conclusion: The presence of nerve fibers can be taken as a novel marker of clinical endometriosis, and thus, it could replace hysterectomy as a definitive modality for diagnosing endometriosis.
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Evaluation of hypertonic saline–sodium hydroxide method for isolation of Mycobacterium tuberculosis on Lowenstein–Jensen medium p. 82
Chettiyath Athira, Noyal Mariya Joseph
DOI:10.4103/jcrsm.jcrsm_6_21  
Background: Decontamination of sputum specimen is a crucial procedure for successful isolation of Mycobacterium tuberculosis (MTB) using Lowenstein–Jensen (LJ) media. The aim of this study was to evaluate hypertonic saline–sodium hydroxide (HSSH) method for decontamination of sputum specimens for the isolation of MTB on LJ medium. Methods: The sputum specimens were divided into three aliquots and were decontaminated by HSSH method, N-acetyl L-cysteine-sodium hydroxide (NALC-NaOH) method, and modified Petroff's method. We have compared the smear positivity, isolation rate, and contamination rate of HSSH method with that of NALC-NaOH method and modified Petroff's method for decontamination of sputum specimens for LJ culture. Results: Sputum samples from 270 patients were processed by the three decontamination methods, of which 24 (8.9%) were smear and culture positive by one or more decontamination methods. Of the 24 smear-positive cases, 23 (95.8%) were positive by NALC-NaOH method, 21 (87.5%) were positive by HSSH method, and 17 (70.8%) were positive by modified Petroff's method. The contamination rate of HSSH method, NALC-NaOH method, and modified Petroff's method was 2.2% (6/270), 8.9% (24/270), and 6.7% (18/270), respectively. The MTB isolation rate of HSSH method, NALC-NaOH method, and modified Petroff's method was 7.0% (19/270), 4.1% (11/270), and 3.3% (9/270), respectively. Conclusion: Among the three decontamination methods, a significantly higher isolation rate and a lower contamination rate were observed with HSSH method. Therefore, we recommend HSSH method for decontamination of sputum samples for the isolation of MTB using LJ medium.
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A comparison of endometrial sampling histopathology by Pipelle curette versus Karman cannula in patients with abnormal uterine bleeding at a tertiary care hospital in Northwest Rajasthan p. 87
Kirti Solanki, Swati Kochar, Laxmi Poonia, Priyanka Gaur, Krishna Poonia, Shweta Choudhary
DOI:10.4103/jcrsm.jcrsm_23_21  
Background: Abnormal uterine bleeding (AUB) is a common and devastating condition affecting women of all ages. Among all patients attending gynecology outpatient department clinic, more than one-third patients are related to AUB, and this proportion rises to 70% in the perimenopausal and postmenopausal age. The condition has a high reported prevalence rate of 17.9% in India. Aims and Objective: To compare endometrial sampling histopathology by Pipelle curette versus Karman cannula in patients with AUB at a tertiary care hospital in Northwest Rajasthan. Materials and Methods: It was a prospective study conducted on 100 female patients of all age groups attending the department of obstetrics and gynecology over a period of 1 year with clinical diagnosis of AUB. After detailed history, examination, and relevant investigations, each patient was subjected first to endometrial aspiration using Pipelle curette followed by endometrial aspiration using Karman cannula No. 4. Samples collected were sent for histopathological assessment and the results were compared. Results: In our study, in 84% of cases, samples obtained by both Pipelle curette and Karman cannula were adequate. In 5% of cases, samples were inadequate by both methods. In 10% of cases, Karman cannula sample was adequate, but Pipelle curette sample was inadequate. In 1% of cases, sample could not be obtained by both procedures due to stenosed nulliparous cervix with large fibroid obstructing cervical os. Considering Karman cannula as the standard, Pipelle curette endometrial sampling demonstrated 100% sensitivity, specificity, positive and negative predictive value (PPV and NPV), and accuracy with regard to diagnosis of adenocarcinoma and endometrial hyperplasia. For secretory endometrium, the corresponding values were 76.5%, 100%, 100%, 95.4%, and 99%, respectively. With regard to proliferative endometrium, sensitivity, specificity, PPV, NPV, and accuracy were 92%, 96%, 98.6%, 80%, and 93%, respectively. With regard to atrophic endometrium, specificity, NPV, and accuracy were 100%, 99%, and 99%, respectively. Pipelle curette had a concordance rate of 87.5% with hysterectomy specimen, while Karman cannula had a concordance rate of 100%. Conclusion: Both Pipelle curette and Karman cannula endometrial aspiration biopsy are easy to perform, efficient, and safe outpatient endometrial sampling procedure in recognizing the endometrial lesions including malignancy and endometrial hyperplasia; however, Karman cannula had more adequate sample than Pipelle curette.
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Morphometric and topographic analysis of calvaria: A special focus on parietal emissary foramina p. 93
Naga Jyothi Chigurupati, K Sriambika, Aparna Muraleedharan, JP Gunasegaran, Rema Devi
DOI:10.4103/jcrsm.jcrsm_57_21  
Background: The parietal foramina (PFs) are located on either side of the sagittal suture at the posterior aspect of the parietal bone. The part of the sagittal suture between the two PFs is called obelion because it resembles the Greek symbol % “obelos.” The PF transmits an emissary vein named Santorini vein which connects the extracranial veins to the superior sagittal sinus. The emissary veins are of clinical significance as they are involved in the pathway of spreading infection from the extracranial to the intracranial source. PF is of special interest to neuroanatomists and neurosurgeons due to its anatomical variations and surgical importance. Materials and Methods: A total of 111 dry human calvariae of unknown gender were included in the study. These human calvariae were observed for the presence or absence and also observed for the unilateral, bilateral, single, or multiple PFs. The foramina were macroscopically observed by using a magnifying lens, and a needle was probed into each foramen to check their patency. Topographical parameters were measured. Results: Out of 111 calvariae, a single parietal emissary foramen was observed in 63 (56.7%) on the right parietal bone, 67 (60.3%) on the left parietal bone, and absence of parietal emissary foramen on right parietal bone in 41 (36.9%) and 37 (33.3%) on the left parietal bone, bilateral absence in 23 (20.7%) of the parietal bones. The presence of parietal emissary foramen on the sagittal suture was observed in 2 (1.8%) of skulls and also noted the single, double, multiple PF in 56.7%, 2.7%, 1.8% and 60.3%, 4.5%, 0, respectively. The different shapes of PF that was observed were circle shape on the right side 69.3%, on the left 66.6%, slit shape on the right 0.9%, on the left 1.8%, oval shape on the right 2.7%, on the left 1.8%. Out of all parietal emissary foramen, bilateral PF was observed in 53 + single parietal foramen on right 63 + on left 67 + double on right 3 + on left 5 + multiple on right 3 = 247. Out of 247 PF, 8 were patent through and the connection was oblique. All the other foramina were found to open into the diploic space. For those foramina through and through patency could not be assessed. The distance between the PF, distance of PF and sagittal suture, distance from the bregma to obelion, distance from lambda to obelion were measured. The obtained results are tabulated. Conclusion: Parietal emissary veins are surgically important structures that receive little attention in scalp surgeries. These veins cause excessive bleeding if not located properly. The current study reports the anatomical variations in the PF which may serve as an important landmark to the neurosurgeon.
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Burden of ocular trauma and its effect on vision: A community-based cross-sectional study in the coastal population of South India p. 97
Bhagwati Wadwekar, Amit Kumar Mishra, Pratima Sahu, Elfride Farokh Sanjana, M Manikandan
DOI:10.4103/jcrsm.jcrsm_12_21  
Background: The burden of blindness worldwide is 39 million. One of the avoidable causes of blindness is ocular trauma. The ocular trauma could be prevented by preventive measures such as use of goggles and helmets. Objective: The study was conducted to estimate the burden of ocular trauma and its effect on vision in the coastal area of South India. Materials and Methods: A community-based descriptive cross-sectional study was conducted in the service area of a tertiary hospital in the coastal area of South India. Ethical approval was obtained from the institute ethics committee. House-to-house visits were done, and relevant information was collected from available and eligible participants. Data were entered in EpiData, and analysis was done in the Statistical Package for the Social Sciences V21. Results: In this study, 1272 participants were interviewed, among which 882 (69.3%) were female. Most of the participants (27.8%) were in ≤30 years of age. Forty-nine (3.9%) participants had a history of one or more times eye trauma; among them, 38.8% reported that the cause of eye trauma was due to plant branch or thorn. The majority of the participants with a history of eye trauma (91.8%) did not use any safety measures while working such as goggles or spectacles. The vision was affected in 21 (42.9%) participants due to the trauma to the eyes. Conclusion: The burden of ocular trauma in the current study is lower than that found in other few studies in India. Most of the eye injuries that occurred could have been prevented by the use of preventive measures such as goggles or spectacles.
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Level of stress among postgraduate junior residents during their postgraduation in medical colleges of Coastal Karnataka – A cross-sectional study p. 102
Madhavi Bhat, Dilshana Nafisa, Anil Kakunje, Rajesh Mithur, Ravichandra Karkal
DOI:10.4103/jcrsm.jcrsm_9_21  
Background: Stress has been an unavoidable reality of resident's life. Postgraduates face numerous stressors in their medical training. Stress may indirectly lead to medical errors which negatively impact the quality of patient care. However, the severity varies among individuals. Here, we present a study where we looked into the levels of stress among postgraduate junior residents of Coastal Karnataka and its association with various sociodemographic and clinical variables. Materials and Methods: This cross-sectional study conducted among postgraduate residents of various departments of seven medical colleges of Coastal Karnataka involved 236 participants. Ethical clearance was obtained from the institutional ethical committee. The sociodemographic and clinical variables of participants were collected using an online questionnaire. Assessment of stress level was done using Perceived Stress Scale. Results: The study indicated statistically significant increase in stress level among females compared to males (P = 0.009). The year of postgraduation, number of years taken to join postgraduation, and subject of postgraduation did not make any significant difference in the level of stress. However, most of the postgraduates had moderate stress scale scores. Conclusion: Postgraduation is indeed a time of incredible stress to all the residents. Our study was also able to indicate the same. There is a need to provide psychological support during their training.
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Awareness on eye donation among medical and nonmedical students: A cross-sectional comparative study p. 108
Guru Dhanushia, Pratima Sahu, Elfride Farokh Sanjana, Amit Kumar Mishra
DOI:10.4103/jcrsm.jcrsm_11_21  
Background: Globally, there are 45 million blind people with an annual increase of 1–2 million. Corneal blindness is the 4th leading cause of blindness. The demand for donor's eyes is much higher than the number of donor's eyes collected, and the number of corneal transplants done is insufficient. One of the reasons for reduced eye donation is the lack of awareness of the process of eye donation and corneal transplantation. Materials and Methods: A comparative, questionnaire-based cross-sectional study was conducted to assess the awareness on eye donation among medical and nonmedical students of Puducherry. The participants were given a predesigned and structured questionnaire which included 25 questions after informed consent was obtained from them. The results were derived through the statistical analysis. Results: The primary source of awareness for both groups was mass media. About 90.3% of medical and 41.9% of the nonmedical students knew that consent for eye donation is given by the donor while alive (P < 0.000), also that the first-degree relatives have the right to give consent for the dead was 88.2% and 49.5% among medical and nonmedical students, respectively (P < 0.000). Three-fourths of medical and half the nonmedical students knew that corneal donation could not cure all types of blindness. Around 87.1% of medical and 36.6% of nonmedical students were aware that eyes with corneal diseases could not be donated. Conclusion: The present study showed that participants from both groups were aware of eye donation, but the awareness among nonmedical students was not adequate. This study also shows that mass media was the most common source of awareness among the students, which could be used to create further awareness among the students.
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Internet gaming disorder among medical students: An observational study from Central Kerala, India Highly accessed article p. 114
Ram Bhaskar, Bichu P Babu, Shaliet Rose Sebastian
DOI:10.4103/jcrsm.jcrsm_28_21  
Background: The development of information technology has popularized Internet gaming as a leisure time activity. India is currently ranked fifth among the list of top countries by game downloads globally. This makes a subset of the population of India, especially the young and adolescents, extremely vulnerable to the harms associated with excessive digital gaming. Although, most of the time, playing video games is harmless and even may be associated with cognitive, social, or physical benefits, excessive use of playing games can lead to various health problems in some individuals. Objective: The objective of the study was to estimate the prevalence of problematic gaming among medical students in Central Kerala by Internet Gaming Disorder Test (IGDT)-10 questionnaire using Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) scale. Materials and Methods: A cross-sectional study was conducted among undergraduate MBBS students across Pathanamthitta, Alappuzha, Kottayam, and Ernakulam districts. Data were collected using a ten-item IGDT-10-English version and analyzed by DSM-5 scale. Data on demographic details and information about gaming were expressed as proportions with a 95% confidence interval (CI). Results: The prevalence of problematic gaming among medical students in Central Kerala is 6.98%. Playing video games (χ2 = 190.10, P = 0.001) and playing games for >3 h (χ2 = 207.05, P = 0.001) were significantly associated with the physical complaints of headaches, neck pain, and wrist pain among gamers (odds ratio = 40.6, 95% CI [18.776–87.936]). Conclusion: Problematic gaming among medical students is on the rise, and therefore, there is a need for a check and timely remedial action.
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CASE REPORTS Top

Use of hydrocolloid dressing to achieve seal in vacuum-assisted closure therapy in anatomically challenging regions p. 119
Jonathan Victor, Vijay Jaganathan, Tanvi Rao, Pappu Lingam
DOI:10.4103/jcrsm.jcrsm_40_21  
In certain anatomical regions achieving seal in the VAC, dressing is challenging. Inadequate seal during VAC therapy can make the therapy ineffective and also leads to wastage of resources. The use of strips of hydrocolloid dressing around the wound can achieve seal when using VAC therapy in these regions. We present our clinical experience with a case series of four patients in whom this technique was used. Hydrocolloid dressings being easily available in most clinical settings and being cost-effective also, this technique can be a simple, readily available solution for a commonly encountered problem during VAC therapy.
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Anesthetic management of a giant cavernous hemangioma of liver posted for right hepatectomy p. 123
Anis Fatima, Prathap Sekar, Sivakumar Segaran, Mamie Zachariah
DOI:10.4103/jcrsm.jcrsm_85_20  
Hepatic hemangiomas (HH) are benign tumors of the liver with an incidence of 0.4%–20%. Most of the HH are asymptomatic with incidental discovery and shows female preponderance. They range from small hemangiomas to large cavernous hemangiomas involving the entire liver. Large hemangiomas will develop symptoms and complications that require prompt surgical intervention or other treatment modalities. Most large liver hemangiomas require hepatic resection which is a complex procedure involving vascular structures and physiological derangements. Hepatic resection requires meticulous anesthetic and surgical management with proper blood replacement therapy. Coagulopathy, hepatic and renal failure and bile leak are some of the important complications of hepatic resection. We present successful management of a case of hepatic hemangioma who underwent right hepatectomy.
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Vascular hamartoma - A rare soft tissue tumor on the back p. 128
Shrihari Chandrasekaran, Nirmal Kumar Palaniyappan, Jacob Jayakar Raju Mandapati, Indira Gunasekaran
DOI:10.4103/jcrsm.jcrsm_66_21  
Hamartoma is a nonneoplastic proliferation of mature cells and tissues indigenous to the affected part. They are classified as lipomatous, neurogenic, vascular, angiomatous, etc., based on the predominance of tissue in them. This is a case of vascular hamartoma of the infrascapular region in a young male. He was evaluated elsewhere with magnetic resonance imaging and incisional biopsy and referred to our institute for further management. After initial contrast-enhanced computed tomography of the thorax, the mass was excised surgically with adequate margins and the wound was closed primarily. The final biopsy report of the mass showed a vascular hamartomatous lesion. Hence, hamartoma should be considered one of the differentials for a soft-tissue mass found anywhere in the body and proper preoperative imaging and planning of appropriate intervention is necessary.
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Lipoma of parotid mimicking as pleomorphic adenoma p. 131
PA Pradeep Raj, Mohammed Fazil, David Livingston, C Peter Manoharan, Kevin Manuel, Emil Phinehas
DOI:10.4103/jcrsm.jcrsm_41_21  
Lipomas are the most common benign mesenchymal tumors, arising in any location where fat is normally present in the head-and-neck region in adults. Lipoma of parotid gland is rare, hence, not often considered for differential diagnosis for parotid swellings. When there is any suspicion, computed tomography, and magnetic resonance helps in confirmatory diagnosis. We present a 27-year-old man with a swelling in parotid gland, which was diagnosed as pleomorphic adenoma on fine-needle aspiration cytology. Surgical excision of parotid gland is the management even though excision is challenging because of the facial nerve, which courses through the parotid gland. The postoperative histopathology revealed a lipoma, the clinical picture, radiological, and histopathological features of this case is being discussed here.
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A rare case of scrotal neoplasm-paratesticular liposarcoma p. 135
DV Sneha, Sampath Kumar Poral, CM Kiran, M Marenika, Malla Ratna Maunika, Emil Phinehas
DOI:10.4103/jcrsm.jcrsm_53_21  
Paratesticular tumors are rare and account for 7% of intrascrotal neoplasms which generally present as painless inguinal or scrotal swelling. Around 200 cases of paratesticular liposarcoma cases have been reported worldwide. They are usually misdiagnosed before surgery. Incomplete treatment may lead to local recurrence. We report a rare case of paratesticular liposarcoma. A 65-year-old man presented with right scrotal painless swelling for 2 years and gradually increasing in size. On examination, swelling in the right inguinal scrotal region was cystic in consistency. Testicular tumor markers were normal. The patient underwent right high orchidectomy with tumor excision. Sample sent for biopsy. Histopathological study reveals paratesticular liposarcoma. The long-term survival is approximately 50% with a favorable prognosis.
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Atypical cutaneous manifestations in lupus erythematosus: A report of three cases p. 138
Soumya Mary Koshy, Remya Raj Rajamohanan, Satyaki Ganguly, Anita Ramdas, Sheela Kuruvila
DOI:10.4103/jcrsm.jcrsm_35_21  
Systemic lupus erythematosus (SLE) can present with a wide morphological spectrum of cutaneous manifestations. In addition to its classical cutaneous presentations such as malar rash, discoid rash, annular, or papulosquamous lesions, there can also be a few unusual manifestations. We present a report of three patients evaluated in a tertiary care center satisfying the Systemic Lupus International Collaborating Clinics criteria for SLE and presenting with unusual manifestations such as bullous lesions, toxic epidermal necrolysis like picture, and coexisting with pemphigus foliaceous.
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Female anterior urethral wall leiomyoma: A rare presentation p. 142
Veda Murthy Reddy Pogula, Ershad Hussain Galeti, Ifrah Ahmad Qazi, Ayesha Galeti
DOI:10.4103/jcrsm.jcrsm_26_21  
Leiomyomas are benign mesenchymal tumors commonly presenting as uterine masses. They are most frequently seen in females during the reproductive age. Extrauterine leiomyomas are rarely seen and primarily observed in the genitourinary tract. In general, patients come up with soft-tissue mass near the urethral meatus and urinary symptoms. We report a case of distal urethral leiomyoma in a 34-year-old woman who presented with periurethral mass with a history of hematuria and dysuria. She underwent complete excision of the mass. Due to their unusual location, these leiomyomas should be treated with great care during surgery. Postsurgery, the patient remained asymptomatic, and there was no evidence of recurrence in the follow-up.
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Unilateral complete duplex ureter – report of a rare underdiagnosed anomaly p. 145
C Naga Jyothi, K Sriambika
DOI:10.4103/jcrsm.jcrsm_34_21  
Duplex ureters are congenital malformations with varying clinical consequences. Identification of this entity is pivotal as exemplified by the failure of first-line investigations to explain the cause for some presenting symptoms in few cases. We report an interesting case of complete duplication of the right ureter in a male cadaver. A brief review regarding embryogenesis, association with other anomalies, and clinical significance is discussed.
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An unusual finding of Courvoisier sign: Gallstone with locally advanced carcinoma gallbladder p. 148
Jayabal Pandiaraja
DOI:10.4103/jcrsm.jcrsm_83_20  
Courvoisier sign is one of the important clinical signs used in the diagnosis of hepatobiliary disease. According to this sign, when the gallbladder is palpable in a jaundiced patient, it is unlikely due to stone. There are exceptions for Courvoisier signs such as double impacted stone, oriental cholangitis, and AIDS-associated cholangiopathy. In our case, there is a gallstone with palpable gallbladder due to concurrent occurrence of gallstone with gallbladder carcinoma compressing the adjacent biliary tree.
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Evaluation of carotid intima-media thickness in primary hypertensive patients using B-mode ultrasound: Cross-sectional study p. 151
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jcrsm.jcrsm_1_21  
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Guillain-Barre Syndrome in COVID-19 patients: An emerging dilemma p. 152
Venkata Dinesh Kumar Kandula, Tarun Kumar Suvvari
DOI:10.4103/jcrsm.jcrsm_27_21  
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