D Y PATIL JOURNAL OF HEALTH SCIENCES

ISSN 2347 - 3665 E-ISSN 2347 - 8020

Volume 7 Issue 2 Apr - Jun 2019

D Y PATIL DEEMED TO BE UNIVERSITY Navi Mumbai 400 706, Maharashtra, INDIA www.dypjhs.com ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

D Y PATIL JOURNAL OF HEALTH SCIENCES Volume 7, Issue 2 (2019)

Patrons Mrs. Shivani V Patil Dr. Vijay D Patil Dr. D Y Patil Managing trustee President and Chancellor Founder president

Chief Editors Dr. Deepak Langade Dr. Abhay Chowdhary Dr. Bharati Kulkarni Dr. Atul Deshmukh

Advisory Board Dr. Nandita Palshetkar Trustee Dr. Priya Patil Cholera Trustee Dr. Shirish Patil Vice-Chancellor, D Y Patil Deemed to be University Dr. Surekha Patil Dean, D Y Patil Deemed to be University School of Medicine

Editorial Board International advisory Dr. James Thomas Dr. Vijaya Badhwar Dr. Kashyap Patel, USA Dr. Avinash Supe Dr. G R Kane Dr. Uddhav Kelavkar, USA Dr. Omkar Shetty Dr. Sanjay Dhar Dr. Vijay Shukla, Denmark Dr. Mahesh Harit Dr. Sharmila Patil Dr. Debjani Dasgupta Dr. Suhas Abhyankar Dr. Rakesh Somani Dr. Anant Patil Dr. Unnati Pandit Dr. Sudhamani S Dr. Datta Patel Dr. Vaishali Thakare Dr. Aishwarya Swaminathan Dr. Sadhana Mendhurwar Dr. Rita Lakhani Dr. Kailas Jawade

Guest Editors Dr. Mrudula Phadke Dr. Hansa Goswami Dr. Abdul Rashid Dr. Bhushan Pathwardhan Dr. Harvindar Sharma Dr. Umesh Luthra Dr. Bharat Bhushan Dr. Pranay Shah Dr. Dilip Pawar Dr. Vishwas Bapat Dr. Pralhad Patki Dr. Deepali Vidhate Dr. Ashok Verma Dr. Bela Shah Dr. Niranjan Murthy Dr. Penaa Suprasanna Dr. Sandip Kale Dr. Bipin Amin Dr. Anil Bhutey Dr. Jyoti Jadhav Dr. Jyoti Raghvendra

ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

= D Y PATIL JOURNAL OF HEALTH SCIENCES Volume 7, Issue 2 (2019)

CONTENT

Abstract ID Title and Authors Page No ANEO1 Anaesthetic Management in a Case of Restrictive Lung Disease 62 Shruti Hazari, R.P. Gehdoo, Varsha Vyas and Priti The Effects of Intravenous Paracetamol on the Quality of Postoperative Analgesia in Patients ANEO2 Undergoing Inguinal Repair Under Subarachnoid Block: A Prospective, Randomized, 62 Controlled Trial Jyoti Gaikwad, Khemraj Meena and Basant Dindor Optimum Time for IV Cannulation in Different Paediatric Age Groups During Incremental Sevoflurane ANEO3 62 Induction Sarah Sheikh, Anila Malde, Shalaka Nellore and Devendra Thakare Evaluation of Dexmedetomidine as a Pretreatment Drug for Attenuation of Haemodynamic Response of ANEO4 63 Laryngoscopy and Intubation Parvati S. and Jayashree Sen Ultrasound Guided Transverses Abdominis Plane (TAP) Block and Conventional Caudal Epidural ANEO5 63 Block for Post-Operative Analgesia in Pediatric Unilateral Ilioinguinal Surgeries Jyoti N. Tat and Kavita U. Adate ANEO6 IV Nalbuphine Vs IV Fentanyl in Attenuating Pressor Response: A Comparison 63 Chanchal Bhandari, Rashmi Bengali and Tushar Patil ANEO7 Alternative Methods of Pain Relief in Patients Suffering from Chronic Pain - A Clinical Study 64 Vasantha Kumar K.R. and Shruti Rajagopal ANEO8 Is Pre-Operative DVT Screening Mandatory in TKR/THR? 64 Vaijanti S. Bhavsar and Akshay Challani Subclavian Vein Catheterisation: Comparative Evaluation of Supraclavicular Versus Infraclavicular ANEO9 64 Approach in Oncology Patients Amit Bodkhe and Sanjay Upadhye Comparative Evaluation of Different Dosage of Clonidine with Ropivacaine 0.25% in Caudal Block for ANEO10 65 Post-Operative Analgesia in Paediatric Patients Shilpa Tiwari, Sudhakar Dwivedi, Subhash Agrawal and A.K. Rathiya ANEO11 Giant Rhinophyma: Challenges to Facemask Fit and Bag Ventilation 65 Shweta N. Satia, Dhanshree Dongre and Girish Soudhantikar Intractable Headache Due to Spontaneous Dural Leak Treated with Fluoroscopic Guided Epidural ANEO12 65 Blood Patch Two Case Reports Shantanu Mallick and Pawan Ojha ANEO13 Management of Ventricular Storm with Thoracic Epidural Anaesthesia 66 Shailendra Shiravadkar and Shakuntala Basantwani Awake Nasal Fiber Optic Intubation of a Patient with Klippel Feil Syndrome for Elective Caesarean ANEP1 66 Section Sumesha S. Chakurkar, Sandhya Gujar, Depankar Datta and Karuna Sidam ANEP2 Bilateral Obstructed Surgery in a Severe COPD Patient - A Challenge to Anaesthetist 66 Kushal Hajela, Sunaina T. Karna, Anuj Jain and Vaishali Waindeskar Anaesthetic Management in a Case of Cerebral Palsy with Type 2 Laryngomalacia Posted for ANEP3 67 Epiglottopexy Shahbaz Naseem and S. Tavri

ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

Abstract ID Title and Authors Page No A Rare Case of Impending Eclampsia with Posterior Reversible Encephalopathy Syndrome for ANEP4 67 Emergency LSCS Sasidhar Datla and Mary Samuel ANEP5 Anaesthetic Management in Case of Wilson’s Disease Posted for Split Skin Grafting 67 Omkar Kale, Dhanashree Dongare and Shalini Sardesai Nephrectomy in a Post Renal Transplant Patient with Dilated Cardiomyopathy and Ejection Fraction ANEP6 68 25% Shivani S. Phansalkar and Aparna Bagle ANEP7 Anesthetic Considerations on Organ Procurement After Brain Death 68 Barkha Dodani and Amol Anesthetic Management of Elderly Male Patient (100 Yrs.) Posted for Left Proximal Femur Nailing ANEP8 68 with Low Ejection Fraction (15%) Ishan R. Gadekar, Rajesh Gore and H.S. Rawat ANEP9 Profound Bradycardia on a Peaceful Day: Intra-Myometrial Vasopressin 69 Delcita Mathias and Radhesh Hegde Anasthesia for Closed Reduction of Shoulder Dislocation in Patient with Multiple Medical ANEP10 69 Comorbidities in Emergency Department Shubhangi N. Omase and Preeti More ANEP11 Unanticipated Airway Challenge in an Anticipated Difficult Airway 69 Suhas S. Dhole Fibrooptic Intubation of Patient Posted for Emergency Tracheostomy with Right Pyriform Fossa ANEP12 70 Growth Which Extending in Supraglotis, Glotis, Subglotis Airway Amey A. Sable and Lakhe J.N. Evaluation of Dexmedetomidine as an Adjunct to Total Intravenous Anaesthesia in Lumbar Spine ANEP13 70 Surgeries P. Lavan Sagar and Vivek Chakole ANEP14 Fatal Pulmonary Embolism After Middle Ear Surgery: A Case Report 70 Abhijeet Shekhawat and Akhil Bhalla ANEP15 Effect of User Experience in The Accuracy of Cuff Pressure Estimation Using Palpation Technique 71 Basant Singh Latwal and Amol Singam Inferior Alveolar Nerve Block with Injection Triamcinolone with 1% Lignocaine for Pain Relief in ANEP16 71 Refractory Trigeminal Neuralgia: A Case Report Ayush Pal Bansal and Vivek Chakole Comparative Double Blind Study of Fentanyl and Tramadol as Adjuvant to Lignocaine for Intravenous ANEP17 71 Regional Anaesthesia in Forearm Orthopedic Surgeries Parag Dongre and Aruna Chandak ANEP18 Two Tube Technique- A New Approach to Submental Intubation - A Case Report 72 Suzanna Varghese and Karuna Taksande Case Report- Emergency LSCS in a Patient with Moderate Mitral Stenosis with Pulmonary ANEP19 72 Hypertension Niraj Bele and Sandhya Gujar Somatosensory and Motor Evoked Potential Monitoring in a Patient of a Spinal Tumor at Lumbar Level ANEP20 73 Under TIVA: A Case Report Aparna A. Ruparel and Shilpa Kanakam Anaesthetic Management of Case of Pan-Facial Trauma for Maxilla Zygomatic Mandibular Osteotomy ANEP21 73 and Plating Shreyank P. Solanki and Aparna Bagle Comparison of Various Formulae for Predicting Skin to Subarachnoid Space Depth: An Observational ANEP22 73 Case Series Samir Kumar Pandey and Ashok Chaudhari

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Abstract ID Title and Authors Page No ANEP23 Iatrogenic Carotid-Jugular Fistula Following Central Venous Catheterization: A Case Report 74 Akhil Bhalla and Aniruddha Nirkhi ANEP24 Simulation in Anaesthesia 74 Narendra S. Patil, Varsha Vyas, Amit Nagpal and Surekha Patil OBGO1 Anaemia in - Its Prevalence and Consequences 74 Rini Sutaria OBGO2 Correlation of Traditional Post-Partum Diet and Customs with Post-Partum Anaemia 75 Pooja A. Pachani and Sonal Walawalkar OBGO3 Successful Outcome of an Ovarian 75 Dharam Shah and Meena Satia OBGO4 The Study of Maternal and Fetal Outcome in Pregnant Women with Thyroid Disorders 75 M. Apoorva Reddy OBGO5 Awareness of Polycystic Ovarian Syndrome Among Young Women in Western India 75 Esha Chainani OBGO6 The Effect of Cerviprime Gel on Cervical Ripening and Induction of Labour 76 Saloni Patil Evaluation of Fetal Health in Cases of Pregnancy Induced Hypertension with or without Growth OBGO7 76 Restricted Fetus by Doppler Flow Study Rounak M. Khandagale, Meena Bhargva and Arindaam Pol OBGO8 Association of Menstrual Disorders with Thyroid Diseases 76 Anushree M. and Sudha Rani OBGO9 A Comparative Study of Extra-peritoneal and Intra-peritoneal Closure of Uterus in Caesarian Section 77 Komal Dahiya OBGO10 Study on Safety and Feasibility of Caesarian Myomectomy 77 Madhura Desai OBGO11 Transverse Vaginal Septum’..Are We Missing Something!!! 77 Amit Agrawal and Deepa Kala OBGO12 Maternal and Fetal Outcome in Oligohydramnios 78 Shalini Kesharwani OBGO13 Interesting Case: Hemolytic Uremicsyndrome in a Postpartum Patient 78 Zaneta Dias and Shailesh Kore OBGO14 Acute Uterine Inversion: Golden Hour to Almost Lost-Need for Revolution 78 Nidya K. and Vidya Tirankar OBGO15 Study of 24 Weeks’ Antenatal Visit as Predictor of Perinatal Outcome 78 Shridula A. Pawar, Shirisha Singham and Sangeeta Desai A Cross Sectional Study on Prevalence of PCOS and Risk Factors Associated with It Among Medical OBGO16 79 Students Mihika Aggarwal, Pramila Yadav and Pradnya Deolekar OBGO17 Thrombocytopenia in Pregnancy: A Prospective Study 79 Charu Srivastava Evaluation of Socio-Demographic Characteristics of Pregnancy Induced Hypertension and Its Outcome- OBGO18 79 A Prospective Study Rudroju Shirisha, Jyosthna Koppula and Vasudha Sawant OBGO19 Rudimentary Horn Ectopic Pregnancy: Managed Laparoscopically 80 Krishna Mandade

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Abstract ID Title and Authors Page No OBGP1 Acute Fatty of Pregnancy: A Rare Disease in Pregnancy 80 Rini Sutaria OBGP2 Incarcerated Gravid Uterus: An Obstetric Challenge 80 Ananya Deekshit OBGP3 A Rare Case of Hydrocele in a Female 80 Prachi Patil and Meena Satia OBGP4 Advantage of Embryoscope in Infertility 81 Sneha Bhoir and Jaideep Malhotra OBGP5 Mucinous Adenocarcinoma of Ovary 81 Tejashri Madamwar and Charu Shrivastava OBGP6 Acute Kidney Injury in Pre-Eclampsia 81 Neha Yadav OBGP7 Perforated Meckel's Diverticulitis in Third Trimester Pregnancy - An Enigma 81 Nidya K., Vidya Tirankar and Prabhakar Gawandi OBGP8 Intravenous Iron Therapy in and Gynaecology 81 Ranu Singh Kushwaha, Kumudini Jha and Manorama Kumari OBGP9 Partial Molar Pregnancy with Normal Fetus: A Rare Occurrence 82 Sneha Patel and Babita Vaswani Dysmenorrhea: An Important Health Issue in Adolescent Girls –Needs to be Addressed at Institutional OBGP10 82 Level to Reduce Its Impact and Improve the Quality of Life Krittika Bhatiya, Aarya Vidhate and Deepali Vidhate Use of Condom Hydrostatic Pack as a Means to Control Generalized Oozing After Surgery in a Case OBGP11 82 with Ovarian Cyst Manvi Verma and Yogeshwar Nandanwar OBGP12 Analysis of Maternal and Fetal Outcome in Placenta Previa and Accreta 83 Aparna Dandale, Amarjeetkaur Bava and S.J. Kore OBGP13 Gestational Trophoblastic Neoplasm- A Case Report 83 Artika Gupta OPHO1 Tolosa Hunt Syndrome 83 Pooja Sharma To Study the Corneal Topography Changes and Surgically Induced Astigmatism Post OPHO2 83 Phacoemulsification Surgery Kshitij S. Tamboli and Nupur Chakravarty OPHO3 Intubation Anaesthesia 84 Nita Shanbhag OPHO4 Assessing the Importance of Ganglion Cell Complex (GCC) in Diagnosing Preperimetric Glaucoma 84 Rohan Dedhia and Nita Shanbhag A Case Report of Bilateral Vernal Keratoconjunctivitis Complicated by Keratoconus, Steroid Induced OPHO5 84 Cataract, Glaucoma and a Spontaneous Descemet Membrane Detachment in a 18 Year Old Female Bhaktee Walawalkar Clinical Profile, Management, Complications and Visual Outcome of Paediatric Cataract – An OPHO6 85 Observational Study Sayyad Kulsum Jahangir, Dharmendra Kose and Amol Tamhane OPHO7 A Case of Ocular Myasthenia Gravis 85 Sanika Jain and Nita Shanbag OPHO8 Exposure Keratitis After Incomplete Taping During PICU Care 85 Srushti Bagde, Faraaz Hussain, Reshma Anand and Shipra Gupta

ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

Abstract ID Title and Authors Page No OPHO9 Retinopathy of Prematurity in Preterms of Multiple Gestational : Risk Factors 86 Sailie Shirodkar and Karobi Lahiri OPHO10 Evaluation of Tear Film in Cases of Rheumatoid Arthritis 86 Kruti K. Shah, Swapnagandha S. Halikar OPHO11 Methotrexate Induced Bilateral Cytomegalovirus (CMV) Retinitis 86 Roma P. Vakade, Mayur Moreke, Tanuj Sharma, Sharang Wartikar, Ajay Dudani and Karobi Lahiri OPHO12 Bilateral Optic Neuritis in a Child with Tuberculosis 87 Rishwa Hariyani and Priyanka Choudhari OPHO13 Corneal Injury - An Occupational Hazard 87 Hema M. Mer, Naina Potdar and Anuj Soni OPHO14 Unilateral Report Unilateral Proptosis in a Young Female Due to Schwannoma – A Rare Case 87 Ishita Mehta, Himika Gupta and Minal Kanhere OPHO15 Bilateral Anophthalmos /Microphthalmos in Monozygotic Twins: A Rare Presentation 87 Akash Jain Pinealoblastoma/Malignant Neuroectodermal Tumor in a Known Case of Alternating Exotropia with OPHO16 87 High Hyperopia in a 6 Year Old Male Child Ankur S. Sancheti and Harsha Pagad OPHO17 Case Report: Study of Management Protocol of Glaucoma in Our Hospital 88 Jay N. Zarkar, Nita Shanbhag and Kshitij Tamboli The Lesser Known Facet of Intraocular Tuberculosis (IOTB). Neurosensory Detachment in IOTB - A OPHO18 88 Case Series Abhishek Heranjalm, Apoorva Ayachit, Sarvesh Tiwari and Anand Subramanyam Bilateral Ischemic CRVO with Accelerated Hypertension CRF and Hyperhomocysteinemia Treated OPHO19 88 with Anti VEGF Sanika Jain, Nita Shanbag and Ankur OPHO20 Multifocality with a Monofocal Lens 88 Nita Shanbhag and Pooja V. Ramnani OPHO21 A Case of Bilateral Traumatic Cataract Secondary to Electrical Injury 89 Suvarna Kalapad, Gayatri Bhonsale, Faraaz Hussain and Yash Gala OPHO22 Case Report : A Rare Case of Acquired Oculomotor Nerve Nucleus Palsy 89 Sandeep S. Arora and Harsha Pagad OPHO23 Lipaemia Retinalis - Gateway to Systemic Disease 89 Yash Gala, Reshma Ramakrishnan, Ishita Mehta and Tanvi Bhosale OPHP1 To Report a Case Osteopetrosis, a Rare Genetic Disorder with Ocular Manifestations 90 Pooja Mehta and Harsha Pagad OPHP2 Toxic Amblyopia 90 Pooja Ramnani and Nita Shanbhag OPHP3 A Rare Case of Congenital Oculomotor Nuclear Palsy 90 Sandeep Arora OPHP4 To Report a Case of Treacher Collins Syndrome Variant in Pediatric Ophthalmology O.P.D 90 Kshitij S. Tamboli, Nita Shanghag and Harsha Pagad OPHP5 A Case Report of Millard-Gubler Syndrome with Ipsilateral Horizontal Gaze Palsy 91 Rohan Dedhia and Harsha Pagad OPHP6 Irvine-Gass Syndrome 91 Anusha Dhiman

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Abstract ID Title and Authors Page No OPHP7 A Case Report of External Ophthalmomyasis Due to Oestrus ovis 91 Machi Reddy R Sekharreddy and Venkatesh Sugantharaj OPHP8 Leber’s Congenital Amaurosis 91 Vaidehi Sathaye OPHP9 Management of a Case of Ocular Surface Squamous Neoplasia (OSSN) 92 Tanvi Khosla and Kishor P. Badhe OPHP10 Adult Giant Dacryocystopyomucocoele: A Rare Case Report 92 Ashishkumar Changbhale, Pooja Jain, Rakesh Barot and Arun Mane OPHP11 Sub-Periosteal Haematoma of the Orbit 92 Vaidehi Bhatt, Rohit Tiwari, Rakesh Barot, Pooja Jain and Tejasvi Poojari OPHP12 Many a Slip between the Cup and The Drop: A Case of Misdiagnosed Glaucoma 93 Mavnika Boopalan and Venkatesh S. OPHP13 Post Traumatic Skin Grafting 93 Priyanka Khade and Akash Shah OPHP14 Various Clinical Presentations of Nystagmus 93 Jagruti Jain and Prashant Purkar OPHP15 Penetrating Ocular Fish Hook Injury: A Rare Case Report 94 Sujay Herekar, Rakesh Barot and Tejaswi Pujari A Prospective Comparative Study of Outcomes of Medial Malleolar Fractures Operated with Open ORTO1 94 Reduction Internal Fixation with Tension Band Wiring and 4mm Cannulated Cancellous Screws Shouryashil V. Khambalkar, Vaibhav Koli, P.D. Samant, Sachin Kale, Gaurav Kanade, Adnan Asif and

Govind Baranwal ORTO2 Assessment of the Utility of Scanograms in Primary Total Knee Arthroplasty 94 Adnan Asif and Sachin Kale ORTO3 Clinical Outcome in Metaphyseal Locking Plate Fixation of Distal Femur and Proximal Tibia 95 Bhushankumar Pawar, Prakash Samant, Sachin Kale, Sandeep Deore, Gaurav Kanade and Vaibhav

Koli ORTO4 Tension Band Wiring – Is It an Outdated Technique? 95 Chirag Manwani, Avinash Date, and Vinay Patel ORTO5 Halo Vest in Cervical Spine Disorders - A Simple Yet Effective Device 95 Rohan B. Gala, Saumyajit Basu, A. Biswas, Somashekhar and Naveen Agarwal Comparing of Treatment Outcomes of Intraarticular Fracture of Calcaneum with Steinmann Pin (K ORTO6 96 Wire) and Plating Suraj Sharma, Prakash Samant, Sachin Kale, Sandeep Deore and Gaurav Kanade ORTO7 A Two Year Follow Up Study of Operative Results of Fractures of Acetabulum 96 Arpit Rajpurohit, Sachin Kale, Ibad Patel and Sanjay Dhar ORTO8 Osteochondroma of the Distal Tibia Inducing Deformity and Stress Fracture of the Fibula 96 Mohit Thapa Magar and Chander Mohan Singh ORTO9 Cage Vs Autologous Bone Grafting in PLIF Surgery for Spine Fusion - Randomized Control Trial 96 Mainak Gupta, Prakash Samant, Sachin Kale, Sandeep Deore, Gaurav Kanade and Vaibhav Koli Influence of Meniscal Repair Versus Meniscectomy on ACL Reconstruction in Terms of Knee Stability ORTO10 97 and Radiological Imaging Varun Agarwal, Prakash Samant, Sandeep Deore, Sachin Kale, Gaurav Kanade and Vaibhav Koli ORTO11 Management of Fractures of Distal Third Tibia by Interlock Nailing 97 Amit Chugh, Prakash Samant, Sunil Shetty, Amit Dhond and Sachin Kale ORTO12 Relative Regenerate Strength 97 Soham Chaudhary

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Abstract ID Title and Authors Page No By-Passing the Perfect Circle Method of Fem-oral Distal Interlocking Screw Insertion (DISI) in ORTO13 98 Interlocking Nailing – A Technical Note and Retrospective Study Divyesh Bukalsaria, Sachin Kale, Prakash Samant, Sanjay Dhar and Sandeep Deore ORTO14 Butala Technique: Poglyglactic-Acid Suture Repair of Comminuted Patella Fracture 98 Rajendraprasad R. Butala, R.G. Khedekar, Shikhar Singh, Saamarthya Gupta, Javed Hussain and

Devendra Results of Modular Megaprosthetic Reconstruction of Tumors Involving the Distal Third Femur: A ORTO15 98 Case Series Rajiv Kaul and Yogesh Sharma To Study the Accuracy of Achieving Correction of Varus Deformity at Knee by Medial Opening ORTO16 Wedge Osteotomy Using Modular HTO Fixator in Treating Predominantly Medial Compartment 98 Osteoarthritis of Knee Kamparsh Thakur ORTO17 Treatment of Complex Proximal Tibia Fractures Using Ilizarov Technique 99 Ajit Chalak, Sunil A. Shetty and Amit Chugh ORTO18 Blood Loss in Total Knee Arthroplasty with and without Tourniquet 99 Atul Jain and Shikhar Singh Diaphyseal Fractures of the Clavicle in Adults, Comparative Study of LCP (Locking Compression ORTO19 99 Plate) Versus Intramedullary Nailing with TENS (Titanium Elastic Nailing System) Arun H.S., Prabhu E., Sreejith Thampy J. and Abhijeet Salunkhe Functional Outcome of Posterior Cervical Microforaminotomy and Discectomy Using Mcculloch ORTO20 100 Retractors for Cervical Radiculopathy Chetan Kumawat and Satyen Mehta ORTO21 Management of Distal Tibia Fracture with Minimally Invasive Plate Osteosynthesis 100 Anirudh Kumar, Parmanand Singh, Sanjay Dhar, Prakash Samant, Sachin Kale and Shikhar Singh ORTO22 Efficacy of Local Infiltration Vs Epidural Analgesia in Total Knee Replacement 100 Melanie Gomes Comparative Study of Platelet Rich Plasma (PRP) Vs Corticosteroids for the Treatment of Chronic ORTO23 101 Lateral Epicondylitis Abdul M. Nagori A Comparative Study on the Outcome of Management of Open Tibia Fractures with Versus without ORTO24 101 Topical Administration of Gentamicin Abhimanyu Singh Comparison of Dynamic Hip Screw and Proximal Femoral Nail in the Treatment of Intertrochanteric ORTO25 101 Fracture of Femur Devendra Kommuru, Shikhar Singh, Rajendra Butala, Sanjay Dhar, Sachin Kale and Prakash Samant ORTO26 Three Stitch Technique for Humerus Nailing 102 Ibad Patel, Prakash Samant, Sachin Kale, Sandeep Deore, Gaurav Kanade and Suraj Sharma ORTO27 Plating for Intra-Articular Calcaneal Fractures…. Is It an Overkill? 102 Vaibhav Koli, Himanshu Kulkarni, Vilas Mane, K.L. Gaonkar and Nishant Gaonkar ORTO28 Conservative Management of Lumbar Canal Stenosis Compared to Operative Decompression 102 Shivam Pandey, Sanjay Dhar, Prasad Chaudhary, Arvind Vatkar and Pratik Tank ORTP1 An Unusual Presentation of Osteochondroma on the Ventral Surface of the Scapula 103 Javed Hussain and Sunil Shetty ORTP2 A Rare Case of Primary Tibiotalocalcaneal Nailing for Talus Fracture 103 Pratik Dhabalia, Prakash D. Samant and Sachin Kale ORTP3 A Rare Case of Isolated Cysticercosis of the Biceps Brachii Muscle: A Diagnostic Dilemma 103 Divyesh V. Bukalsaria, Prakash Samant, Sachin Kale, Sanjay Dhar and Sandeep Deore A Rare Case of Right Paravertebral Myoepithelioma with Intradural Extension Causing Cord ORTP4 103 Compression Divyesh V. Bukalsaria, Prakash Samant, Sachin Kale, Sanjay Dhar and Sandeep Deore

ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

Abstract ID Title and Authors Page No ORTP5 Clinical Outcomes in Patients Undergoing Micro Lumbar Discectomy for Lumbar Disc Herniation 103 Anirudh Kumar P. Singh, Prakash Samant, Sachin Kale, Sanjay Dhar, Sandeep Deore and Shikhar D.

Singh ORTP6 Compound Total Dislocation of Talus Without Fracture 104 Rajendraprasad R Butala, R.G. Khedekar, Shikhar Singh, Daamarthya Gupta, Javed Hussain and

Devendra A Comparative Study of the Conservative and Operative Management of Midshaft Clavicle Fracture ORTP7 104 Based on Functional Outcome and Post-Operative Complications Anirudh Kumar P. Singh, Prakash Samant, Sachin Kale, Sanjay Dhar, Sandeep Deore and Shikhar D.

Singh ORTP8 Case Report of Bent and Incarcerated Vnail in Distal 1/3rd Distal Tibia and Fibula Fracture 104 Suraj Sharma, Prakash Samant, Sachin Kale, Sandeep Deore and Gaurav Kanade ORTP9 An Arthroscopic Study of Evaluation of Patients with Chronic Shoulder Pain 105 Govind Baranwal, Shikhar Singh, Prasad Chaudhari and Sachin Kale ORTP10 A Rare Case of Epitheliod Malignant Peripheral Nerve Sheath Tumor (EMPNST) at D5 Vertebrae 105 Amit Chugh, Sanjay Dhar, Prakash Samant, Prasad Chaudhari and Sachin Kale ORTP11 Results of Multilevel Laminectomy Using High Speed Burr Without Fusion in Cervical Myelopathy 105 Chetan Kumawat and Satyen Mehta ORTP12 Arthroscopic Management of Mucoid Degeneration of Anterior Cruciate Ligament 105 Ibad Patel, Sachin Kale, Prakash Samant and Pratik Dhabalia Randomized Controlled Study Comparing Clinical Outcomes After Injection Botulinum Toxin Type A ORTP13 106 Versus Corticosteroids in Chronic Plantar Fasciitis Varun Agarwal, Prakash Samant, Sandeep Deore, Sachin Kale, Gaurav Kanade and Vaibhav Koli ORTP14 Prospective Study of Arthroscopic Evaluation of Patients with Chronic Shoulder Pain 106 Bhushankumar Pawar, Prakash Samant, Sachin Kale, Sandeep Deore and Gaurav Kanade ORTP15 Benign Tumors and Tumor-Like Lesions of the Calcaneum 106 Ibad Patel, Sachin Kale, Prakash Samant and Pratik Dhabalia A Comparative Study of Functional Outcome of External Fixation and Volar Plating in Unstable Distal ORTP16 107 Radius Fractures Rajiv Kaul ORTP17 Consent in Surgical Practice: A Brief Overview 107 Melanie Gomes ORTP18 A Case of Giant Cell Tumor of L5 Vertebrae with Paraplegia in A 34 Year Old Female 107 Govind Baranwal, Sanjay Dhar, Prasad Chaudhari and Sachin Kale ORTP19 Outcome of Patellar Clunk Syndrome Treated Arthroscopically 108 Suraj Sharma, Sandeep Deore, Prakash Samant, Sachin Kale, Gaurav Kanade, Bhushankumar Pawar

and Anirudh Kumar P.C. Clinico-Epidemiological Profile of Lower Lumbar Disc Herniation Patients Undergoing Microlumbar ORTP20 108 Discectomy Adnan Asif, Sachin Y. Kale, Pramod Bhor and Shikhar D. Singh ORTP21 Steinmann Pin Fixation for Displaced Tounge Type Calcaneal Fracture 109 Javed Hussain, Rajendraprasad R. Butala and Saamarthya Gupta Proximal Femur Replacement with Megaprosthesis in a Pathological Right Sided Subtrochanteric ORTP22 109 Fracture in a Case of CA Lung Arpit Rajpurohit, Prakash D. Samant, Sachin Kale and Divyesh Bukalsaria ORTP23 A Rare Case of Aneurysmal Bone Cyst of Intertrochanteric Area 109 Shouryashil Khambalkar, Bhushan Patil, Mishil Parekh and Sunil Shetty ORTP24 A Case of Synovial Chondromatosis of Right Knee with Arthroscopic Removal of 20 Loose Bodies 109 Devendra Kommuru and Bhushan Patil

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Abstract ID Title and Authors Page No ORTP25 Osteitis Condensans Ilii 110 Sarath C. Poodi ORTP26 Management of a Case of Septic Arthritis of Bilateral Knee Joints: A Case Report 110 Abhimanyu Singh ORTP27 Evaluation of Comminuted Shaft Femur Fracture Treated with Intramedullary Nailing 110 Pratik Tank, Sachin Kale, Shikhar Singh, Sanjay Dhar, Prasad Chaudhary and Shivam Pandey ORTP28 A Rare Case of Chondroblastoma of Cervical Spine at C7, D1 and D2 111 Kedar Parelkar, Sanjay Dhar, Mayur Mahtre, Prasad Choudhari and Arvind Vatkar ORTP29 Outcome of Hemiarthroplasty Versus Internal Fixation in Unstable Intertrochanteric Femur Fracture 111 Sarath C. Poodi, Hariprasad, S.N. Patil and Cecil Fernando Case of 15 Years Old NON UNION of Distal Humerus in a 56 Years Old Male – Managed with Total ORTP30 111 Elbow Arthroplasty Faizan Vaja, Sunil Shetty and Amit Dhond An Unusual Case of Atlanto-Axial and Basi-Occipital TB with Prevertebral Abscess and Epidural ORTP31 112 Abscess Divyesh V. Bukalsaria, Prakash Samant, Sachin Kale, Sanjay Dhar and Sandeep Deore Management of Comminuted Fracture of Shaft of Femur by Interlocking Nail at a Ter-tiary Level ORTP32 112 Hospital Amit Chugh, Shikhar Singh, Prakash Samant, Sachin Kale and Sanjay Dhar ORTP33 Bilateral Shoulder Anterior Fracture Dislocations: A Case Report 112 Abhishek Yadav, B.S. Nazeer and Eshwer Reddy ENTO1 Laryngeal Palsy Secondary to Non-Infective Chest Pathology 113 Stuti Mathur ENTO2 Rhinosporidiosis – A Mysterious Disease of Man 113 Bhagyashree S. Deshmukh ENTO3 A Randomized Study on the Efficacy of Music Therapy on Pain and Anxiety in Nasal Septal Surgery 113 Avinash G. and Satvinder Singh Bakshi ENTO4 Role of in Juvenile Nasopharyngeal Angiofibroma 113 Sonali S. Dodal ENTO5 Postoperative Antral Pseudocyst of Maxillary Sinus 113 Akansha Yadav ENTO6 Primary Diffuse Laryngeal Amyloidosis - A Rare Entity 114 Anmol Wadhwa Comparison of Vestibular Evoked Myogenic Potential and Dizziness Handicap Inventory in Patient ENTO7 114 with Peripheral Vestibular Lesions Between Pre and Post Vestibular Rehabilitation Kaushlendra Kumar and Greeshma Jomin ENTO8 Skull Base Osteomyelitis - Overcoming Challenges and Optimising Outcomes 114 Snekha P. Dominic ENTO9 Indications and Outcome of Balloon Sinuplasty in Sinonasal Pathologies 115 Sreena Dev ENTO10 Management of Orbital Trauma - Our Experience 115 Priyanka Aage ENTO11 Diagnostic Paradox Behind Facial Nerve Schwannoma 115 Gabriela Hawkes ENTO12 Scope of an ENT Surgeon in Endoscopic Orbital Surgery 115 Manisha Sharma

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Abstract ID Title and Authors Page No ENTO13 Rare case of Branchial Apparatus Anomaly 115 Saumya Mishra A Case of Labryinthine Fistula, A Rare Finding in A Common Complication of Chronic Suppurative ENTO14 116 Otitis Media, Squamosal Type Aarzoo S., Swapnil Gosavi and Kalpana Rajivkumar ENTO15 Modern Management of Obstructive Diseases 116 Chaitali R. Chikhale ENTO16 Reasons for Inadequate Usage of Hearing Aids in Elderly Adults 116 Jignesh P. Shah, Rajeev Jalvi and Sachin Patil ENTO17 Unilateral Mucoceles 116 Vishakha Rane, Haritosh K. Velankar, Yogesh G. Dabholkar and Merin S. Mathew ENTO18 Subhyoid Ectopic Thyroid with A Solitary Colloid Nodule: A Novel Diagnostic Entity 117 Sejal Mehta ENTO19 Laryngopharyngeal Reflux Disease: The Silent Epidemic 117 Deeksha Agrawal and Prasun Mishra ENTO20 Cochlear Implant Programme: Our Experience 117 Sai Belsare ENTO21 Retrograde Dissection for Parotidectomy : Review of An Uncommon Approach 118 Ankur Pareek ENTO22 Newer Methods in Treating Chronic Rhinosinusitis 10 Cases, Results and Follow Up 118 Arjun Singh ENTO23 Ectopic Thyroid – Management Dilemmas: A Case Series 118 Keya Shah ENTO24 Visual Loss: An ENT Perspective 118 Ashwathy K.P. ENTP1 Tuberculous Otitis Media with Facial Paralysis – A Case Report 119 Shilpi Agrawal Sphenoid Sinus (SS) Anterior Medial Temporal Lobe Encephalocoele (aMTLE) with Spontaneous CSF ENTP2 119 Rhinorrhea - Case Report Apoorva Salguti ENTP3 Tuberculous Osteomyelitis of Frontal Bone with or Ital Involvement - A Rare Case Presentation 119 Snekha P. Dominic ENTP4 Revolution in Bone Conduction Technology – Bone Anchored Hearing Aid 119 Sonali S. Dodal ENTP5 Unusual Histopathological Presentation of Laryngeal Lesion 119 Priyanka Aage ENTP6 Cochlear Implant Surgery in Waardenburg Syndrome 120 Chaitali R. Chikhale ENTP7 Role of Imaging Vs Endoscopic Assessment of Airway in Management of Laryngotracheal Stenosis 120 Sreena Dev ENTP8 Cochlear Implantation in Congenital Malformation of Cochlea: Rare Case 120 Manisha Sharma RADO1 Role of Cervical Elastography in Assessing Induction of Labour 120 Prajwith J. Rai, Sherine Mariam and Prasad Hegde

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Abstract ID Title and Authors Page No RADO2 Spectrum and Incidence of Neck Masses on Cross Sectional (CT) Imaging 121 Ashish M. Vidhate, Ankur Pramanick, Pratik Patil, Arnab Marick and Madan Manmohan RADO3 Encephalocele: A Pictorial Assay 121 Harshvardhan Singh Rathore, Shyam Sobti, Nilesh Ingale and Harsha Jeswani RADO4 Percutaneous Radiofrequency Ablation of Osteiod Osteoma: Principle, Cases and Technique 122 Ammar S. Modi, Kishor Rajpal and Ravi Varma RADO5 Variations in Short Saphenous Vein On Ultrasound and Doppler 122 Gurrala A. Reddy and Siddesh M.B. RADO6 Role of Magnetic Resonance Imaging in the Evaluation of Articular Cartilage in Painful Knee Joint 122 Ayesha Hadi RADO7 MRI Brain in Perinatal Hypoxia - A Case Series 123 Avinash Bansal and Sanjay Khaladkar RADO8 Endovascular Management of Intracranial Aneurysms – Various Methods, Efficacy and Complications 123 Prateek Gandhi, Aarti Anand, Amit Disawal and Jawahar Rathod CT Angiography Versus Digital Subtraction Angiography for Evaluation of Intracranial Vascular RADO9 123 Pathologies Kanchan Dhanokar, Aarti Anand and Amit Disawal RADO10 To Assess the Role of MRI in Evaluation of Orbital Pathologies 124 Tarun Dharme and Amit Disawal RADO11 Diffusion Tensor Imaging and Tractography in Brain Tumours 124 Kalyani Wani and Parate RADO12 Utility of MRI in Neonatal Hypoglycemic Brain Injury (NHBI) 124 Avinash Bansal and Sanjay M. Khaladkar Assessment of Thyroid Lesions with High Resolution Ultrasonography and Colour Doppler: A Case RADO13 121 Series Ronak N. Savani, Sanjay M. Khaladkar and S.G. Gandage RADO14 To Study and Analyze the MRI Brain Findings in Perinatal Hypoxia 125 Nikita Nemade RADO15 Endometrial Evaluation on Infertility 125 Arnab Mandal and Dahlia Chowdhury RADO16 Dural Artrio-Venous Fistula - A Rare Entity 126 Priti Komatwar, Akshit Gangwal, Pooja Kakani, Ashu Dixit and Shashank Kolge RADO17 Case Report: Artery of Percheron Infarction 126 Akshit Gangwal, Pooja Kakani, Priti Komatwar and Ashu Dixit RADO18 A Rare Case Report of Pyloric Atresia Epidermolysis Bullosa Aplasia Cutis Syndrome 126 Mallikarjuna C.M. RADO19 Salvaging of Hemodialysis AV Fistula - A Single-Center Experience 126 Vikram Shende RADO20 Superior Rectal Artery Embolization - Treatment of Hemorrhoid 127 Vikram Shende RADO21 MDCT Evaluation of Abdomen: A Cross-Sectional Study of Blunt Trauma Cases 127 Chetan Shetty, Jeevika M.U. and Joish Upendrakumar RADO22 MRI Imaging Features of Hypertrophic Olivary Degeneration 127 Preeti Chaure

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Abstract ID Title and Authors Page No Correlation Between Clinical Features and Magnetic Resonance Imaging Findings in Lumbar RADO23 127 Spondylosis Cases Guruprasad C. RADO24 An Overview of MRI Artifacts 128 Chetana S. Kalburgi RADO25 Prenatal Diagnosis of Fetal Cross Fused Ectopic Kidney: A Case Report 128 Subodh D. RADP1 Magnetic Resonance Imaging of the Developmental Malformations of Paediatric Brain 128 Siddhant Bhardwaj, Madan Manmohan, Kunal Arora, Nilesh Ingale, Pratik Patil and O.J. Tavri RADP2 Imaging Spectrum of Spinal Dysraphism on Magnetic Resonance 129 Abhishek Das and Madan Manmohan RADP3 Tracheal Atresia with Laryngeal Agenesis: A Rare but Fatal Pathology 129 Roopali Bansal RADP4 Atypical Presentation of Uremic Encephalopathy 129 Divya B. Desai, Sanjay Pasoria and Arnab Marik RADP5 The Double Panda Sign of Wilson's Disease, as Seen on MRI Brain 130 Roopali Bansal, Thahir V.U. and Madan Manmohan RADP6 Skull Base Osteomyelitis: A Diagnostic Dilemma 130 Lekha Sachdev and Nilesh Ingale RADP7 Hypermelanosis of ITO – From A Radiologist’s Point of View 130 Ankur Pramanick, Omprakash Tavri, Smita Borale, Pratik Patil and Nilesh Ingale RADP8 Meningeal Hemangiopericytoma and Its Intracranial Complications 131 Zeny A. Vyas, Pratik Patil and Arnab Marik RADP9 Magnetic Resonance Imaging of Clival Chordoma and Its Differential Diagnosis 131 Harsha Jeswani, Madan Manmohan, Nilesh Ingale, Thahir V.U. and Kunal Arora RADP10 Radiation Protection: Let’s Talk About Surroundings 131 Ammar S. Modi, Ravi Varma, Ankita Jadhao and Sachin Khatakalle RADP11 Non-Ketotic Hyperglycemic Hemichorea Hemibalismus Syndrome 132 Harshvardhan Singh Rathore, Arnab Marik, Madan Manmohan and Kunal Arora RADP12 Review of Neuroimaging of Arnold-Chiari Malformation 132 Vikash Rustagi, Sanika Patil and Aakash Ramteke RADP13 Cerebrotendinous Xanthomatosis – The Spectrum of Imaging Findings 132 Jagadish K. Pawara RADP14 Eyes Can See What Brain Knows- The Peppering Pons 133 Suresh Sahani RADP15 Not Just Trauma – Fat Embolism Syndrome Imaging in Non-Traumatic Patients 133 Pankaj Kumar Nanda RADP16 Pictorial Essay: B-Scan Ultrasonography in Orbital Tumors 133 Shriram B. Mate RADP17 Two Dots in The Brainstem-What Are They? 134 Bhagyashree Bhoir RADP18 Oliers Disease 134 Poonam Mali RADP19 Dyke–Davidoff–Masson Syndrome with Crossed Cerebellar Atrophy 134 Ronak N. Savani and Sanjay M. Khaladkar

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Abstract ID Title and Authors Page No RADP20 Misleading Lung Masses 135 Swati Raut, S. Sangani and B. Suprabhat Mineralizing Angiopathy Causing Basal Ganglia Stroke in Infant Following Minor Trauma – A Case RADP21 135 Report Rubab Kaur Sekhon and Rajesh Kuber RADP22 Role of Imaging in Mayer–Rokitansky–Kuster–Hauser Syndrome 135 Bethireddy Nagireddy and Sanjay M. Khaladkar RADP23 Autosomal Recessive Infantile Osteopetrosis 135 Sharana Prabhu and Tushar Kalekar RADP24 Imaging in Neurofibromatosis-Type 2 136 Chetan Shetty and Jeevika M.U. RADP25 Case Report: Optic Pathway Glioma 136 Pooja S. Kakani and Akshit Gangwal RADP26 Unique Associations of Pneumosinus Dilatans 136 Meenu Zacheriah RADP27 A Rare Case of Rudimentary Horn Pregnancy 136 Moinuddin A. Mulla Hemiconvulsion Hemiplegia Epilepsy (HHE) Syndrome: MRI of Brain with Diffusion Weighted RADP28 137 Sequences: A Case Report Meghana S. RADP29 Rare Case Report: Telangiectatic Osteosarcoma 137 Avi V. Jain RADP30 Imaging in A Case of Dysgerminoma of Bilateral Ovaries 137 Guruprasad C. RADP31 OHVIRA Syndrome- An Unusual Case Presentation 138 Jeevika M.U. and Pranav Srinath Reddy E. RADP32 Imaging Features of Aneurysmal Bone Cyst in A Rare Site 138 Abdul K. Shareef Computed Tomographic Appearances of Pancreatic Pseudocysts: A Case Series On Unusual RADP33 138 Presentations of Pancreatic Pseudo-cysts Sahana C.M. RADP34 Scimitar Syndrome and Its Mimics 139 Dain Davis SURO1 Negative Pressure and Oxygen Therapy Dressing in Chronic Non - Healing Ulcer 139 Rontgen Rajakumar, Abhishek Mahadik and Nida Khan SURO2 Traumatic Dislocation of Testis - A Diagnostic Enigma 139 Pragati Singhal SURO3 Case Report-Idiopathic Hypertrophic Pyloric Stenosis in an Adult Female 140 Nida Khan SURO4 Ileal Tuberculosis Presenting as a Case of Massive Rectal Bleeding 140 Attman P. Velani SURO5 Rhomboid Flap for Pilonidal Sinus – A Case Series 140 Shantanu Chandrashekhar Incidence and Risk Factors for Post-Injection Phlebitis in Patients Undergoing Peripheral IV SURO6 141 Catheterization in a Tertiary Care Hospital Pranjal Rai and Vinaykumar Thati

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Abstract ID Title and Authors Page No SURO7 Impact of Subcutaneous Negative Suction Drain to Prevent SSI 141 Rontgen Rajakumar, Meena Kumar, Abhishek, Kailash Jawade and Jefeena Rontgen SURO8 Commonest Cause of Lymphadenopathy in Lateral Neck Swelling 141 Kavit Shrishrimal and Ali R. Shojai SURO9 Malignant Phyllodes: A Case Report 142 Divya Daga SURO10 Laparoscopic in Acute Calculus Cholecystitis 142 Shashwat Kumar Singh and Ajay Gujar Unusual Occurrence of Two Sister Tumours in the Same Patient Gastrointestinal Stromal Tumour and SURO11 142 Gastrointestinal Autonomic Nerve Tumour Yashraj Shah and Abhijit Bagul SURO12 Chronic Pancreatitis and Its Management - A Study of 50 Cases 142 Pragati Singhal and Dipesh Goel SURO13 Outcome of Postnatal Management of Antenatally Diagnosed Hydronephrosis 143 Dipesh Goel, S.S. Borwankar, Hemant Lahoti and Bharati Kulkarni Role of Vaccum Assisted Healing in Diabetic/Chronic Ulcers - An Ongoing Study at Railway Hospital, SURO14 143 Pettah, Trivandrum Sobha Jasmine S. SURO15 Case Report of Orchidopexy in 22-Year-Old Adult 143 Budigi Manish Kumar SURO16 Pre-Operative Scoring System for Difficult Laparoscopic Cholecystectomy 143 Aniket Ray and Ajay Gujar SURO17 An Unusual Case Presentation of Lower Oesophagus Malignancy 144 Sonal B. Chavan and N.L. Vyas SURO18 Analysis of Scoring System to Identify High Risk Patients in Blunt Chest Trauma and Their Outcome 144 Annrish T. Baby and Ashok N. Oommen SURO19 Post-Operative Pulmonary Complications in Open Upper Abdominal Surgeries 144 Akshay Rao and Ravi Kharat To Study the Effect of Liver Flushing with Olive Oil and Lemon Juice on the Lithogenicity in Gall SURO20 145 Bladder Stone Formation Draun Upadhyay and N.L. Vyas SURO21 Improving Surgical Care in Rural Areas 145 Akash Satpathy SURO22 Limberg Flap for Multiple Epidermoid Cysts 145 Rohith Pillai, Nida Khan and Karan Cheda SURO23 Laparoscopic Repair of Morgagni’s (Anteromedial) Diaphragmatic Hernia 146 Shrikrishna Parab and Rajinder Singh SURO24 A Novel Technique of Reduction Clitoroplasty 146 Shravya Shetty Study of Diagnostic Accuracy of Modified Alvarado Score with Post-Operative Findings in Acute SURO25 146 Appendicitis in Rural Population Neha Kumari SURO26 Surgical Treatment of Scrotal Calcinosis: Report of Two Cases and Review of Literature 147 Kailash Jawade, Shweta Verma and Shantanu Chandrashekhar SURP1 Fossilised Tombs Under the Skin of Those Who are Extinct: Dracunculiasis – A Case Report 147 Pankil K. Mota, Abhijit Bagul, Nandkishor and Khilchand

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Abstract ID Title and Authors Page No SURP2 Open 3D Mesh Repair in a Case of Sliding Inguinal Hernia Involving the Urinary Bladder 147 Yashraj Shah and Abhijit Bagul SURP3 A Case Report on Steatocystoma Multiplex of Scrotum 147 Ashwanth Krishna Kumar SURP4 Scrotal Calcinosis in A 29-Year-Old Male - Case Report 148 Nida Khan SURP5 Diverticuli of Diverticulum Causing Acute Small Bowel Obstruction 148 Budigi Manish Kumar SURP6 Lymphangioma of Mesentery Presenting as Case of Lump in Abdomen 148 Attman P. Velani SURP7 Retractile Testis with Testicular Torsion 148 Shantanu Chandrashekhar SURP8 Recurrent Achalasia Cardia 148 Bharat Sharma, Samriddhi Sharma, Prasad P.C., Gupta S. and Panchal A. SURP9 Ectopic Thyrothymic Parathyroid Adenoma 149 Sharma S., Sharma B., Singh V.K. and Panchal A. SURP10 A Rare Case of a Large Omental Cyst 149 Asmita Patil SURP11 A Case Report of Non -Penetrating Right Ventricular Rupture Following Railway Accident 149 Vidhi Minakin Mehta S. Prabhakar and Pallavi Shambhu SURP12 A Rare Case of Pleuro-Pulmonary Blastoma in A 2-Year-Old Male Child 150 Aniket Patil SURP13 Laser-Based Guidance System for Training in Suturing in Minimally Invasive Surgery 150 Deepika Hamav SURP14 A Rare Case of Non Hodgkin's Lymphoma in Parotid Swelling 150 Ajinkya S. Kale and Ajay Naik SURP15 Unusual Presentation of Multiple Fibroadenoma in Bilateral Breasts 151 Neha Kumari SURP16 Angiokeratoma of Fordyce- Case Report 151 Nida Khan and Dipesh Goel SURP17 Meckel’s Diverticulum 151 Anvitha Manoj SURP18 A Right Superior Lumbar Hernia: A Rare Case Report 152 Dineshbhai M. Chaudhary and Sanjeev Agrawal SURP19 Plantar Dermal Skin Grafting in Management of Plantar Ulcers in Patients with Hasen's Disease 152 Shashwat Kumar Singh SURP20 Ectopic Splenic Pregnancy: A Case Report 152 Rahul Borude SURP21 Right Lobectomy for Giant Liver Hemangioma 152 Shweta R. Verma, Meena Kumar, Kailash Jawade, Abhishek M. and Shweta SURP22 A Rare Case Report – Extra-Cranial Vagal Nerve Schwannoma 153 Anand Doshi, Ravi Kharat and Akshay Rao SURP23 Review of Literature - Rare Case of Nauvari Saree Causing Skin Cancer 153 Geeta Ghag, Saurabh Sanjanwala, Vinay Thati, Rishabh Jain, Ishan Merchant and Pranjal Rai ISSN (Print) 2347-3665 ISSN (Online) 2347-8020

D Y PATIL DEEMED TO BE UNIVERSITY Navi Mumbai 400 706, Maharashtra, INDIA www.dypjhs.com

D Y Patil Journal of Health Sciences ISSN (Print) 2347-3665 Volume 7, Issue 2, Apr-Jun 2019 ISSN (Online) 2347-8020

ANEO1 anesthetic agents is done. To overcome this, intrathecal adjuvants are given in spinal anesthesia. IV opioids in post operative period Anaesthetic Management in a Case of have dose related side effects. IV paracetamol has high safety Restrictive Lung Disease profile with efficient postoperative pain relief. Shruti Hazari*, R.P. Gehdoo, Varsha Vyas and Priti Aim: To evaluate quality and duration of postoperative anal- gesia with intravenous paracetamol administered intraoperatively Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- after spinal anesthesia. bai, Maharashtra, India. *Corresponding author Email: [email protected] Material and methods: After hospital ethical committee clear- ance and written informed consent from all participants included Abstract: Anaesthetic management in a case of restrictive in study, 98 ASA grade I-II patients aged 18-60 years undergoing lung disease especially interstitial lung disease pose many chal- elective inguinal under spinal anesthesia were ran- lenges to anaesthesiologists as these patients have decreased lung domly allocated into two groups – Group P and C in which pa- compliance and volumes with preservation of expiratory flow tients received 1gm (100ml) iv paracetamol infusion and 100 ml rates. Patients present with rapid and shallow breathing pattern NS respectively over 15 mins after spinal block respectively. Spi- with alteration in respiratory gas exchange and V/Q mismatch nal anesthesia was administered by standard technique with hy- which causes increase in perioperative complications. A86 year old male weighing 106kgs k/c/o diabetes and hypertension con- perbaric 0.5% (3ml) using 25G spinal needle in lat- trolled on medications was posted for bilateral hernioplasty. He eral position under all aseptic precautions. Demographic data, was operated for CABG 10 years back and lumbar spine surgery intraoperative and postoperative hemodynamics, oxygen satura- with instrumentation. Patient had shallow and rapid breathing. tion, postoperative analgesia and side effects were compared be- Spo2 on room air 92%. PFT revealed severe restrictive pattern; tween group P & group C. chest xray showed hazy opacities over both lung fields CT scan Results: There was significant prolongation of duration in suggestive of interstitial pneumonia. 2D echo-LVEF 50-55% and sensory block in group P(197.35±9.25min) as compared to group hypokinetic distal Interventricular septum. Due to huge ingui- C(152.76± 8.60min). The time for first request for analgesic was noscrotal swelling, inguinal block was not feasible, neuroaxial significantly prolonged in group P(163.98±16.86min) as com- block contraindicated due to spine surgery, hence general anaes- pared to group C (134.59±16.45min) and 24 hour requirement of thesia was the technique of choice. Patient was optimised by neb- analgesics were significantly lowered in group P(p=0.000). ulisation with bronchodilators, antiplatelets stopped 5 days before surgery. Premedication with midazolam 0.03mg/kg and fentanyl Conclusion: We conclude that IV Paracetamol is effective in 2mcg/kg iv. prolonging the duration of sensory and motor blockade after Bupi- vacaine spinal block. Paracetamol is effective in providing post- Propofol 2mg/kg was used for induction. Intubation was done operative analgesia in first 24 hours. with 8mm ID endotracheal tube using 0.75mg/kg atracurium and maintained on oxygen, air and isofluorane-0.2-2%. Volume con- trol mode at tv-480ml, PEEP-5, RR-16 increased the peak pres- ANEO3 sures upto 38cmh20. patient was converted to pressure control Optimum Time for IV Cannulation in with pressure settings between 20-25cmh20 which delivered 300ml tidal volume approximately. Saturation was maintained to Different Paediatric Age Groups During 100% and end tidal co2 remained between 32-35 intraoperatively. Incremental Sevoflurane Induction Patient was electively ventilated to reduce work of breathing in view of postoperative pain care and better breathing in a k/c/o Sarah Sheikh*, Anila Malde, Shalaka Nellore and interstitial lung disease with prolonged exposure to anaesthesia, as Devendra Thakare gradual weaning process is beneficial for such patients. Patient Lokmanya Tilak Municipal Medical College & Government Hos- was successively extubated 24hours postoperatively. For anaes- pital, Sion, Mumbai, Maharashtra, India. thetic management in a case of interstitial lung disease good peri- *Corresponding author Email: [email protected] operative optimisation and proper anaesthesia care is mandatory. Abstract: Background and Aim: A prospective observational study was done to find optimal time for intravenous cannulation ANEO2 in children of various age groups following incremental method of The Effects of Intravenous Paracetamol on the sevoflurane induction. Quality of Postoperative Analgesia in Patients Methods: Unpremedicated, ASA I/II children (n=78) receiving Undergoing Inguinal Hernia Repair Under incremental method of sevoflurane were divided into group 1: 3 months to ≤ 1 year {n=17), group 2: >1 year to ≤3 years (n=20), Subarachnoid Block: A Prospective, group 3: >3 years to ≤5 year (n=22) and group 4: >5 years to ≤8 Randomized, Controlled Trial years (n=19). Sevoflurane (50% N2O:O2 @6L/min) concentra- tion was increased in increments of 1% every 3 breaths till either Jyoti Gaikwad*, Khemraj Meena and Basant Dindor 8% is reached or till loss of eyelash reflex (LOER) whichever Rabindranath Tagore Medical College, Udaipur, Rajasthan, India. occurred earlier. After this flow was reduced to 3L/min and *Corresponding author Email: [email protected] sevoflurane reduced to 4%. Intravenous cannulation was attempt- ed 30 seconds after LOER. If there was no movement or slight Abstract: Introduction: with Bupivacaine movement intravenous cannulation was possible. In case of failure is commonly used for lower abdominal and lower limb surgeries to cannulate, subsequent attempts were done at interval of 15 of duration lasting for 2-2.5 hours. If surgery is prolonged conver- seconds. Time for LOER, successful IV cannulation, dial setting sion to or supplementation with intravenous at the time of LOER, Fi, Fe sevoflurane and MAC at the time of

Conference proceedings : MedInspire 2019 62

D Y Patil Journal of Health Sciences ISSN (Print) 2347-3665 Volume 7, Issue 2, Apr-Jun 2019 ISSN (Online) 2347-8020

IV cannulation were analysed using ANOVA. Pearson’s correla- ANEO5 tion and Kaplan Meier curves were used to find relation between various parameters and age groups. Ultrasound Guided Transverses Abdominis Plane (TAP) Block and Conventional Caudal Results: Younger the child, lesser was the time for LOER (r - 0.615; p=0.000), dial setting at LOER (r-0.596;p=0.000) and time Epidural Block for Post-Operative Analgesia for optimum IV cannulation (r-0.492;p=0.000). Time required in Pediatric Unilateral Ilioinguinal Surgeries (seconds) in 95% of children for successful IV cannulation was significantly different (Group 1 – 34.133, Group 2 – 48.788, Jyoti N. Tat* and Kavita U. Adate Group 3 – 51.669, Group 4 – 83.334 seconds; p= 0.000). There Department of Anaesthesia, Smt. Kashibai Navale Medical Col- was no significant correlation between age and Fi, Fe, and MAC. lege and General Hospital, Pune, Maharashtra, India. Conclusion: Optimum time for IV cannulation following *Corresponding author Email: [email protected] LOER is 34-84 seconds in unpremedicated children of 3 months Abstract: Introduction: Conventional Caudal Block (CCB) is to 8 years during incremental sevoflurane induction plus N2O. being used frequently for postoperative analgesia in pediatric Younger the child lesser is the time. patients. Transverses Abdominis Plane (TAP) block is now rapid- ly evolving peripheral nerve block technique with lower risk pro- ANEO4 file. Evaluation of Dexmedetomidine as a Aim & Objective: This study aims to evaluate analgesic effica- Pretreatment Drug for Attenuation of cy and safety of USG guided TAP block and compare it with Haemodynamic Response of Laryngoscopy caudal block for duration and quality of postoperative analgesia. and Intubation Material and Methods: 60 patients of age group 01-05 years belonging to ASA Ι and ΙΙ posted for unilateral ileoinguinal sur- Parvati S.* and Jayashree Sen gery were randomized into two groups C and T of 30 each to re- Department of Anaesthesia, Jawahar Lal Nehru Medical College, ceive either CCB with 1ml/kg 0.25% bupivacaine or USG guided Sawangi Meghe, Wardha, Maharashtra, India. TAP block with 0.5ml/kg 0.25% bupivacaine after induction of *Corresponding author Email: [email protected] anesthesia. Parameters observed for 24 hours post-operative in- cluded hemodynamic changes, postoperative duration of analgesia Abstract: Background: Choice of a drug as pretreatment to by CHEOPS (Children’s Hospital Eastern Ontario Pain Scale) attenuate the Hemodynamic changes such as hypertension, tachy- pain score, total analgesic requirement, quality of analgesia with cardia and arrhythmias associated with direct laryngoscopy and Parent Patient Satisfaction score, residual motor block with Modi- endotracheal intubation due to reflex sympathetic discharge, is a fied Bromage Scale and adverse effects. concern. Amongst various agents used, dexmedetomidine, a cen- Background: TAPB has emerged as safe and effective tech- trally acting α2 agonist having sedative, analgesic, hypnotic, opi- nique for postoperative analgesia in pediatric lower abdominal oid sparing effects as well as antisialagogue and sympatholytic surgeries. Complications with USG guided TAPB are rare and action makes it the most suitable agent. pose overall lower risk than CCB technique which is considered Aims: Our aims for this study was to evaluate efficacy of in- as gold standard for the same. jection Dexmedetomidine 1µg/kg intravenously as pretreatment Result: TAPB is initially equivalent to CCB in providing post- on attenuation of hemodynamic response to laryngoscopy and operative pain control but would also show improved immediate intubation. post-operative pain relief and analgesic efficacy beyond the antic- Materials and Methods: Sixty American Society of Anesthesi- ipated caudal duration ologists physical status I or II, either gender patients of age 20 to Conclusion: USG guided TAP block is safe and effective meth- 60 years scheduled for elective surgeries were randomly divided od with good Parent Patient satisfaction for post operative analge- into two groups with 30 patients in each. Group A (n = 30) re- sia in pediatric unilateral ilioinguinal surgeries. So it is good alter- ceived injection dexmedetomidine 1 μg/kg body weight dissolved native to CCB. in 10 ml normal saline, which was administered over 10 min and Group B (n = 30) received 10 ml of normal saline administered over 10 min. In both the groups premedication Inj glycopyrrolate ANEO6 0.004mg/kg iv, inj midazolam 0.04mg/kg iv, inj butorphanol IV Nalbuphine Vs IV Fentanyl in Attenuating 40ug/ kg were given, induction was done with Inj propofol 2mg/ Pressor Response: A Comparison kg and Inj vecuronium 0.08mg/kg. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial Chanchal Bhandari*, Rashmi Bengali and Tushar Patil pressure (MAP) were recorded during laryngoscopy and at regular intervals of 1,3,5,10 min after the intubation. Department of Anaesthesia, Govt Medical College, Aurangabad, Maharashtra, India. Result: Statistically significant (p=0.0001) difference in HR, *Corresponding author Email: [email protected] SBP, DBP, and MAP were observed in Group A during and after intubation when compared to Group B. The vitals were more sta- Abstract: Introduction: Laryngoscopy and tracheal intuba- ble in group A. tion are noxious stimuli that evoke a transient but exaggerated hemodynamic response and increased intracranial pressure. This Conclusions: Injection Dexmedetomidine 1µg/kg provided response may manifest as tachycardia, hypertension, and effective and complete attenuation of haemodynamic response to dysrhythmias with deleterious respiratory, neurological and cardi- laryngoscopy and endotracheal intubation as a pretreatment. ovascular effects. It is lethal to patients with preexisting coronary

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artery disease, recent myocardial infection, hypertension, geriatric of Indian Ayurvedic Marma, Chinese & Korean methods, we can population, pre-eclampsia and cerebrovascular pathology. Fenta- bring a revolution in the management of pain relief to patients nyl is opioid receptor agonist that blocks the stress response to without any significant side effects. surgical stimuli and it is cardiovascular stable. Nalbuphine is a semi-synthetic opioid analgesic that does not increase systemic ANEO8 blood pressure, pulmonary artery blood pressure, heart rate, or arterial filling pressure. These drugs are compared in attenuating Is Pre-Operative DVT Screening Mandatory pressor response to laryngoscopy and intubation. in TKR/THR? Material and Methods: In a prospective, randomized, com- Vaijanti S. Bhavsar* and Akshay Challani parative study, 60 patients ASA I and II, aged 20-55 years, weight 40-70 kgs undergoing elective surgeries requiring general anaes- Sterling Wockhardt Hospital, Vashi, Navi Mumbai, Maharashtra, thesia were included. India. *Corresponding author Email: [email protected] Group N: 30 patients were given IV Nalbuphine 0.2 mg/kg diluted in 10ml distilled water. Abstract: 66 /F /5Ft /76Kg, NO H/O illness, A/w C/o Pain and Swelling in both knees (> Lt side), Difficulty in walking since 4 to Group F: 30 patients were given IV Fentanyl 2 µg/kg diluted 6 months. in 10ml distilled water. O/E, Afebrile, HR 76, BP 140/80, RS Clear, RR 18, SpO2 98% Results: Hemodynamic variations after intubation was more RA, Rest NAD. in group F as compared to group N. L/E Both Knees and Lt Leg swelling +nt. Conclusions: From present study it is concluded that both drugs show almost equal rise in heart rate at intubation, but in- No clinical e/o-DVT crease in both systolic blood pressure and diastolic blood pressure Patient was posted for B/L TKR i/v/o- clinical and radiological was more with Fentanyl than Nalbuphine. Hence Nalbuphine can Picture of severe osteoarthritis be preferred to control the pressor response to laryngoscopy and Pre Operative Investigations intubation with no significant adverse effects. CBC – Hb 7.9 ( Iron deficiency) TC 5900 Platelet 142000 RFT, ANEO7 LFT WNL Alternative Methods of Pain Relief in Patients ECG NSR, 2D Echo Normal, EF 60% RA /RV –Normal, Chest x- Suffering from Chronic Pain - A Clinical ray NAD. Study Venous Doppler of Lt Lower Limb s/o Near complete Deep Vein Thrombosis in Left Common Femoral Vein, Superficial Femoral Vasantha Kumar K.R.* and Shruti Rajagopal Vein, Popliteal Vein, Proximal part of Posterior and Anterior tibial Vein. Minimal intermittent peripheral flow in above vessels. Department of Anaesthesiology, Adichunchanagir Institute of Medical Sciences, Karnataka, India. Rt Lower Limb normal. *Corresponding author Email: [email protected] All work up for DVT aetiology including PET scan did not reveal Abstract: Introduction: Pain is a physical, mental & social any abnormality phenomenon. Pain is a friend & also an enemy. Pain is a sign, a Surgery postponed i/v/o DVT symptom & a disease by itself in later stages. There are wide vari- ety of approaches to treatment of pain & but a very few single DVT was treated appropriately with LMWH approach that have clearly been demonstrated as superior to the Conclusion: In pre operative assessment for TKR/THR there management of a wide variety of painful conditions. Treatment of are no clear Guidelines or recommendation for Lower limb ve- pain is essentially an important process & a wide variety of tech- nous Doppler to rule out significant Deep vein thrombosis. niques are available as analgesics, neuromodulators, intervention- al techniques, Ayurvedic Marma therapy, Chinese Accuoressure Routine Screening: of lower limb to rule out proximal /distal & accuouncture, South Korean Su Jok, Ozone therapy, Medita- DEEP VEIN THROMBOSIS may prevent intra /post operative tion, Silver Ion applications & other holistic modalities. life threatening adverse events. Objective: The clinical trial for the assessement of effective- We intent to do routine pre op screening for all TKR/THR pa- ness of Alternative methods of pain relief on patients suffering tients, irrespective of clinical suspicion. from chronic pain

Material & Method: A total of 30 patients suffering from ANEO9 Cancer, Migrain & back pain were given the Alternative methods Subclavian Vein Catheterisation: of pain relief. The duration & quality of analgesia was assessed Comparative Evaluation of Supraclavicular using VAS Versus Infraclavicular Approach in Oncology Result: The onset of pain relief was between 3 to 5 minutes & the duration of pain relief was between 6 to 14 hours. In one of Patients the cases (Ca tongue – had 336 hours of analgesia). The quality of Amit Bodkhe* and Sanjay Upadhye analgesia was between 6 to 9 in most of the patients Department of Anaesthesia, Asian Cancer Institute, Sion, Mum- Conclusion: We conclude that by adopting Ancient knowledge bai, Maharashtra, India.

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*Corresponding author Email: [email protected] in group C, when compared to A and B( GroupA-7.73+1.81 hr, Group B-11.2+2.65hr, Group C -13.95 +3.73 hr). There was less- Abstract: Introduction: The Subclavian Vein (SCV) is the er pain (FLACC score) in Group C. More sedation obtained in preferred site for central venous catheter (CVC) insertion due to Group C, when compared with A and B. Also, addition of several reasons. Infraclavicular (IC) and supraclavicular (SC) Clonidine with Ropivacaine for caudal block increases the time approach are the two techniques of SCV catheterisation. SC ap- interval for the requirement of rescue analgesia. proach is not commonly used despite having several advantages. Conclusion: Clonidine 2mcg/kg BW with Ropivacaine 0.25% This study compared venipuncture, access time, success rate and for caudal block, provide much longer duration of post operative complications of SCV catheterisation via SC versus IC approach. analgesia and also reduces the analgesic requirement. Materials & Methods: 120 patients were randomly divided into two groups of 60 each. SCV catheterisation was performed ANEO11 with SC approach in SC group and IC approach in IC group. Ven- ipuncture attempts, access time, success rate and complications Giant Rhinophyma: Challenges to Facemask were recorded. Fit and Bag Ventilation Results: The mean access time in group SC was 4.51 ± 0.58 Shweta N. Satia*, Dhanshree Dongre and min and 5.83 ± 1.04 min in group IC, which was statistically sig- Girish Soudhantikar nificant (P = 0.001). Overall success rate using SC approach was better than IC approach, which was statistically non-significant (P Department of Anaesthesia, Smt Kashibai Navhale Medical Col- = 0.5). lege Pune, Maharashtra, India. *Corresponding author Email: [email protected] First attempt success rate was higher in SC group. All successful attempts were associated with smooth guidewire insertion. In SC Abstract: Rhinophyma is painless benign swelling due to hy- group, two failure were due to arterial puncture and another two pertrophy of the sebaceous gland of the face and nose in particu- due to failure of locating vein. In IC group, failure were due to lar. In a neglected case it may present as ‘Proboscis-nose’. Hang- arterial puncture, inability to venipuncture and failure to insert ing in front of nose it can sometimes compromise breathing dur- guidewire. Via SC approach, one case of catheter malposition was ing sleep. It can pose difficulty in placing normal size face-mask. noted while in IC approach there were three cases. Right Brachio- Endotracheal intbation was not very difficult but it was challeng- cephalic vein laceration was the only complication occurred in ing to fit the facemask and do bag ventilation So we placed a naso this study with IC approach. -pharyngeal airway under local anesthesia to retain nasal patency and largest size facemask (size-5) in a manner that it’s air filled Conclusion: The access time in SC approach is lesser than cushion was kept deflated and wide mandibular arch was placed that of IC approach. In terms of other parameters, both groups are nasally to encase the swelling inside mask and then cushion was comparable. inflated to make it air tight fit on face. This helped us to get air- tight fitting of the anatomical face mask and through nasopharyn- ANEO10 geal airway allowed ventilation of the lungs during induction of Comparative Evaluation of Different Dosage general anesthesia before intubation. Rest of management and of Clonidine with Ropivacaine 0.25% in orotracheal intubation was achieved uneventful. We suggest use of nasal and oropharyngeal air way use and reverse use of large Caudal Block for Post-Operative Analgesia in facemask to attain bag-mask ventilation during induction of anes- Paediatric Patients thesia in cases which result from disfigured or dismantled facial anatomy. Shilpa Tiwari*, Sudhakar Dwivedi, Subhash Agrawal and A.K. Rathiya ANEO12 Department of Anaesthesia, Shyam Shah Medical College, Rewa, Intractable Headache Due to Spontaneous Madhya Pradesh, India. *Corresponding author Email: [email protected] Dural Leak Treated with Fluoroscopic Guided Abstract: Introduction: Caudal block in pediatric anesthesia, Epidural Blood Patch Two Case Reports for providing intra and post operative analgesia, more so with use Shantanu Mallick* and Pawan Ojha of adjuvant, to prolong the action of the local anesthetic agent used. Clonidine is an alpha 2-adrenergic agonist being used with Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, 0.25% Ropivacaine. India. *Corresponding author Email: [email protected] Aims and objectives: The study conducted to assess and com- pare the efficacy of different doses of Clonidine with Ropivacaine Abstract: Spontaneous CSF leakage is recognized as a cause 0.25% for post operative analgesia. of headache due to decreased intracranial pressure. Spontaneous intractable headache was developed in a 43 year-old man and in a Methodology: 90 children of ASA I and II (1-6 yr) were ran- 26 year-old female which was diagnosed on CT Myelography domly divided into 3 groups. After intubation, Group A received imaging with a generous CSF leak was identified at C6 in male 1ml/kg 0.25% Ropivacaine alone, Group B received 1ml/kg patient and at right side L4-5 level and left side D12-L1 level in 0.25% Ropivacaine with Clonidine 1mcg/kg and Group C re- female patient. Successful treatment was performed by fluorosco- ceived 1ml/kg 0.25% Ropivacaine with Clonidine 2mcg/kg. Post py-guided epidural blood patch at the leakage site. Image-guided operative pain was assessed for 24 hours using FLACC scale. precise placement of the blood patch is safe and recommended Results: Duration of post operative analgesia was maximum which gives dramatic relief of symptoms.

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ANEO13 Anaesthesia management: Patient was posted for elective cae- sarean section, her mode of anaesthesia was decided and patient Management of Ventricular Storm with was explained for fiber optic intubation preparation a day prior to Thoracic Epidural Anaesthesia surgery. Her nose was anaesthesised with oxymetazoline nasal drops and nebulised with 2% lignocaine:adrenaline (1:200000) for Shailendra Shiravadkar* and Shakuntala Basantwani 5mins after which she was made to gargle with Lox 4%, nasal Department of Anaesthesia, LTMMC, Sion, Mumbai, Maharash- patties soaked in 2% ligno:adr were placed in each nasal foramens tra, India. for 2mins and 10% Lox spray in metered dose was given. An *Corresponding author Email: [email protected] awake nasal fibreoptic intubation with an ETT tube of 6.5mm ID was performed. Patient was then given GA after the airway was Abstract: Introduction: Incidence of recurrent ventricular successfully secured and confirmed. Patient did not have any arrhythmias is increasing these days. Ventricular electrical storm intraoperative complications and the surgery ended uneventful. can be of three types: Monomorphic ventricular tachycardia, Poly- morphic ventricular tachycardia and ventricular fibrillation. The Results: At the time of extubation patient was reversed with mechanism of ventricular storm is complex and its management is inj Myopyrrolate. She was then shifted on T piece and in the ICU quite a challenge for the clinicians due to its life threatening con- put on CPAP PSY and extubated 1 hr post surgery with saturation sequences. We report a case of ventricular storm in whom all the 100% spontaneous breathing. conventional methods for management of arrhythmias were inef- Conclusion: A thorough airway assessment and adequate fective and the case is managed effectively with thoracic epidural preparation is a critical component for airway management in anesthesia. such cases. After considering all the modes of airway manage- Case Details: A 60 year old male patient was admitted with ment, we advise awake fibreoptic intubation as one of the best and recurrent ventricular arrhythmias. He received defibrillator shocks safest options for securing the airway in KFS patients. and other antiarrhythmic drugs but he was not responding to the treatment. We managed to revert the ventricular arrhythmias to ANEP2 the sinus rhythm with thoracic epidural anaesthesia. Bilateral Obstructed Inguinal Hernia Surgery Result: After starting epidural infusion the frequency of VT in a Severe COPD Patient - A Challenge to has significantly reduced in our patient with stable vital parame- ters. Sympathetic hyperactivity is an important modulator of ven- Anaesthetist tricular storm therefore neuraxial modulation with Thoracic epi- Kushal Hajela*, Sunaina T. Karna, Anuj Jain and dural anaesthesia is an attractive option for arrhythmia manage- ment. Vaishali Waindeskar Conclusion: Ventricular storm is a challenging complication, Department of Anaesthesia, All India Institute of Medical Scienc- which can be managed effectively with timely diagnosis and ef- es, Bhopal, Madhya Pradesh, India. fective management. *Corresponding author Email: [email protected] Abstract: Introduction: Chronic obstructive pulmonary dis- ANEP1 ease (COPD) is an important risk factor for postoperative pulmo- nary complications (eg, pneumonia, re-intubation after initial Awake Nasal Fiber Optic Intubation of a extubation, and prolonged intubation >48 hours), as well as for Patient with Klippel Feil Syndrome for increased length of hospital stay and mortality. With risk identifi- Elective Caesarean Section cation, pre-operative optimisation and appropriate anaesthetic management, the risks of developing postoperative pulmonary Sumesha S. Chakurkar*, Sandhya Gujar, Depankar Datta complications can be reduced even in patients with severe disease. and Karuna Sidam Case characteristic: A 60years old male, chronic smoker with ESIC Hospital, Andheri, Mumbai, Maharashtra, India. past history of defaulted treatment of pulmonary tuberculosis, *Corresponding author Email: [email protected] presented at AIIMS Bhopal OPD, with chief complains of sweeling in b/l inguinal region, breathlessness at rest (NYHA IV), Abstract: Introduction: Klippel Feil syndrome is an autoso- recurrent cough with expectoration, Physical examination re- mal dominant disorder characterised by a congenital defect in the formation or segmentation of the cervical spine which results in vealed grade III clubbing, trachea shifted to left and positive Hoo- limited extension with restricted neck movements. It is also asso- ver’s sign. ABG suggestive of Respiratory Acidosis. Characteris- ciated with presence of short neck, low hairline, kyphoscoliosis, tic signs of COPD with cavitory lesions (honeycomb appearance) anomalies of the kidney, Sprengel deformity which pose a big were found in CXR, PFT suggestive of severe obstruction and challenge for conventional laryngoscopy and regional anaesthesia. ECG shows LBBB with inverted T waves in lead I and aVL was posted for B/L inguinal hernia surgery. Foreseeing the complica- Case report: We present a case of a 25 years old, fifth gravida, tions associated with general and spinal anaesthesia, the patient Mallampatti classification grade 3, mouth opening less than one was planned for low dose spinal anaesthesia with adjuvant fenta- finger, thyromental distance less than 3 finger breadth with lim- nyl. Drugs used were 0.5% bupivacaine heavy with 15mcg fenta- ited extension of the neck with breech presentation for elective nyl. The procedure was uneventful and the patient was kept in caesarean section. ICU under observation for 12 hours. Patient was a known case of KFS with typical signs and symp- Conclusion: Low dose spinal anaesthesia is the technique of toms. Her USG Abdomen reported Unicornuate uterus, Ectopic choice in COPD patients, though this hernia block could be anoth- right kidney and Ectopic right ovary. er choice but it requires special expertise.

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ANEP3 of anaesthesia to a neonate and children is in itself a challenge which is compounded in these cases by the presence of laryngo- Anaesthetic Management in a Case of malacia. Careful assessment is required for a successful outcome. Cerebral Palsy with Type 2 Laryngomalacia

Posted for Epiglottopexy ANEP4 Shahbaz Naseem* and S. Tavri A Rare Case of Impending Eclampsia with Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Posterior Reversible Encephalopathy bai, Maharashtra, India. Syndrome for Emergency LSCS *Corresponding author Email: [email protected] Sasidhar Datla* and Mary Samuel Abstract: Introduction: Cerebral palsy (CP) refers to a group of disorders that affect muscle movement and coordination. CP is Department of Anaesthesia, Dr. D.Y. Patil Medical College and the most common cause of motor disabilities in childhood. Laryn- Hospital, Nerul, Navi Mumbai, Maharashtra, India. gomalacia (LM) is the most common cause of stridor in small *Corresponding author Email: [email protected] children accounting for around 60 % of all congenital anomalies Abstract: Posterior reversible encephalopathy syndrome of the larynx. there are three types: floppy supra arytenoid tissue (PRES) is a cliniconeuroradiological syndrome associated with in type I, short aryepiglottic folds and omega-shaped epiglottis in various clinical conditions, presenting with headache, encephalo- type II, and retroflexed epiglottis in type III. At the time of pathy, seizures, cortical visual disturbances or blindness. Imaging presentation to a health care provider approximately 40% of in- predominantly shows parieto-occipital white matter changes, with fants will have mild laryngomalacia. They present with inspirato- vasogenic oedema being the most accepted pathophysiology. A 22 ry stridor and the occasional feeding-associated symptom, they -year-old primigravida who presented in term pregnancy with have a coordinated suck swallow breath sequence and feed com- seizures and blindness is scheduled for emergency caesarean sec- fortably. Airway obstruction does not lead to hypoxia. tion. She was managed peri-operatively under general anaesthesia They have an average resting oxygen saturation of 98-100%. Oth- and shifted to intensive care unit. Postoperative MRI brain re- er causes of stridor such as subglottic stenosis, laryngotracheal vealed ill-defined hypointense lesions in the bilateral parieto- cleft, foreign bodies or vallecular cyst. occipital and bilateral frontoparietal regions involving white mat- ter in T2 and FLAIR and hypointense lesions on T1W1, few foci Case report: Preoperative assessment- 2year old male child 5kg of restricted diffusion noticed on DW1. Similar foci were noted of weight with cerebral palsy with omega shaped epiglottis with on bilateral lentiform nuclei and adjoining posterior limb of the delayed milestone, no neck holding, on lying supine there was internal capsule. Both eyeballs showed hyperintense lesions in the chest retraction and in drawing of chest but SPO2 on room air was posterior segment on the temporal side on FLAIR: retinal detach- 100%, with no other feeding difficulties, patient posted for epi- ment due to haemorrhage in the retinal space, suggestive of glottopexy. PRES. Clinical improvement with complete resolution of visual Intraoperatively: General anaesthesia with awake intubation disturbances was observed with supportive treatment. The im- was planned because of suspicion of difficult airway, short acting portance of prompt suspicion and management in preventing short muscle relaxant could not be used like succinylcholine because of and long-term neurological deficits in a reversible condition like cerebral palsy, patient taken under anaesthesia with oxygen and PRES is highlighted. sevoflurane 0.2-4%, glycopyrrolate and propofol given in graded doses so that patient doesn’t go in apnoea, patient on spontaneous ANEP5 respiration laryngoscopy was done and vocal cord were not visi- ble because of omega shaped epiglottis, intubation was done with Anaesthetic Management in Case of Wilson’s uncuffed endotracheal tube of 4.5mm and correct placement of Disease Posted for Split Skin Grafting endotracheal tube was confirmed with chest expansion and ETCO2 graph, as emergency situation venturi was kept ready in Omkar Kale*, Dhanashree Dongare and Shalini Sardesai standby. Department of Anaesthesia, Smt. Kashibai Navale Medical Col- Postoperatively: Patient was extubated after confir ming spon- lege, Narhe, Pune, Maharashtra, India. taneous breathing with good tidal volume, SPO2-100%, and endo- *Corresponding author Email: [email protected] tracheal tube removed. Breathing improved chest retraction de- Abstract: Introduction: Wilson’s disease (WD) is an inherited creased patient given prone position and shifted to PICU. Nebu- autosomal recessive disease results due to deficiency of cerulo- lized epinephrine (1:1000, 3 drops of adrenaline in 3ml NS) is plasmin leading to copper deposition in liver and extra hepatic given after operation to improve the airway Swelling, and patient tissue. This accumulation can cause liver cirrhosis, ataxia and was comfortably sleeping in supine position after surgery and Kayser Fleischer ring (KF) in cornea. Common extra hepatic indrawing of chest decreased. manifestations of copper deposition include joint pain (arthritis), Discussion: Laryngomalacia is the most common cause of cardiomyopathy, non-immune haemolytic anaemia and renal fail- congenital stridor. The high pitch noise of inspiratory stridor oc- ure. curs when supraglottic structures collapse into the airway during Case: This is a case of 19-year-old male patient diagnosed with the inspiratory phase of respiration Stridor with respiratory com- Wilson’s disease 7 years back who was on treatment with zinc promise and feeding difficulties with failure to thrive, severe air- and D- penicillamine, having large non healing ulcer over left way obstruction are absolute indications for surgery. lumbar and gluteal region (30x20x25 cm) posted for split skin Conclusion: General anaesthesia has been found to be more grafting. He was complicated with anaemia, thrombocytopenia, safe, useful for surgical treatment to be instituted. Administration with hepato-splenomegaly and required pre-

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op optimisation for septic shock with ARF (acute renal failure). ANEP7 He has undergone split skin grafting under general anaesthesia (GA) with successful outcome. There were no post-operative Anesthetic Considerations on Organ derangements in liver function and psychiatric condition. We did Procurement After Brain Death intra-operative monitoring of pulse, blood pressure, electrocardi- ography (ECG), respiratory gas monitoring (RGM), urine output. Barkha Dodani* and Amol Post-operatively we monitored for complete blood count (CBC), Department of Anaesthesia, Index Medical College & Research liver and kidney function. The anaesthetic management in pres- Center, Indore, Madhya Pradesh, India. ence of hepatic dysfunction with thrombocytopenia, anaemia, *Corresponding author Email: [email protected] hepato-splenomegaly, portal hypertension was challenging as there are increased chances of post-operative hepatic encephalo- Abstract: Introduction: Organ transplantation requires the pathy, hepato-renal failure and also there are no specific guide- donation and successful procurement of human organ.Brain death lines for same. There are only a few reported cases of anaesthetic is often associated with marked physiological instability, which, if management in patients with Wilson’s disease. This case portrays not managed, can lead to deterioration in organ function before the safe use of general anaesthesia in such a patient. retrieval. In some cases, this prevents successful donation. Organ used for transplantation are from donors after declaration of brain Conclusion: Wilson’s disease patient can be safely adminis- death (DBD), donors after cardiac death (DCD) & living organ tered general anaesthesia for split skin grafting using agents which donor. DCD & living donors are in minority. Organ procurement are least toxic to liver with meticulous monitoring during in- from these sources have different characteristics and present vary- traoperative and post-operative period. Regular follow up in sub- ing challenges in management. Our literature have focused vari- sequent days is indicated for better outcome and avoidance of post ous challenges after organs from donors after brain death (DBD). -operative complications. Further large studies are recommended in this area. Aim: To preserve the best possible function of donated or- gans, anesthesiologists need to understand the pathophysiologic ANEP6 derangements associated with brain death on each organ system as well as the effects of the preoperative measures that the donor Nephrectomy in a Post Renal Transplant required in the intensive care unit. Patient with Dilated Cardiomyopathy and Source: A thorough literature review was undertaken to lo- Ejection Fraction 25% cate all relevant articles that describe systemic effects of brain dead and their anesthetic implications. Shivani S. Phansalkar* and Aparna Bagle Conclusion: Anesthesiologist-guided physiological optimization Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India. of the brain-dead donor maintains organ function, thereby increas- *Corresponding author Email: [email protected] ing the number and functional quality of organs available for Abstract: Introduction: Anaesthetic management and chal- transplantation, it may be a factor in determining the outcome of lenges in a post renal Transplant patient with dilate cardiomyopa- the organ recipient. thy and ejection fraction 25%. ANEP8 Background: asymptomatic 2 months back when developed mild grade fever, recurrent UTI and breathless on exertion. Anesthetic Management of Elderly Male Patient (100 Yrs.) Posted for Left Proximal Case: 48 year old male patient, known case of hypertension with right sided transplanted kidney diagnosed with infected poly- Femur Nailing with Low Ejection Fraction cystic left kidney posted for nephrectomy. Ultrasonography re- (15%) vealed b/l polycystic native kidneys. Ishan R. Gadekar*, Rajesh Gore and H.S. Rawat Left kidney: Enlarged with cyst of various sizes. Department of Anaesthesia, Dr Vitthalrao Vikhe Patil Medical Recipient kidney: Appears normal in right illiac fossa. College and Hospital, Ahmednagar, Maharashtra, India. *Corresponding author Email: [email protected] Other investigations showed ejection fraction of 25% increased blood urea and creatinine and BUN. On the operating table the Abstract: Introduction: As life expectancy increases, the num- anaesthetic concerns were low cardiac output, complications of ber of geriatric patients posted for surgery and anesthesia makes low immunity, electrolyte and acid base disturbances and main- up an increasing portion of our practice. Geriatric patients have taining hemodynamics close to the baseline. decreased beta-adrenergic responsiveness and they experience an increased incidence of conduction abnormalities, Brady arrhyth- Intraoperatively patient was given right lateral position and vitals mias and hypertension. Fibrotic infiltration of cardiac conduction were recorded. pathways makes the elderly patient vulnerable to conduction de- lay and to atrial and ventricular ectopy. The elderly is more sensi- Patient was shifted to SICU after the operation and was stabilized tive to anesthetic agents and generally require smaller doses for and shifted to ward on POD5. the same clinical effect and drug action is usually prolonged. Conclusion: Management of patients with DCM and renal Case Report: My patient 100yrs old male was admitted with transplant is a challenge for an anaesthesiologist. Meticulous plan- diagnosis of left fracture neck of femur after trivial household ning and coordination with the surgeon with judicious use of trauma and posted for left proximal femur nailing. All routine pharmacological agents and tailored anaesthesia led to favourable investigations were done including CBC, LFT, RFT, Serum elec- outcomes. trolytes, ECG, BSL Fasting and Post Prandial. Patient had history

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of breathlessness after exertion and ECG showed poor R wave ANEP10 progresiion and T wave inversions in lead I, II, III, Avr, aVF, V4, V5, V6. Cardiologist opinion was taken and 2DECHO was done Anasthesia for Closed Reduction of Shoulder suggestive of Ejection Fraction 15-20 %, dilated coronary sinus, Dislocation in Patient with Multiple Medical globally hypokinetic LV, trivial mitral and tricuspid regurgitation Comorbidities in Emergency Department and sclerocalcific aortic valve. Cardiologist opinion suggested very high risk of surgery and advised Death On Table consent. Shubhangi N. Omase* and Preeti More Anesthetic Management: Development of new modalities such ESI-PGIMSR, Andheri, Mumbai, Maharashtra, India. as Peripheral Nerve Stimulator and ultrasound has led to shifting *Corresponding author Email: [email protected] of horizon of anesthesia from general anesthesia and central neu- Abstract: Introduction: Shoulder dislocation is one of the raxial blockade to peripheral nerve blocks. Peripheral nerve most painful &common orthopaedic emergencies. blocks avoid hemodynamic instability, post operative pain man- agement and assure timely discharge of patient. In view of pa- There are various options available for reduction of shoulder dis- tient’s cardiac status, advanced age and general condition, PNS location like analgesics, procedural sedation, intra-articular injec- guided lumbar plexus block was proposed for the surgery. How- tion, peripheral nerve block & GA. ever, due to difficult positioning, sciatic nerve block was not pos- Peripheral nerve block is great option for patient facing high risk sible in our case. So for blocking sensory supply of lower limb from procedural sedation & GA. PNS & USG guidance have in- and post operative analgesia, we used low dose of cardiostable creased the safety & reliability of peripheral nerve blocks. isomer levobupivacaine through epidural catheter. Suprascapular nerve block is safe & effective method for shoulder Conclusion: With advancing age, altered pharmacokinetics pain therapy & it is being used increasingly for management of and pharmacodynamics lead to increased morbidity and mortality. shoulder pain. This popularity is mainly due to ease of technique We avoided the need for General Anesthesia as well as Spinal &fewer complications &carries significant advantages over other Anesthesia in our patient. We successfully managed a 100 yrs old methods. patient posted for lower limb orthopedic surgery with finding of Case Report: 74yr/M, 66kgs,traumatic shoulder dislocation 15% ejection fraction, with lumbar plexus block with addition of right sided, presented to emergency department with C/O severe epidural analgesia with levobupivacaine. pain, posted for closed reduction of shoulder dislocation

ANEP9 On evaluation: K/C/O HTN, DM, ASTHMA, IHD & CKD on regular medications, undergoing HD 3/week. On examination PR- Profound Bradycardia on a Peaceful Day: 76/min, NIBP-130/70mmhg, RR-18/min. Resp. system examina- Intra-Myometrial Vasopressin tion showed b/l wheeze. Investigations: HB 8.5 gm%, creat-3.7. Delcita Mathias* and Radhesh Hegde ECG: T wave inversion in inferior leads. Father Muller Medical College, Mangaluru, Karnataka, India. *Corresponding author Email: [email protected] 2Decho: EF-35%, mod TR, PUL HTN, inferior wall hypokinesia on airway examination, mouth opening was adequate with MPC Abstract: Introduction: Vasopressin, a potent vasoconstrictor, grade 2. has often been used intramyometrially, to reduce blood loss dur- ing surgery. For this reason, vasopressin, has been used. Vaso- Anaesthesia management: NBM status & consent confir med. pressin has longest clinical effect, but its systemic effects may be Patient taken on table &all routine monitors were attached. profound and can sometimes cause lethal complications. The loss The patient was positioned, prepped & draped, anatomical land- of peripheral pulse along with bradycardia, non measurable arteri- marks were identified & marked, the suprascapular nerve block al blood pressure & cardiac complications have been reported waws given by 5 cm & 22 G PNS needle under PNS guidance, 7 after myometrial injections of vasopressin. ml of 0.5% bupivacaine was given, procedure was performed &was uneventful. Case Report: 30year old female presented with menorrhagia, palpitations & dyspnea on exertion was posted for elective myo- Conclusion: Suprascapular nerve block is safe & effective mectomy under subarachnoid block. 3.2cc of 0.5% hyperbaric method for shoulder dislocation in emergency department. bupivacaine was injected at L4-L5 disc space using 27g Quincke Babcock spinal needle. During the course of surgery, 60ml of 0.2 ANEP11 units/ml vasopressin was injected intra-myometrially. Soon after, Unanticipated Airway Challenge in an decremental heart rate was noticed, which regressed towards asys- tole. Surgery was stopped immediately. CPR commenced. 0.6mg Anticipated Difficult Airway of atropine injection was given intravenously twice. Patient was Suhas S. Dhole* resuscitated and surgery was resumed. Tata Memorial Centre Mumbai, Maharashtra, India. Conclusion: Bradycardia induced by vasopressin infiltration *Corresponding author Email: [email protected] has been described in surgeries such as myomectomy & cervical conization. Vasopressin induced bradycardia is described widely. Abstract: Fibreoptic Intubation (FOI) is the gold standard for Most minimal dose in range of 0.05-0.3 units/ml must be adminis- securing airway in an anticipated difficult airway. But sedation tered. Closed communication between the anesthesiologist and should be used carefully while doing FOI, otherwise airway col- surgeon is pivotal. lapse may occur. We report a case of 48 year old male with no co

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morbidities, with carcinoma of the left buccal mucosa, posted for tion where surgeons were unable to locate trachea after fibrooptic wide local excision and reconstruction. Mouth opening was < intubation with flexo metallic tube they able to locate trachea for 0.5cms. I/v/o anticipated difficult intubation, FOI was planned. tracheostomy. Patient was well counselled about the procedure. Monitors were ANEP13 attached, IV line was secured. Intravenous glycopyrolate and a dexmedetomidine infusion (50 mcg over 10 minutes) was started. Evaluation of Dexmedetomidine as an Adjunct Lignocaine (4%) nebulisation and transtracheal instillation was given for topical anaesthesia. Intravenous fentanyl (50 mcg) was to Total Intravenous Anaesthesia in Lumbar given. Spine Surgeries The patient was calm, maintaining oxygen saturation and hemo- P. Lavan Sagar* and Vivek Chakole dynamics. FOI was started using the right nostril. After perform- ing anterior rhinoscopy and entering nasopharynx, epiglottis was Dutta Meghe Institute of Medical Sciences, Sawangi (Meghe), visualised and looked collapsed. Attempts getting below and by Wardha, Maharashtra, India. the side of the epiglottis failed. Patient was drowsy but arousable, *Corresponding author Email: [email protected] oxygen saturation dropped to 93%. Tongue protrusion was not Abstract: Introduction: General anaesthesia with use of TIVA possible due to the ulcerative lesion. Jaw thrust manoeuvre was has been found to be superior that is provided by inhalational performed, following which vocal cords were visualised, satura- agents because of earlier recovery from anaesthesia and less inter- tion rose to 100%.Bronchoscope was advanced into the trachea, ference during neurophysiological monitoring, both of which are endotracheal tube was railroaded over it and general anesthesia desirable in spine surgeries. was given. Dexmedetomidine (α2 agonist) is a substance that produces a Even a small amount of sedation sometimes can compromise the unique type of sedation-analgesia with less ventilator depression airway resulting in airway obstruction and compete airway loss. than commonly used sedative-hypnotic and opioid analgesic In such cases counselling and topical preparation should suffice. It drugs. is important to distinguish between a difficult airway and a poten- tially compromised airway before considering sedation. If tongue Methods: In our study, sixty (60) adult patients undergoing protrusion is not possible, a jaw thrust manoeuvre should be con- spine surgery recruited for the study. Patients are randomly as- sidered. signed into two groups. Group C (n=30): Propofol + fentanyl; Group D (n=30): Propofol ANEP12 + fentanyl + Dexmedetomidine Fibrooptic Intubation of Patient Posted for Depth of anaesthesia monitored using entropy levels maintained Emergency Tracheostomy with Right between 40-60 by titrating propofol in both the groups. Intraoper- Pyriform Fossa Growth Which Extending in ative monitoring included during the surgery are Non-invasive blood pressures (NIBP), Heart rate (HR), Mean arterial blood Supraglotis, Glotis, Subglotis Airway pressures (MAP), Propofol requirement for induction and mainte- Amey A. Sable* and Lakhe J.N. nance, Spo2, EtCO2, ECG. Duration of surgery in both groups were noted. Time of first Post operative analgesic requirement Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India. (Rescue analgesia) was noted after assessing pain score through *Corresponding author Email: [email protected] Visual analog scale (VAS) if exceeding 3 during study period. Abstract: Introduction: Right pyrifor m fossa mass extending Conclusion: This study concludes that use of dexmedetomi- into right aryepiglotic fold and right vocal cord becoming chal- dine in perioperative period significantly reduced the requirement lenge for intubation and tracheostomy. of propofol for induction and maintenance of adequate depth of Background: Patient was apparently alright before 6months anaesthesia with stable haemodynamic parameters with better back to develop change in voice which is insidious in onset gradu- postoperative analgesia, little effect on recovery profile and with- ally progressive along with dysphagia since 20 days insidious in out any significant side effects. onset for solid and liquid gradually progressive. History of cough which is non productive in nature. ANEP14 History of halitosis present Fatal Pulmonary Embolism After Middle Ear Case: 65 years old male patient posted for emergency trache- Surgery: A Case Report ostomy without any comorbidities with history of breathlessness since 7 days. Preoperative pulse 121/min. Blood pressure: 121/71. Abhijeet Shekhawat* and Akhil Bhalla SPO2: 83% on room air. Use of Accessory muscles of respiration. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Respiratory system on auscultation shows bilateral crepts. Sur- bai, Maharashtra, India. geon tried tracheostomy under local but failed to identify tra- *Corresponding author Email: [email protected] chea.so decided awake intubation with fibrooptic. It was done with number 6 flexo metallictube through right nostril. Abstract: Background: Pulmonary thromboembolism is a complication of underlying venous thrombosis. factors contrib- Patient had an uneventful postoperative course and was dis- uting to thrombus formation include venous stasis, hypercoagula- charged 3 days of ICU stay. ble state, immobilisation, surgery, pregnancy, OCP. Incidence of Conclusion: This report intends to highlight the anaesthetic pulmonary embolism is estimated to be 20 to 25 per 100000 hos- challenges in managing right pyriform fossa mass during intuba- pitalized patients.

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Case report: 35 year old female with complaint of decreased Group A (cuff pressure assessed by anaesthetists with 5 years’ hearing since 2 years along with tinnitus and giddiness was admit- experience) and ted for stapedectomy. She also gave history of dyspnoea and pedal edema one month back for which she was hospitalized and under- Group B (cuff pressure assessed by anaesthesia resident with 1 went investigations which were normal. Patient was discharged as year experience). her clinical symptoms improved. Preoperative workup was unre- Results: In group A, the mean cuff pressures estimated by markable and patient was taken up for surgery under local anaes- palpation method and the mean cuff pressure obtained by manom- thesia with iv sedation. Perioperative period was uneventful and eter were comparable, whereas a statistically significant differ- patient was advised strict bed rest in wards. On postoperative day ence was found in the mean cuff pressures measured by palpation 5, she developed sudden dyspnoea after getting up and walking a method and the mean cuff pressure obtained by manometer in few steps. Dyspnoea along with falling saturation and bradycardia group B. progressed to cardiopulmonary arrest. CPCR was started and pa- tient was shifted to ICU. After securing airway, infusions of nora- Conclusion: From this study we conclude that experience has drenaline, dopamine and adrenaline were started via IJV. 2DEcho a positive effect on the ability to accurately estimate the cuff pres- revealed dilated RA/RV with PASP of 68mmof Hg and dilated sure utilizing palpation technique. non collapsing IVC. Bilateral lower limb venous Doppler showed deep venous thrombosis. Clinical diagnosis of pulmonary embo- ANEP16 lism was made and patient was lysed with Tenecteplase 30mg. 2DEcho showed signs of resolution of embolism after lysis, but Inferior Alveolar Nerve Block with Injection gradually patient deteriorated and developed cardiogenic shock. Triamcinolone with 1% Lignocaine for Pain Intra aortic balloon pump was inserted via right femoral artery Relief in Refractory Trigeminal Neuralgia: A and ionotropic support was continued. However patient’s condi- tion worsened and she developed cardiopulmonary arrest on Case Report POD6 and could not be revived. Ayush Pal Bansal* and Vivek Chakole Conclusion: Prevention of pulmonary embolism is a major Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, clinical problem for which prophylactic measures like early am- Maharashtra, India. bulation in post-op periods, elastic stockings, graduated compres- *Corresponding author Email: [email protected] sive stockings for bed ridden patients and preventive anticoagula- tion therapy in high risk patients should be considered. Abstract: Introduction: Inferior alveolar nerve block involves insertion of a needle near the mandibular foramen in order to de- ANEP15 posit a solution of local anesthetic near to the nerve before it en- ters the foramen. Trigeminal neuralgia is described by the interna- Effect of User Experience in The Accuracy of tional headache society as paroxysmal attack of pain affecting one Cuff Pressure Estimation Using Palpation or more divisions of the trigeminal nerve. Treatment of refractory trigeminal neuralgia are limited with high reoccurrence rate and Technique ultimately surgery needs to be considered. Basant Singh Latwal* and Amol Singam Case Report: Our patient 45 years old female presented with Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, the complaint of pain in the lower left side of the face and diffi- Maharashtra, India. culty in mastication. Pain was sudden in onset and there were 4-6 *Corresponding author Email: [email protected] episodes per day which lasted for 5 minutes. Patient had history of lower left molar extraction. On examination there was tenderness Abstract: Introduction: Tracheal intubation constitutes a present in left external oblique ridge and retromolar pad area. The routine part of anaesthetic practice. An optimum cuff pressure is trigger points for pain were lower border of mandible, left pre absolutely mandatory for proper seal during PPV. 20-30 cmH2O auricular region and left body of ramus of mandible. There was no is the optimum cuff pressure. While insufficient pressure may abnormality on MRI and a diagnosis of trigeminal neuralgia in- lead to microaspiration, over inflation may jeopardize tracheal volving left mandibular branch was made. She was started on mucosa blood supply leading to ischemia. tablet gabapentin 300mg post which she experienced no sympto- matic relief and was subsequently referred to pain clinic. We In this study we investigated the effect of user experience in the planned for inferior alveolar nerve block with injection triamcino- accuracy of cuff pressure estimation using palpation technique. lone 20mg with 1% lignocaine and on subsequent follow up she Aim: The aim of this study was to assess whether cuff pres- had symptomatic relief. sures obtained from estimation techniques significantly differed Conclusion: Refractory trigeminal neuralgia is a painful con- from the recommended levels of 20-30 cm H2O between anaes- dition with high morbidity. Inferior alveolar nerve block with thesiologist with 5 year’s experience and anaesthesia residents Injection Triamcinolone with 1% lignocaine can prove to be an with 1 year of experience. effective alternative to surgery and limit disabilities. Material & Method: After the approval from institutional ethics committee, this prospective, randomized, comparative ANEP17 study was carried out in 60 adult patients of either sex belonging to ASA physical status class I and II in the age more than 18 yrs, Comparative Double Blind Study of Fentanyl orally intubated with high volume low pressure ETT of 7mm and and Tramadol as Adjuvant to Lignocaine for 8mm internal diameter, scheduled to undergo emergency or elec- Intravenous Regional Anaesthesia in Forearm tive surgeries under general anaesthesia with assess to the ETT cuff. Orthopedic Surgeries

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Parag Dongre* and Aruna Chandak Case: Patient was a 35 year old male with bilateral Le fort III fracture, posted for open reduction internal fixation under general Department of Anaesthesia, Jawaharlal Nehru Medical Universi- anaesthesia. Patient was intubated orally with size 7.5 armoured ty, DMIMS, Sawangi, Maharashtra, India. endotracheal tube. A 2 cm sub mental incision was made. Second *Corresponding author Email: [email protected] tube of size 7.5 was passed via the submental incision into the Abstract: Introduction: Intravenous regional anaesthesia is floor of the mouth and manoeuvred with McGill forceps so that it one of the useful and popular techniques in anaesthesia. IVRA is was positioned in the oropharynx and negotiated further while safe, technically simple and cost effective as compared to general withdrawing the first tube. Cuff was inflated, throat pack inserted anaesthesia with a success rate of 94-98%. and tube was stabilised via temporary sutures. Nil perioperative airway complications encountered. Patient was extubated via Aim: To compare prolongation of duration of analgesia of submental route after return of spontaneous ventilation and gener- lignocaine with fentanyl and tramadol in IVRA. ation of adequate tidal volume with return of airway reflexes. No Materials and Methods: After obtaining ethics committee airway compromise encountered in post anaesthesia care unit. approval and obtaining informed written consent study was under- Conclusion: The modified use of two tubes for submental intu- taken in 60 patients randomly for surgeries of duration 45 mins bation maybe considered as a routine procedure as it avoids air- and less. way compromise during procedure with negligible tube damage Group LF – 0.5% lignocaine 40 ml + fentanyl 1 mcg/kg and is also economical and well tolerated by the patient. Group LT – 0.5% lignocaine 40ml + tramadol 1 mcg/kg ANEP19 The preparation and monitoring of patient were done by two dif- Case Report- Emergency LSCS in a Patient ferent anaesthesiologists. 20/18G IV access was secured as distal as possible in the limb followed by exsanguination of limb to be with Moderate Mitral Stenosis with operated by Esmarch bandage by elevating it for 10 mins. Upper Pulmonary Hypertension tourniquet is inflated to 50-100 mmHg above systolic pressure. Now 40ml 0.5% lignocaine + fentanyl 1 mcg/kg or tramadol 1 Niraj Bele* and Sandhya Gujar mcg/kg is injected slowly. After 10-15 mins, first the lower tour- Department of Anaesthesia, ESI-PGIMSR, Andheri, Mumbai, niquet is inflated later the upper is deflated sequentially. Maharashtra, India. Results: In a set of 60 patients, thirty were given Inj Tramadol *Corresponding author Email: [email protected] as adjuvant and the rest Inj Fentanyl as an adjuvant. It was noted Abstract: 37Y/F/61 kg gravida 3, para 1; unregistered; posted that the patients who were administered with Inj Tramadol had for Emg lscs i/v/o non progress of labor, prev h/o normal delivery longer duration of post operative analgesia compared to those who and MTP. Diagnosed mitral stenosis 10yrs back; Balloon Mitral were administered Inj Fentanyl. Valvotomy done 9yrs back. Her ECG showed P mitral and mild Conclusion: Thus we conclude that tramadol as a adjuvant of right ventricular hypertrophy. intravenous regional anaesthesia had a significantly longer dura- Echocardiography was also done 3 months back which showed tion of analgesia, with better tolerance of tourniquet pain com- Moderately stenosed mitral valve (1.4 cm2), peak/mean pressure pared to fentanyl when added to lignocaine for forearm orthopae- gradient 26/18-mm of Hg, with mild PHT with LVEF of 55% and dic surgeries. intact IAS and IVS. Heart disease occurs during pregnancy in 0.4% to 4.1%

ANEP18 Understanding of pathophysiological changes associated with Two Tube Technique- A New Approach to mitral stenosis is most important. Submental Intubation - A Case Report Pregnancy and labour each impose demands on circulation and anaesthesia may compromise an already stressed cardiovascular Suzanna Varghese* and Karuna Taksande system. Department of Anaesthesia, Jawahar Lal Nehru Medical College, On preanaesthetic examination on the operation table, pulse-72/ Sawangi (Meghe), Wardha, Maharashtra, India. min, regular in rate & rhythm with no apex pulse deficit, blood *Corresponding author Email: [email protected] pressure-110/70 mm Hg with no signs of failure. No sign and Abstract: Introduction: Submental intubation is a useful tech- symptoms of dyspnea with effort tolerance 3 flights of stairs. nique used by anaesthesiologists for securing airway in severe Breath holding time was >35 sec. cranio-maxillo-facial injuries where oro-tracheal and naso- Auscultation revealed mid diastolic murmur. Her obstetric exami- tracheal intubation cannot be performed. It provides a safe, less nation revealed 36 weeks’ size uterus with LOA and FHS was 160 invasive alternative to tracheostomy and provides undisturbed min per minute. After taking informed written high risk consent, access to oral and nasal airways and good dental occlusion. Rou- she was taken for LSCS. Patient was nil by mouth for 4 hours. tinely a flexible and kink resistant reinforced endotracheal tube Left lateral tilt was given. Before induction she was premedicated with detachable universal connector is used for the procedure. with Inj. Ranitidine 50mg IV, Inj. Metoclopramide10mg. IV, Inj However, we have often experienced drawbacks wherein there Ondansetron 4mg IV. Antibiotic prophylaxis was given. Oxygen was damage to the pilot balloon, rise in peak pressures, misplace- supplementation at 4l/min via hudsons mask. ment of tube during the procedure and improper fixation of uni- versal connector. We are hereby reporting a case where we used It was decided to administer continues Epidural anaesthesia be- two tubes as a modified method of submental intubation thereby cause we needed slower onset of anaesthesia, allows the maternal avoiding the drawbacks. cardiovascular system to compensate for the occurrence of block-

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ade, resulting in a lower risk of hypotension (risk of hypotension useful alternative. It obviates the need for tracheostomy and its and decreased uteroplacental perfusion. The total dose could be related complications. We presented a case where we avoided titrated to the desired sensory level. tracheostomy in this patient and opted for the transmyelohyoid endotracheal intubation. No increase in pulmonary arterial pressure and tachycardia was seen in general anaesthesia during laryngoscopy and tracheal Case description: Following preoxygenation, intravenous in- intubation and also the adverse effects of positive-pressure venti- duction of anaesthesia and neuromuscular blockade were lation are avoided which may lead to cardiac failure. achieved. The following airway consideration were noted: easy bag and mask ventilation with an oropharyngeal airway, Cormack These patients are required to decide an anaesthetic technique and lehane grade 1 on direct laryngoscopy, size 8 oral flexometallic proper and adequate intraoperative as well as postoperative care is tube used which had been checked to ensure that 15mm universal the key to the outcome of such cases. A better understanding of connector was removable, inhalational anaesthesia was main- the physiological changes in pregnancy and the pathological im- tained using isoflurane. pact of mitral stenosis over pregnancy and a multidisciplinary approach in diagnosis and management reduce the mortality and Under full aseptic technique the submental intubation was carried morbidity. out in following manners: 1) Incision was made in submental region and blunt dissection using an artery forcep performed to ANEP20 floor of mouth. 2) Oral mucous membrane was incised to create mucocutaneous passage. 3) Pilot tube and balloon of endotracheal Somatosensory and Motor Evoked Potential tube guided through this mucocutaneous tract using an artery Monitoring in a Patient of a Spinal Tumor at forceps. 4) Patient disconnected from the ventilator circuit and Lumbar Level Under TIVA: A Case Report universal connector removed from ETT. 5) Oral component of ETT was passed out from mucocutaneous tract guided by an ar- Aparna A. Ruparel* and Shilpa Kanakam tery forceps. 6) Ventilator circuit reconnected. 7) Correct position confirmed with auscultation and capnography and ETT position Department of Anaesthesia, Dr. D.Y. Patil Medical College and secured with sutures. The surgery proceeded without any issue. Hospital, Nerul, Navi Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] ANEP22 Abstract: This is a case report of a 40 year old, ASA1 patient Comparison of Various Formulae for posted for intradural extra medullary tumor at the level of L2-L3 spine. Patient was operated for the same and the tumor was resect- Predicting Skin to Subarachnoid Space Depth: ed. Postoperatively after 36 hours, patient complained of loss of An Observational Case Series bladder sensation associated with urinary retention. Surgical, uro- logical and radiological findings were suggestive of mass effect Samir Kumar Pandey* and Ashok Chaudhari (remnant tumor or clot) at the site of the previous surgery. A deci- Department of Anaesthesia, Jawahar Lal Nehru Medical College, sion was taken to perform a re-exploration at the site with the use Sawangi (Meghe), Wardha, Maharashtra, India. of electrophysiological monitoring including somatosensory and *Corresponding author Email: [email protected] motor evoked potential. The surgery was performed completely under total intravenous sedation with the use of midazolam, fenta- Abstract: Introduction: In a patient, the skin to Subarachnoid nyl and propofol. The remnant mass was resected and the patient Space Depth (SSD) varies considerably at different levels of the regained sensory functions in the post-operative period. Hence spinal cord. It also varies from patient to patient at the same verte- this case report highlights the use of total intravenous sedation for bral level as per age, sex and Body Mass Index (BMI). Estimation somatosensory and motor evoked potential monitoring in major of the skin to SSD reduces complications related to spinal anaes- neurosurgeries. thesia. Aim: To measure the skin to SSD in the Vidarbh rural male ANEP21 population and to find which formula is most suitable for predict- Anaesthetic Management of Case of ing the SSD. Pan-Facial Trauma for Maxilla Zygomatic Materials and Methods: Twenty adult male patients belonging to American Society of Anaesthesiologist class I and II, undergo- Mandibular Osteotomy and Plating ing surgery using spinal anaesthesia in various surgical specialties Shreyank P. Solanki* and Aparna Bagle of Acharya Vinobha Bhave Rural Hospital, Sawangi, Wardha were selected by systemic sampling for this prospective, observa- Department of Anaesthesia, Dr. D.Y. Patil Medical College, Pune, tional study. Patients comprised primarily of Vidarbh Rural male Maharashtra, India. population. SSD was measured after performing Spinal needle *Corresponding author Email: [email protected] insertion/ Lumbar puncture. Various formulae available [The formulae are as follows: (Abe's formula) (Bonadio's formula) Abstract: Introduction: Airway management of a challenging (Craig's formula) (Stocker's formula)] were used for predicting the case of a pan facial trauma for a maxillo zygomatic mandibular SSD and compared with SSD measured during procedure. The osteotomy and plating. relationship between SSD and patient characteristics were studied, Case Report: We report a case of RTA of 23 years old male correlated and statistical analysis was used to find which formula patient with pan facial trauma. Surgical repair of a complex max- is suitable for predicting the skin to SSD. Multivariate analysis illofacial trauma presents a challenge to the surgeon and anaesthe- was done for the covariates followed by a multivariate regression siologist. Where intubation via oral and nasal route cannot be analysis to evaluate the covariates influencing SSD for each group performed, sub mental route of endotracheal intubation is very separately.

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Results: In our study of twenty patients it was observed that Abstract: Resilience is the preparedness to a situation and Craig’s formula is the most suitable for predicting the SSD in providing remedy to this situation. Resiliency is always essential Vidarbh Rural Indian male population. and expected from anaesthesiologist to avoid unexpected out- comes. Therefore, maximizing performance and improving pro- Conclusion: Skin to SSD correlated with the BMI in all the fessional identity and hence to save life. Being flexible, robust, patients in our study. elastic translates to an ability to respond sudden, dynamic, unan- ticipated demands for high quality performance with goal of zero ANEP23 harm. To achieve this anaesthesiologist must be thoroughly Iatrogenic Carotid-Jugular Fistula Following trained. Central Venous Catheterization: A Case Adaptation of simulation based learning and training doctors can Report be an innovative and deliberate training experience in safe and controlled environment. As stated by Dr David Gaba “Simulation Akhil Bhalla* and Aniruddha Nirkhi is a technique, not a technology, to replace or amplify real experi- ences, often immersive in nature, that evoke or replicate substan- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- tial aspects of the real world in a fully interactive fashion.” Simu- bai, Maharashtra, India. lation not only helps gain procedural skill but also develops lead- *Corresponding author Email: [email protected] ership and communication quality. Briefing, debriefing and re- Abstract: Background: Central venous cannulation is a com- sourse management helps in preparedness. monly performed procedure which facilitates resuscitation, nutri- Simulation can be used in various fidelity to gain degree of real- tional support, and long-term vascular access. Complications most ism. In anaesthesia simulation can be used in airway management, often occur during insertion and are directly related to the under- access lines, technological appraisal, regional anaesthesia models, lying anatomy such as an arteriovenous fistula i.e an abnormal operational theatre environment, emergency procedure, case sce- connection between an artery and a vein. narios and team work. Case report: A 53 years old man presented in january 2018, Simulation based learning is must and should be included in cur- with the complaints of breathlessness since 2 months on and off, riculum for skill and decision making learning. Recently virtual and sweating associated with palpitation. The patient gave a past based simulation learning is on the rise. Giving a brighter future history of PTCA to LAD in Feb 2017. Due to blockage of stent in for simulation in anaesthsia November 2018 he had undergone CABG ( LIMA→LAD, LIMA -RIMA ‘y’→ Diagonal & OM). OBGO1 He was known case of DM & HTN which were controlled on Anaemia in Pregnancy - Its Prevalence and medication. Consequences General examination: HR: 110 bpm, BP: 130/80 mmhg, Spo2: 100% @2ltrs oxygen, RR: 40/min, JVP raised. Systemic examina- Rini Sutaria* tion: CVS: S1 S2 heard, no murmur present; RS: B/L air entry Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- equal few basal crepts; P/A: soft; CNS :normal bai, Maharashtra, India. Investigations: Hb 11gm/dl, TLC 6,500, Platelet count *Corresponding author Email: [email protected] 367,000. 2DECHO showed an EF 30-35% with regional wall Abstract: Introduction: Anemia is the most common hemato- motion abnormality present. Coronary angiogram: shows all logical abnormality detected during the pregnancy and forms a grafts are patent. Selective carotid angiography shows and AV major problem in affecting the females especially in the develop- fistula seen between right common carotid artery and right inter- ing countries. nal jugular vein. Methods: All pregnant females with clinical evidence of ane- Under general anaesthesia, an incision was taken at the border of mia without any other co-morbidity attending the antenatal clinic sternocleidomastoid muscle. Distal & proximal control taken over were included in the study. common carotid artery. 10 to 15mm fistulous track b/w rt. IJV & CCA. The fistula was ligated and the procedure was uneventful. Results: Total no. of patients were 150, age ≤20 years were 32 and ≥35 years were 18, mild anemia (10-10.9 gm%) 48, moderate Conclusion: AV fistula is preventable with suitable insertion anemia (7-10 gm%) 75, severe anemia (<7 gm%) 27. Normal technique. If a fistula is suspected duplex scanning & angiography vaginal delivery with medio-lateral episiotomy was done in 90 to be done to determine the severity and location of AV fistula. patients, normal vaginal delivery without medio-lateral episioto- Early obliteration of AV fistula to avoid early and late complica- my in 25 while lower-segment caesarean section in 35 patients. tions. Pre-term delivery was done in 28 patients, post-term delivery in 40. 40 babies delivered were low-birth weight (<2500 gm), ante- ANEP24 partum hemorrhage was seen in 6 patients while 32 patients had Simulation in Anaesthesia Post-partum hemorrhage. Narendra S. Patil*, Varsha Vyas, Amit Nagpal and Conclusion: The present study concludes that anemia is still rampant in the society especially in pregnant women. The main Surekha Patil cause of anemia-in-pregnancy is still the iron deficiency anemia. Department of Anaesthesia, Dr. D.Y. Patil Medical College and The multiple facilities are to be made available to each pregnant Hospital, Nerul, Navi Mumbai, Maharashtra, India. female and that requires community, government as well as *Corresponding author Email: [email protected] healthcare professional’s participation.

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OBGO2 M. Apoorva Reddy* Correlation of Traditional Post-Partum Diet Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- and Customs with Post-Partum Anaemia bai, Maharashtra, India. *Corresponding author Email: [email protected] Pooja A. Pachani* and Sonal Walawalkar Abstract: Introduction: Thyroid disorders are among the Dr. D.Y. Patil Medical College and Hospital, Kolhapur, Maha- common endocrine disorders in pregnant women after diabetes rashtra, India. mellitus. Several changes are observed in maternal thyroid func- *Corresponding author Email: [email protected] tion during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. It is well established that Abstract: Anaemia is one of the leading causes of disability in not only overt, but subclinical thyroid dysfunction also has ad- developing countries like India. Coverage of antenatal care has verse effect on mother and the fetus, like miscarriages, preterm improved after implementation of the National Rural Health Mis- delivery, preeclampsia, eclampsia, polihydromnios, placental sion 2005 to provide quality health care to rural populations, but abruption, post-partum haemorrhage, low birth weight, neonatal care during the post-partum period remains unscientific and poor. hypothyroidism. Decreased availability of thyroid hormones may Also very few studies are available and they have reported that also impair neurological and intellectual development of foetus. postpartum iron deficiency anaemia are more common than ex- With this background, we are conducting a study to know the pected ranging from 50% to 80%. According to mission ANAE- effect of thyroid disorders on pregnancy and its maternal and the MIA MUKT BHARAT which is aiming to decrease anaemia by fetal outcome. 18% in respective ages. After delivery, maternal haemoglobin status is expected to improve as the expanded red cell mass of Methods: The present study was conducted in Dr. DY Patil pregnancy contracts and a large proportion of iron returns to body medical college, Nerul, Navi Mumbai. It is a prospective study stores. The customs and diet followed by females from past many which involved 100 patients diagnosed to have thyroid disorder years i.e. diet without salt and spices, fruits and juices, high sugar during their antenatal checkup in the first trimister. It also in- diet, hot water for drinking, continuous hot fomentation, etc. caus- cludes known cases of thyroid disorder. TSH level was estimated. es dehydration, hyponatremia, anaemia, decreased breast milk If it is deranged, then FT3 and FT4 levels estimated. Patients were secretions, delayed wound healing, low immunity and postpartum managed accordingly and followed till delivery. Their obstetric psychosis. In our study, prospective study of 200 pregnant fe- and perinatal outcomes were noted. males in the Kolhapur district, we observed them from antenatal Results: In our study out of 100 cases, 96 cases are subclinical period throughout the Labour and post-partum 6 weeks. We have hypohyroid and 4 cases are subclinical hyperthyroid. Subclinical found that 200 patients had antenatal anaemia which was correct- hypothyroidism in pregnancy are associated with abortions ed and at the time of discharge, the Hb level were normal. When (2.1%), Anaemia (4.20%), PIH (14.7%), GDM (4.2%), Preterm they were examined 6 weeks later, we found that out of 76% labour (3.1%), oligohydromnios (16.67%), LSCS (22.9%), PPH women who followed this traditional customs and diet, 53% (6.3%), LBW (21.9%), Hyperbilirubinemia (9.4%), NICU admis- women were found to be anaemic. The high prevalence of post- sion (14.6%), Which are co-relatine with other studies and hyper- partum anaemia highlights the importance of anaemia screening at thyroid cases in our study were not sufficient for outcome analy- 6 weeks’ post-partum and to educate females at discharge to not sis. to follow unscientific customs which leads to anaemia. Conclusion: Thyroid disorders in pregnancy have adverse OBGO3 effects on maternal and fetal outcome emphasizing the importance Successful Outcome of an Ovarian Ectopic of routine antenatal thyroid screening. Pregnancy OBGO5 Dharam Shah* and Meena Satia Awareness of Polycystic Ovarian Syndrome Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Among Young Women in Western India bai, Maharashtra, India. Esha Chainani* *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Abstract: is rare and a conspicuous vari- bai, Maharashtra, India. ant of ectopic pregnancy and an accurate preoperative diagnosis is very challenging. Various advances in diagnostic modalities like *Corresponding author Email: [email protected] Transvaginal ultrasonography has evolved in identifying an ovari- Abstract: Background: Polycystic ovary syndrome (PCOS) is an pregnancy. We report here one such case of a 30-year-old with a complex condition characterized by elevated androgen levels, severe lower abdominal pain and bleeding per vaginum following menstrual irregularities, and/or small cysts on one or both ovaries. six weeks of amenorrhoea confirmed as ovarian ectopic pregnan- It is a common issue affecting more than 7% of adult women, cy consistent with Spiegelberg’s criteria on ultrasonography. This causing many problems including but not limited to infertility, case highlights the significance of 3D ultrasonography in the diag- irregular menses, hirsutism, acne and alopecia. The primary cause nosis. Histopathological report concluded it to be an ovarian ec- of PCOS is still unknown but awareness and lifestyle modification topic pregnancy. is known to be an efficient therapy route to relieve symptoms of this syndrome. OBGO4 Objective: To assess the knowledge about PCOS in young The Study of Maternal and Fetal Outcome in women in Navi Mumbai Pregnant Women with Thyroid Disorders Methods: A cross sectional study was perfor med on 500 wom-

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en of age group 18-30 years coming to Out Patient Departments India. of D Y Patil Hospital, Navi Mumbai. Written informed consent *Corresponding author Email: [email protected] was obtained and simple random technique was applied for selec- tion of study participants. Pre-designed, pre-tested, semi- Abstract: This prospective cohort study was conducted in the structured questionnaire was used for data collection. The data department of OBGY Index MCHRC, Indore collected was analyzed through percentages and frequencies using Aims: Detection of fetal hypoxia with Doppler flow studies of Excel. Relevant statistical test was applied was applied and p Umblical (UA) & Middle cerebral artery (MCA), to reduce peri- value was calculated where ever required and considered statisti- natal morbidity and mortality by timely intervention. cally significant when <0.05. Objectives: 1) Evaluate fetal health in cases of severe PIH & Results: Among 500 participants, only 38% of the women IUGR by serial Doppler flow studies of UA and MCA flow veloc- were aware of the term PCOS. 26% of the subjects were aware imetry 2) Study GA at time of delivery& mode 3) study Perinatal about the organ system involved in this disease. Most of the peo- outcome (PNO) by , GA, nursery admissions, birth ple know about this disorder through friends or relatives. 17% of weight. the women knew about the various symptoms associated with PCOS. Material and Methods: Study period: Jan. 2018 to Nov. 2018. Conclusion: The alarming results of present study show that Women attending ANC OPD and admitted in emergency hours’ very small number of young women understand what this disease b/w 30-40 weeks with BP ≥160/110 mm of Hg & without compli- is and thus when to consult a physician. This could be why PCOS cations (DM, Rh-ve mother, contracted pelvis, CPD, previous is an underrepresented and underdiagnosed disease. This widely LSCS, convulsions), were subjected to Doppler, later on, as need- prevalent disease among young women should be talked about ed till abnormal waveforms could be detected in uterine, umblical, more and more young women must be educated on this to help MCA and DV flow. Waveforms were analysed for RI, PI, S/D prevent the sequelae of this syndrome on fertility and insulin re- ratio measured. Hence any increased resistance, absent end dias- sistance. tolic flow &reversed end diastolic flow in uteroplacental fetal blood flow was found. OBGO6 No. of subjects selected were 100 and divided in: The Effect of Cerviprime Gel on Cervical 1) STUDY Group: severe PIH, 50 cases, divided in to: (i) 25 pa- Ripening and Induction of Labour tients with FGR, (ii) 25 patients without FGR. Saloni Patil* 2) CONTROL Group: 50 cases normotensive without FGR. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- According to the deterioration of fetal health by Doppler and con- bai, Maharashtra, India. trol of BP, pregnancy was terminated by inducing labor/ *Corresponding author Email: [email protected] emergency LSCS. Abstract: Topic: The effect of cerviprime gel on cervical rip- Results: UA S/D ratio values >3 had statistical correlation ening and induction of labour. with poor perinatal outcome and increased perinatal morbidity & mortality. Objectives: To study the effect of intracervical cerviprime (PGE2) gel for induction of labour and cervical ripening. In UA elevated RI & PI has high sensitivity in predicting APGAR <7 at 5 minutes& in predicting poor perinatal outcomes. And PI Method: Thirty patients with Singleton pregnancies and ce- highest specificity for predicting NICU admissions. Reduced RI phalic presentation with no prior abdominal surgeries were select- in MCA (brain sparing) AEDF/REDF also had correlation with ed for the study. PGE2 gel was applied intracervically and results adverse perinatal outcome. were noted. Conclusions: Study showed an adverse fetal outcome in cases Result: Out of 30 patients 12 delivered in the first 6 hours 8 of severe pre-eclamsia with/without FGR which showed abnormal delivered in 12 hours and the remaining patients 10 underwent Doppler results and thereby help to determine the optimal time for emergency lscs. Out of the 10 lscs 6 were in view of foetal dis- delivery and timely intervention for better perinatal outcome. tress and 4 were in view of failure of induction. S/D ratio is better predictor of perinatal outcome & thus Doppler Conclusion: This study shows that application of intracervical flow studies of umblical artery & has an edge over biophysical cerviprime is safe and effective for induction of labour and cervi- score profile in prediction. cal ripening in women with unfavourable cervix. OBGO8 OBGO7 Association of Menstrual Disorders with Evaluation of Fetal Health in Cases of Thyroid Diseases Pregnancy Induced Hypertension with or without Growth Restricted Fetus by Doppler Anushree M.* and Sudha Rani Flow Study Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Rounak M. Khandagale*, Meena Bhargva and *Corresponding author Email: [email protected] Arindaam Pol Abstract: Introduction: Menstrual disorder is a common Index Medical College Hospital and Research Centre, Indore, MP, problem among women in the reproductive age. These menstrual

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irregularities can be a polymenorrhea, menorroghia, oligomenor- return of bowel function and wound infection. Period of hospitali- rheo, amenorrhea etc., Thyroid dysfunction is associated with zation was also same. menstrual disorders in female of all age groups. Conclusion: Exteriorization of uterus at cesarean delivery has Aims and objective: To examine association of menstrual dis- advantage over intraperitoneal closure of uterus. Advantages were orders with thyroid diseases - good closure, less intraoperative haemoglobin reduction, easy Materials and methods: A hospital based prospective observa- identification of uterus anomaly, adnexal mass if present and ex- tional study was carried out in the department of obstetrics and posure of posterior aspect of lower segment. gynaecology of D.Y. Patil Medical College, Nerul. Over a period of two years from August 2014 to November 2016, 100 women of OBGO10 reproductive age group, 18-45 years presenting in OPD with men- Study on Safety and Feasibility of Caesarian strual disorder were recruited in this study. Myomectomy Results: In this study 44% out of 100 cases have thyroid dys- function. Among which 20% have substantial hypothyroidism and Madhura Desai* 4% have hypothyroidism. Hypothyroidism was seen in 5 % of the cases and subclinical hyperthyroidism was seen in 8%. Memor- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- rhagia was the commenst menstrual seen in hypothyroid patients bai, Maharashtra, India. followed by polymemorrhea, oligomenorrhea followed by am- *Corresponding author Email: [email protected] morrhea were commonly seen in hyperthyroid patients. Abstract: Introduction: Traditionally myomectomy during Conclusion: Thyroid dysfunction is an important causative caesarian section is not done due to fear of excessive blood loss factor of menstrual abnormalities. Thus every woman with men- and post operative morbidity. strual irregularities should undergo thyroid function test and this Aims and objectives: To determine whether myomectomy at will ultimately avoid unnecessary intervention like Hormonal and the time of caesarian section leads to increase incidence of intra- surgical treatment. partum and post partum complications. 1) To evaluate and dictate the thyroid dysfunction in patients pre- Materials and Methods: This is the retrospective study of senting with menstrual disorders from 18 to 45 years, 96cases over the period of last 30yrs in Virar maternity and nurs- 2) The prevalence of thyroid dysfunction in menstrual disorders. ing home Wherein all sorts of fibroids were removed ranging from seedling fibroids to 22 wks size fibroid from upper as well 3) To correlate between menstrual bleeding pattern T3, T4, and as lower Segment. lower segment fibroids were removed before T5H Hormone. delivery of baby ascending uterine artery were ligated prophylac- tically. OBGO9 Results: Time of surgery depends on no of fibroids. But for A Comparative Study of Extra-peritoneal and single fibroid it may take approximately 10-15 min. There was no Intra-peritoneal Closure of Uterus in increase in hospital stay. No increase in neonatal morbidity or Caesarian Section significant postoperative morbidity Komal Dahiya* Conclusion: In selected patients myomectomy during caesari- an section is safe at well equipped centres with experienced well Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- skilled surgeons. bai, Maharashtra, India. *Corresponding author Email: [email protected] OBGO11 Abstract: Background: The most common surgical procedure Transverse Vaginal Septum’..Are We Missing in obstetrics is cesarean delivery. Something!!! Different techniques have been proposed to minimize morbidity but the debate about the ideal technique is going on still. Amit Agrawal* and Deepa Kala The aim of this study was to assess the intraoperative and postop- Terna Medical College & Hospital, Nerul, Navi Mumbai, Maha- erative advantage and disadvantage following exteriorization of rashtra, India. uterus at cesarean section under intraperitoneal repair of uterus. *Corresponding author Email: [email protected] Methods: It is a randomised control trial conducted by DY Abstract: Transverse vaginal septum is a rare genital tract Patil Medical College. abnormality due to defect in fusion between Mullerian duct and urogenital sinus. Septum can be high mid or low in vaginal canal. Sample size 100 cases, 50 each were randomly allocated into case Septum cam be complete or incomplete. Incomplete septum usu- and control group. Patients going through either emergency or ally presents late with dyspareunia or infertility. This is a case of elective cesarean section more randomly allocated into exteriori- incomplete septum presenting with infertility 8 years after mar- zation and intraperitoneal group. riage. On examination, blind vagina seen with opening on anterior Result: There is significant difference in operating time in wall through which regular menstrual bleeding occurs. MRI was intraperitoneal and exteriorization groups. There is significant done to confirmed the diagnosis using a soft vaginal mould and a difference between 2 groups regarding vomiting, nausea in- high septum was diagnosed. Septum was excised with amnion traoperatively number of analgesic doses, incidence of cystitis, graft for epithelisation. Post op period was uneventful.

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OBGO12 Almost Lost-Need for Revolution Maternal and Fetal Outcome in Nidya K.* and Vidya Tirankar Oligohydramnios Department of Obstetrics and Gynaecology, Dr. Vaishampayan Shalini Kesharwani* Memorial Government Medical College, Solapur, MH, India. *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Abstract: Objectives: Advances over the years in most obstet- *Corresponding author Email: [email protected] ric conditions have occurred, including extensive work in the I st and IInd stage of labour as compared to the 3rd stage. Abnormal Abstract: Background: Oligohydramnios has got significant events in the 3rd stage can have serious consequences. Active impact on perinatal outcome and maternal morbidity. Therefore, management of 3rd stage of labour with prophylactic oxytocics early detection and its management will help in reduction of peri- and controlled cord traction has made 3rd stage of labour fairly natal morbidity and mortality, decreased operative interventions. safe. This has caused a shorter 3rd stage and decreased the blood Hence, the present study is undertaken to study the impact of loss. Only a small minority of cases of collapse occur after deliv- oligohydromnios on perinatal-maternal outcome. ery without hemorrhage. Uterine inversion though quite rare is Methods: The present study was prospective comparative one such condition which is potentially fatal. observational study conducted in the Department of Obstetrics Methods: This study was carried out retrospectively at and Gynaecology, Dr. D Y Patil hospital from January 2018 to Dr.V.M.Medical College Solapur in the Department of Obstetrics July 2018. 100 patients in the third trimester of pregnancy with and Gynecology over a period of 23 Years.45 cases of acute uter- oligohydramnios. ine inversion were analyzed. Results: Out of the 100 women most common cause of oligo- Results: Majority of the patients were young (55% ) in the age hydramnios is idiopathic (52%), and second commonest cause is group of 22-26 years. The incidence of acute inversion in our PIH (25%).out of 100, 87 babies were full term out of which 51 hospital was found to be 0.049%. Thus mortality due to acute delivered vaginally and 1 expired in neonatal period. 13 babies uterine inversion is 90 Times more than the normal Maternal were preterm, out of which 7 delivered vaginally, out of them 2 Mortality Rate. expired in neonatal period. Thus vaginal delivery is associated with high perinatal mortality (3/4=75%). Foetal distress was the Conclusion: Proper management of third stage of labour most common indication for LSCS. plays a very important role in reducing maternal mortality. Conclusions: In this study amniotic fluid index of ≤5 cm was commonly associated with increased cesarean section rates, intra- OBGO15 uterine growth restriction Hence, every case of oligohydramnios Study of 24 Weeks’ Antenatal Visit as needs to be evaluated carefully, early detection and initiation of Predictor of Perinatal Outcome appropriate treatment and treat the cause if possible. Shridula A. Pawar*, Shirisha Singham and Sangeeta Desai

OBGO13 Dr. D.Y. Patil Medical College and Hospital, Kadamwadi, Kolha- Interesting Case: Hemolytic Uremicsyndrome pur, Maharashtra, India. in a Postpartum Patient *Corresponding author Email: [email protected] Abstract: Once the pregnancy progresses to 24weeks, almost Zaneta Dias* and Shailesh Kore all the congenital anomalies, and teratogenicities are ruled out. Department of Obstetrics and Gynaecology, Lokmanya Tilak The progress there after is influenced by the maternal and obstet- Municipal Medical College, Mumbai, Maharashtra, India. ric factors. There is a need to establish the significance of all these *Corresponding author Email: [email protected] variables with perinatal outcome and for thorough analysis. This study was focused on all low risk patients at 24 weeks of gesta- Abstract: A 21 yr female was referred from a private hospital tions to determine maternal factors affecting the perinatal out- on 6/10/18 In view of Primigravida with 30 weeks of gestation come. The present study was a prospective observational study of with PIH and abruptio placenta with USG s/O IUFD. Emergency 50 cases conducted in the Outpatient department of Obstetrics & lSCS was done under general anaesthesia and patient was shifted Gynaecology of Dr. D.Y Patil, Hospital and research institute, to surgical ICU. Although patient withstood the procedure she had Kadamwadi, Kolhapur. The patients were advised all the regular oliguria, decreasing platelets & raised creatinine. Hemodialysis investigations and the data collected was analyzed to determine was started after AKD advised. With no further improvement 4 maternal or fetal factors affecting the perinatal outcome. 82% had cycles of plasmapheresis was given on alternate days with dialy- remained with normal Blood pressure and 18% patients had de- sis. Patient was started on immunosuppressants after Hematology veloped signs of preeclampsia of which 8% were with oligohy- reference, Inj. Methyl prednisolone followed by oral steroids. dramnios and IUGR, 6% with only IUGR, 4% each of anemia, Patient received a total of 10PRC, 12 FFP's and 10 platelets. An IUGR with Doppler changes, normal weight baby with oligohy- improvement in urine output, platelets and hemoglobin with de- dramnios respectively. In this study, late onset preeclampsia and creasing LDH and creatinine was seen. Patient was symptomati- anemia are the factors that were not detected at 24 weeks. It is cally better, discharged and now follows up in the OPD. also observed that pre-eclampsia and anemia had association with IUGR. All the complications occurred after 36 weeks of gesta- OBGO14 tional age, that means patient of low risk pregnancy if come at 24 Acute Uterine Inversion: Golden Hour to weeks of gestation may not need follow up upto 36 weeks but needs definite and regular follow up after 36 weeks.

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OBGO16 common hematological abnormality encountered in pregnancy. The aim of our study is to study maternal and fetal outcomes in A Cross Sectional Study on Prevalence of pregnancies associated with thrombocytopenia. PCOS and Risk Factors Associated with It Material and methods: This is a prospective study of 100 Among Medical Students pregnant women, irrespective of their gestational ages having thrombocytopenia enrolled in the Department of Obstetrics and Mihika Aggarwal*, Pramila Yadav and Pradnya Deolekar Gynecology at D Y Patil Hospital, Navi Mumbai. All the women Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- were followed through out their pregnancy till delivery and in bai, Maharashtra, India. postpartum period. Maternal and fetal outcomes were noted. *Corresponding author Email: [email protected] Results: Out of 100 patients in our study 82 had moderate Abstract: Introduction: Polycystic ovary syndrome is a com- thrombocytopenia while 18 had severe low platelet count. The mon female endocrine disorder, complex for managing clinicians various causes of thrombocytopenia in our study were pregnancy and a scientific challenge for researchers. It is a multifaceted dis- induced Gestational thrombocytopenia, hypertension, HELLP, pre ease arising from hereditary, non-hereditary intra and extra uterine eclampsia, ITP, drugs, viral infections, etc with the most common environmental influences. The exact pathophysiology of PCOS is cause being Gestational thrombocytopenia. Platelet infusion was complex and remains unclear. done in most of the patients suffering from severe thrombocytope- nia (14) as compared to only 10 patients with moderate thrombo- PCOS may manifest itself in adolescence but may not be diag- cytopenia. A dose of steroid was given in all patients with severe nosed at that time because most adolescents have irregular men- thrombocytopenia. We did not report any maternal or neonatal strual cycles and is diagnosed much later in adulthood. Thus, deaths in our study. there is a need to identify young women at a risk of developing PCOS to improve the quality of life and provide adequate treat- Conclusion: We concluded that with a proper antenatal and ment. intrapartum management, with timely platelet and blood product infusion along with timely medical management it is possible to Objective: This cross-sectional study was done to find the preva- get a favourable maternal and fetal outcome. lence of PCOS and also the risk factors associated with it among women aged 17-24 years of age. OBGO18 Material and Methods: This cross -sectional study was conduct- ed in a medical college in Nerul, Navi Mumbai situated in Maha- Evaluation of Socio-Demographic rashtra among 400 medical, dental, physiotherapy students in the Characteristics of Pregnancy Induced age group of 17-24 years. A detailed, self-administered question- Hypertension and Its Outcome- A Prospective naire was given to the students. Study The data was entered into excel and were analysed statically for correlation between the risk factors and the manifestation of the Rudroju Shirisha*, Jyosthna Koppula and Vasudha Sawant disorder. Dr. D.Y. Patil Medical College, Hospital and Research Centre, Results: From our study, a prevalence rate of 21.05 % was Kolhapur, Maharashtra, India. identified. Among those with PCOS, the mean age was 21.18 *Corresponding author Email: [email protected] years. 22.22% of the subjects were at high risk and 77.77% were Introduction: Pregnancy induced Hypertension includes at low risk for PCOS. Most of the ones diagnosed with PCOS had group of hypertensive disorders developed due to gravid state a waist to hip ratio greater than 0.8 (P<0.05) and were either after 20wks of pregnancy. Incidence of Eclampsia in developed obese or overweight (BMI>25 kg/m2) (P<0.01), suffered from countries is about 1 in 2000 deliveries compared to developing menstrual irregularities (P<0.05), hirsutism (P<0.05) and emo- countries where it varies from 1 in 100 to 1 in 1700. 13% of ma- tional problems like feeling moody and easy fatigability (P<0.05). ternal deaths are seen in women with pregnancy induced hyper- Conclusion: The study reveals that PCOS is a common prob- tension and Eclamsia, the most terrible form that accounts for lem among young women that demands lifestyle modification, major cause of death. High incidence observed has pointed to- better awareness and early diagnosis among the masses to prevent wards poverty, lack of education & unawareness regarding further complications. healthcare in this part of the world. Aim of the Study: To do comparative study between pregnant OBGO17 women of different socioeconomic group, gestational age & liter- Thrombocytopenia in Pregnancy: A acy and their influence on outcome. Prospective Study Objective: To correlate association of PIH with socioeconomic status, gestational age, literacy of the patient. Charu Srivastava* Material & Method: A Prospective observational study was Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- conducted on 100 pregnant women in 1 year in the department of bai, Maharashtra, India. Obstetrics & Gynaecology at D.Y. Patil Hospital, Kolhapur. *Corresponding author Email: [email protected] Selection Criteria: Inclusion Criteria: All pregnant women of Abstract: Introduction: Thrombocytopenia is seen in 6-10% of age 19yrs and above with BP >140/90 mmHg after 20 wks of pregnant women. Thrombocytopenia in pregnancy occurs due to gestation and willing to give consent. several aetiologies which include both pregnancy specific and non pregnancy related causes. It is second only to anemia as the most Exclusion Criteria: Pregnant women unwilling for follow-up

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and Subjects with history of Obesity, Chronic Hypertension, Cor- Maternal mortality rate is estimated to be 12.5-18% with neonatal onary Heart Disease, Impaired Renal Failure, Smoker, Alcoholic. mortality rate of 7-66%. Plan for Analysis of Result: Master Chart and descriptive Case report: A 24 year old primigravida with 36 weeks period statistics are prepared. Socio-economic group are classified on the of gestation was admitted in our hospital with complaints of yel- basis of revised Kuppuswamy classification. Research is carried lowish discoloration of eyes and urine and fever, loose stools and out in 1 year. Analysis is done. vomiting since 4-5 days with past history of jaundice 9 months back for which she took some Ayurvedic medication. On exami- Result: By this study, I hence forth observed that low socio- nation she was conscious, well hydrated and afebrile with normal economic status, low literacy rate, pregnancy in young age are vitals. Her liver function test showed a S. bilirubin of 17.3 mg/dl, more adversely effecting the incidence and outcome of Pregnancy SGOT of 184.4 IU/L and SGPT of 237.9 IU/L, alkaline phospha- Induced Hypertension. tase was 689.3 UL/L. Kidney function test revealed serum creati- nine of 2.6 and BUN of 9.86, prothrombin time- 30.2, INR- 2.5, OBGO19 APTT - 38.9 and S. fibrinogen of 110. USG abdomen showed Rudimentary Horn Ectopic Pregnancy: normal liver and other organs. Hepatitis A IgG was reactive with titric of 6.98 rest all viral markers were negative. Decision for Managed Laparoscopically termination of pregnancy was taken by caesarian section with Krishna Mandade* informed high risk consent. MIMSR Medical College, Latur, Maharashtra, India. Discussion: Precise etiology of AFLP is not known. It is thought to be due to a mitochondrial dysfunction in the oxidation *Corresponding author Email: [email protected] of fatty acids leading to an accumulation in hepatocytes. Pregnan- Abstract: Background: Ectopic pregnancy, the implantation cy with jaundice has many differential diagnoses like cholestasis, of a fertilised ovum outside of the endometrial cavity. viral hepatitis, preeclampsia with or without HELLP syndrome and AFLP. Intrahepatic cholestasis of pregnancy usually occurs in Uterus with rudimentary horn occurs due to Mullerian ducts in- the third trimester, characterized by itching in palms and soles and complete fusion with the contralateral side. Pregnancy in a non- S.bilirubin is mostly less than 6mg/dl. The progression is rapid communicating rudimentary horn is extremely rare, incidence of and unpredictable. Prompt diagnosis and management in form of less than 1 in 150,000, usually ruptures during first or second early delivery and intensive care support may be lifesaving. trimester of pregnancy. It can be missed in routine ultrasound scan and in majority of cases it is detected after rupture. It requires a high index of suspicion as is often confused with tubal ectopic. OBGP2 Excision of the pregnant horn is of crucial importance because Incarcerated Gravid Uterus: An Obstetric 80% to 90% of these pregnancies eventually culminate in rupture, Challenge typically between the 10th and 20th weeks of gestation. Managing such conditions laparoscopically is always challenging. Ananya Deekshit* Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Case: We report a case of G2PlL1 with rupture rudimentary bai, Maharashtra, India. horn pregnancy at 13 weeks of gestation which was misdiagnosed *Corresponding author Email: [email protected] as tubal ectopic pregnancy by ultrasound, referred to our hospital after the patient developed hemoperitoneum and shock with a Abstract: Incarceration of gravid uterus is a rare condition diagnosis of rupture tubal ectopic. Instead of , we did but serious presentation which requires early diagnosis to prevent revealed rupture of left rudimentary horn pregnancy complications. with massive hemoperitoneum. Timely laparoscopy, excision of the horn, and blood transfusion saved the patient. Case: A 42yrs old primigravida, an IVF conception and k/c/o diabetes mellitus, hypertension, bronchial asthma and HIV infec- Conclusion: Minimal incision, reduced tissue trauma, less post tion. Patient was having recurrent episodes of urinary retention -operative pain, better cosmetic result, faster recovery, and shorter and sacral pain and Diagnosed as incarcerated gravid uterus at hospital stay favour a laparoscopic approach and makes it an ex- 26weeks of gestation. Pregnancy was continued till 35weeks and cellent alternative to laparotomy in the surgical management of elective LSCS was done. even ruptured rudimentary horn. Discussion: Retroversion of uterus is a common condition in non-gravid uterus and 11-19% incidence is seen in gravid patients OBGP1 prior to 12weeks. By 14-16 weeks of gestation, it undergoes spon- Acute Fatty Liver of Pregnancy: A Rare taneous reduction as uterus enlarges and becomes abdominal or- gan. In incarceration of uterus, uterine fundus is trapped within Disease in Pregnancy sacral hollow and mid segment and lower segment of uterus is Rini Sutaria* stretched by growing foetus. Patient usually presents with com- plain of urinary retention and sacral pain in Midtrimester of preg- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- nancy. Abortion and uterine rupture is a complication of this con- bai, Maharashtra, India. dition. *Corresponding author Email: [email protected]

Abstract: Introduction: Acute fatty liver of pregnancy (AFLP) OBGP3 is a rare disease affecting women in pregnancy. AFLP affects 1 in A Rare Case of Hydrocele in a Female 7000 to 1 in 16000 deliveries. There is prediction for nulliparous women with multiple gestation and pregnancies with male fetus. Prachi Patil* and Meena Satia

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Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Neha Yadav* bai, Maharashtra, India. *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Abstract: Vulval swellings have always been a case of a diffi- *Corresponding author Email: [email protected] cult and a puzzling situation and more so when they are huge in size. Vulval swellings are of various types such as Bartholin cyst, Abstract: Pregnancy Related Acute Kidney Injury is rare but sebaceous cyst, cyst of canal of nuck, inguino-labial hernia and life threatening complication of pregnancy. Recent studies in In- vulval varicosities. Most common vulvar cysts are epidermal in- dia has shown MMR of around 20%. An understanding of various clusion cysts. Usual location is beneath the epidermis. An alterna- aetiologies of AKI in pregnancy is the key to appropriate clinical tive histogenesis is embryonic remnants or occlusion of piloseba- management & prevention of adverse fetomaternal outcomes. ceous ducts of sweat glands. Cutaneous cysts which are lined by Case Discussion: A 27 yr. old obese G5P4L4 34 wks. gestation ciliated epithelium are very rare, and we present a rare case of a k/c/o pre-eclampsia with BP: 170/100 mm of Hg came with c/o cyst arising from a left labium majus resembling a hydrocele seen pain abdomen & bleeding per vaginum since 3 hrs referred from in males with histopathology suggestive of ciliated cyst of the private hospital to DY Patil Hospital tertiary care centre with vulva. USG s/o IUFD, induction of abortion done, developed blurring of vision associated with marked oliguria & anasarca in puerperium. OBGP4 Her sr. creatinine levels increased to as high as 5.1 mg/dl (normal Advantage of Embryoscope in Infertility range 0.6 - 1.2 mg/dl). Haemodialysis along with antihyperten- sives and hemodynamic monitoring were done to treat the case Sneha Bhoir* and Jaideep Malhotra itself before progressing to irreversible kidney damage. Rainbow IVF, Global Rainbow Hospital, Agra, U.P., India. Conclusion: Though AKI is rare but it is mandatory to treat *Corresponding author Email: [email protected] these cases in earlier stage itself before progressing to irreversible kidney damage. Attention should be paid on specific conditions in Abstract: An EmbryoScope is an incubator that maintains the second and third trimesters, such as preeclampsia, HELLP syn- necessary conditions for a living embryo to thrive. drome, TTP-HUS, acute fatty liver of pregnancy. With apt inves- The EmbryoScope technology removes the need for embryolo- tigations and protocols, it can be treated with simply human albu- gists to remove the embryo from the incubator, increasing the min, FFP infusion, haemodialysis with a very good prognosis. chances of pregnancy as there is no need to handle the embryo or distress it. OBGP7 The EmbryoScope allows us to carry out detailed and thorough Perforated Meckel's Diverticulitis in Third studies of the embryos, their development and cell division. Trimester Pregnancy - An Enigma We hereby present two cases where Embryoscope was used one of a successful and other unsuccessful pregnancy. Nidya K.*, Vidya Tirankar and Prabhakar Gawandi The importance and advantages of using Embryoscope are high- Dr. Vaishampayan Memorial Government Medical College, Sola- lighted in the cases. pur, Maharashtra, India. *Corresponding author Email: [email protected]

OBGP5 Abstract: Background: Incidence of acute abdomen during Mucinous Adenocarcinoma of Ovary pregnancy is 1in 500-635 pregnancies. Increase in heart rate, car- diac output, physiological anemia may all be present even without Tejashri Madamwar* and Charu Shrivastava underlying pathology in pregnancy. Diagnosis is difficult as grav- id uterus presses over abdominal viscera which results in dimin- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ished response to peritoneal irritation and alteration in the referred bai, Maharashtra, India. pain perception making localisation of etiology more difficult. *Corresponding author Email: [email protected] Meckel's Diverticulitis is rare in women and rarest during third Abstract: A 22 year Para 0 Live 0 and 1 abortion presented in trimester of pregnancy, which is due to delay in diagnosis World- the OPD with abdominal distention following abortion two years wide only 25 cases have been reported with perforation. Leads to back and had been experiencing regular menses after her abortion. high mortality both maternal and fetal. Examination and investigation findings revealed a large ovarian tumour (20x 10 cm s) occupying lower abdomen upto umbilicus. Case Report: We report the rarest of the rare cases of Meck- Tumour markers were all normal except for slightly increased el's as a cause of intestinal obstruction in 3rd trimester of pregnan- lactate dehydrogenase enzyme. Patient underwent staging laparot- cy which was diagnosed late because of masking of symptoms by omy with left ovariotomy with omental biopsy with peritoneal Vesical calculus. cytology.Histopathology revealed Mucinous Adenocarcinoma Conclusion: A High index of clinical suspicion can lead to an (Intestinal type). Her post operative period was uneventful and earlier diagnosis and thus help in keeping maternal and fetal mor- she was advised follow up with oncologist for chemotherapy. tality and morbidity to a minimum. Malignant primary cystadenocarcinoma are rare in young patients with borderline prognosis and follow up is mandatory. OBGP8 OBGP6 Intravenous Iron Therapy in Obstetrics and Acute Kidney Injury in Pre-Eclampsia Gynaecology

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Ranu Singh Kushwaha*, Kumudini Jha and Institutional Level to Reduce Its Impact and Manorama Kumari Improve the Quality of Life Darbhanga Medical College and Hospital, Laheriasarai, Bihar, India. Krittika Bhatiya*, Aarya Vidhate and Deepali Vidhate *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Abstract: Iron deficiency anaemia is a major factor in devel- oping countries which increasing the morbidity of women espe- *Corresponding author Email: [email protected] cially in reproductive age group. Intravenous iron therapy signifi- Abstract: Background: Dysmenorrhea is an important health cantly improves the health and tackle this problem. The objectives condition in adolescent girls which affects even the ordinary of the study are to assess the efficacy of intravenous iron in the chores in the daily life of the female almost every month. In pri- treatment of iron deficiency anemia in obstetrics and gynaecology mary dysmenorrhea the adolescent females suffer with a high practice. A prospective cohort study was conducted in the depart- degree of pain, mood swings, vomiting which ultimately affect the ment of obstetrics and gynaecology for a period of 6 months. A quality of life. Many School and college girls are suffering with total of 42 cases with iron deficiency anaemia were studied. 2 dysmenorrhea which is affecting their carrier. This health issue is cases were lost to follow up. On the basis of patient’s choice; not addressed well at institutional level. either Inj. FCM or Inj. Iron sucrose was given to each group and the rise in haemoglobin over a period of 3 weeks was observed. Method: A prospective study has been carried out in D Y Patil Out of all the cases studied, maximum belonged to the age group School of Medicine and Hospital. The study was approved by of 21 to 30 years and majority cases also had moderate type of institutional ethical committee. A questionnaire is circulated anaemia. 60% obstetric cases were given Inj. FCM and rest 40% amongst the medical students and Science college students. Total cases were given Inj. Iron sucrose. Amongst gynaecologic cases, 358 students aged between 18 to 24 years participated in the pre- 70% were given Inj. FCM and 30% were given Inj. Iron sucrose. sent study. Data was analysed using SPSS version 17 software The mean rise of haemoglobin in FCM group was 2 and 2.5 in with specific statistical tests. obstetric and gynaecologic cases respectively. With Inj. Iron su- Results: The prevalence of dysmenorrhea in the study partici- crose, the mean rise of haemoglobin in obstetric cases was 2 and pants was observed as 69.55%. The other variables like mean age, in gynaecologic cases was 2.5. The rise in haemoglobin after 3 age at menarche of the students were 18.8 (±0.31) and 13.1 weeks amongst both groups was statistically significant. Inj. FCM (±1.36) respectively, which were not significant. The frequency of proved to be better than Inj. Iron sucrose in improving the haemo- menstrual cycle has been reported between 26-28 days, duration globin status of women in Obstetrics & Gynecological practice in of bleeding in days 3-5 days. The other variables studied are- terms of both compliance and efficacy. Duration and quality of sleep, Degree of pain, frequency of mood swings which were highly affected in 89% of study participants OBGP9 during the phase of dysmenorrhea. A good number of medical students (93%) are aware about the effects of diet and exercise on Partial Molar Pregnancy with Normal Fetus: quality of life but never practise it. A Rare Occurrence Conclusion: The present study concluded that there is a need Sneha Patel* and Babita Vaswani of regular workshops in schools and colleges for adolescent girls for appropriate and effective management of dysmenorrhea to Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- improve quality of life and to reduce the impact of dysmenorrhea. bai, Maharashtra, India. *Corresponding author Email: [email protected] OBGP11 Abstract: Partial molar pregnancy is a rare entity in which Use of Condom Hydrostatic Pack as a Means there is usually a triploid abnormal fetus associated with a large placenta with cystic changes. A pregnancy with a partial molar to Control Generalized Oozing After Surgery placenta and a normal diploid fetus is an extremely rare condition. in a Case with Ovarian Cyst Few guidelines exist for antenatal evaluation and management, particularly with respect to selecting cases for conservative man- Manvi Verma* and Yogeshwar Nandanwar agement. Here we report one such rare case of partial molar preg- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- nancy in which a normal appearing foetus with normal karyotype bai, Maharashtra, India. coexisted. In this case a 36yr old primigravida with IVF concep- *Corresponding author Email: [email protected] tion presented at 18 wks of gestation with pv spotting and USG suggestive of partial molar placenta which was low lying. She was Abstract: Introduction: Condom catheter finds its traditional treated conservatively with progesterone support since it was a use in control of massive post partum hemorrhage. Another use precious pregnancy with previous 2 IVF failed cycles. However, can be as a temporary pressure device to achieve hemostasis after at 20 weeks gestation she spontaneously aborted a grossly normal . This case highlights the use of a condom as a looking fetus. The product of conception and placenta were sent hydrostatic pack to control the generalized ooze after surgery in a for histopathology and karyotyping which confirmed partial hyda- 20 year old unmarried girl with ovarian cyst. tiform mole with normal foetus. Case: 20 years old unmarried girl presented with bleeding per vaginum, abdominal pain, fever and generalized weakness for 6 OBGP10 months. She had a history of Right ovarian cystectomy 6 months Dysmenorrhea: An Important Health Issue in back and mitral valve replacement 1 year back. MRI showed a 6.5×6.4 cm thin walled peripherally enhancing cystic septated Adolescent Girls –Needs to be Addressed at lesion with hyperintensities in the pelvis more on the left side,

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with the ovary within the lateral aspect. definitely neoplastic, the various types of molar pregnancies are basically benign, but with a potential to behave like a malignant On , uterus, fallopian tubes and ovaries disease that requires chemotherapy. Abnormalities of uterine size, were found densely adherent to POD and omentum. On the right vaginal bleeding, and first trimester toxaemia are common presen- side, ovary was not visualized, fallopian tube was excised com- tations. After a D & C, follow-up consists of close monitoring of pletely as it was distended, adherent and hematosalpinx was pre- the serum beta-hCG and adherence to contraception. Approxi- sent. On the left side, ovary was adherent to POD and lateral pel- mately 15% of patients have malignant disease requiring chemo- vic wall, adhesiolysis was done and the healthy tube and ovary therapy. Prognosis has changed from fatal to highly curable with were preserved. Hemorrhagic? chocolate cyst was removed from preservation of the uterus for future childbearing. POD. All adhesions were oozing hence condom hydrostatic pack made of two condoms was kept, inflated with about 200cc of Case Study: A case presented to the OBGY department of saline. Abdominal drain was kept. Estimated blood loss was SAIMS & PGI Indore. She was a G5P1L1A3 with three and half 200cc. Procedure was uneventful. The pack was removed after 24 months of amenorrhoea with spotting per vagina. Patient came hours. The postoperative recovery period was uneventful. with USG report of partial mole. All routine investigations were done at our institute. Discussion and Conclusion: Condom hydrostatic pack is a novel approach to achieve hemostasis and can be a lifesaving Positive Findings: measure. Though many new hemostatic sealants are coming up in the market, but this pack can be easily made anywhere in varied  On OBS USG scan an IU embryo of 8.4 weeks and enlarged setups especially in a country like India. More case reports need heterogenous placenta with multiple cystic spaces – partial to be published on this innovative use of condoms. mole.  On MRI F/S/O Gestational trophoblastic disease invading OBGP12 partial myometrium not reaching serosa with small gestational Analysis of Maternal and Fetal Outcome in sac with thin linear fetus. Placenta Previa and Accreta  On routine investigations- beta HCG 1621. Aparna Dandale*, Amarjeetkaur Bava and S.J. Kore Treatment: Patient was planned for D and C with High risk consent taken for hysterectomy. HPR report of Gestational troph- LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India. oblastic disease (non- neoplastic) was reported. Patient was put on *Corresponding author Email: [email protected] methotrexate 1gm/kg with folic acid with serial beta HCG follow Abstract: Objectives: 1) To study the incidence and types of up along with further symptomatic and supportive management. placenta previa at our institute. 2) To know the high risk factors responsible for the same. 3) To evaluate various maternal compli- OPHO1 cations in these patients. 4) To analyse maternal and perinatal outcome in these patients. Tolosa Hunt Syndrome Materials and Method: A prospective study was conducted Pooja Sharma* over a period of one and half year. 250 patients were included in Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- the study. following parameters were studied : maternal risk fac- bai, Maharashtra, India. tors, maternal and perinatal outcome, maternal complications and *Corresponding author Email: [email protected] Management. Abstract: THS is an idiopathic granulomatous inflammation Result: Placenta previa is acute obstetric emergency and preg- of the cavernous sinus & a diagnosis of exclusion. Treatment is nant woman admitted with it should be considered very high risk with high dose pulse intravenous methyl prednisolone. Rapid because it entails high maternal and fetal morbidity and mortality. amelioration of symptoms specially pain following institution of if complicated with accreta is a severe pregnancy complication therapy support the diagnosis. A 47 year old healthy female pre- and is currently most common indication for peripartum hysterec- sented to our medicine outpatient department. Sudden onset of tomy. to manage this multidisciplinary approach including Gyne- painful drooping of left upper eyelid of 3 days duration. There cologists, radiologists and Intensivists is required. was history of fever associated with non-projectile vomiting. Pa- tient reported nil systemic illness. MRI was planned which re- OBGP13 vealed moderately enhancing soft tissue in the region of cavern- Gestational Trophoblastic Neoplasm- A Case ous sinus and orbital apex, based on MRI findings a diagnosis of THS was made. Patient was advised pulse IV methyl prednisolone Report @1 g/day for 5 days followed by tapering dose of oral steroid. Artika Gupta* Patient reported rapid resolution of pain in 2 days of starting iv methyl prednisolone. High-dose glucocorticoids are the first line Sri. Aurobindo Institute of Medical Sciences, Indore, Madhya treatment for Tolosa-Hunt syndrome considering its inflammatory Pradesh, India. pathology. *Corresponding author Email: [email protected]

Abstract: Background: Gestational trophoblastic disease OPHO2 (GTD) is a disease of the proliferative trophoblastic allografts and To Study the Corneal Topography Changes includes partial mole (PM), complete hydatidiform mole (CM), invasive mole, metastatic mole, chorio carcinoma (CC), and pla- and Surgically Induced Astigmatism Post cental site trophoblastic tumour (PSTT). While CC and PSTT are Phacoemulsification Surgery

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Kshitij S. Tamboli* and Nupur Chakravarty who are not experienced with topical anesthesia. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- OPHO4 bai, Maharashtra, India. *Corresponding author Email: [email protected] Assessing the Importance of Ganglion Cell Abstract: Aim: To Study the corneal topography changes and Complex (GCC) in Diagnosing Preperimetric surgically induced astigmatism post phacoemulsification surgery. Glaucoma Material and methods: After approval of institutional ethics Rohan Dedhia* and Nita Shanbhag committee, written informed consent was obtained from each patient. An observational analysis of patients undergoing cataract Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- surgery by phacoemulsification and matching the inclusion crite- bai, Maharashtra, India. ria at our hospital was done within the duration of 1 year. In all *Corresponding author Email: [email protected] patients a complete ophthalmic examination with refraction and Abstract: Background: Glaucoma is a multi-factorial optic keratometry, slit lamp examination along with intraocular pres- neuropathy characterized by a loss of retinal ganglion cells with sure measurement was done. Corneal topography was recorded subsequent loss of the retinal nerve fibers ultimately resulting in preoperatively and 1 and 3 months postoperatively. Surgically visual impairment. The macula region has a high density of retinal induced astigmatism postsurgery was studied. ganglion cells thereby being a likely region to detect early cell Results: Out of the total 100 eyes studied, 60% male and 40 % loss. Since glaucoma affects mainly the inner layers of the retina, female. Mean age was 64 years. Age range was 48-80 years. 40 Ganglion Cell Complex (GCC) mapping can help to detect glau- patients had against the rule astigmatism (ATR), 35 patients had comatous damage early as compared to the total retinal thickness with rule astigmatism (WTR) and 25 patients had no astigmatism. Purpose: To map GCC thickness and average Macular Reti- Preoperative mean corneal topography (sim k) in patients with nal (MR) thickness with Spectral- Domain Optical Coherence superior incision phacoemulsification surgery, was 43.50(+/- 1- Tomography (SD-OCT) and correlate it with the Retinal Nerve 2D) at 180(Ks) and 43.00(+/-1-2D) at 90 (kf) corresponding to fiber layer (RNFL) thickness in preperimetric glaucoma. astigmatism ATR of -0.50DC at 90. In superior phacoemulsifica- tion surgery, the mean topography (sim K) of 43.75(+/- 1-2D) at Design: Observational cross-sectional study. 180 (ks) and 42.75 (+/-1-2D) at 90(kf) after 1 month and 43.75 (+/ -1-2D) at 180(Ks) and 43.00(+/-1-2D) at 90(Kf) after 3 months Methods: 38 eyes Of 25 patients diagnosed as preperimetric corresponding to postoperative astigmatism ATR of -1.00Dc at 90 glaucoma were studied. GCC, MR thickness and RNFL thickness (post 1 month) and -0.75DC at 90 (post 3 months). In temporal was mapped using the Cirrus High-Definition (HD) OCT (Carl phacoemulsification surgery, the mean topography (sim K) of Zeiss Meditec, Inc., Dublin, CA). Average GCC thickness and 43.00(+/- 1-2D)at 180 (ks) and 43.00(+/-1-2D) at 90(kf) after 1 MR thickness were correlated with the RNFL thickness. month and 42.75 (+/-1-2D) at 180(Kf) and 43.00(+/-1-2D) at 90 Results: Average GCC of patients was 85.99±6.9 μm. There (Ks) after 3 months corresponding to no postoperative astigma- was GCC loss in 33 eyes(86.84%) which correlated well with tism (post 1 month) and -0.25DC at 90(post 3 months) Conclu- areas of RNFL loss (r=0.408, p<0.001). 6 eyes (15.78%) were sion: Corneal topography done preoperatively can help in plan- seen to have decreased MR thickness. GCC loss correlated well ning site of incision to produce minimal surgically induced astig- with the loss of average RNFL thickness and MR thickness. Fur- matism (SIA). Incision at steeper meridian produces lesser SIA. ther GCC loss was also seen in 26 eyes (68.42%) with a normal MR thickness OPHO3 Conclusion: GCC analysis may prove to be a robust diagnos- Intubation Anaesthesia tic parameter and is complementary to RNFL analysis in preperi- metric glaucoma. Nita Shanbhag* Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- OPHO5 bai, Maharashtra, India. A Case Report of Bilateral Vernal *Corresponding author Email: [email protected] Keratoconjunctivitis Complicated by Abstract: Objective: To be able to do prick-less anaesthesia in patients who are anxious, in globe perforation. Top up anesthesia Keratoconus, Steroid Induced Cataract, when it wanes during surgery and in long Axial Lengths to pre- Glaucoma and a Spontaneous Descemet vent globe penetration. Membrane Detachment in a 18 Year Old Methodology: 0.5 cc of bupivacaine and 1cc of 2% xylocaine is Female injected in the avascular plane 6-7mm behind the limbus in the supero-temporal quadrant in the muscle cone with an 24 G angio- Bhaktee Walawalkar* cath to achieve anesthesia with akinesia in Ocular surgeries. K B H Bachooali Charitable Ophthalmic & ENT Hospital, Parel, Results: The results of this study showed that the patients Mumbai, Maharashtra, India. achieved full anesthesia with the advantage of it being minimally *Corresponding author Email: [email protected] invasive and harboring a risk of fewer complications. Abstract: Vernal keratoconjunctivitis (VKC) is a severe bilat- Conclusion: This study is being presented to highlight a safe, eral allergic inflammatory disorder of the ocular surface common- effective, repeatable and easily adaptable procedure of anesthesia, ly limited to the tarsal conjunctiva and limbus. However there especially in anxious patients and for beginner ophthalmologists may be sight threatening complications like keratoconus, corneal

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scarring, as well as complications of unsupervised use of topical treated with cataract extraction and IOL implantation. Only 6 eyes steroids like cataract and glaucoma. were left aphakic. 18 eyes had BCVA equal to or better than 6/12. The common post-operative complications were PCO (24 eyes) The case discussed here is of a 18 year old nil systemic female and post-operative inflammatory reaction (14 eyes). with complains of severe itching, watering, redness and diminu- tion of vision. Clinical findings revealed VKC in both eyes. Right It was concluded that etiology, age at presentation, early detection eye showed corneal scarring with a spontaneously detached and management play a vital role in the visual prognosis of cata- descemet membrane confirmed on Anterior segment OCT, visual- ract in children. ly significant posterior subcapsular cataract, C:D ratio 0.9 and high pressures. Left eye showed faint PSC, 0.7 cupping and nor- OPHO7 mal pressures. H/O of using topical steroids with antiallergic drops since a long time andanti glaucoma medications since 5 A Case of Ocular Myasthenia Gravis months in both eyes. Corneal topography revealed bilateral irregu- Sanika Jain* and Nita Shanbag lar astigmatism, elevated posterior corneal elevation suggestive of keratoconus. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Management of such cases presenting with multiple complications *Corresponding author Email: [email protected] is critical and decision of what to treat first is crucial. We primari- ly focused on allergy control using a steroid sparing agent, medi- Abstract: Myasthenia Gravis (MG) is a potentially serious, cal management of glaucoma for both eyes and planned a cataract but treatable autoimmune disease affecting the neuro-muscular surgery with trabeculectomy in the right eye. High astigmatism a junction of the skeletal muscles. Ocular myasthenia gravis (OMG) preoperative detached descemet and scarred cornea result in a can mimic isolated cranial nerve palsies, gaze palsies, internuclear difficult cataract surgery. Also simultaneous management of kera- ophthalmoplegia, blepharospasm, and even a stroke. toconus, pressure control and deciding on an appropriate steroid sparing agent is challenging. A point of interest in this case is the OMG is a subtype of MG where the weakness is clinically isolat- spontaneously detached descemets without signs of acute hy- ed to the EOMs, levator, and orbicularis oculi. Ptosis and diplopia drops. This is an unusual and previously unrecognized entity. are the initial signs of the disease in over 50% of MG patients; 50- Cause is unclear, could be because of mechanical forces from a 80% of these patients go on to develop generalized disease. In the retrocorneal membrane or progressive keratoconus leading to majority of cases (90%), progression of OMG to its generalized corneal steepening and thinning. To summarize, prompt recogni- form will occur within the first 2 years after ocular symptoms tion of complications and judicial use of steroids with close fol- begin. low ups is necessary in all cases of VKC. Extraocular muscles are more commonly affected as twitch fibers in EOMs develop tension faster and have a higher frequency of

OPHO6 synaptic firing than limb muscles. This makes them more suscep- tible to fatigue. Furthermore, tonic muscle fibers are necessary to Clinical Profile, Management, Complications sustain the gaze in any direction. These type of fibers have fewer and Visual Outcome of Paediatric Cataract – ACh receptors, which makes them more susceptible to receptor loss or damage. An Observational Study Here, we present a case of a patient who came to our OPD with Sayyad Kulsum Jahangir*, Dharmendra Kose and complaints of sudden onset dropping of eyelids since 15days. Amol Tamhane Upon further examination she showed characteristic findings such as Cogan Lid twitch and she tested positive for the Ice pack test N K P Salve Institute of Medical Sciences and Research Centre, and fatiguability test which suggested of Ocular Myasthenia Nagpur, Maharashtra, India. Gravis. *Corresponding author Email: [email protected] Owing to the early involvement of ocular muscles in Myasthenia Abstract: Aims and objectives: 1) To study clinical profile of Gravis, it is important for the ophthalmologist to be watchful of patients upto 18 years of age, suffering from cataract. 2) To ana- the relevant clinical features and advise appropriate diagnostic lyse the various treatment modalities to which these patients are tests so as to initiate timely treatment and arrest the progression. subjected. 3) To study complications and visual outcome in these patients belonging to age group of less than 18 years and undergo- OPHO8 ing cataract surgery. Exposure Keratitis After Incomplete Taping Material and methods: In a prospective descriptive observa- tional study conducted over a period of 1 year, children less than During PICU Care 18 years of age diagnosed with cataract were studied. Detailed Srushti Bagde*, Faraaz Hussain, Reshma Anand and history, vision assessment, anterior and posterior segment exami- nation was done pre-operatively. Cases were operated upon as per Shipra Gupta institute’s standard protocol. Follow-up visits up to 2 months post MGM Medical College and Hospital, Navi Mumbai, Maharashtra, -surgery were conducted. India. Results and conclusion: 48 cases were studied, 32 males and *Corresponding author Email: [email protected] 16 females. 62 eyes were studied in total as 14 cases showed bilat- Abstract: Purpose: To highlight the importance of proper eye eral cataract. Majority belonged to age group of 6-10 years. Non- care of infants admitted under critical care in order to prevent and traumatic cataract was more common than traumatic cataract. The manage ocular complications. most common etiology was idiopathic, and the most common morphological type was lamellar cataract. Majority of cases were Methods: 8 month/male admitted under pediatric ICU for lrti

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and low GCS, with underlying immunocompromised status. Child ministration was more likely to lead to the development of ROP. was intubated on day 2 of admission and both eyes taping was done. On day 4 redness, chemosis and whitish lesion on cornea The study enabled us to identify the amount of risk that may be was seen in left eye, an ophthalmology consult was done. On attributed to each factor, and gave us insight into conditions which examination, circumcorneal congestion seen in both eyes, with would require us to adopt a low threshold for screening, intervals left eye corneal haze and stromal infiltrate about 5x4mm infer between follow-ups and intervention in this sight-threatening temporally with 7x8mm epithelial defect. Right Eye showed two disease. infiltrates, 1mm diameter inferiorly at 5-6 o’clock position. Child was started on left eye fortified vancomycin and fortified OPHO10 ceftazidime drops hourly, E/oint atropine BD and E/oint HPMC Evaluation of Tear Film in Cases of TDS. Right eye E/drop moxifloxacin and tobramycin 2 hourly, E/ oint atropine at night and E/drop CMC 6 times a day. Rheumatoid Arthritis Results: improvement seen by day 4. Lesion size reduced in Kruti K. Shah*, Swapnagandha S. Halikar left eye. Right eye showed complete resolution. Drops tapered. Smt. Kashibai Navale Medical College, Pune, Maharashtra, India. Conclusions: The focus of intensivist is more on saving life of *Corresponding author Email: [email protected] patient during which eye care is often neglected, thereby endan- Abstract: Rheumatoid Arthritis (RA) is a chronic inflammato- gering ocular prognosis of trivial pathologies or otherwise healthy ry autoimmune disease with unknown origin that is shown with eyes leading to grave consequences. A proper eye care should be symmetric erosive arthritis. It is the most common inflammatory given in PICU especially with immunocompromised patients. An arthritis. Involvement of surface layer of the eye is common in aggressive mode of treatment with close monitoring of the patient RA. Keratoconjunctivits sicca, scleritis, episcleritis and uveitis are should be done in case of exposure related corneal ulceration. ocular complications. Generally, the most common form of ocular involvement is dry eye. The main objective of this study is to OPHO9 evaluate the tear film status in patients of RA. A cross sectional Retinopathy of Prematurity in Preterms of study of 30 patients suffering from RA underwent evaluation of their tear film status using Schirmer test, Tear Break Up Time and Multiple Gestational Pregnancies: Risk Tear Meniscus Height. Out of the thirty patients included in the Factors study, 4 had moderate dry eye; 7 had mild dry eye; and 18 pa- tients had a normal tear film. There was a 36.6% correlation of Sailie Shirodkar* and Karobi Lahiri dry eye in patients with Rheumatoid Arthritis of which 13.3% had Bombay Hospital Institute of Medical Sciences, Mumbai, Maha- moderate dry eye and 23.3% had mild dry eye. rashtra, India. Dry eye syndrome is the most common conflict in terms of man- *Corresponding author Email: [email protected] agement. Particular studies suggested dry eye has been associated Abstract: Retinopathy of prematurity (ROP) is a multifactori- with greater rheumatoid arthritis severity. al disease, characterised by the development of abnormal retinal Evidence of clinical correlation of dry eye conditions with RA has vasculature in prematurely born infants. The risk of its occurrence been accumulating in recent years. Research data on the effects of may be the consequence of interaction between a host of different RA and ocular surface epithelium are widely available. Various factors – including, but not limited to gestational age, low birth methods [i.e. Tear Break Up Time (TBUT), Schirmer and Tear weight, anaemia, jaundice, blood transfusions, respiratory distress, Meniscus Height (TMH)] are available for the investigation of surfactant therapy, supplemental oxygen and others. Dry Eye Syndrome (DES). Thus, this study has been undertaken Materials & Methods: Study site: Bombay Hospital to evaluate the tear film status in patients suffering from RA and thus give the appropriate treatment at the earliest for better overall Study design: Retrospective observational study patient care. Inclusion Criteria: Preter m births of multiple gestational pregnancies OPHO11 Exclusion Criteria: Parents who did not give consent. Methotrexate Induced Bilateral Sample size: 36 patients Cytomegalovirus (CMV) Retinitis Study conduct: Our study was designed to understand more Roma P. Vakade*, Mayur Moreke, Tanuj Sharma, about the impact of the aforementioned factors in the pathogenesis Sharang Wartikar, Ajay Dudani and Karobi Lahiri of ROP. It was conducted in preterm births of multiple gestational Bombay Hospital and Institute of Medical Sciences, Mumbai, pregnancies, comprising of 16 pairs of twins (including 14 pairs Maharashtra, India. of IVF twins) and 1 set of quadruplets. Gestational age being *Corresponding author Email: [email protected] common to both children of a pair of twins and all four of a set of quadruplets, the impact of other risk factors on the retina was Introduction: Immunosuppression with Methotrexate can studied. The differences in the behaviour of the retina were ob- occasionally result in serious ocular infections. served, and the results were analysed. Methods: Two patients who were HIV Non-Reactive (HIV – Conclusion: We observed that the behaviour of the retina is Negative) presented to us with bilateral infectious posterior uvei- different in the two babies of a set of twins, thereby concluding tis after use of Oral Methotrexate. The first was a 69 year old that gestational age is not the chief criteria for this condition. lady; diabetic and a known case of Rheumatoid Arthritis and In- Among other things, we also discovered that earlier oxygen ad- terstitial Lung Disease and the second was a 63 year old lady with

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Chronic Kidney Disease and Psoriasis. Both patients had been on OPHO14 oral Methotrexate for their rheumatological condition and present- ed with clinical features of bilateral CMV Retinitis. Unilateral Report Unilateral Proptosis in a Young Female Due to Schwannoma – A Rare Results: Methotrexate was stopped in both patients. The first patient was treated with oral Valganciclovir and the second pa- Case tient with Intravenous Ganciclovir. Both patients required use of Ishita Mehta*, Himika Gupta and Minal Kanhere Intravitreal Ganciclovir for control of infection in one eye while the other eye responded to only systemic treatment. While the MGM Medical College and Hospital, Kamothe, Navi Mumbai, second patient responded to treatment without any complications; Maharashtra, India. the first patient had rhegmatogenous retinal detachments which *Corresponding author Email: [email protected] required Vitrectomy with Silicon Oil Injection and EndoLASER Abstract: A Schwannoma is a benign, slow-growing peripheral in both eyes. nerve sheath tumor that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of orbital neo- Conclusion: Managing bilateral CMV Retinitis can be diffi- plasms. A 22 year female presented with unilateral proptosis of cult but can be achieved with cessation of Methotrexate and ap- 1year duration which was painless and gradually increased in size. propriate use of anti-viral agents but can be wrought with compli- No complaints of diminution complications. Of vision, diplopia or cations. field defect. Examination revealed a non-pulsatile swelling of firm consistency causing proptosis of 23mm. MRI showed extraconal OPHO12 mass involving superolateral part of orbit, not indenting the globe. Vertical lid split incision with cryoassisted removal of the mass Bilateral Optic Neuritis in a Child with with superior orbitotomy. HPE revealed Schwannoma. There Tuberculosis were no complications & she had a full recovery. Postop VA was maintained at 6/6p. Preoperative diagnosis is difficult because of Rishwa Hariyani* and Priyanka Choudhari its variable presentation and location. Appropriate early assess- ment of orbital tumors by CT or MRI and prompt management is Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- warranted to prevent the development of severe complications. bai, Maharashtra, India. *Corresponding author Email: [email protected] OPHO15 Abstract: Linezolid is a new synthetic anti-microbial known as Bilateral Anophthalmos /Microphthalmos in oxazolidinone with activity against many important pathogens including multidrug-resistant tubercle bacillus, methicillin- Monozygotic Twins: A Rare Presentation resistant staphylococcus and streptococcus. We report a case of Akash Jain* toxic optic neuropathy due to linezolid occurring in a patient who was on concurrent linezolid, cycloserine, pyridoxine and para Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- amino salicylate for extremely drug-resistant pulmonary tubercu- bai, Maharashtra, India. losis (XDR-TB). 6 yr old male child presented with gradual loss *Corresponding author Email: [email protected] of vision. Visual acuity was FC at 2 meter. Colour vision was Abstract: Anophthalmia, a term used to summarize true defective in both eyes. Fundus examination shows bilateral swol- anophthalmia (absence of eyes) and strong microphthalmia where len discs. Vision was improved on linezolid withdrawal. Our re- macroscopically the eyeballs seem to be absent even though rem- port emphasizes the need for monitoring of visual function, cor- nants can be found histologically. rect diagnosis and timely withdrawal in patients on long-term Anophthalmia and microphthalmia (A/M) are developmental linezolid treatment. ocular malformations. A/M conditions have been estimated to affect 2-6 in 50 000 live OPHO13 births. Corneal Injury - An Occupational Hazard Bilateral anophthalmos is a rare entity and similar phenotypic features of bilateral A/M in monozygotic twins is an even more Hema M. Mer*, Naina Potdar and Anuj Soni rare condition. LTMMC & Sion Hospital, Mumbai, Maharashtra, India. Anophthalmos is defined as the absence of eyeballs in the pres- *Corresponding author Email: [email protected] ence of eyelid, conjunctiva or lacrimal apparatus and is usually diagnosed clinically. Abstract: Material: A 3 case series of corneal injury patients secondary to occupational injury, attending tertiary care hospital for visual management. OPHO16 Pinealoblastoma/Malignant Neuroectodermal Method: 2 patients were treated with Cynoacrylate glue with Bandage Contact lens & 1 patient was treated with 10-15 inter- Tumor in a Known Case of Alternating rupted sutures using 10-0 ethilon under local anesthesia over tear. Exotropia with High Hyperopia in a 6 Year Results: All 3 cases were successfully managed. Old Male Child Conclusion: Any if the aforesaid methods are beneficial for Ankur S. Sancheti* and Harsha Pagad treating patients with corneal injury following occupational insult. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum-

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bai, Maharashtra, India. as central serous chorioretinopathy elsewhere. When they present- *Corresponding author Email: [email protected] ed to us, they were diagnosed as tuberculosis after extensive workup. We present the clinical features, multimodal imaging Abstract: Aim: To highlight remote possibility of a Space Oc- features investigative workup and treatment outcomes of these cupying Lesion in the brain of a child already diagnosed and fol- cases. All cases had a small choroidal tuberculoma with or with- lowing up for Exotropia with refractive error presenting with re- out peripheral features of vasculitis, and choroiditis. These cases cent onset headache. were positive for immunological tests and/or radiological tests for Case: This case was seen in a Pediatric Ophthalmology tuberculosis. In addition, they had the typical ‘’contact sign’’ on (Squint) Clinic. 6 years old male child, known case of alternating optical coherence tomography. We discuss the differentiating exotropia since 1.5 years, On his 3rd follow up visit in Squint features between central serous chorioretinopathy and choroidal Clinic presented with complaints of recent onset headache, occu- tubercle. The treatments for both entities are vastly different and it lar pain and vomiting. On Evaluation, CT Brain+Orbit showed is necessary for all ophthalmologists to make the distinction be- evidence suggestive of Mass/Neoplasm in the region of Pineal tween these entities to avoid potential devastating vision threaten- Gland and Posterior part of 3rd Ventricle, possibly a Pinealoblas- ing complications. toma/Germinoma. OPHO19 Hence concluding, Since Intracranial Tumours are second most common type of neoplasm in children and can present as Head- Bilateral Ischemic CRVO with Accelerated ache secondarily, Pre-existing diagnosis should not deter Paediat- Hypertension CRF and ric Ophthalmologist to early and timely evaluation of child with such fresh complaints. Hyperhomocysteinemia Treated with Anti VEGF OPHO17 Sanika Jain*, Nita Shanbag and Ankur Case Report: Study of Management Protocol Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- of Glaucoma in Our Hospital bai, Maharashtra, India. *Corresponding author Email: [email protected] Jay N. Zarkar*, Nita Shanbhag and Kshitij Tamboli Abstract: CRVO is a common vascular disorder causing visu- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- al impairment at any age. Usually it is unilateral, though bilateral bai, Maharashtra, India. CRVO is associated with underlying systemic illness which needs *Corresponding author Email: [email protected] a detailed workup of risk factors and appropriate management. Abstract: Glaucoma is the second most prominent cause of Here we report a case of 63 year old female who presented with blindness in the world. In India, glaucoma is the third-leading severely impaired vision in both eyes. Examination revealed Bi- cause of irreversible blindness. lateral ischaemic CRVO with cystoid muscular edema in both eyes. We in our case study establish step wise assessment of Glaucoma suspects and in established Glaucoma cases from the patients who Systemic evaluation revealed patient’s blood pressure 180/110 have been coming to our Glaucoma clinic since the past one year mm Hg (Accelerated Hypertension). Patient is a known case of and assess the requirement of Medical /surgical intervention in CKD, hypertension and diabetes mellitus since 5 years with past them. history of PTCA. Blood investigations showed Creat as 5.2, Se- rum homocysteine 44.2, Coagulation profile was normal, ECG We saw 94 patients from which 52 patients had glaucoma out of showed T Wave inversion in leads 1 and aVL, 2D echo with which 8 patients needed Surgery. LVEF of 40%, Carotid Doppler revealed atheromatous plaques in Early Detection is key. both common carotid arteries. We treated this patient with intravi- Clinical examination is the only way to catch glaucoma, and early treal anti VEGF following which there was some improvement in detection and treatment can check vision loss. her vision.

OPHO18 OPHO20 The Lesser Known Facet of Intraocular Multifocality with a Monofocal Lens Tuberculosis (IOTB). Neurosensory Nita Shanbhag* and Pooja V. Ramnani Detachment in IOTB - A Case Series Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Abhishek Heranjalm*, Apoorva Ayachit, Sarvesh Tiwari bai, Maharashtra, India. *Corresponding author Email: [email protected] and Anand Subramanyam Abstract: Objective: 1) To find the percentage of people who K.B.H. Bachooali Eye Hospital, Parel, Mumbai, Maharashtra, achieved unaided 6/6-6/9 for distance and N6 –N8 for near simu- India. lating multifocality following a unique technique of manual small *Corresponding author Email: [email protected] incision cataract surgery using Monofocal IOLs. 2) To determine Abstract: Intraocular tuberculosis (IOTB) can have myriad the relationship of: visual acuity (unaided) and best corrected presentations in the anterior segment, posterior segment, orbit and visual acuity distance and near, to the astigmatism post-surgery. optic nerve pathway. IOTB is also a great masquerader and can 3) Pupil size post-surgery correlating to depth of focus giving frequently be misdiagnosed. We present 4 cases of IOTB that unaided vision. 4) Type of IOL Monofocal PMMA v/s others to presented with neurosensory detachment and were misdiagnosed visual outcome.

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Methodology: 100 Patients eligible for small incision cataract stressed. surgery were chosen and a detailed workup of pre-operative cata- ract surgery was done with the use of slit Lamp, Keratometer, OPHO22 AutoK and Corneal topography, Immersion A- Scan, Ophthal- moscopy was done. A hand held keratoscope which projected Case Report : A Rare Case of Acquired mires on cornea was used intraoperatively to ascertain the corneal Oculomotor Nerve Nucleus Palsy astigmatism for titration. Post operatively unaided best corrected visual acuity (BCVA), Pupil size, Astigmatism and Type of IOL Sandeep S. Arora* and Harsha Pagad was documented to ascertain multifocality of the operated eye in a Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Monofocal in the bag PCIOL. bai, Maharashtra, India. Results: The results of this study showed that the study *Corresponding author Email: [email protected] achieved unaided vision of 6/6 on the Snellen’s chart and near Abstract: Oculomotor nerve palsy may be congenital or ac- vision of N6 with pseudo-accomodation. This was irrespective of quired, complete or partial, pupil-involving or pupil-sparing, iso- the Pupil size, the type of Astigmatism, the type of IOL material. lated or accompanied by signs of extensive neurological involve- The multifocality was contributed by the change in corneal con- ment. Precise knowledge of its origin & course from nuclear level tour at the corneal apex. to terminal muscles along with accompanying clinical features Conclusion: This study is being presented to highlight the helps in localising the site of involvement & thus appropriate economical way of providing multifocal vision to the less de- management. The oculomotor nerve originates from the third prived who cannot afford Premium IOLs like accommodative / nerve nucleus at the level of the superior colliculus in the mid- Multifocal diffractive or refractive & Toric IOls. brain, ventral to the cerebral aqueduct, then passes through the red nucleus, substantia nigra & exits through the interpeduncular fos- OPHO21 sa to enter the orbit through superior orbital fissure. Of all the types of Oculomotor Nerve involvement the Nuclear Type is very A Case of Bilateral Traumatic Cataract rare. Nuclear lesions can be diagnosed with some specific patterns Secondary to Electrical Injury of oculomotor weakness such as Unilateral 3rd nerve palsy with bilateral superior rectus weakness, or bilateral ptosis or isolated Suvarna Kalapad*, Gayatri Bhonsale, Faraaz Hussain and bilateral ptosis, or bilateral third nerve palsy without bilateral Yash Gala ptosis, which occur only with nuclear damage & not with fascicu- lar or neuropathic lesions. We present here a case report of a pa- Department of Ophthalmology, MGM Medical college and Hos- tient with history of stroke one year ago, who presented with blur- pital, Kamothe, Navi Mumbai, Maharashtra, India. ring of vision in both eyes & inability to open, adduct, elevate & *Corresponding author Email: [email protected] depress the left eye. Right eye showed mild ptosis & elevation Abstract: Background: Electrocution induced cataracts may deficiency. Since nuclear involvement is rare, it is important to occur following contact with high tension conductor, lightning or recognise these specific patterns of bilateral superior rectus weak- electric shock therapy. The amount and rapidity of changes in the ness & bilateral ptosis along with ipsilateral third nerve palsy lens seem to bear no relation to the strength of the current. The which are pathognomic for nuclear involvement of oculomotor cataract is due to coagulation of lens proteins and the osmotic nerve so as to advise urgent imaging of the brain & neurological changes following damage to the subcapsular epithelium usually checkup & prevent life threatening complications with timely develops 1–12 months after the electric shock. Though they begin treatment. initially as anterior sub-capsular opacities, they can mature rapid-

ly, leading to mature cataract with capsular invovlement. Though OPHO23 electric injuries are relatively common in our country, ocular Lipaemia Retinalis - Gateway to Systemic complications have not been reported as frequently, possibly due to slightly delayed sequalae. Disease Case Report: A 23year male presented with complaints of Yash Gala*, Reshma Ramakrishnan, Ishita Mehta and gradually progressive diminution of vision in both eyes following Tanvi Bhosale an accidental electric injury 6 months back when he stepped on MGM Medical College and Hospital, Kamothe, Navi Mumbai, exposed wire having electric supply. General examination showed Maharashtra, India. multiple scarred lesions over the face. An entry wound was seen *Corresponding author Email: [email protected] on the right foot but an exit wound could not be localised. On ophthalmic examination, best corrected visual acuity was 6/24 in Abstract: Background: Lipaemia retinalis is a rare unusual the right eye and hand movements close to face with accurate ocular manifestation of certain types of hyperlipidemias with projection of rays in left eye. A near mature cataract was seen in elevated triglyceride levels. right eye and mature cataract in left eye, associated with anterior Case Report: We report a case of 20 year male, diagnosed capsular involvement. USG B scan was reported to be within case of eruptive xanthoma with type 1 diabetes mellitus referred normal limits. Patient underwent Cataract extraction with PCIOL from Department of Dermatology for ophthalmic evaluation. On implantation in both eyes. Postoperative recovery was associated ocular examination patient had visual acuity of 6/6 in both eyes. with severe inflammation but the patient regained visual acuity of Anterior segment examination was unremarkable. On fundus 6/6 in both eyes within two weeks. Fundus examination was with- examination, there was creamy white appearance of retinal blood in normal limits post-operatively. Patient has been advised close vessels with no extravasation of lipid or blood. Serum triglycer- follow-up as late optic atrophy can be a rare possibility. ides cholesterol were raised at presentation. Following treatment Conclusion: The need for awareness of the possibility of ocu- with oral statins and insulin therapy, serum triglyceride and cho- lar complications and screening of all cases of electrical injuries is lesterol levels decreased significantly with dramatic resolution of

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fundus changes within 10 days. Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Conclusion: A thorough Ophthalmic evaluation of all patients of primary and secondary hyperlipoproteinemia must be done as Abstract: Oculomotor nerve palsy may be congenital or ac- persistent lipaemia retinalis can lead to massive irreversible lipid quired, complete or partial, pupil-involving or pupil-sparing, iso- exudation causing visual deterioration. Also patient with lipaemia lated or accompanied by signs of extensive neurological involve- retinalis along with eruptive xanthoma should undergo complete ment. Precise knowledge of its origin & course from nuclear level systemic evaluation for detection of underlying conditions like to terminal muscles along with accompanying clinical features pancreatitis, heart disease and other manifestation of atherosclero- helps in localising the site of involvement & thus appropriate sis which can be fatal. management. The oculomotor nerve originates from the third nerve nucleus at OPHP1 the level of the superior colliculus in the midbrain, ventral to the To Report a Case Osteopetrosis, a Rare cerebral aqueduct, then passes through the red nucleus, substantia nigra & exits through the interpeduncular fossa to enter the orbit Genetic Disorder with Ocular Manifestations through superior orbital fissure. Pooja Mehta* and Harsha Pagad Congenital Third Nerve Palsy is rare, & most commonly occurs Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi due to lesions of the nerve & rarely due to hypoplasia of the ocu- Mumbai, Maharashtra, India. lomotor nucleus. *Corresponding author Email: [email protected] We present here a case report of a 10days old child referred to our Abstract: 17-year-old male presented with a history of progres- center i/v/o Right eye appearing smaller than the Left. The birth sive visual loss with left eye squinting. On examination, BCVA history of the child was FTND with LBW of 1.4kg. was 6/60 in the right eye and finger counting to 2 meters in the Investigation with MRI brain showed Right Hypoplastic Oculo- left eye. Anterior segment examination was normal. Fundoscopy motor Nerve. revealed disc pallor in both the eyes A CT-Brain and Orbit (plain) confirmed are findings suggestive of oseteopetrosis. It is important to recognise & diagnose this condition as timely & appropriate treatment can be initiated so as to prevent amblyopia. In osteopetrosis there is a dysfunction in or lack of osteoclasts Detailed neurological check up is mandatory in such cases as to resulting in an increase in bone mass. Visual loss occurs because diagnose other neurological deficits. of optic nerve compression and more rarely retinal dysfunction. Playing a pivotal role in the diagnosis of rare systemic conditions. OPHP4

OPHP2 To Report a Case of Treacher Collins Syndrome Variant in Pediatric Toxic Amblyopia Ophthalmology O.P.D Pooja Ramnani* and Nita Shanbhag Kshitij S. Tamboli*, Nita Shanghag and Harsha Pagad Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi Mumbai, Maharashtra, India. Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi *Corresponding author Email: [email protected] Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Abstract: Purpose: To report a case of toxic amblyopia Abstract: The aim was to report a case of suspected treacher Methods: A 33 year old male presented with a history of pro- Collins syndrome variant in pediatric ophthalmology OPD. A 16 gressive visual lossin both eyes. He underwent a full ophthalmic year old male child walked in pediatric ophthalmology O.P.D examination and best-corrected visual acuity (BCVA) was record- with his parents giving complaints of mucoid discharge from right ed. Subsequently, fundus examination and perimetry was also eye on and off regularly since birth. Apart from this complaint of carried out, and they revealed findings suggestive of toxic ambly- hearing loss, breathing difficulties, and speech difficulties were opia. present since birth. Results: BCVA was 6/18 in both eye. Color vision was 12/16 in Clinically downward slanting of both eyes, nebular grade corneal both eyes as tested on ishiara’s chart. Anterior segement examina- opacity in visual axis and adherent leukoma inferiorly in right eye tion was normal. Fundoscopy revealed temporal disc pallor in was noted. both the eyes. From the history and clinical evaluation along with the opinion of Conclusion: In toxic amblyopia there is visual impairment due E.N.T, Medicine AND Oral Facio Maxillary department a provi- to increased cyanide in the blood and decreased vitamin B 12 sional diagnosis of a variant of Treacher Collins Syndrome was which in turn causes degeneration of ganglion cells in the optic made and symptomatically medical and surgical treatment was nerve head. planned. OPHP3 As part of treatment right eye lacrimal sac probing was done, glasses were prescribed using cycloplegic correction. Further he A Rare Case of Congenital Oculomotor was operated for lip scar revision and closure of oronasal fistula Nuclear Palsy procedure. Appropriate medical therapy was also given. All the investigations were sent and patient is to be further evalu- Sandeep Arora* ated for genetic studies as facilities are not available in our hospi- Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi tal.

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Concluding that, Treacher Collins syndrome (TCS) is a disorder ten presents after 4-6 weeks after cataract surgery, but in rare characterized by deformities of the ears, eyes, cheekbones, and cases it can occur months or even years after surgery. IGS, first- chin. The degree to which a person is affected, however, may vary line therapy involves topical combined treatment with a nonsteroi- from mild to severe. Complications may include breathing prob- dal anti-inflammatory agent and a corticosteroid. New technolo- lems, ocular complaints, cleft lip and palate, and hearing loss. gies and improvements in pharmacological agents have made Those affected generally have a normal intelligence. Symptoms in significant improvement in treatment and outcomes for this seri- people with Treacher Collins syndrome vary. Some individuals ous condition. are so mildly affected that they remain undiagnosed, while others have moderate to severe facial involvement and life-threatening OPHP7 airway compromise. Thus, appropriate diagnosis with early inter- vention and a multidisciplinary team approach can symptomati- A Case Report of External Ophthalmomyasis cally make the patient lead a better life. Due to Oestrus ovis Machi Reddy R Sekharreddy* and Venkatesh Sugantharaj OPHP5 Shri Sathya Sai Medical College and Research Institute, A Case Report of Millard-Gubler Syndrome Ammapettai, Tamil Nadu, India. with Ipsilateral Horizontal Gaze Palsy *Corresponding author Email: [email protected] Rohan Dedhia* and Harsha Pagad Abstract: Myasis is a zoonotic infestation of the body with maggots of files. Ophthalmomyasis is an infestation of the eye Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi with larvae. These larvae are released from the wings of the adult Mumbai, Maharashtra, India. female flies. Oestrus ovis commonly called as sheep bot fly *Corresponding author Email: [email protected] breeds in the nasal cavity and paranasal sinuses of the sheep. Abstract: Millard-Gubler Syndrome (MGS) defined as a unilat- Case report: A 20 years old male patient, presented on Mon- eral lesion of the ventrocaudal pons at the level of the facial nerve day morning with ocular irritation, severe discomfort and water- nucleus, may involve the basis pontis and the fascicles of VI. and ing in both eyes since the previous evening. On further question- VII. cranial nerves. MGS leads to abducens nerve paresis and a ing, the patient said he had visited the local meat market on Sun- contralateral hemiparesis that often affects the face, while an ipsi- day morning to some purchases. lateral peripheral facial nerve paresis may also occur when the lesion extends sufficiently laterally to damage the fascicle of the On slit lamp examination: Eyelids appear swollen with mild facial nerve. congestion in bulbar and palpebral conjunctiva. Cornea appeared clear. A creepy sight of multiple small larvae crawling upon pa- Though rare, it is possible for a patient with Millard Gubler syn- tient’s bulbar conjunctiva was noticed. The larval motility in- drome to present with Horizontal gaze palsy in the event that the creased on throwing light. These larval forms were removed with PPRF is involved. The PPRF is a collection of cells lying in the forceps and killed on exposure to 100% alcohol solution. The pons adjacent to the nucleus of cranial nerve VI, and is an im- patient was instructed to follow up for 5 days. The patient was put portant center for horizontal gaze. Efferent fibers from the PPRF on topical antibiotic and anti-inflammatory. A research study of project to the ipsilateral abducens (VI) nucleus, and to the contra- literature found the fact. lateral oculomotor (III) nucleus through the MLF, stimulating both eyes to move horizontally. Depending upon the structures OPHP8 involved, their respective ocular manifestations may help in local- ising the site of infarction in patients with stroke. Leber’s Congenital Amaurosis We present here a case report of a patient who was referred to us Vaidehi Sathaye* by the In-Hospital medicine department with history of Left sided gaze palsy with Right sided hemiparesis since the previous night. Dr. D.Y. Patil Medical College and Research Centre, Nerul, Navi Since the involvement of PPRF and the Corticospinal tract is not Mumbai, Maharashtra, India. seen often, it is important to identify this association as a type of *Corresponding author Email: [email protected] MGS and advise urgent imaging of the brain and neurological Abstract: Leber’s Congenital Amaurosis is an extremely rare work up so as to initiate appropriate and timely treatment. eye disorder due to a defective gene that affects the retina in the eye. It presents at a very early age, often times a few months after OPHP6 birth,with symptoms of reduced vision or even blindness. Irvine-Gass Syndrome It’s inherited as an autosomal recessive condition. Both parents of Anusha Dhiman* the affected child carry one copy of the defective gene and one normal copy. Children of such parents have a 25% probability of K. J. Somaiya Hospital, Sion, Mumbai, Maharashtra, India. having the condition. *Corresponding author Email: [email protected] Affected infants show symptoms like very poor vision, often be- Abstract: The post-surgical macular edema is one of the most ing able to perceive only hand movements. important causes of suboptimal visual acuity that can occur after Other symptoms include nystagmus, frequent rubbing of the eyes, any intraocular surgery, namely cataract surgery. It is also called keratoconus, enophthalmos, photophobia and cataracts. Irvine-Gass Syndrome (IGS). It was first described by Irvine in 1953 and later defined by Gass. With the recent technological We present here a case of Leber’s Congenital Amaurosis in a 10 advances, as the optical coherence tomography lead to the detec- year old female child who presented to our outpatient department tion of much more cases of Irvine Gass Syndrome. IGS most of- with complaints of reduced vision since birth. Her visual acuity in

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both eyes was reduced to perceiving only hand movements, with Abstract: Introduction: Dacryocystocele refers to diffuse en- Perception of light and accurate projection of rays. She also had largement of the lacrimal sac resulting from combined proximal & enophthalmos, nystagmus and oculodigital sign. She was advised distal obstructions in the tear drainage system. Here we report a an ERG, which revealed diminished response in both eyes. A case of giant dacryocystopyomucocoele in 42 year male. diagnosis of LCA was made. Once LCA is diagnosed, genetic counselling is recommended for the family and the patient as it is Case: 42- yr male, came with history of progressive swelling in right lacrimal sac region since last 1 year. He had history of multi- an autosomal recessive condition. ple similar episodes of painless increase in size of swelling in the OPHP9 past followed by spontaneous rupture and some reduction in size. On examination a 5*5*4cm fluctuant, non tender swelling in right Management of a Case of Ocular Surface lacrimal sac region, with single pus point was noted. There was no Squamous Neoplasia (OSSN) erythema, induration of overlying stretched skin. CT scan orbit plain and contrast showed a well defined cystic lesion 3.3*3*3.4 Tanvi Khosla* and Kishor P. Badhe cm (AP *ML*SI) in inferomedial aspect of right orbit with homo- geneously enhancing wall, connected to nasolacrimal duct, with- Department of Ophthalmology, Pravara Institute of Medical Sci- out invasion into adjacent sinuses or associated bone destruction. ences, Loni, Maharashtra, India. Diagnosis of right sided giant dacryocystopyomucocoele was *Corresponding author Email: [email protected] established. Cyst excision was performed under infiltration anaes- Abstract: Introduction: OSSN is a broad term coined by Lee thesia & short sedation. Histopathology revealed cyst lined by and Hirst which includes precancerous and cancerous epithelial hyperplastic stratified squamous epithelium with focal denuda- lesions of conjunctiva and cornea. Morphologically it is of three tion. Subepithelium showed dense lymphoid cell infiltration with types-placoid, nodular and diffuse. Role of sunlight exposure is a few neutrophils in fibrocollagenous tissue and normal muscle major etiological risk factor. UV –B causes pyrimidine dimer tissue. Pus from cyst on gram stain revealed occasional gram posi- formation, hampering DNA repair. tive cocci and gram negative bacilli. Pus culture grew Klebsiella. Wound healed well, and the patient was continued on intravenous Case Report: A 54 yr old male came to ophthalmology OPD, amoxicillin and clavulanic acid twice a day for 5 days in addition with a mass at limbus in left eye since four months which was to oral NSAIDs with chymotrypsin and serratiopeptidase with gradually increasing in size and was painless in nature. Patient local application of betadine ointment over the wound. 6 months was a farmer by occupation. He gave no history of seropositivity follow up shows no recurrence as yet. or viral infection. On local examination patient had a 4mmx5mm well circumscribed, fleshy, sessile, elevated focal mass at limbus Conclusion: Dacryocystopyomucocoele must be differentiated in the interpalpebral area in temporal part of left eye. Rest anterior from dacryocystitis, diverticula, malformations & neoplasms. segment examination was within normal limits. Dilated fundus Surgical options include drainage followed by external or endo- examination was also within normal limits. Ocular movements in scopic dacryocystorhinostomy, or dacryocystectomy. Due to rari- the affected eye were within normal limit. Serology report was ty of adult cases, there is no consensus to the best surgical ap- negative. B scan of the patient showed no posterior segment pa- proach. thology. Anterior segment OCT showed epithelial thickening. < Provisional diagnosis from all above findings was given as ocular OPHP11 surface squamous neoplasia. Sub-Periosteal Haematoma of the Orbit Management: The entire mass was excised surgically and sent Vaidehi Bhatt*, Rohit Tiwari, Rakesh Barot, Pooja Jain and for histopathology. Keratectomy was done to clear the part en- Tejasvi Poojari croaching corneal surface. Cryoablation of bleeding vessels was done. A supero-temporal conjunctival autograft taken from the Chhatrapati Shivaji Maharaj Hospital & Rajiv Gandhi Medical same eye was placed on the bare sclera created after excision of College, Kalva, Thane, Maharashtra, India. the limbal mass. Post operatively local antibiotic, steroid and lu- *Corresponding author Email: [email protected] bricating eye drops were started. On histopathology the mass was Abstract: Here we report a case of sub periosteal hematoma diagnosed as squamous cell carcinoma. Consequently, patient was started on mitomycin C regime with weekly off as per existing of right eye in a 7 year old boy. protocols. A 7 year old boy presented with right eyeball protrusion, pain, Discussion: Histopathology is the gold standard for diagnosis double vision since 3 days. Patient had history of fall while walk- of OSSN. It helps in differentiating dysplasia, carcinoma in situ ing which was trivial in nature leading to blunt trauma to super- and Squamous cell carcinoma to prognosticate local tumour recur- onasal aspect of right eye. Patient's mother noticed forward pro- rence and metastasis. trusion of right eye ball on the very next day. Patient had right eye eccentric proptosis with supraorbital fullness OPHP10 in superomedial aspect. EOM in right eye showed marked re- Adult Giant Dacryocystopyomucocoele: striction of elevation in primary gaze and abduction. Visual acuity in right eye was 6/24 & left eye was 6/6. Anterior segment and A Rare Case Report fundus was normal. CT scan of brain and orbit was done which Ashishkumar Changbhale*, Pooja Jain, Rakesh Barot and showed a hypodense lesion of 3×2×1 cm in superior quadrant of Arun Mane right orbit pushing the globe down and out which was suggestive of post traumatic subperiosteal hematoma. Steroid pulse therapy Department of Ophthalmology, Rajeev Gandhi Medical College, (Inj dexamethasone 3mg BD for 2 days which was converted to Kalwa, Thane, Maharashtra, India. oral steroid – tab wysolone 1mg/kg body weight which was ta- *Corresponding author Email: [email protected] pered every 4 days) under antibiotic cover was given. Patient

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responded well to treatment. Proptosis resolved, EOM improved The HFA 24-4 was normal.she visited us in 2016 and had serial with mild restriction of movement in upward gazes. Patient is still printouts showing non progression. This paper deals with the pre- under follow up. perimetric Glaucoma and the curious Diagnosis which was even- tually established in this patient. Here we report a case of sub periosteal hematoma of right eye in a 7 year old boy. OPHP13 A 7 year old boy presented with right eyeball protrusion, pain, Post Traumatic Skin Grafting double vision since 3 days. Patient had history of fall while walk- ing which was trivial in nature leading to blunt trauma to super- Priyanka Khade* and Akash Shah onasal aspect of right eye. Patient's mother noticed forward pro- Chhatrapati Shivaji Maharaj Hospital & Rajiv Gandhi Medical trusion of right eye ball on the very next day. College, Kalva, Thane, Maharashtra, India. Patient had right eye eccentric proptosis with supraorbital fullness *Corresponding author Email: [email protected] in superomedial aspect. EOM in right eye showed marked re- Abstract: Introduction: Skin grafting is one of the most indis- striction of elevation in primary gaze and abduction. Visual acuity pensible technique in plastic surgery and dermatology. Indications in right eye was 6/24 & left eye was 6/6. Anterior segment and for full thickness skin grafting in ophthalmology are reconstruc- fundus was normal. CT scan of brain and orbit was done which tion surgeries in conditions like congenital anomalies, trauma and showed a hypodense lesion of 3×2×1 cm in superior quadrant of post excision of neoplasm. The reconstruction should be based on right orbit pushing the globe down and out which was suggestive both functional and cosmetic aspects. We got two cases who re- of post traumatic subperiosteal hematoma. Steroid pulse therapy quired skin grafting post trauma to upper eyelids. (Inj dexamethasone 3mg BD for 2 days which was converted to oral steroid – tab wysolone 1mg/kg body weight which was ta- Case 1: A 52 yrs old female came with history of blackish dis- pered every 4 days) under antibiotic cover was given. Patient colouration of right upper eyelid following trauma by bamboo responded well to treatment. Proptosis resolved, EOM improved stick 4days back. On examination there was necrosis of upper with mild restriction of movement in upward gazes. Patient is still eyelid measuring around 2*1.5cm in the centre. Hard in consisten- under follow up. cy and non tender. Here we report a case of sub periosteal hematoma of right eye in a The necrotic tissue was removed under local anaesthesia. There 7 year old boy. was defect of around 2*1.5cm exposing tarsal plate on upper eye- A 7 year old boy presented with right eyeball protrusion, pain, lid. As the raw area had pale pink granulation tissue which was double vision since 3 days. Patient had history of fall while walk- not healthy for healing and as defect was large we decided to go ing which was trivial in nature leading to blunt trauma to super- for skin grafting. Full thickness skin graft of size 2*1.5mm taken onasal aspect of right eye. Patient's mother noticed forward pro- from postauricular region and grafted over defect. Sutures were trusion of right eye ball on the very next day. taken with 5-0silk. Dressing was done with sofra tulle. After 3days. Graft was healthy, in place and well approximated. Patient had right eye eccentric proptosis with supraorbital fullness in superomedial aspect. EOM in right eye showed marked re- Case 2: A 27yrs old male came with history of trauma to right striction of elevation in primary gaze and abduction. Visual acuity eye upper lid. On examination right eye upper lid full thickness in right eye was 6/24 & left eye was 6/6. Anterior segment and tear with tissue loss, with 1.7mm at lid margin. It could not be fundus was normal. CT scan of brain and orbit was done which approximated with primary suturing. 1.7mm full thickness skin showed a hypodense lesion of 3×2×1 cm in superior quadrant of graft taken from postauricular region and grafted over defect and right orbit pushing the globe down and out which was suggestive sutured with 5-0 vicryl. Sofra tulle dressing done. After 3days of post traumatic subperiosteal hematoma. Steroid pulse therapy wound was healthy and well approximated. (Inj dexamethasone 3mg BD for 2 days which was converted to Conclusion: So with the early intervention and skin grafting oral steroid – tab wysolone 1mg/kg body weight which was ta- we could achieve better healing of the wound and cosmetic ap- pered every 4 days) under antibiotic cover was given. Patient pearance of the eye lid. responded well to treatment. Proptosis resolved, EOM improved with mild restriction of movement in upward gazes. Patient is still OPHP14 under follow up. Various Clinical Presentations of Nystagmus OPHP12 Jagruti Jain* and Prashant Purkar Many a Slip between the Cup and The Drop: A Case of Misdiagnosed Glaucoma Department of Medicine, Dr. DY Patil Medical College and Hos- pital, Nerul, Navi Mumbai, Maharashtra, India. Mavnika Boopalan* and Venkatesh S. *Corresponding author Email: [email protected] Department of Ophthalmology, Shri Sathya Sai Medical College Abstract: Introduction: Nystagmus is a rhythmic regular os- and Res Institute, Nellikuppam, Tamil Nadu, India. cillation of the eyes. In this case series, we present four cases who *Corresponding author Email: [email protected] presented to the emergency department different clinical com- plaints and had nystagmus on examination. Abstract: A 40years old anglo- indian lady visited us for a rou- tine glaucoma check-up. History revealed that she was on latono- Methodology: The patients presented to the D.Y. Patil Medi- prost eyedrops in her right eye for the past 10 years. She had re- cal College & Hospital, Navi Mumbai, India with varied clinical ports dating back to 2004 showing a focal notching of the disc and presentations and on ophthalmologic examination had nystagmus. a Corresponding wedge defect in The RNFI, which corresponded The data presented in this article were obtained from the retro- to A defect in the oCT RNFL printouts and the GDx printouts. spective review of the medical records of the patient.

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Results: One patient, recently diagnosed with seizure disor- Sachin Kale, Gaurav Kanade, Adnan Asif and der, presented with decreased vision and slurred speech. Horizon- Govind Baranwal tal nystagmus with fast component to the left was observed on ophthalmologic examination and serum phenytoin levels were Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- more than 40 µg/ml. Final diagnosis of phenytoin toxicity was bai, Maharashtra, India. made. One hypertensive patient with giddiness and loss of balance *Corresponding author Email: [email protected] presented with blood pressure of 170/100 mm Hg. Vertical nys- Abstract: Introduction: Medial malleolar fractures of ankle tagmus with positive Romberg sign was noted. Magnetic Reso- being intra articular, are one of the significant lower extremity nance Imaging (MRI) revealed an infarct on the right hemi-pons. fractures. Open reduction and internal fixation have become the Another patient with no significant past medical history presented main stay of treatment for most of the medial malleolar fractures with headache, slurred speech and blurred vision. Horizontal nys- as it restores the anatomy, biomechanics and contact loading char- tagmus and impaired cerebellar signs were noted. MRI revealed acteristics of the ankle. an infarct in the right middle cerebellar peduncle. Last patient with history of hypertension had ptosis, opthalmoplegia and verti- Aims and Objectives: To compare the merits and demerits, cal nystagmus, who had an ischemic stroke of ventromedial por- functional outcomes and complications involved in treating medi- tion of bilateral thalami and peri-aqueductal grey matter. al malleolar fractures with open reduction internal fixation with tension band wiring and 4mm cannulated cancellous screws. Conclusions: Nystagmus can present with various clinical conditions. Eliciting relevant past medical history, understanding Materials and Methods: In this study total 40 cases of medial present illness in detail and correlating with laboratory and imag- malleolar fractures were included. 20 cases were operated with ing studies is necessary to make a correct and timely diagnosis. open reduction internal fixation with tension band wiring and 20 cases were operated with open reduction internal fixation with OPHP15 4mm cannulated cancellous screws. Patients were followed up at regular intervals and functional and radiological outcomes were Penetrating Ocular Fish Hook Injury: A Rare evaluated in all patients. Case Report Results: Out of 20 patients treated with open reduction inter- Sujay Herekar*, Rakesh Barot and Tejaswi Pujari nal fixation with tension band wiring, 8(40%) had excellent result, 11(55%) had good and 1(5%) had fair result. And in 20 patients Department of Ophthalmology, Rajeev Gandhi Medical College, treated with open reduction internal fixation with 4mm cannulated Kalwa, Thane, Maharashtra, India. cancellous screws, 4(20%) had excellent, 9(45%) had good and 7 *Corresponding author Email: [email protected] (35%) had fair results. Assessment of the outcome was done using Abstract: Introduction: Ocular penetrating fish hook injuries the scoring system of Baird and Jackson which is based on subjec- represent a rare but devastating form of ocular trauma. We report tive, objective and radiological criteria. Patients treated with ten- a case of ocular penetrating trauma in a 50 year old male due to sion band wiring showed better outcome as compared with other fish hook injury and its emergency management. group. There were no intra operative complications. The postoper- ative complications were skin infection seen in five patients which Case: A 50-year-old male presented to our casualty department healed with proper management. with a fish hook embedded in his right eye. The patient sustained the injury while fishing when he tried to retrieve the fish hook Conclusions: Tension band wiring ensured biomechanically which was stuck in the sand of the riverbank. The fish hook had stronger and more rigid fixation and it allowed for early mobiliza- obliquely penetrated the cornea at the 4’o clock position. The fish tion. Also, fracture union was seen earlier in tension band wiring hook was removed from the right eye in the operation theater by group as compared to cannulated cancellous screws group. Open employing the cut it out technique in which the entry wound was reduction and internal fixation with tension band wiring remains the mainstay of treatment showing better functional and radiologi- increased in size by using a scalpel blade followed by retrieval of cal outcomes as compared to open reduction and internal fixation the fish hook by the back out technique. The corneal wound was with cannulated cancellous screws. well approximated with 10’0 ethilon sutures. Post-operatively he was started on intensive systemic and topical antibiotics along with topical steroids. The patient later developed traumatic cata- ORTO2 ract for which he was advised cataract surgery. Assessment of the Utility of Scanograms in Conclusion: Prompt initial surgical intervention along with Primary Total Knee Arthroplasty regular follow up of the patient as in our case is essential to re- Adnan Asif* and Sachin Kale duce complications like endophthalmitis which are common with such injuries. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. ORTO1 *Corresponding author Email: [email protected] A Prospective Comparative Study of Abstract: Background and objectives: Technological advance- ments in the field of knee arthroplasty is leading to an increased Outcomes of Medial Malleolar Fractures number of surgeries being performed every year. This upward Operated with Open Reduction Internal trend is due to the aim of the operating orthopaedicians to achieve Fixation with Tension Band Wiring and 4mm the most accurate limb alignment to thereby deliver improved functional outcome. Pre-operative assessment of limb alignment Cannulated Cancellous Screws is done by two modalities commonly, scanograms and conven- Shouryashil V. Khambalkar*, Vaibhav Koli, P.D. Samant, tional radiographs. The current study was hence designed to eval-

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uate, validate and compare these pre-operative assessment tech- Chirag Manwani1*, Avinash Date2, and Vinay Patel2 niques in terms of their post-operative outcomes. Post-operative 1 outcomes were assessed in different dimensions, namely post- Department of Orthopaedics, V.N. Desai Municipal General Hospital, Santacruz East, Mumbai, Maharashtra, India. operatively achieved limb alignment was analyzed using scano- 2 grams and the functional outcomes using specific outcome tools - Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, WOMAC score and Oxford Knee score. India. *Corresponding author Email: [email protected] Methods: A total of 24 subjects (47 knees) were enrolled in the study as per the inclusion and exclusion criteria. Abstract: Tension band wiring – a technique which has been used since generations to fix the commonly encountered fractures Results: The results obtained from our study indicate that such as patella, medial malleolus, olecranon etc. The results of despite better neutral alignment was achieved by the use scano- using the tension band principle have been good but we are now grams, it did not provide any significant improvement in the func- realizing that the complication rate is also noticeably high most tional outcome of our subjects. troublesome of which is prominent hardware with incidence rate from 18-80%. The trends in the last decade have shown a gradual Interpretation and Conclusion: The use of scanograms pre- transition of fixing fractures using alternative techniques to mini- operatively has little practical value and is an additional cost mize the complications associated with tension band wiring. borne by the patient. Larger scale, organized and sophisticated research needs to be done on the same, to enable its application in Objectives: Here we present a case series of 5 patients with orthopedic surgery. Patella fracture treated by using a predesigned locking plate (Arthrex) for fixation. The aim was to evaluate the functional ORTO3 outcome and complication rate of using a locking plate in place of Clinical Outcome in Metaphyseal Locking tension band wiring for the management of patella fractures. Plate Fixation of Distal Femur and Proximal Materials and methods: The locking patella plate is available Tibia in two designs which are anatomically shaped with added benefit of having suture holes for fixation of soft tissues to the plate. Post- Bhushankumar Pawar*, Prakash Samant, Sachin Kale, operatively, knee was immobilised in extension for 2weeks. Pa- Sandeep Deore, Gaurav Kanade and Vaibhav Koli tients were mobilized by weight bearing as tolerated immediately post surgery. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Results: Five patients were included in the study with follow- *Corresponding author Email: [email protected] up of 18months. All 5 patients have full range of motion and no revision surgeries were needed Abstract: Introduction: Fracture of distal femur and proximal tibial are often difficult to treat and associated with many compli- Conclusion: Inspite of the high complication rate, the com- cations. We aimed to assess the clinical and radiological union monly used method for treatment of patella fractures still include time and functional outcome in fractures of distal femur and prox- tension band/cerclage wiring. These plates can provide us with imal tibia managed by metaphyseal locking plates and to study the advantages like less soft tissue irritation, anatomical reduction and complications associated with it. a higher mechanical stability. The findings suggest that fixation of patella fractures with anatomical locking plating is clinically ap- Methodology: This prospective study was conducted in the plicable with good early outcomes. However, more research needs Department of Orthopedics, Dr. D Y Patil Medical College, Hos- to be conducted to assess midterm and long term results and also pital and Research Centre, Nerul, Navi Mumbai, using a consecu- analyze the complications we can expect in the future. tive sample of 50 patients fulfilling our study eligibility. Detailed clinical history of the patients and operative details were noted. ORTO5 All patients were followed up at 3 and 6 months, and were as- sessed for pain, range of movement (ROM), functional outcomes, Halo Vest in Cervical Spine Disorders - A union times and complications. Simple Yet Effective Device Results: Distal femur fracture were seen in 42% cases (most common type A2) while proximal tibia fractures were seen in Rohan B. Gala*, Saumyajit Basu, A. Biswas, Somashekhar 58% cases (most common type II). 28.6% patients showed frac- and Naveen Agarwal ture union by 5 months, 85.74% showed union by 6 months. Park Clinic, Kolkata, West Bengal, India. Complaint of pain at 3 months was given by 22% cases and at 6 *Corresponding author Email: [email protected] months by 6% cases. Delayed, mal and non-union were seen in 12%, 4% and 2% of cases respectively. As per the Oxford Knee Abstract: Introduction: Halo vest is a useful tool for a Variety Score, excellent outcome was seen in 86% cases while good and of cervical spine disorders, possibly under-utilised by spine sur- fair outcome was seen in 8% and 6% cases respectively. geons. The purpose of this descriptive study was to evaluate the efficacy of Halo vest in a wide range of cervical disorders. Conclusion: Metaphyseal locking plates is a superior implant for the fractures around knee with an excellent functional out- Materials and methods: This is a single centre retrospective come. study of 30 cases having various cervical spine pathologies treated by Halo Vest from 2010-2017. Data was retrieved using electron- ic medical record system and clinical and radiological images ORTO4 were retrieved using PACS software. Patients were followed up at Tension Band Wiring – Is It an Outdated regular intervals of 1,3,6 and 12 months. Halo was kept for a peri- Technique? od of 8-12 weeks. At subsequent followup all the patients were assessed clinically and radiologically.

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Results: 30 cases with age ranging from 2- 65 years with at Arpit Rajpurohit*, Sachin Kale, Ibad Patel and Sanjay Dhar least 1 year followup were included.14 patients had a traumatic aetiology, 2 were congenital in origin, 5 infective, 1 had primary Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bone tumour and 8 patients underwent post operative halo vest bai, Maharashtra, India. immobilisation for better stabilisation. There was significant im- *Corresponding author Email: [email protected] provement both functionally (VAS, NDI, Frankel/JOA) and radio- Abstract: Objective: To analyse the operative results of ace- logically (healing/fusion), in all patients except one where thera- tabulum fracture with respect to operative technique, clinical and peutic Halo immobilisation had failed. 5 patients had superficial radiological union, time for mobilisation, complications and func- pin tract infection which was managed by oral antibiotics and by tional outcome measured by Merle d’Aubigne score and Harris pin removal/readjustment. None of the cases had pin migration or Hip score at the end of follow up. brain abscess. Materials: 26 patients with acetabulum fracture treated by Summary: Halo Vest is an important tool in a surgeons arma- open reduction and internal fixation were included in the study mentarium due to its wide spectrum of application with minimum and evaluated for 2 years complications and therefore stands out as one of the promising devices in managing cervical disorders. Results: In 14 (70% ) of the patients radiological union was seen in 4-5 months of surgery. Operative outcome of present ORTO6 study as per Merle d’ Aubigne scoring system shows excellent to Comparing of Treatment Outcomes of good result in 17 (85%) of patients and fair to poor result in 3 (15%) of patients. In the present study 18 (90%) patients had flex- Intraarticular Fracture of Calcaneum with ion of more than 90 degrees and 15 (75%) patients had extension Steinmann Pin (K Wire) and Plating of more than 10 degrees. Abduction and adduction of more than 20 degrees and more than 10 degrees was seen in 17 and 18 pa- Suraj Sharma*, Prakash Samant, Sachin Kale, tients respectively. The internal and external rotation was more Sandeep Deore and Gaurav Kanade than 15 degrees in 14 and 15 patients respectively. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. ORTO8 *Corresponding author Email: [email protected] Osteochondroma of the Distal Tibia Inducing Abstract: Introduction: Calcaneal fractures usually occur by Deformity and Stress Fracture of the Fibula a fall from height when one lands on their feet. In this study we aimed to compare the functional outcome and radiological find- Mohit Thapa Magar* and Chander Mohan Singh ings after treatment by steinmen pin (K-wire) and by plating Department of Orthopaedics, Armed Forces Medical College, method. Pune, Maharashtra, India. Methodology: We designed a prospective study of all patients *Corresponding author Email: [email protected] who were admitted and operated for calcaneum fractures in the Abstract: Osteochondromas seldom arise from the interosse- Department of Orthopedics, Padmashree Dr. D. Y, Patil Medical ous border of the distal tibia and may progress to involve the dis- College, Hospital & Research Centre, Navi Mumbai. Of the 30 tal fibula. We present the case of a 14 year old teenager with a cases, half received treatment with K-wire and the other half of stress fracture of the distal fibula, secondary to an osteochondro- the patients underwent plating. Baseline characteristics, pre- and ma arising from the distal tibia. Early excision of this deforming post-operative Bohler’s and Gissane’s angles and complications distal tibial osteochondroma was necessary in order to avoid a were noted for all patients. Functional outcome was assessed us- progressive deformity which would affect the biomechanics of the ing the American Orthopaedic Foot and Ankle Society (AOFAS). ankle joint resulting in gait disturbances Results: Bohler’s angle increased significantly postoperatively (p<0.05) for both the group of patients. Similarly Gissane’s angle ORTO9 decreased in the postoperative period significantly (p<0.05). Of the patients who received K-wire, 5 patients (34%) had excellent Cage Vs Autologous Bone Grafting in PLIF outcome, 6 patients (40%) had good outcome, 2 patients (13%) Surgery for Spine Fusion - Randomized had fair outcome while 2 patients (13%) had poor outcome. For Control Trial the patients who underwent plating procedure, 7 patients (47%) had excellent outcome, 6 patients (40%) had good outcome while Mainak Gupta*, Prakash Samant, Sachin Kale, 2 patients (13%) had fair outcome. In the group which received Sandeep Deore, Gaurav Kanade and Vaibhav Koli Kwire treatment, 5 out of 15 patients developed heel pain while 3 patients had subtalar and ankle stiffness. In the group which un- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- derwent plating, 2 out of 15 patients got wound infection while 1 bai, Maharashtra, India. had subtalar and ankle stiffness. *Corresponding author Email: [email protected] Conclusion: Cannulated screw and plate fixation have similar Abstract: Introduction: Posterior lumbar interbody fusion clinical outcomes. Future studies are needed to support our find- (PLIF) is been used increasingly for degenerative lumbar spine ings. disease to achieve a 360 degree fusion. With the advent of newer techniques and instrumentations the results are good.

ORTO7 Aim: To study the outcome of PLIF with cages and that with A Two Year Follow Up Study of Operative bone graft for degenerative Lumbar spinal canal stenosis. Results of Fractures of Acetabulum Material and Methods: We did a double blinded randomized

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controlled trial at single center. All patients who met with our when meniscus is excised as compared to meniscal repair. The inclusion criteria and operated from 2007 to 2010 were included anterior tibial translation remains higher when meniscus is ex- in our study. The patients were followed up serially for 5 years for cised during ACL reconstruction, though short term functional the final outcome. Modified Oswestry low back score and final results are same. CT scan based interpretations were applied.

Results: Totally 101 patients were included in the study of ORTO11 which 53 underwent PLIF with titanium cage and rest 48 under- Management of Fractures of Distal Third went PLIF with bone grafting. We found the results of union rates in both the groups were gratifying, but early and better results Tibia by Interlock Nailing with fewer complications were in group with titanium cages. Amit Chugh*, Prakash Samant, Sunil Shetty, Amit Dhond Conclusion: We fairly conclude that better and faster fusion and Sachin Kale rates with good ambulation can be achieved with titanium cages Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- rather than bone grafting in degenerative lumbar spine disease. bai, Maharashtra, India. ORTO10 *Corresponding author Email: [email protected] Influence of Meniscal Repair Versus Abstract: Introduction: Most of the distal third tibia is subcu- taneous and has precarious blood supply. Fractures of the distal Meniscectomy on ACL Reconstruction in third tibia have comminution at the fracture site, as it is metaph- Terms of Knee Stability and Radiological yseal cancellous bone with a thin shell of cortex, and have associ- Imaging ated significant soft tissue injury. Generally, skin condition is not satisfactory due to ecchymosis, blebs, swellings, wounds, etc. All Varun Agarwal*, Prakash Samant, Sandeep Deore, these factors contribute to delayed union, nonunion, and malu- Sachin Kale, Gaurav Kanade and Vaibhav Koli nion. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- The present study is about the ability to maintain a mechanically bai, Maharashtra, India. stable reduction in the distal third tibia with intramedullary nail. *Corresponding author Email: [email protected] Materials and methods: 50 patients of distal tibia fracture Abstract: Introduction: Meniscectomy has been shown to admitted to Dr. DY Patil Hospital, Navi Mumbai were operated have detrimental effects on knee in terms of increased contact and followed up prospectively. pressure in femoral and tibial condyles, rotary instability and early Results: Mean age of patients was 35 years (25–50). Fracture changes of osteoarthritis. These changes are exaggerated in ACL union was seen radiologically within 3 to 4 months, depending on deficient knees. Patients present to the surgeon at different times fracture geometry. after injury ranging from 3 weeks to one year. Depending upon status of meniscal tears and its reparability at the time of surgery, Conclusion: We conclude that results of fractures of distal surgeon has to choose between meniscectomy and meniscus re- third tibia not extending into lower 4 cm of tibia treated with in- pair during ACL reconstruction. We tried to compare meniscus terlock nailing were found satisfactory. Meticulous planning and repair and meniscectomy in terms of knee stability and radiologi- placement of nail at the center of a wide metaphysis in the antero- cal tunnel widening after ACL reconstruction in short term follow posterior and lateral is mandatory to avoid varus, valgus, and up. posterior tilt. Polar screw or temporary K-wire during surgery is very helpful. Same-level fibula fracture fixation with a plate or Methodology: Thirty patients who underwent ACL recon- square nail is very effective for stability of reduction. struction were selected after going through selection criteria, were divided between meniscus repair group and meniscus excision group. Meniscus tears, which were in the red red zone were re- ORTO12 paired with inside out, all inside and outside in methods, depend- Relative Regenerate Strength ing upon their location from anterior to posterior zones. Those tears which presented late were irreducible, avascular and became Soham Chaudhary* loose body scuffing articular cartilage, were excised with shaver. All patients underwent standard ACL reconstruction with ham- Dr. D.Y. Patil Medical College and Hospital, School of Medicine, string graft. Patients were evaluated clinically and radiologically Nerul, Navi Mumbai, Maharashtra, India. at 3 months 6 months and 12 months. *Corresponding author Email: [email protected] Results: Group 1 had 14 patients who underwent meniscus Abstract: Aims: To use Pixel Value Ratio of regenerate and repair and group 2 had 16 patients who underwent meniscectomy normal bones to determine an ideal ratio to determine removal of during ACL reconstruction. Evaluation with Lachman’s test external fixation devices in lengthening. showed that, 14% patients (2 out of 14) from Group 1 had grade 2 Patients and methods: We measured the xrays of 127 femur & Lachman test. Thirty seven % of group 2 had grade 2 Lachman tibiae in 89 patients at end of distraction and end of consolidation test though the difference was not significant (p = 0.151). Tibial phases. The Pixel value ratio was measured by the open source tunnel diameter in meniscectomy group increased from 8 mm to software ImageJ (NIH, Bethesda Md. USA) A region of interest is 11.86mm (S.D= 1.11.) at 12 months. Tibial diameter in group 2 chosen which excludes any metallic shadows in AP & LAT xrays increased from 8 mm to 12.28 mm (S.D. = 1.52), (p= 0.394). and mean pixel value ratio is calculated by software (MS Excel, Conclusion: Whenever ACL tear is associated with medial or Redmond Wa. USA). It is multiplied with width of the new bone lateral meniscal tears, meniscal repair is the preferred treatment to give a product. At end of distraction phase the mean PVR was over meniscectomy. The amount of tunnel widening is higher 0.87 (range 0.46 -1.36). Mean PVR at time of fixator removal was

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1.05(range 0.6 -1.5). These measurements were made at two inter- ORTO15 vals. Intra-Observer variation measured by ICC (IntraClass Core- lation Coefficient) was 0.85 and 0.86 at the two phases. None of Results of Modular Megaprosthetic the bones had a refracture or bending in this series. Reconstruction of Tumors Involving the Distal Conclusion: The Pixel Value Ratio of nor mal to new regener- Third Femur: A Case Series ate bone should be 0.8 at end of distraction and at least 1.0 at end Rajiv Kaul* and Yogesh Sharma of consolidation for safe removal of external fixation. This is an objective measurement to help decide time of removal of fixator Department of Orthopaedics, Armed Forces Medical College, device. Pune, Maharashtra, India. *Corresponding author Email: [email protected] ORTO13 Abstract: Introduction: Limb salvage surgery for tumorous By-Passing the Perfect Circle Method of conditions has now evolved as the preferred treatment in most Femoral Distal Interlocking Screw Insertion centers. Our preferred option following resection of tumors, is the use of a modular prosthesis, i.e., standard-sized components with (DISI) in Interlocking Nailing – A Technical varying lengths according to the amount of bone resected. We Note and Retrospective Study treated two patients with tumors of the distal femur by resection and limb salvage with a cemented megaprosthesis (ReStor, AD- Divyesh Bukalsaria*, Sachin Kale, Prakash Samant, LER). Diagnoses included one chondroblastic osteogenic sarcoma Sanjay Dhar and Sandeep Deore and one giant cell tumor (GCT) with a pathological fracture. The mean follow-up was 2 years. The mean postoperative Musculo- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- skeletal Tumor Society (MSTS) score was 24. Neither required a bai, Maharashtra, India. revision or an amputation. The overall incidence of complications *Corresponding author Email: [email protected] was low. Abstract: Interlocking nailing in femoral shaft fractures is a Materials and methods: From 2015 to 2018, two patients, both world wide accepted and practised procedure. One of the main males, one aged 22, with chondroblastic osteogenic sarcoma and step is Distal interlocking screw insertion (DISI). This procedure the other aged 65, with a pathological fracture involving a GCT of requires lot of time and significant x ray exposure. We have de- the distal femur. Both patients had a complete tumor work-up vised a technique to do Distal interlocking with minimal exclusive prior to the surgery. Using a standard midline approach, femoral AP X Rays shoots in a short span of time. We did a retrospective resection was done leaving a 2 cm margin of normal tissue for the study of 27 cases, with a average time of 8.29 minutes and aver- GCT and a wide resection for the osteosarcoma. A cemented age AP x ray shoots of 11.26. modular megaprosthesis was used in both cases. Standard radio- graphs were assessed for follow-up radiolucency, subsidence, or ORTO14 migration of prosthesis. Patients were followed up at 3, 6 12 and Butala Technique: Poglyglactic-Acid Suture 24 months. Repair of Comminuted Patella Fracture Results: The mean score for pain and function was 75% , for support and walking ability 90%, gait 90%, and emotional ac- Rajendraprasad R. Butala*, R.G. Khedekar, Shikhar Singh, ceptance 70% of the normal. The mean flexion was 80° (70°– Saamarthya Gupta, Javed Hussain and Devendra 90°). The extensor lag in one patient was 10°and nil in the second. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Conclusion: Since the incorporation of modern modular meg- bai, Maharashtra, India. aprostheses in tumor surgery, trends have shifted from primary *Corresponding author Email: [email protected] amputation to limb preservation which is currently the gold stand- ard in orthopaedic oncology. Advantages include reconstruction Abstract: Fractures of the patella can be from direct or indi- of large skeletal defects, a high limb salvage rate combined with a rect forces. The subcutaneous position of the patella makes it cosmetically acceptable end result. The functional outcome after susceptible to injury from direct blow, which is more likely to surgery appears to be very satisfactory, offering a good quality of result in the comminution than an indirect pull. The indication for life to the patient. internal fixation is a fracture greater than 2mm of articular dis- placement, 3mm of fragment separation or a comminuted fracture. ORTO16 A fracture is considered comminuted when there are fragments of 4mm in diameter or more that are separated by at least 3mm or To Study the Accuracy of Achieving overriding by at least 2mm. A heavily comminuted fracture or Correction of Varus Deformity at Knee by inability to obtain a precise reduction may require patellectomy. Medial Opening Wedge Osteotomy Using Quadriceps strength is reduced by as much as 49%, if the fracture Modular HTO Fixator in Treating is treated by patellectomy. Thus, the patella provides an important role in extension of the knee and patellar salvage is the rule. Predominantly Medial Compartment Currently, circumferential cerclage stainless steel wiring is the Osteoarthritis of Knee most popular methods for repairing comminuted patellar frac- Kamparsh Thakur* tures, but we encountered many complications with his technique. Consequently, we developed a new technique of fixing patella Armed Forces Medical College, Pune, Maharashtra, India. using a braided absorbable suture instead of a traditional stainless- *Corresponding author Email: [email protected] steel wire. Abstract: Osteoarthritis of knee is one of the most common

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reasons to seek orthopaedic consultation with multiple modalities Atul Jain* and Shikhar Singh for treatment depending on the severity of osteoarthritis. Surgical management of varus degenerative knee in an active individual Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- presents a challenge to the orthopaedic surgeon with option of bai, Maharashtra, India. arthroplasty not suitable for such patients. *Corresponding author Email: [email protected] HTO (High Tibial Osteotomy) is a well-established procedure for Abstract: Introduction: Total knee arthroplasty (TKA) is a treating varus deformity associated with osteoarthritis of knee and commonly used surgical intervention utilized for patients suffer- can be performed by multiple methods – medial opening wedge, ing from arthritis. The present study evaluated the blood loss in lateral closing wedge, dome osteotomy and medial opening Hemi- TKA, with and without pneumatic tourniquet and to assess the callotosis effect of tourniquet release on the overall pain and the functional outcome. A total of 15 patients who met the inclusion criteria and were offered HTO using medial opening hemicallotosis technique with Methodology: This prospective study was conducted from HTO self-aligning external fixator were analysed in terms of the July 2015 till September 2017 in which patients who were admit- correction of the mechanical axis using FTA (Femoro-tibial an- ted for TKA were included. The patients were divided into two gle) and functional improvement in terms of KOOS score at the groups of 30 patients each, one group scheduled to undergo TKA end of 03 and 06 months from end point of correction of deformi- with tourniquet while the other group without tourniquet. Blood ty. loss in the drain, haemoglobin levels, pain (using visual analogue scale) and function outcome using Knee Society Score was noted Conclusion: In present day scenario, HTO using medial open- and compared between the two intervention groups. ing Hemicallotosis is a useful modality in patients with varus degenerative knee and are physiologically active. It helps in sig- Results: Significantly lower blood loss was observed in the nificant improvement in the mechanical axis of lower limb and patients who underwent TKA with tourniquet as compared to functional status of individual who wish to pursue active lifestyle. those who underwent TKA without a tourniquet at the three time points. Between group comparison revealed no significant differ- ORTO17 ence in the haemoglobin levels. Pain score were similar in the patients in the two groups. KSS between the patients in the two Treatment of Complex Proximal Tibia intervention groups was not significantly different at different Fractures Using Ilizarov Technique time points. None of the patients had complication of thromboem- bolism or need for blood transfusion. Ajit Chalak*, Sunil A. Shetty and Amit Chugh Conclusions: Tourniquet resulted in decreased blood loss. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Further randomized, multi-centric studies are required to better bai, Maharashtra, India. understand the role of tourniquet in patients undergoing TKA. *Corresponding author Email: [email protected] ORTO19 Abstract: Background: In proximal tibial fractures, the most frequently used treatment is ORIF with screws and plates. Mini- Diaphyseal Fractures of the Clavicle in Adults, mally-invasive techniques using ilizarov are an alternative. The Comparative Study of LCP (Locking aim of this study was to analyse the clinical, radiological and functional outcome results using the Ilizarov technique in proxi- Compression Plate) Versus Intramedullary mal tibial fractures. Nailing with TENS (Titanium Elastic Nailing Methods: Thirty consecutive patients with isolated fractures System) of the proximal tibia were treated with the Ilizarov technique, 30 Arun H.S., Prabhu E., Sreejith Thampy J. and Schatzker V-VI with 3–4 tibial rings IF UNSTABILITY present then femoral ring was used for 4 weeks. Unrestricted weight- Abhijeet Salunkhe* bearing was allowed. Pre and post-operatively, conventional radi- Department of Orthopaedics, Sri Devaraj Urs Medical College, ographs, post-operative pain assessments and complications were Kolar, Karnataka, India. evaluated. The knee function was evaluated. *Corresponding author Email: [email protected] Results: All the fractures healed. Twenty-seven patients Abstract: Background: Open reduction and internal fixation achieved a range of motion better than 10-100º. The type V-VI with locking compression plate have become the mainstay of fractures had a shorter operating time and hospital stay, as well as treatment for most of the midshaft clavicle fractures, as these better knee flexion, and the self-appraisal indicated that they toler- operative methods restores the anatomy, biomechanics and con- ated the treatment better. Pin infections occurred in 4% of the pin. tact loading characteristics of the clavicle. Intramedullary nailing No patient complained of functional knee instability but poor skin with TENS (Titanium elastic nailing system) has also proved to is a problem in this technique. The overall result was judged as be effective with better cosmetic effect, faster union, and less satisfactory in all patients. operating time. Conclusions: The Ilizarov method produces a good clinical Need for Study: Indication to use LCP or TENS for midshaft outcome and is a valuable treatment alternative in proximal tibial clavicle fractures is still a matter of debate as both have its own fractures of all types. merits and demerits. Hence a study comparing both is required to have an understanding on selection of cases for each procedure. ORTO18 Aims and Objectives of Study: To determine the functional Blood Loss in Total Knee Arthroplasty with outcome using constant scoring system following both plating and and without Tourniquet nailing technique and also to observe the various complications

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arising with both procedures. Minimally Invasive Plate Osteosynthesis Materials & Methods: Study Design: Prospective study; Sam- Anirudh Kumar*, Parmanand Singh, Sanjay Dhar, ple Size: n=80,40 patients LCP fixation and 40 intramedullary Prakash Samant, Sachin Kale and Shikhar Singh nailing; Study Period: June 2016 - December 2018; Study Centre: R.L. Jalappa Hospital, Tamaka, Kolar. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Results: Length of incision, operation time and duration of *Corresponding author Email: [email protected] hospital stay were significantly less for the TENS group. Constant Shoulder scores were higher in the TENS group than the LCP Abstract: Introduction: Unstable fractures of distal tibia with group for the first 2 months but there was no significant difference or without intra-articular extension can present a clinical dilemma. found between the two groups regarding functional and radiologi- Historically, there have been a variety of methods of management cal outcome at 6 months of follow-up. Infection and revision sur- described but with high rates of associated complications. Mini- gery rates were also higher in the plate group. mally Invasive Plate Osteosynthesis (MIPO), has now become more popular with the development of the Locking Compression Conclusion: We can conclude from our study that Titanium Plates. MIPO offers many biological advantages including mini- elastic intramedullary nailing TENS is a safe, minimally invasive mal soft tissue dissection with preservation of vascular integrity of surgical technique with a lower complication rate, faster return to the fracture as well as preserving osteogenic fracture haematoma. daily activities, excellent cosmetic and comparable functional results, and can be used as a better alternative for surgical fixation Materials & Methods: A total of 30 patients with distal tibia of displaced midshaftclavicular fractures in place of current trend fractures (open/closed) were included in the study after informed of locking compression plating. consent. Patients were treated by MIPO with LCP and were pro- spectively followed up. Duration of follow-up ranged from 12–36 ORTO20 weeks. Demographic variables, mode of injury, time required for union, complications and clinical improvement were recorded and Functional Outcome of Posterior Cervical analysed. Microforaminotomy and Discectomy Using Results: Most of the fractures were united by 20th week Mcculloch Retractors for Cervical (80%) with mean union time of 17.9 ± 3.2 weeks. Excellent clini- Radiculopathy cal results with MIPO were observed in 46.7% cases while poor results were obtained in 10% cases. Complications were seen in Chetan Kumawat* and Satyen Mehta 13 subjects (43.3%), of which most common was wound infec- tion, seen in 13.3% of the cases. Delayed union was noted in 1 Department of Orthopaedics, Surana Sethia Hospital, Mumbai, case while no case of non union was observed. Maharashtra, India. *Corresponding author Email: [email protected] Conclusion: MIPO is an effective technique for the manage- ment of distal tibial fractures. It is minimally invasive, though Abstract: Background: Cervical disc herniation and cervical technically demanding, but preserves the biological environment spondylosis are frequently encountered progressive diseases. It by preserving the soft tissue with better outcome in terms of radi- can be done through anterior or posterior approach. Anterior sur- ological union and clinical improvement. geries are most commonly used but complications are more fre- quent with longer stay. Using implants make it costlier. Posterior ORTO22 cervical microforaminotomy using novel posterior approach is newer, easy, duration is short, preserves mobility of the operated Efficacy of Local Infiltration Vs Epidural segments and provides accessibility to one or multiple segments. Analgesia in Total Knee Replacement This prospective study was designed for functional outcome of posterior cervical microforaminotomy. Melanie Gomes* Materials and methods: 31 patients having cervical radicu- Department of Orthopaedics, Father Muller Medical College, lopathy were included in this prospective study. Posterior midline Mangalore, Karnataka, India. incision was used with McCulloch retractors. VAS score was used *Corresponding author Email: [email protected] for radicular pain to evaluate clinical outcomes. Abstract: Total knee arthroplasty is one of the most successful Results and discussion: Out of 31 patients 17 were male and surgical treatments for patients with end-stage osteoarthritis. Pain 14 were female. Mean age was 41.58 years. Most common affect- control and comfort level are linked to earlier mobilization and ed level was C5-6 followed by C6-7. Soft disc and hard disc were initiation of physiotherapy, better range of motion, and improved present in 28 and 3 patients respectively. For radiculopathy post- patient satisfaction. Epidural analgesia (EPA) has been a regular operative VAS score (0.2) was improved in all patients in compar- regimen, postoperatively after TKA. However, some studies have ison with preoperative VAS score (7.7). Posterior cervical lam- indicated that the benefit of epidural analgesia must be weighed inoforaminotomy performed for posterolaterally localized disc against the frequency of its adverse effects. In recent years, there herniation, cervical spondylosis, and intervertebral foramen steno- is a growing interest in the use of local infiltration analgesia (LIA) sis is more economical, involve Less days of hospitalization, safer containing various constituents for postoperative pain control. In to perform, doesn’t involve use of implants and preserves mobili- view of this we conducted this study to evaluate the efficacy of ty of segments. both modalities. Materials: Randomized trial was conducted at Father Muller ORTO21 Medical College Hospital, on a total of 30 patients (local infiltra- tion anesthesia= 15, epidural analgesia= 15) who underwent total Management of Distal Tibia Fracture with knee arthroplasty, between December 2016 and November 2017.

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Adult human subjects prepared for TKA were included, and ran- Abstract: Background: Local antibiotics have a role in ortho- domly split into two groups. Outcomes were assessed on visual pedic trauma for both infection prophylaxis and treatment. The analogue scale (VAS) with rest or mobilization at 12, 24, 48, and primary cause of infection has multiple etiologies, it can arise 72 hours, and the occurrence of nausea. from haematogenous, post-traumatic or post-operative colonisa- tion. Locally applied antiseptics date back to the mid-1800s when Results: 30 patients (LIA = 15, EPA = 15) were included in the Joseph Lister began using carbolic acid as an antiseptic on surgi- study. There was no significant difference between LIA and EPA cal wounds. High concentrations of antibiotics have proven effec- group in terms of the VAS score with rest at 12 and 24 h. LIA was tive against biofilms. They provide the advantage of high local associated with a reduction of the VAS score with rest at 48 and antibiotic concentration without excessive systemic levels. Simple 72 h than EPA (P < 0.05). LIA was associated with an increase of aqueous antibiotic solutions continue to be investigated and ap- the range of motion at 24 and 48 h (P < 0.05). LIA was associated pear to be clinically effective. A paucity of high quality evidence with a reduction of the occurrence of the nausea. in the literature has prevented widespread adoption of this tech- Conclusions: LIA has equivalent efficacy as EPA for pain nique. control after TKA and shows an increase of the range of motion Methods: A retrospective analysis of 40 patients with open and a reduction in the occurrence of nausea. tibia fracture (Gustilo-Anderson Type I to IIIB), of which 20 were given local gentamicin injection and 20 were not given local anti- ORTO23 biotic between September 2017- September 2018, was done. The Comparative Study of Platelet Rich Plasma aims were to ascertain the incidence of wound/surgical site infec- tion following management of open tibia fractures and to compare (PRP) Vs Corticosteroids for the Treatment of infection rates in patient treated along with local antibiotic injec- Chronic Lateral Epicondylitis tion versus without local antibiotic injection. The outcomes were assessed in terms of post-operative infection rates, total duration Abdul M. Nagori* of hospital stay, need for prolonged antibiotic therapy and second- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ary debridement. bai, Maharashtra, India. Results: The infection rate was higher in the group without *Corresponding author Email: [email protected] any local antibiotics with 5 patients needing a secondary debride- Abstract: Lateral Epicondylitis is the most commonly diag- ment, prolonged antibiotic therapy, with one patient requiring a nosed condition of the Elbow and affects approx. 1% to 3% of the secondary flap coverage 2 months post-operatively whereas in population. This condition mostly occurs in patients whose activi- local antibiotic group only 1 patient needed a secondary debride- ties require repetitive wrist movements and strong gripping. It ment. affects individuals between the ages of 35 and 60 years of age. Conclusion: The group that was administered local antibiotics It is thought the lesions occurs in the common origins of wrist and had fewer infections and better outcome although the p value was finger extensors on the Lateral Epicondyle. ECRB origin is the not significant (p-value= 0.076). The results are encouraging and most commonly cited location of Lateral Epicondylitis pathology. the use of local antibiotics according to the study can be a rather The aim of this study is to compare the efficacy and safety of inexpensive method of limiting infection in open tibia fracture PRP, Corticosteroids and placebo injections for the treatment of management. chronic lateral epicondylitis in 90 patients with lateral epicondyli- tis. ORTO25 The objectives were to study pain and function using various tools Comparison of Dynamic Hip Screw and like VAS (Visual Analouge Score), Function and Disability score Proximal Femoral Nail in the Treatment of for both PRP and Corticosteroid. According to visual analogue Intertrochanteric Fracture of Femur scale data all groups had significant improvement in scores pre- injection and 12 months follow up. Both the PR and CS group had Devendra Kommuru*, Shikhar Singh, Rajendra Butala, significant improvement in VAS score vs. the placebo group at Sanjay Dhar, Sachin Kale and Prakash Samant the end of the follow up. The sub group compared against each other were PRP vs. CS, PRP vs. Placebo, CS vs. Placebo. There Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- was a statically significant difference between the PRP group and bai, Maharashtra, India. CS group at 3 weeks, (P =<0.01) and at 6 months and 12 months *Corr. author Email: [email protected] (P=<0.01).PRP and Placebo groups at 3 weeks, (P=<0.01) and at Abstract: Introduction: The number of hip fractures contin- 6 months and 12 months (P=<0.01). CS and Placebo group at 3 ues to increase, as the elderly population grows. The study aims to weeks, (P=<0.01) and at 6 months and 12 months (P=<0.01). compare the clinical outcomes of DHS (dynamic hip screw) and PFN (proximal femoral nail) in the fixation of intertrochanteric ORTO24 fracture of femur. A Comparative Study on the Outcome of Methodology: After obtaining approval of the ethics commit- Management of Open Tibia Fractures with tee, a prospective study was conducted in the department of ortho- Versus without Topical Administration of pedics, DY Patil school of medicine from June 2017 till Decem- ber 2018. Informed consent was taken from patients who fulfilled Gentamicin the inclusion/exclusion criteria and relevant clinical information Abhimanyu Singh* was collected, including intra and post-operative details. The pa- tients were called for follow-up to check for complications. Sri Devaraj Urs Medical College, Kolar, Karnataka, India. *Corresponding author Email: [email protected] Results: During the study period, 38 patients with intertro-

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chanteric fracture were included in the study, of which 18 were K.L. Gaonkar and Nishant Gaonkar treated with PFN and 20 with DHS.72% Of the PFN patients needed no blood transfusion, while 40% of DHS patients needed 2 Department of Orthopaedics, Krishna Institute of Medical Scienc- units of blood transfusion. Post-operative fever and deep vein es, Karad, Maharashtra, India. thrombosis was more common in DHS Patients.78% of the PFN *Corresponding author Email: [email protected] Patients started mobilizing on the first postoperative day as com- Abstract: Objectives: Even after evolution of computerized pared to 65% of DHS patients who started mobilizing on third tomography and improved surgical measures, treatment of intraar- postoperative day. Similarly post-operative weight, full weight ticular calcaneal fractures remains a controversy. Hence this study bearing and return to activity of daily living was seen to be better was carried out to compare functional outcomes of displaced in- in PFN patients. traarticular calcaneal fractures, treated with operative manage- Conclusion: Our study showed that PFN is a superior method ment with plating and conservative management with cast. of osteosynthesis as compared to DHS in the treatment of intertro- Material and methods: This study was carried out as a pro- chanteric fractures. Future research should focus on studying the spective, comparative study. Twenty-nine (30 fractures) patients economic and rehabilitative impact of PFN on patients with inter- with acute, displaced intraarticular fractures of calcaneum aged 18 trochanteric fractures. –50 years, were enrolled in the study. Open fractures and fractures older than two weeks were excluded. 30 fractures were divided ORTO26 into two groups (operative and conservative; n = 15 in each). Three Stitch Technique for Humerus Nailing Evaluation in form of post treatment restoration of Bohler's angle, heel varus angle and with Creighton–Nebraska (C–N) score for Ibad Patel*, Prakash Samant, Sachin Kale, Sandeep Deore, functional outcome was done at the end of 12 months. Gaurav Kanade and Suraj Sharma Results: When we consider the clinical evaluation under the C Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- –N score, the results of operatively managed calcaneal fractures bai, Maharashtra, India. are slightly better than those of the conservative group. But this *Corresponding author Email: [email protected] did not have any statistical significance. Also, there was signifi- cant difference in pre and post treatment Bohler's angle and heel Abstract: Approximately 5-10% of all long bone fractures occur varus angle in operative group. Three cases of plating suffered in the humerus. And of them humeral diaphyseal fractures ac- from post-operative wound dehiscence. count for about 20% of all humeral fractures. There are various modalities for internal fixation of humeral diaphyseal fractures, of Conclusion: A relatively better functional outcome was ob- which plate osteosynthesis and intramedullary nailing are the served in displaced and comminuted fractures in plating, provided most common. Although plate osteosynthesis can afford a rigid that the Bohler's angle was restored. In conservative group, func- fixation and good functional recovery, its disadvantages have tional outcome of minimally displaced fractures were better than been reported like plate fixation does require a wide surgical ex- displaced comminuted fractures. Post treatment Bohlers angle has posure and more time when compared with intramedullary fixa- prognostic importance in functional outcome. tion. Intramedullary nails being biomechanically better are sub- jected to smaller bending loads and are less likely to fail due to ORTO28 fatigue. They act as load sharing and stress shielding devices. The two most common are the antegrade humerus nailing and retro- Conservative Management of Lumbar Canal grade humerus nailing. Retrograde nail insertion is technically Stenosis Compared to Operative more demanding that antegrade insertion. The nail enters the ca- Decompression nal diagonally under a small angle, which may lead to a longitudi- nal fracture above the site of bone trepanation. Proximal interlock Shivam Pandey*, Sanjay Dhar, Prasad Chaudhary, with screws in retrograde nailing could damage the vulnerable Arvind Vatkar and Pratik Tank soft tissues around the shoulder girdle, for example, the axillary nerve. In young patients, a narrow medullary canal may be an Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- obstacle for retrograde insertion. The prone position of the patient bai, Maharashtra, India. used for the retrograde technique may be associated with high *Corresponding author Email: [email protected] anesthesia-related risks. Abstract: Back pain, one of the major musculoskeletal prob- Hence antegrade humerus nailing is a preferred choice for fixing lems, has troubled humans since we evolved the upright bipedal diaphyseal humerus fractures. But they too have their own tech- position from that of quadruped. It is a result of our enimosity nical problems like violation of the rotator cuff, soft tissue injury against the gravity. As common as the common cold it affects 60- around the shoulder and elbow while doing proximal and distal 80 percent of adult population. locking. So taking in to account all of the above considerations we Lumbar canal stenosis remains one of the most frequently encoun- have come up with a new 3 stitch technique for antegrade humer- tered cause. It is a terminology used to describe developmental or us nailing which aims at avoiding all the technical difficulties and congenital narrowing of spinal canal that compresses the nerve complications encountered while using traditional method of ante- before their exit from the neural foramen leading to radicular pain grade humerus nailing. or atypical leg pain, neurogenic claudication or neurological defi- cit. The narrowing may be limited to a single motion segment or it ORTO27 may be more diffuse spanning two motion segments or more. Plating for Intra-Articular Calcaneal Treatment is aimed at not only obtaining immediate pain relief but Fractures…. Is It an Overkill? also to prevent long term disabling sequele such as chronic back ache and spinal instability. With advancement in our understand- Vaibhav Koli*, Himanshu Kulkarni, Vilas Mane, ing of pathoanatomy and its correlation with the clinical side,

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there has been a huge shift of treatment modalities starting from regards to mobility and socio economic point of view is satisfac- conservative management to operative decompression to decom- tory. Ankle arthrodesis is though a salvage procedure; it is good pression and fusion with or without instrumentation. alternative to amputation. This study focuses on improvement of symptoms like back pain, ORTP3 leg pain, sensation and motor power in patients treated with oper- ative and conservative management. A Rare Case of Isolated Cysticercosis of the The presented paper based on 50 cases of lumbar canal stenosis Biceps Brachii Muscle: A Diagnostic Dilemma treated over a period of 2 year either by non –operative approach Divyesh V. Bukalsaria*, Prakash Samant, Sachin Kale, or operative modality. Sanjay Dhar and Sandeep Deore ORTP1 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. An Unusual Presentation of Osteochondroma *Corresponding author Email: [email protected] on the Ventral Surface of the Scapula Abstract: Cysticercosis is an infection with the larval form of Javed Hussain* and Sunil Shetty the pork tapeworm Taenia solium that commonly presents with central nervous system involvement. Isolated muscular involve- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ment is rare with only a handful of cases reported in the literature. bai, Maharashtra, India. Involvement of the biceps brachii muscle is rarer with only two *Corresponding author Email: [email protected] such cases reported. We present a case of isolated cysticercosis of Abstract: Introduction: Osteochondroma of the scapula is a the biceps brachii muscle that presented a diagnostic challenge. rare tumour of the thorax. It constitutes 14.4% of all tumours of Misdiagnosed on ultrasound but diagnosed correctly on Magnetic the scapula with the ventral surface being the most common site Resonance (MR) imaging, the patient’s infection was successfully of presentation. The ventral surface of the scapula is rarely seen as managed non-operatively with oral antihelminthic and sympto- a potential site for the origin of osteochondroma from our review matic treatment. of the literature, which was the case in our patient. Most of the

patients presenting with osteochondroma on the ventral aspect of ORTP4 scapula have been reported to be of the pedunculated variant. A Rare Case of Right Paravertebral Case Report: We report one rare cases of a pedunculated Myoepithelioma with Intradural Extension variety of osteochondroma at an unusual site-ventral surface of Causing Cord Compression the scapula in a 6-year-old male child. The tumours were excised and the diagnosis was confirmed by histopathological studies. Divyesh V. Bukalsaria*, Prakash Samant, Sachin Kale, Conclusion: This case reported for its rarity and its unusual Sanjay Dhar and Sandeep Deore site of presentation. A solitary congenital variant of osteochondro- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ma of the scapula has never been reported to the best of our bai, Maharashtra, India. knowledge. *Corresponding author Email: [email protected] ORTP2 Abstract: Myoepithelial tumors occur mainly in the salivary A Rare Case of Primary Tibiotalocalcaneal glands, the sweat glands or the breast. There has been no case of paravertebral myoepithelioma with intradural extension reported Nailing for Talus Fracture in the literature. We present a case of a large right paravertebral myoepithelioma with intradural extension causing cord compres- Pratik Dhabalia*, Prakash D. Samant and Sachin Kale sion that was referred to our institution for palliative cord decom- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- pression. bai, Maharashtra, India. *Corresponding author Email: [email protected] ORTP5 Abstract: Tibiotalocalcaneal arthrodesis is a salvage option Clinical Outcomes in Patients Undergoing for severe ankle and subtalar joints arthritis. Ankle arthrodesis can Micro Lumbar Discectomy for Lumbar Disc be considered for patients who have limited motion of the ankle and chronic pain, in whom conservative measures have failed. Herniation Patient expectations must be determined and discussed before Anirudh Kumar P. Singh*, Prakash Samant, Sachin Kale, surgery. Although pain relief is to be expected and functional Sanjay Dhar, Sandeep Deore and Shikhar D. Singh activities will be substantially improved, impact sports rarely are possible after ankle arthrodesis. Tibiotalocalcaneal nailing (TTC) Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- nailing is helpful in intractable deformities such as those in Char- bai, Maharashtra, India. cot arthropathy, Rheumatoid arthritis, and severe arthritis at ankle *Corresponding author Email: [email protected] joint. Ankle arthordesis is rare procedure done for ankle arthritis Abstract: Introduction: Lumbar microdiscectomy has been and offers a safe and reliable salvage option as it has acceptable associated with high rates of success and low postoperative mor- functional outcome and low complication rates Patient is advised bidity. We aimed to evaluate the clinical outcome of patients un- for follow up after 1 week, 3 weeks, 6 weeks and 12 weeks and dergoing lumbar microdisectomy for disc herniations. nil weight bearing walk for 6 weeks then partial weight bearing walk for 6 weeks and then full weight bearing walk. Outcome in Methodology: The study was perfor med in the Department of

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Orthopedics, Lokmanya Hospital Chinchwad and Lokmanya Hos- operative management and its compare with conservative modali- pital Nigdi, Pune from August 2002 till May 2004 on all patients ty. scheduled for microlumbar discectomy for lumbar disc herniation. Intra-operatively, type and level of prolapse and operative time Material and Methods: Ethics committee permission was tak- was noted. We also noted the length of hospital stay and any com- en and 33 patients with middle-third clavicle fracture were includ- plications experienced by the patient. For assessing the patients, ed in this study. The affected limb was treated either conservative- instruments like Visual Analog Scale (VAS) for pain at the end of ly (“Figure of 8” brace and sling) or operatively (OR+IF using first week and return to normal activity of daily living (ADL) and recon plate or AO pre-contoured plate). Regular follow-up till 1 satisfaction with the result of surgery at the end of six months year post-treatment was done. The functional outcome were as- sessed by Constant and Murley score. Descriptive statistics and were used. Chi- square test were applied for analysing the data. Results: All surgeries were single level microdiscectomy. Op- erative time on the average was 85 minutes and 83% of the pa- Results: 17 patients were treated conservatively while 16 oper- tients had a stay of less than 5 days in the hospital. Disc sequestra- atively. 23 (69.7%) had excellent or good functional outcome at 4 tion and disc exclusion were the most commonly seen types of weeks irrespective of the treatment. The patients in the operative prolapse. Pre-operatively five patients had a back pain VAS of group who showed excellent results were significantly more than more than 4 and four patients had a leg pain VAS of more than 4. that in the conservative group (p = 0.0324). Average union time in On assessing the outcome in patients in terms of returning to ac- the conservative group was 9.4 weeks, more than the 7.8 weeks tivities of daily living and satisfaction with surgery only four and seen in the operative group. Mal-union was present in 7 of 17 five patients had a score more than two respectively. patients treated conservatively. Superficial infection, implant failure and keloid formation were seen in one patient of operated Conclusion: Proper preoperative planning and correct surgi- group. cal technique can prevent complications in these cases. Future multicentric studies with larger sample size and longer follow up Conclusion: Clavicle fractures managed operatively had bet- periods are needed to support our findings. ter outcome with lesser post-operative complications.

ORTP6 ORTP8 Compound Total Dislocation of Talus Without Case Report of Bent and Incarcerated Vnail in Fracture Distal 1/3rd Distal Tibia and Fibula Fracture Rajendraprasad R Butala*, R.G. Khedekar, Shikhar Singh, Suraj Sharma*, Prakash Samant, Sachin Kale, Daamarthya Gupta, Javed Hussain and Devendra Sandeep Deore and Gaurav Kanade Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. bai, Maharashtra, India. *Corresponding author Email: [email protected] *Corresponding author Email: [email protected] Abstract: Total compound dislocation of talus without frac- ture is an extremely rare injury. This is associated with major Abstract: Intramedullary nailing is the gold standard tech- complications. We present our case of compound dislocation of nique for treatment of tibial shaft fractures. Bending of a nail talus treated with closed reduction and primary debridement of the secondary to high velocity trauma is a complication, encountered wound and below knee plaster done six years ago with good re- in healed or unhealed tibial shaft fractures. Removal of such a nail sults. is always a challenge as the bent nail needs to be removed be- cause it might take the shape of the nail; which is likely to become ORTP7 weaker and weaker. As a result of the angulation and may break A Comparative Study of the Conservative and in future. Removal should be done as early as possible. Operative Management of Midshaft Clavicle We report this case of bent nail removal in a 47-year-old man, Fracture Based on Functional Outcome and admitted in our hospital who sustained a fracture of the left distal 1/3rd tibia and fibula with V nail in situ due to a roadside acci- Post-Operative Complications dent. Anirudh Kumar P. Singh*, Prakash Samant, Sachin Kale, Discussion: In growth of bone into the inside of a clover leaf Sanjay Dhar, Sandeep Deore and Shikhar D. Singh nail, bent nails, excessive callus formation closing the medullary Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- canal, and bone in growth through the locking screw holes are the bai, Maharashtra, India. biggest challenges a surgeon faces during its removal. In our case, *Corresponding author Email: [email protected] the V- nail had been impacted throughout its length after bony union of the fracture, excessive bone growth around the nail head Abstract: Introduction: Clavicle fracture is a common condi- coupled with the tapering design of the nail apex lead to its im- tion mostly treated conservatively. Newer operative modalities paction. After failure of removal of the nail due to breakage of the have come up to obtain early fixation. Accurate reduction and extraction eye by standard technique we recommend that to ex- fixation is important for complication-free management of clavi- tract the nail, decision should be made to do a surgical osteotomy cle fractures. However, there is still doubt amongst orthopaedic to approach the implant and refixation of fracture with interlock- surgeons regarding the choice of management for clavicle frac- ing nail. We feel that a preoperative analysis of such cases with a tures. CT scan should be done for better surgical management. It is im- Study aimed at analysis of the outcomes and complications of the portant to consider imaging the full extent of the implanted hard-

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ware because the hardware alters the mechanical properties of the mas. The most common locations for MPNSTs are the trunk, bone and complications such as loosening may begin proximal or limbs, and head and neck. Spinal MPNSTs have rarely been re- distal to the original fracture site. Failure of implants may have a ported. MPNSTs are highly malignant and the associated survival variety of causes including mechanical failure or fracture of the rate is very low. metal components, fracture of the surrounding bone, infection, Preoperative biopsies were obtained from most patients under the component wear, osteolysis, and particle disease which can be guidance of CT, and histology and immunohistochemical staining better analyzed on CT scan. of S-100, SMA, and EMA were obtained. ORTP9 Result: The patient recovered gradually from bedridden to An Arthroscopic Study of Evaluation of good ambulatory condition in four weeks and was referred to higher center for radio/chemotherapy. Patients with Chronic Shoulder Pain << Govind Baranwal*, Shikhar Singh, Prasad Chaudhari and ORTP11 Sachin Kale Results of Multilevel Laminectomy Using High Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Speed Burr Without Fusion in Cervical bai, Maharashtra, India. Myelopathy *Corresponding author Email: [email protected] Chetan Kumawat* and Satyen Mehta Abstract: Background: Shoulder pain is a common musculo- skeletal complaint that may be due either to intrinsic disorders of Department of Orthopaedics, Surana Sethia Hospital, Mumbai, the shoulder or referred pain. In this study, we aimed to find out Maharashtra, India. the sensitivity and specificity of the clinical and radiological *Corresponding author Email: [email protected] methods in diagnosing the chronic shoulder problems and to com- Abstract: Background: Cervical spondylotic myelopathy is a pare clinical and radiological diagnosis with arthroscopic diagno- leading cause of spinal cord dysfunction and commonly consid- sis. ered as a surgical disease. The ultimate aim of operative interven- Methods: After obtaining approval of the institutional ethics tion is decompression of the spinal cord and deformity prevention. committee, we enrolled patients who presented with chronic Operative intervention includes anterior decompression shoulder pain in the outpatient clinic of Department of Orthope- (discectomy with or without corpectomy) which is associated with dics, Dr. DY Patil Medical College and Hospital, Navi Mumbai frequent complications and can be done up to 2 levels, posterior from August 2017 till August 2018. We obtained historical data of decompression (laminectomy with or without fusion, laminoplas- each patient in detail and made clinical, radiological and arthro- ty). Laminectomy without fusion done using a high speed burr is scopic diagnosis. The findings from each diagnostic modality found to be a very effective procedure without affecting the stabil- were compared and analysed. ity of the spine with less complications. Aim of the study is evalu- ation of results of this surgery. Results: During the study period, 34 patients were enrolled in the study. Injury was traumatic in 32% of the patients and 50% of Material and Method: In this prospective analysis, 22 consec- all patients were heavy workers by occupation. Half of all the utive patients presenting with clinical and Radiological features of patients had pain in shoulder for more than 6 months. Clinical multilevel (three or more) cervical spondylotic myelopathy be- diagnosis of biceps tendinitis was made in 44% of patients, but tween 2009 and 2014, were included. After standard posterior radiological and arthroscopic diagnosis of biceps tendinitis was approach using a high speed match stick burr laminectomy done made in 18% and 12% respectively. Impingement was diagnosed and the laminae were lifted off and excised in one piece. Severity in 29% patients clinically, in 15% patients radiologically and in of myelopathy was assessed pre and post operatively using mJOA 21% patients arthroscopically. Rotator cuff injury was diagnosed score. in 26% patients clinically, in 41% patients radiologically and in Results and Discussion: Patients presented with following 67% patients arthroscopically. Conclusions: Findings from this symptoms: Gait disturbances in 18 patients (improvement in 15), single centre study suggest that arthroscopy can diagnose and treat Paraesthesia in upper limbs in 18 patients (improvement in 13), conditions causing chronic shoulder pain, which is cost effective paraesthesia in lower limbs in 12 (improved in 9), Patients as well. (54.5%), motor weakness in upper limbs in 18 patients (improved in 14), and in lower Limbs in 10 patients (improved in 9). Radicu- ORTP10 lar pain was observed in 15 patients (improved in 3). There was A Rare Case of Epitheliod Malignant no significant reduction (p=0.995) in curvature in most of the Peripheral Nerve Sheath Tumor (EMPNST) at patients. Mean preoperative mJOA score was 13.18 and post- operative mean mJOA Score was 14.68. Multilevel laminectomy D5 Vertebrae using high speed burr without fusion in cervical myelopathy is Amit Chugh*, Sanjay Dhar, Prakash Samant, safer and less time consuming method at multilevel without com- promising stability for comparable results. Prasad Chaudhari and Sachin Kale

Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ORTP12 bai, Maharashtra, India. Arthroscopic Management of Mucoid *Corresponding author Email: [email protected] Degeneration of Anterior Cruciate Ligament Abstract: Malignant peripheral nerve sheath tumours (MPNSTs) are a rare soft tissue sarcoma, often originating from Ibad Patel*, Sachin Kale, Prakash Samant and Schwann cells, which account for 3-10% of all soft tissue sarco- Pratik Dhabalia

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Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Results: There were no significant differences in the patients bai, Maharashtra, India. in both the groups at baseline. Patients in both the groups had *Corresponding author Email: [email protected] significant improvement in VAS pain scores over a 12 months follow- up. At the end of the study (12 month follow up), the VAS Introduction: Mucoid degeneration is a less understood entity. pain score was significantly lower in the group of patients who The injury or loss of synovial lining protecting the ACL is prima- received botulinum toxin A (1.68±0.62 vs. 4.72±1.02, p val- ry lesion causing Mucoid degeneration though there was no pre- ue=0.001). There was a significantly less plantar fascia thickness ceding trauma. the symptomatology, MRI findings, and arthrosco- in the group of patients who received botulinum toxin as com- py appearance are consistent. The excision of the degenerated pared to those who received corticosteroids at the 3 week, 3 ACL has been the treatment of the choice, the authors believe that month, 6 month and 1 year follow up. if the taut and hypertrophied ACL were to be debulked and notchplasty done, full extension could be achieved without having Conclusions: Better clinical outcomes were observed with to excise the entire ACL. The purpose of this study was to de- botulinum toxin type A as compared to corticosteroids. Similar scribe the clinical characteristics and diagnosis of mucoid degen- studies need to be replicated with larger sample sizes before this eration of the ACL and to assess the outcomes of arthroscopic can be offered as a standard treatment for plantar fasciitis patients. treatment. ORTP14 Materials and Methods: This study was conducted at Dr DY Patil Hospital, Navi Mumbai. 20 patients were diagnosed to be Prospective Study of Arthroscopic Evaluation suffering from mucoid degeneration of anterior cruciate ligament of Patients with Chronic Shoulder Pain (ACL) on the basis of magnetic resonance imaging (MRI). MRI Bhushankumar Pawar*, Prakash Samant, Sachin Kale, showed an increased signal in the substance of the ACL both in the T1- and T2-weighted images, with a mass-like configuration Sandeep Deore and Gaurav Kanade that was reported as a partial or complete tear of the ACL by the Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- radiologist. bai, Maharashtra, India. Result: Good to excellent pain relief on terminal flexion- *Corresponding author Email: [email protected] extension was obtained in 19 of 20 knees. The extension deficit Abstract: Background: Shoulder pain is a common musculo- was normalized in all knees. Lachman and anterior drawer test skeletal complaint that may be due either to intrinsic disorders of showed a firm endpoint in all, and 85% (n=17) showed good to the shoulder or referred pain. In this study, we aimed to find out excellent subjective satisfaction. the sensitivity and specificity of the clinical and radiological Conclusions: Mucoid hypertrophy of the ACL should be sus- methods in diagnosing the chronic shoulder problems and to com- pected in elderly persons presenting pain on terminal extension or pare clinical and radiological diagnosis with arthroscopic diagno- flexion without preceding trauma, especially when there is no sis. associated meniscal lesion or ligamentous insufficiency. They Methods: After obtaining approval of the institutional ethics respond well to a judicious arthroscopic release of the ACL with committee, we enrolled patients who presented with chronic notchplasty. shoulder pain in the outpatient clinic of Department of Orthope- dics, DY Patil Medical College and Hospital, Navi Mumbai. We ORTP13 obtained historical data of each patient in detail and made clinical, Randomized Controlled Study Comparing radiological and arthroscopic diagnosis. The findings from each Clinical Outcomes After Injection Botulinum diagnostic modality were compared and analysed. Toxin Type A Versus Corticosteroids in Results: During the study period, 34 patients were enrolled in the study. Injury was traumatic in 32% of the patients and 50% of Chronic Plantar Fasciitis all patients were heavy workers by occupation. Half of all the patients had pain in shoulder for more than 6 months. Clinical Varun Agarwal*, Prakash Samant, Sandeep Deore, diagnosis of biceps tendinitis was made in 44% of patients, but Sachin Kale, Gaurav Kanade and Vaibhav Koli radiological and arthroscopic diagnosis of biceps tendinitis was Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- made in 18% and 12% respectively. Impingement was diagnosed bai, Maharashtra, India. in 29% patients clinically, in 15% patients radiologically and in *Corresponding author Email: [email protected] 21% patients arthroscopically. Rotator cuff injury was diagnosed in 26% patients clinically, in 41% patients radiologically and in Abstract: Background: The plantar fascia is a common condi- 67% patients arthroscopically. tion, for which there is no consensus on the best treatment option. Conclusion: Findings from this single centre study suggest Aim: The aim of this study is to compare the pain and fascia that arthroscopy can diagnose and treat conditions causing chronic thickness outcomes of patients treated with botulinum toxin A shoulder pain, which is cost effective as well. injection versus corticosteroids injection.

Methods: 50 patients of plantar fasciitis randomly received ORTP15 injections of either botulinum toxin A (100 units in 2.5 ml normal Benign Tumors and Tumor-Like Lesions of saline) or methylprednisolone (2 ml of 40 mg/ml) under ultraso- nographic guidance. Patients were assessed for pain using the the Calcaneum visual analogue scale (VAS) and fascia thickness at baseline, 1 Ibad Patel*, Sachin Kale, Prakash Samant and and 3 week, 3, 6 and 12 months post injection. Patients in the two Pratik Dhabalia treatment groups were compared for pain scores and thickness at each follow up. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum-

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bai, Maharashtra, India. in the mean DASH scores at 3, 6 and 12 months in the volar plat- *Corresponding author Email: [email protected] ing group as compared to the external fixation group. Abstract: Introduction: Benign tumors of the calcaneum are Conclusion: Volar plating, with its definitive advantage of rare. Cystic lesions such as simple bone cysts and aneurysmal direct fracture visualization, has an overall better functional out- bone cysts are commonly seen. Tumors and tumor-like lesions of come with greater postoperative wrist motion and a lower inci- the calcaneum are rare, most common being simple bone cysts, dence of complications. aneurysmal bone cysts, and chondroblastomas. Other lesions that have been encountered are lipomas, pseudocysts, and hemophilic ORTP17 cysts. Cystic lesions in the calcaneum differ from those at other sites because they are less prone to pathological fractures and also Consent in Surgical Practice: A Brief respond differently to therapy. Overview Materials and methods: This study was conducted at Dr. D.Y. Melanie Gomes* Patil Hospital and Research Centre, Navi Mumbai, where, nonin- Department of Orthopaedics, Father Muller Medical College Hos- flammatory and benign lesions of the calcaneum were seen.Data pital, Mangalore, Karnataka, India. was collected from the histopathology reports, radiographs, and *Corresponding author Email: [email protected] inpatient and outpatient records. Abstract: Consent is an instrument of mutual understanding Results: Twelve benign lesions were seen in 12 patients. In our between the patient and the doctor. This protects the doctor from series, cysts predominated, with three aneurysmal bone cysts and accusation if obtained in a proper manner. A valid consent repre- five simple bone cysts. The other benign tumors were: one fibrous sents patient's trust in the medical profession. therefore, it is very dysplasia, one vascular hamartoma, one osteoblastoma, and one important for the surgeons to understand the ethical and legal chondromyxoid fibroma. The bone cysts were treated by curet- values of the consent. tage, with or without bone grafting, except for one large aneurys- mal bone cyst, which was treated by excision of the calcaneum. Ethics and Law: Surgical practice is governed by medical The postoperative function in this patient was good, with modi- ethics. The guiding principle in practice should be that the pa- fied footwear. The calcaneum is an uncommon site for most bone tient's interest is paramount. Every person has the right to have his tumors, and in our series, bone cysts were the most common be- or her bodily integrity protected against invasion by others. A nign lesions. Curettage and bone grafting or the use of bone sub- surgeon who performs a procedure without a patient’s consent stitutes can be effectively used in the treatment of symptomatic commits and assault in the eyes of the law. bone cysts of the calcaneum. Consent: There are two types of consent; implied and ex- ORTP16 pressed consent. The patient must be capable of understanding the explanation regarding the nature, purpose and risks of the pro- A Comparative Study of Functional Outcome posed investigation or treatment, together with alternatives and of External Fixation and Volar Plating in likely outcome of the treatment. Unstable Distal Radius Fractures Practical aspects: A patient may be entitled to sue for the damages or claim negligence on the ground that a doctor failed to Rajiv Kaul* obtain consent. Hence, accurate and relevant information must be Department of Orthopaedics, Armed Forces Medical College disclosed prior to consent for treatment. Pune, Maharashtra, India. Special Circumstances: There are special circumstances *Corresponding author Email: [email protected] where consent rules can be bent. This include: unconscious pa- Abstract: Distal radius fractures are amongst the most com- tient, consent in children, child in social service care, surrogate mon injuries seen in the emergency department. It is imperative to consent, testing for HIV and informed refusal. restore the anatomy as much as possible in order to restore wrist Conclusion: Consent represents a patient's faith/trust in the function. Identifying a fracture as ‘unstable’ is critical in predict- medical profession. Good communication and mutual understand- ing the final outcome of treatment. The present study compares ing maintain a strong patient-surgeon relationship. Adequate com- two primary modalities of treatment: external fixation and volar munication, proper dialogue at the appropriate time and involving plating in terms of the functional outcome post-surgery. the patient/guardians in decision making regarding therapy, reduc- Aim: To compare the functional outcome of fixation of unsta- es the chances of malpractice claims. ble distal radius fractures by external fixation to that of volar plat- ing by the Disabilities of the Arm, Shoulder and Hand (DASH) ORTP18 scoring system and analysis of recovery of grip strength and range A Case of Giant Cell Tumor of L5 Vertebrae of motion. with Paraplegia in A 34 Year Old Female Settings and Design: Hospital-based; Randomized Control Trial. Govind Baranwal*, Sanjay Dhar, Prasad Chaudhari and Methods and Material: 80 patients presenting with unstable Sachin Kale distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second re- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- ceived open reduction with volar plate fixation as the primary bai, Maharashtra, India. intervention. DASH scores were obtained and compared at speci- *Corresponding author Email: [email protected] fied time intervals following surgery. Abstract: Giant cell tumor (GCT) of the spine is uncommon Results: The results of our study show a better improvement but most aggressive benign tumor of the spine with unpredictable

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outcome with a high predilection for recurrences. Spinal GCTs patient complaining of pain after total knee arthroplasty done in a most commonly present with pain due to the expansile lesion with month of post op. or without vertebral collapse and spinal instability. This often gets compounded by neurological deficit due to encroachment onto the For the study X-rays of before and after total knee arthroplasty spinal canal. Asymptomatic, incidental radiological occurrence is were taken in consideration. The Study also included uncommon in spinal GCTs. Results: The outcome of treating patellar clunk syndrome Spinal GCTs often present with the unique problem of spinal cord with arthroscopically gives patient an early mobilization and compression due to extension into the spinal canal. Also, as it is symptomatic relief. It also reduces the chance of infections which often situated on either side of the neural tissues, complete resec- could be more in open surgery for its excision. tion becomes surgically challenging and most often, marginal or intralesional excision with backup therapy has to be resorted to. ORTP20 Radiologically, GCTs of the spine present as cystic, expansile Clinico-Epidemiological Profile of Lower lesions on plain roentgenograms. ‘Soap bubble’ appearance has Lumbar Disc Herniation Patients Undergoing been described. Differential diagnosis of spinal GCTs, on clinico- Microlumbar Discectomy radiological evidence remains aneurysmal bone cyst (ABC) and tuberculosis (TB). Definitive diagnostic biopsy before treatment Adnan Asif*, Sachin Y. Kale, Pramod Bhor and should be performed. Shikhar D. Singh Giant cell tumor being a highly vascular tumor, DSA aided tumor Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- embolization within 24 hours before surgery is recommended. bai, Maharashtra, India. This not only minimizes blood loss, but also permits the surgeon a *Corresponding author Email: [email protected] dry field to carry out optimum tumor excision. Abstract: Introduction: The clinical presentations of lumbosa- Symptomatology, clinical examination as well as imaging modali- cral radiculopathy vary according the level of nerve root or roots ties should be made use of in the best possible manner and with an involved. Lumbar Discectomy is very commonly performed for optimum frequency. If suspected, a biopsy may be done to prove this. We aimed to study the clinico-epidemiological profile of the this, unless it is very obvious on the CT / MRI. Herein lies the patients who presented to our hospital with low back pain, were importance of baseline postoperative radiological imaging to com- diagnosed with lumbar disc herniation and were operated with pare against follow up scans to rule out recurrence. micro-lumbar discectomy. Methodology: The study was designed and performed in the ORTP19 Department of Orthopedics, Lokmanya Hospital Chinchwad and Outcome of Patellar Clunk Syndrome Treated Lokmanya Hospital Nigdi, Pune from August 2002 till May 2004. Arthroscopically After approval of the institutional ethics committee, we included patients who were admitted and operated for lumbar disc herni- Suraj Sharma*, Sandeep Deore, Prakash Samant, ation with microlumbar disc surgery. We collected personal, de- Sachin Kale, Gaurav Kanade, Bhushankumar Pawar and mographical, clinical history and clinical examination findings of Anirudh Kumar P.C. the patients. The data was compiled and analysed descriptively using Epi Info software. The frequency tables were prepared and Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- percentages were calculated. bai, Maharashtra, India. *Corresponding author Email: [email protected] Results: We included 24 patients, 15 patients were males, av- erage age was 45.85 years. L4-L5 was the most commonly in- Abstract: Introduction: A painful, palpable " audible clunk" volved level of disc involved in our patient population. Radiation at the patellofemoral articulation of posterior stabilized total knee of pain towards the right was more commonly seen then left. Ma- arthroplasty caused by a fibrous nodule of scar tissue at the poste- jority of the patients had duration of symptoms between 2 to 6 rior surface of the distal quadriceps tendon/superior patellar pole months (42%). 7 patients had sensory distribution of neurological catching on the box of the femoral component during knee exten- symptoms, 4 had motor and reflex distribution of symptoms each. sion.its prevalence is reported less than the 5% around the globe. Conclusions: Understanding the clinical and epidemiological Patella clunk syndrome occurs when a fibrous nodule develops profile of patients with disc herniation can help us in identifying just proximal to the patellar button. At approximately 30 to 45 candidates for microdiscectomy and better outcomes as a result. degrees from full extension, the nodule or tissue catches the ante- rior flange of the femoral component, resulting in the clunk and a Abstract: Introduction: The clinical presentations of lumbosa- cral radiculopathy vary according the level of nerve root or roots painful range of motion. It has many risk factors preoperative and involved. Lumbar Discectomy is very commonly performed for component factors of total knee arthroplasty. In olden days the this. We aimed to study the clinico-epidemiological profile of the patella clunk syndrome was treated via open surgeries or by phys- patients who presented to our hospital with low back pain, were ical therapy. But due to the chances of infection in open surgeries diagnosed with lumbar disc herniation and were operated with to excise the tissue and the troublesome in physical therapy, ar- micro-lumbar discectomy. throscopic management can be good option as patient is relieved symptomatically. The added advantage of arthroscopic manage- Methodology: The study was designed and performed in the ment of patella clunk syndrome is also an early mobilization and Department of Orthopedics, Lokmanya Hospital Chinchwad and recovery. Lokmanya Hospital Nigdi, Pune from August 2002 till May 2004. After approval of the institutional ethics committee, we included Materials and Methods: This is a prospective study conducted patients who were admitted and operated for lumbar disc herni- at Dr. D.Y. Patil Hospital and Research Centre, Navi Mumbai in a ation with microlumbar disc surgery. We collected personal, de-

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mographical, clinical history and clinical examination findings of Abstract: Skeletal metastasis is a common cause of severe the patients. The data was compiled and analysed descriptively morbidity, reduction in quality of life (QOL) and often early mor- using Epi Info software. The frequency tables were prepared and tality. Its prevalence is rising due to a higher rate of diagnosis, percentages were calculated. better systemic treatment, longer lives with the disease and higher disease burden rate. The incidence of pathological fracture has Results: We included 24 patients, 15 patients were males, av- increased, and constitutes a challenge for the orthopedic surgeon erage age was 45.85 years. L4-L5 was the most commonly in- to maintain their quality of life. The criteria for resection/ recon- volved level of disc involved in our patient population. Radiation struction are inadequate reaction to adjuvant therapy, life expec- of pain towards the right was more commonly seen then left. Ma- tancy beyond 6 weeks, a lytic lesion more than 2.5 cm in diame- jority of the patients had duration of symptoms between 2 to 6 ter, and destruction of the cortex of more than 50%. The goal is to months (42%). 7 patients had sensory distribution of neurological replace as much tumor-destroyed bone as possible to try to elimi- symptoms, 4 had motor and reflex distribution of symptoms each. nate a second procedure, restore function and weight bearing as Conclusions: Understanding the clinical and epidemiological soon as possible. Replacement prosthesis are designed to restore profile of patients with disc herniation can help us in identifying structural skeletal stability and enable functional joint mobility in candidates for microdiscectomy and better outcomes as a result. patients undergoing limb salvage surgery for bone tumors < For patients with pathologic fractures and ossified metastatic tu- ORTP21 mors in the proximal section of the femur extending into the di- Steinmann Pin Fixation for Displaced Tounge aphysis internal fixation frequently fails; therefore, prosthetic Type Calcaneal Fracture replacement following femoral resection is an appropriate opera- tive choice. Javed Hussain*, Rajendraprasad R. Butala and

Saamarthya Gupta ORTP23 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- A Rare Case of Aneurysmal Bone Cyst of bai, Maharashtra, India. Intertrochanteric Area *Corresponding author Email: [email protected] Shouryashil Khambalkar*, Bhushan Patil, Mishil Parekh Abstract: The optimal treatment of the calcaneal fracture is a and Sunil Shetty controversial topic. Many patients get a very good result with open reduction and internal fixation using extensile lateral ap- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- proach. But there are many patients who do not qualify this cate- bai, Maharashtra, India. gory. This is the reason why many of them are either denied any *Corresponding author Email: [email protected] surgical intervention or are put at a significant risk of developing Abstract: Aneurysmal bone cyst are locally destructive, blood major complications because of the open surgical intervention. filled reactive lesion of the bone and are not considered to be true The height, width, length and shape of the hindfoot can be re- neoplasm. stored using Minimally invasive reduction and fixation (MIRF) and also the orientation of the posterior facet of calcaneus Any bone may be involved, but most common locations are proxi- (Bohler’s angle) can be restored. In this paper we present a series mal humerus, distal femur, proximal tibia and spine. of 23 patients treated with minimally invasive reduction and fixa- tion using Steinmann as a treatment method for the patients not Most common in younger age group less than 20 years with fe- suitable for open reduction and internal fixation. The use of Stein- male preponderance. mann pin in the MIRF technique proved out to be very effective. Radiographs reveal expansile lytic lesion that elevates periosteum As per our experience the time of the surgery is short and it can be but remains contained by a thin shell of cortical bone. easily performed even in the presence of extensive soft tissue swelling in the period immediate after the injury. The risk of in- Most aneurysmal bone cysts are treated with extended curettage fection is low also the morphology of the calcaneus was improved and grafting with or without bone substitute. and properly maintained in the term of Bohler’s angle. This tech- Recurrence rate after curettage of an aneurysmal bone cyst is 10- nique is very suitable for the patients with medical co-morbidities 20%. such as smokers, diabetics and is also very effective for the pa- tients who are not suitable foe extensile approach and internal Although rare aneurysmal bone cyst can grow rapidly and mimic fixation. malignancy. ORTP22 Low dose radiation has been reported to be effective method of treatment often associated with rapid ossification however it is not Proximal Femur Replacement with used routinely because of the potential to malignant transfor- Megaprosthesis in a Pathological Right Sided mation. Subtrochanteric Fracture in a Case of CA ORTP24 Lung A Case of Synovial Chondromatosis of Right Arpit Rajpurohit*, Prakash D. Samant, Sachin Kale and Knee with Arthroscopic Removal of 20 Loose Divyesh Bukalsaria Bodies Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Devendra Kommuru* and Bhushan Patil *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum-

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bai, Maharashtra, India. therapy and NSAIDs were employed. *Corr. author Email: [email protected] Results: Satisfactory symptoms control. Abstract: Synovial chondromatosis is a benign condition char- acterized by development of cartilaginous or osteocartilaginous Conclusion: OCI is a rare cause of LBP. It is usually self- loose bodies within synovial membranes of joints, bursae or ten- limiting. Often seen following pregnancy but no clear association don sheaths as a result of metaplasia of synovial fibroblasts and between OCI and pregnancy have been shown. Clinicians must be synovial membrane proliferation. It is a benign, nonhereditary, guided by history, radiographic findings, and laboratory studies in monoarticular, typically self-limiting process that may recur local- differentiating OCI with other disorders like ankylosing spondyli- ly. It has a predilection of 2 to 4 fold for males over females with tis, spondyloarthropathy, metastatic disease or sacroiliitis and middle age adults more often diagnosed with this condition, but hence the condition could represent a diagnostic challenge in pa- tients with polyarthralgia. Treatment is primarily conservative individuals of all ages can be affected. with surgical resection being reserved for refractory cases. Here, the synovial lining of a joint, bursa or tendon sheath under- goes nodular proliferation, and fragments may break off from the ORTP26 synovial surface into the joint. There, nourished by synovial fluid, the fragments may grow, calcify, or ossify. The intra-articular Management of a Case of Septic Arthritis of fragment may vary in size from a few millimeters to a few centi- Bilateral Knee Joints: A Case Report meters. Abhimanyu Singh* We present to you a case of synovial chondromatosis of right knee. A 76-year-old male patient came with chief complaints of Department of Orthopaedics, Sri Devaraj URS Medical College pain and swelling over right knee since 5-6 months. He gave a and Research Centre, Kolar, Karnataka, India. history of locking of the right knee with associated limitation in *Corresponding author Email: [email protected] range of motion. X-ray of the right knee revealed grade 2 osteoar- Abstract: Introduction: Acute septic arthritis occurs through thritis with presence of loose bodies. We performed an arthro- hematogenous spread, direct inoculation from trauma or surgery, scopic loose body removal. The knee joint was visualized and or contiguous spread from an adjacent site of osteomyelitis or around 20 loose bodies were removed from the right knee arthro- cellulitis. Risk factors for developing joint sepsis include rheuma- scopically, from the suprapatellar pouch and also from the poster- toid arthritis, osteoarthritis, low socioeconomic status, intravenous olateral and posteromedial corners. Postoperatively, the patient drug abuse, alcoholism, diabetes, previous intraarticular cortico- was kept in a long rigid knee brace for 15 days and suture removal steroid injection, cutaneous ulcers, cirrhosis, and uremia. Young was done after 2 weeks postoperatively. children and elderly adults are most susceptible. The lower ex- tremity joints are predominantly affected and multiple joint infec- ORTP25 tions do occur. Septic arthritis of bilateral knee joints is very rare. Osteitis Condensans Ilii History and examination: A 63 years old male presenting with complaints of severe pain and swelling of both the knee joints for Sarath C. Poodi* 2 days. There was no history of any fever, trauma, chronic drug Sri Devaraj URS Medical College and Research Centre, Kolar, intake, intraarticular injection. Patient was not a known case of Karnataka, India. rheumatic arthritis, diabetes, smoker or alcoholic. Local rise of *Corresponding author Email: [email protected] temperature with restricted, tender movements were present on examination and joint aspiration was done in suspicion of septic Abstract: Background: Osteitis Condensans Ilii (OCI) is a arthritis which showed frank pus from both knees. benign rare cause of low back pain (LBP). Although no clear etiology has been identified, the prevailing theory is that mechani- Treatment: The patient was taken up for emergency arthroto- cal strain affects the inferomedial aspect of the ilium adjacent to my and the pus collection from both knees was evacuated and sacroiliac joint. The location of the sclerosis has been traditionally joint thoroughly debrided and irrigated. Patient was initially start- confined to the ilium and may give the false impression of sacroil- ed on empirical antibiotics followed by antibiotics as per culture iac joint involvement. Typically affected females following preg- and sensitivity. Regular dressings were done. The patient im- nancy, males and nulliparous females have also been reported. It proved symptomatically and the wound showed healthy granula- is often bilateral, symmetric and triangular. tion tissue after 3 weeks on the left knee and 4 weeks on right knee. The patient was started on physiotherapy and gradual History: 52 year old woman presented with no history of inju- weight bearing ambulation following that and discharged after 6 ry or trauma. She is a housewife and the condition affected her weeks. The ROM at last follow up were 1200 for both knees at daily activities with difficulty to lie flat and disturbed her night final follow-up. In conclusion, bilateral septic arthritis, though sleep. She was a diabetic and had undergone hysterectomy 10 very rare, can occur. There have been reports of simultaneous years ago in view of fibroid uterus. Clinically, patient had bilateral septic arthritis of knee in immunocompetent patients and paraspinal and midline tenderness at L4/L5 levels, good spinal if suspicion arises promt action is warranted if the damage has to flexion, neurovascular intact. Hip examination was unremarkable. be limited. Distraction, compression FABER and Gaenslen's test for sacroili- ac joints were positive. Radiology findings demonstrated well defined sclerotic area, adjacent to left SIJ on the iliac side. No ORTP27 sacral involvement or joint space narrowing. MRI LS spine and Evaluation of Comminuted Shaft Femur pelvis were performed to rule out other causes. Fracture Treated with Intramedullary Nailing Laboratory studies have shown: Vitamin D deficiency, normal CRP and ESR and Rh factor. Conservative treatment like physio- Pratik Tank*, Sachin Kale, Shikhar Singh, Sanjay Dhar,

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Prasad Chaudhary and Shivam Pandey distinct cytoplasmic borders and clefted, or sometimes crenated, nuclei. This feature gives the tumour its chondroid appearance. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- True basophilic, hyalinc cartilage is distinctly uncommon in chon- bai, Maharashtra, India. droblastoma. So-called 'chicken wire calcification ' describes the *Corresponding author Email: [email protected] connected network of pericellular calcification that is quite com- Abstract: Introduction: Surgery is indicated for the large monly seen in chondroblastoma. Surgical curettage has been de- majority of femur fractures because of the high rate of union. In scribed as the preferred treatment for chondroblastoma, but treat- this study, we aim to describe our findings of managing fracture ment is difficult as the tumour is epiphyseal in location and future femur shaft patients with intermedullary nailing at out surgical joint function is a concern. The claimed existence of true malig- center. nant chondroblastoma is controversial. Methodology: This prospective study was conducted in the ORTP29 Department of Orthopaedics at Dr. D.Y. Patil University School of Medicine, Navi Mumbai from January 2015 till January 2017 Outcome of Hemiarthroplasty Versus Internal of patients scheduled to undergo surgery for comminuted shaft of Fixation in Unstable Intertrochanteric Femur femur fractures using the intramedullary interlocking nailing Fracture method. Clinical and radiological union of fracture was assessed for all patients and post-operative complications were noted. Sarath C. Poodi*, Hariprasad, S.N. Patil and Results: During the study period 50 patients were included in Cecil Fernando the study. In our study group, 46% of the patients achieved clini- Sri Devaraj URS Medical College and Research Centre, Kolar, cal union in 12 to 14 weeks, 24% in 10 to 12 weeks and 20% in Karnataka, India. 14 to 16 weeks. Half of all patients achieved radiological union in *Corresponding author Email: [email protected] 16 to 18 weeks, 24% in 18 to 24 weeks and rest in 14 to 16 weeks. Partial weight bearing was achieved by 36% of the patient at 10 Abstract: Background: Intertrochanteric fractures in the weeks, and full weight bearing was achieved by 38% of the pa- elderly pose certain special problems and need to be addressed in tients at 16 weeks. 78% of the patients had a total hospital stay of a balanced way as on one hand senile osteoporosis requires pro- 10 to 14 days. Functional outcome (Klemm and Borner) was ex- longed immobilization, on the other hand rapid mobilization is cellent in 56% of the patients, good and fair in 18% each and poor required as they are generally medically compromised due to age in only four patients. and associated diseases. Despite several randomized trials and comparative studies treatment of unstable intertrochanteric frac- Conclusions: Good functional outcomes and low complication tures in elderly patients is still controversial, which we want to rates can be expected if the surgeon has a thorough understanding investigate in this set-up which caters to a vast rural population. of the anatomy, and the surgical technique. Methods: A retrospective analysis of 54 patients, of which 27 ORTP28 each were operated with cemented bipolar hemiarthroplasty (BPA) and proximal femur nail (PFN) between January 2012 till A Rare Case of Chondroblastoma of Cervical July 2016 was done. Primary outcome was assessed in both Spine at C7, D1 and D2 groups using Harris hip score( HHS) at 4weeks, 6 weeks, 12weeks, 6months and 1 year on outpatient basis. The secondary Kedar Parelkar*, Sanjay Dhar, Mayur Mahtre, outcome measures were intraoperative blood loss, transfusion Prasad Choudhari and Arvind Vatkar rate, surgical time, bed to chair time, chair to walking time, limb length discrepancy at final follow up. All complications were Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- noted at follow ups. bai, Maharashtra, India. *Corresponding author Email: [email protected] Results: The HHS was significantly higher for BPA group at all follow ups, at 4 weeks of follow up was 77.81 for BPA and Abstract: Chondroblastoma is a benign, chondroid neoplasm 71.18 for PFN (p-value = 0.001) and at 1 year of follow up was that nearly always arises in the epiphyseal region of bones before 85.55 for BPA and 77.03 for PFN (p-value = 0.001). Statistically physeal closure. Chondroblastoma is an uncommon benign bone significant differences were found between BPA and PFN groups tumour especially in the spine. Chondroblastoma is present with with reference to intraoperative blood loss, transfusion rate, surgi- persistent, often longstanding. cal time, bed to chair time, chair to walking time, limb length In this case the patient presented with pain in the neck since 3 discrepancy at final follow up. months with loss of power in both upper and lower limb as well as Conclusion: The bipolar hemiarthroplasty group had fewer bowel and bladder involvement. Decompression and instrumenta- complications and earlier mobilization with better Harris hip score tion was done at level C4,C5,C6 and D3, D4 was done. at all follow ups, which indicate bipolar hemiarthroplasty is a Radio logically, chondroblastoma are lytic small (average 4 cm better option in the treatment of unstable intertrochanteric frac- diameter), well-demarcated (sometimes with a thin rim of bony tures in senile osteoporotic patients. sclerosis) lesions that occur in the epiphyseal region of young adolescents/adults. A bone scan can help in identifying the lesion. ORTP30 There may an effusion due to localized synovitis. A CT scan Case of 15 Years Old NON UNION of Distal shows calcifications in one-third of the cases, which can be help- ful in making the diagnosis Chondroblastoma may create a sec- Humerus in a 56 Years Old Male – Managed ondary aneurysmal bone cyst. with Total Elbow Arthroplasty The neoplastic cell is a medium-sized, round to ovoid cell, with Faizan Vaja*, Sunil Shetty and Amit Dhond

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Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Methods: This prospective study was perfor med at a tertiary bai, Maharashtra, India. level hospital in Navi Mumbai. All patients aged 18 years or *Corresponding author Email: [email protected] above, who presented with comminuted femur fracture and were treated with interlocking nailing was included in the study. Vari- Abstract: Nonunion occurs in 2% to 10% of distal humerus ous clinical and radiological parameters were collected during the fracture. It has multifactorial. Causes: osteoporosis, alcoholism, course of treatment. smoking, infection. The condition is difficult to treat and no single treatment modality has a high success rate. Without the interven- Results: 50 patients were included in the study; 84% males. tion the patient will be left with an unstable and often flail extrem- 88% aged 50 years or less. Road traffic accident was the most ity and with limitations in activities of daily living. common mode of injury and 54% of patients had fracture in the middle one-third femur. 76% of the patients presented within 24 Patient was operated 15 years ago with open reduction internal hours of injury. 52% of the patient’s demonstrated clinical union fixation with plating. There was subsequent loosening of implant, of the fracture in 12 to 14 weeks and majority showed radiological non union and resorption at the fracture end. In this neglected case union in 16 to 18 weeks. Partial weight bearing was started in of nonunion there is a higher risk of complications with osteosyn- 36% patients in 10 weeks and full weight bearing in 42% patients thesis hence prosthetic replacement of elbow provides a more in 16 weeks. Majority of the patients stayed in hospital for 10 to appealing treatment option. 14 days and the functional outcome as measured by Klemm and We did a Total Cemented Elbow Arthroplasty via posterior ap- Borner criteria was excellent in 66% patients. Complications were proach. seen only in 6 patients. Conclusions: In our experience, interlocking nailing had very ORTP31 low complication rate and excellent functional outcome in two An Unusual Case of Atlanto-Axial and Basi- thirds patients of comminuted femur fracture. Occipital TB with Prevertebral Abscess and ORTP33 Epidural Abscess Bilateral Shoulder Anterior Fracture Divyesh V. Bukalsaria*, Prakash Samant, Sachin Kale, Dislocations: A Case Report Sanjay Dhar and Sandeep Deore Abhishek Yadav*, B.S. Nazeer and Eshwer Reddy Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Department of Orthopaedics, Sri Devaraj Urs Medical College, *Corresponding author Email: [email protected] Kolar, Karnataka, India. *Corresponding author Email: [email protected] Abstract: TB is a re-emerging disease worldwide, affecting about one-third of the world’s population, and second only to Abstract: Case presentation: A 38-year-old male patient came HIV/AIDS as the greatest killer worldwide. Skeletal TB consti- with the chief complaints of pain over both the shoulders. Patient tutes 3-5% of all cases of TB, with cervical spine TB making up was apparently normal 3 weeks back when he sustained injury to only 2-3% of cases of TB spine. Tuberculosis of the cranio- both the shoulders while working at a construction site. Patient cervical junction is rare and accounts for only about 1% of all was taken to a local hospital, where he was diagnosed as bilateral cases of spinal TB. Co-existence with pre or paravertebral abscess shoulder fracture dislocation. Patient took native treatment but is rarer. We present a case of atlanto-axial and basi-occipital TB pain did not subside following which patient came to RLJH for with a large paravertebral abscess and anterior epidural abscess further management. Clinical examination of both shoulders without any neurological symptoms. To our knowledge this is the showed loss of deltoid contour. Diffuse tenderness was present first such reported case in the literature. The patient was managed over both shoulders and proximal humerus. Empty glenoid sign non-operatively using the middle path regimen with significant was present. Humerus head was palpable anteriorly. Dugas test, improvement in symptoms. Callaways test and Hamilton ruler test were positive. Elbow and Wrist flexion and extension were normal. There was no distal ORTP32 neurovascular deficit. Elbow and wrist flexion and extension was normal. X-rays showed bilateral anterior fracture dislocations. Management of Comminuted Fracture of Patient underwent open reduction of right shoulder dislocation Shaft of Femur by Interlocking Nail at a and ethibond fixation of greater tuberosity under GA. Open reduc- tion of the left shoulder dislocation and kwire fixation for the Tertiary Level Hospital comminuted fracture of the humeral head with autologous bone Amit Chugh*, Shikhar Singh, Prakash Samant, Sachin Kale graft from right illiac crest under GA. Postoperatively upper limb and Sanjay Dhar was immobilized in abduction with strapping and shoulder immo- bilization. At the end of 3 months, patient attained full range of Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- motion of both shoulders and radiographs showing a uniting frac- bai, Maharashtra, India. ture. *Corresponding author Email: [email protected] Conclusion: This report suggests that bilateral anterior frac- Abstract: Background: Fracture shaft of femur is one of the ture dislocation of shoulder joint is a rare injury with not many most common fractures encountered in orthopaedic practice. Frac- reported cases in literature. Inability to diagnose a fracture associ- ture shaft of femur is major cause of morbidity and mortality in ated with anterior dislocation at presentation is not uncommon. patients who sustain high energy trauma. This study looks at the Prompt diagnosis and appropriate management leads to a satisfac- epidemiology of patients presenting with femur fracture at a ter- tory outcome with regaining of functional and acceptable range of tiary level hospital in Navi Mumbai. motion.

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ENTO1 the ENT department for nasal septal surgery were divided two study groups. Group A received routine postoperative care and Laryngeal Palsy Secondary to Non-Infective analgesics. Group B received routine postoperative care and anal- Chest Pathology gesics along with music therapy for 30 minutes per session twice daily for two postoperative days, one session on day 0 of postop- Stuti Mathur* erative care and Two session before & after surgery for anxiety. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Patients were evaluated for pain score by VAS scale on postoper- bai, Maharashtra, India. ative day 0, 1, 2 and by GAD7 scale for anxiety score before and *Corresponding author Email: [email protected] after surgery. Abstract: As otorhinolaryngologists it is relatively common to Results: The decrease in the post operative pain in the music encounter patients with hoarseness of voice on a daily outpatient group was found to be statistically significant as compared to the basis. Many a times it is secondary to vocal cord palsy. The recur- control group on post operative day 0 (p<.001), 1 (p<.001) and 2 rent laryngeal and superior laryngeal nerves are a crucial element (p<.001). The difference in the preoperative (6.73 ± 2.32 and 3.14 in phonation. Damage to either of them or both is one of the com- ± 1.71, p < .0001) and postoperative anxiety scores (8.93 ± 2.20 monest causes for this presenation. Very frequently, patients we and 2.86 ± 2.33, p< .0001) in both the groups was statistically see on the outpatient basis with this complaint go uninvestigated significant with reduced anxiety in the music therapy group. and undiagnosed with a secondary cause. A missed or delayed Conclusion: Music therapy is an effective, safe and easy to diagnosis may lead to an erroneous treatment plan. comply with adjunctive modality in the management of pain and anxiety in patients undergoing nasal sepal surgery. ENTO2

Rhinosporidiosis – A Mysterious Disease of ENTO4 Man Role of Endoscopy in Juvenile Nasopharyngeal Angiofibroma Bhagyashree S. Deshmukh* Sonali S. Dodal* Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Topiwala National Medical College and BYL Nair Charitable *Corresponding author Email: [email protected] Hospital, Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Abstract: Rhinosporidiosis is a non-contagious disease of mu- cous membranes of the body, caused by eukaryote Rhinosporidi- Abstract: Introduction: Juvenile nasopharyngeal angiofibro- um seeberi, endemic in south-Asian countries like India, and Sri ma is a histologically benign but locally aggressive vascular tu- Lanka. Predominantly it affects the nose, nasopharyngeal mucosa, mor. Endoscope is an effective tool in its management. Here we and ocular regions. Cutaneous spread of the disease is much rarer study on juvenile nasopharyngeal angiofibroma and how they and is often misdiagnosed. Here we describe a case of 40-year-old were managed by endoscopic approach. male presenting with nasal obstruction and recurrent epistaxis for 1 year, and lesions arising from scalp, face and mouth. It is im- Material and Method: Retrospective study on 13 patients of portant for clinician to consider Rhinosporidiosis as a differential juvenile nasopharyngeal angiofibroma. diagnosis in patients presenting with nasal growth and epistaxis. Summary: Endoscopic approach is safe and extremely effec- tive procedure with total tumor removal in early stages. it offers ENTO3 several advantages including excellent illumination, direct visuali- zation, enhanced magnification, maximal preservation of unin- A Randomized Study on the Efficacy of Music volved vital structures and sparing of facial incisions and subse- Therapy on Pain and Anxiety in Nasal Septal quent scars as well as less intraoperative and postoperative mor- Surgery bidity. Results and Conclusions: With the data presented in this Avinash G.* and Satvinder Singh Bakshi study, we may conclude that the endoscopic approach is a safe Mahatma Gandhi Medical College and Research Institute, Pondi- procedure having low morbidity and great effectiveness, with total cherry, Tamil Nadu, India. tumor removal in early stages. *Corresponding author Email: [email protected] ENTO5 Abstract: Background: Nasal septal surgery is one of the com- monest surgeries performed in Otolaryngology practice. Post- Postoperative Antral Pseudocyst of Maxillary operative pain is a major concern and a multitude of medications Sinus are available for its management, but they have a lot of side ef- fects and are costly. Therefore we planned to evaluate the efficacy Akansha Yadav* of music therapy on pain and anxiety in patients undergoing nasal septal surgery. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Objectives: To evaluate the efficacy of music therapy in re- *Corresponding author Email: [email protected] ducing pain and anxiety in patients undergoing nasal septal sur- gery. Abstract: Introduction: Postoperative maxillary pseudocyst is a quite rare and almost always a delayed complication of surgical Methodology: In this randomized study, patients admitted in intervention associated with maxillary sinuses. Although most

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often it occurs secondary to odontogenic infection, cysts of intrin- cVEMP. The VEMP recorded nearer to the inferior oblique mus- sic origin have also been documented. cle known as oVEMP. Dizziness Handicap Inventory (DHI) is a useful, reliable and valid measure of self- perceived postural in- Case report: A 42 years old male presented at our hospital stability. Vestibular rehabilitation (VR) is one of the powerful with complaints of abnormal protrusion of right eye since 6 methods which enable the efficient restoration of vestibular dys- months, following a maxillary sinus cyst excision 6 years ago. On function mostly pertaining to periphery. examination, there was widening of right palpebral fissure with bilateral facial tenderness. Maxillary cyst marsupilisation was A total of 30 participants with peripheral vestibular lesions were performed in this patient. considered, among which 15 were given vestibular rehabilitation, and 15 were not given vestibular rehabilitation. The contestants Conclusion: Maxillary pseudocysts are usually harmless and were subjected for cVEMP, oVEMP, and DHI testing before and therefore no treatment is needed but in this case a surgical inter- after VR. The responses were analyzed for latency and amplitude vention was required to prevent complications like cicatrisation of measures pre and post VR. cVEMP responses were analyzed for sinus or stenosis, and any orbital disorders as the Computed To- P1 and N1 latency and P1-N1 amplitude. Similarly, oVEMP re- mography Scan (CT Scan) revealed orbital involvement. sponses were analyzed for n1 and p1 latencies and n1-p1 ampli- tude. DHI scores on all domains were measured pre and post ves- ENTO6 tibular rehabilitation. Primary Diffuse Laryngeal Amyloidosis - A The latency and peak to peak amplitude measures showed no Rare Entity major difference among the training phase and between training and group for both cVEMP and oVEMP responses. However, the Anmol Wadhwa* DHI scores were found to be significantly improved after vestibu- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- lar training in the experimental group. The above findings explain bai, Maharashtra, India. that even in the presence of peripheral vestibular lesion, sympto- matic relief from vertiginous symptoms is possible. These were *Corresponding author Email: [email protected] inculcated by vestibular rehabilitation prompted vestibular com- Abstract: Introduction: Amyloidosis is a heterogenous group pensation. Vestibular rehabilitation should be practiced among of disorders characterised by deposition of amyloid proteins in individuals with peripheral vestibular lesions, irrespective of age. various organs of the body. Of the many types, Laryngeal amyloi- dosis is an extremely rare disease of unknown etiology. It ac- ENTO8 counts for 0.2-1.2% of benign tumors of larynx. Skull Base Osteomyelitis - Overcoming Case report: We report a case of a 30 year old female who presented with complaints of hoarseness of voice, shortness of Challenges and Optimising Outcomes breath and foreign body sensation in throat. The excision biopsy Snekha P. Dominic* taken using a microlaryngoscope led to the histopathogical diag- nosis of Laryngeal Amyloidosis. Tracheostomy was performed Topiwala National Medical College and BYL Nair Charitable since the patient had appreciable stridor. Hospital, Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Conclusion: Amyloidosis of the larynx though a rare disease, is the most common site for isolated amyloid deposits to occur in Abstract: Aims and Objective: The aim of this paper is to the head and neck region. Tissue biopsy is required for definitive discuss the cases of skull base osteomyelitis with respect to their diagnosis which is confirmed histopathologically using congo red etiology, clinical presentation, imaging features, and the challeng- stain. Because different types of amyloidosis require different es faced in diagnosis and management. approaches to treatment, determining only that a patient has a diagnosis of amyloidosis is no longer adequate. A clinical situa- Methodology: This is a retrospective analysis of patients who tion may suggest the type of amyloidosis, but the diagnosis gener- were treated for skull base osteomyelitis at our institute. The pa- ally must be confirmed by immunostaining a biopsy specimen. tients of skull based osteomyelitis managed by us are included in the Study and have been discussed with respect to the clinical ENTO7 condition, diagnosis and management. Comparison of Vestibular Evoked Myogenic Summary: Majority of our patients were cases of central skull Potential and Dizziness Handicap Inventory in base osteomyelitis. Patient with Peripheral Vestibular Lesions Diabetes mellitus was the most common predisposing factor. Pseudomonas was the commonest microorganism isolated. Not all Between Pre and Post Vestibular cases had a proven microbiological and/or histopathological diag- Rehabilitation nosis, but a presumptive diagnosis of skull base osteomyelitis was made based on high index of clinical and radiological suspicion. Kaushlendra Kumar* and Greeshma Jomin All the patients needed prolonged intravenous antibiotics and the Department of Audiology and SLP, Kasturba Medical College, treatment was assessed by monitoring clinical and radiological Mangalore, Karnataka, India. parameters. *Corresponding author Email: [email protected] Conclusion: Skull base osteomyelitis is a life threatening con- Abstract: Vestibular evoked myogenic potential (VEMP) is dition and must be considered as a differential in atypical presen- brief latency electromyography and are elicited by the high- tations. Early diagnosis and appropriate treatment is important for intensity auditory stimulus. There are two types of VEMP, VEMP timely management of the patient. Multidisciplinary approach documented from tensed sternocleidomastoid muscle, termed including otorhinolaryngologist, neurologist, radiologist, speech

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language pathologist and physiotherapists is the cornerstone of the ENT surgeon. effective management. ENTO11 \ ENTO9 Diagnostic Paradox Behind Facial Nerve Indications and Outcome of Balloon Schwannoma Sinuplasty in Sinonasal Pathologies Gabriela Hawkes* Sreena Dev* Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Department of ENT, B.Y.L. Nair Charitable Hospital, Mumbai, bai, Maharashtra, India. Maharashtra, India. *Corresponding author Email: [email protected] *Corresponding author Email: [email protected] Abstract: Schwannomas are benign, slow growing tumours Abstract: Introduction: Sinusitis affects more than 37 million that arise from schwann cells which ensheath axons of peripheral people each year, leading to a greater impact on quality of life. and cranial nerves and autonomic nervous system. A high level of Apart from the conventional procedures (FESS), balloon sinuplas- clinical suspicion with detailed neuro-otological and radiological ty is being widely used as a minimal invasive surgery. studies play an important role in preoperative diagnosis. Aims and objectives: Aim of the study was to assess the long term efficacy and final outcome after balloon sinuplasty for pa- ENTO12 tients of chronic rhinosinusitis. Scope of an ENT Surgeon in Endoscopic Methodology: We have done a study of 30 patients of chronic Orbital Surgery rhinosinusitis with no significant improvement after receiving maximum medical therapy. Preoperative assessment (SNOT 20, Manisha Sharma* DNE) followed by balloon sinuplasty followed by postoperative Topiwala National Medical College and BYL Nair Charitable assessment (SNOT 20, DNE) was done. Hospital, Mumbai, Maharashtra, India. Results and conclusion: Balloon sinuplasty is as effective as *Corresponding author Email: [email protected] FESS in treating patients with chronic rhinosinusitis with reduc- Abstract: Introduction: Endoscopic orbital surgery is per- tion in average operating time, hospital stay, blood loss, recovery formed primarily via Sino nasal approaches by ENT surgeons. time. However it is a highly selective procedure for patients hav- Trans nasal endoscopic approaches are well established for orbital ing chronic rhinosinusitits. decompression, Orbital medial wall fracture repair and optic nerve decompression. Endoscopic view of posterior ethmoid sinuses and ENTO10 sphenoid sinuses enables surgeon to successfully carry out a pos- terior decompression and provides opportunity to decompress Management of Orbital Trauma - Our optic nerve if needed. Experience Materials and methods: A Retrospective study on 3 patients Priyanka Aage* who underwent Endoscopic orbital Surgery. Department of ENT, B.Y.L. Nair Charitable Hospital, Mumbai, Summary: The Endoscopic approach is a safe and extremely Maharashtra, India. effective procedure and in cases like in which there is a clear *Corresponding author Email: [email protected] compression of optic nerve by a bone fragment and patient is able to give clear examination, removal of bony fragment via trans Abstract: Introduction, Aims and Objectives: Orbital trauma forms a large contributor in the morbidity associated with facio- nasal endoscopy is a preferred treatment of choice. maxillary trauma. It can manifest as blindness, diplopia, epiphora, Results and conclusion: With the data presented in this study, proptosis etc. Due to the intimate relationship of the sinonasal we may conclude that the endoscopic approach is a safe procedure compartment with the orbit, the latter is highly vulnerable, yet being less invasive, having less post op risk of infection and pain, simultaneously accessible to the endoscopic sinus surgeon. The no visible scarring over face and faster recovery time. Study also various diagnostic and therapeutic modalities for orbital trauma emphasize the significance of an ENT surgeon in such cases about have been evaluated, and the probable pitfalls identified. which even other medical specialities are unaware of. Materials and Methods: A number of cases of orbital trauma such as orbital haematoma, medial rectus entrapment, optic nerve ENTO13 trauma, caroticocavernous fistula etc. that have been managed over the past twelve years have been studied for their presenta- Rare case of Branchial Apparatus Anomaly tion, symptomatology, diagnostic techniques and management Saumya Mishra* protocols. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Summary and Conclusion: Orbital trauma can present in bai, Maharashtra, India. various ways to the endoscopic sinus surgeon. A detailed clinical *Corresponding author Email: [email protected] evaluation followed by the necessary radiological investigations is vital to arrive at a correct diagnosis. The anatomical proximity of Abstract: Embryological anomalies of first branchial cleft are the sinonasal compartment can be used to advantage, for gaining uncommon. They usually present as cysts, swelling or fistulas in access to the orbit. In today’s age of endoscopic sinus surgery, pre-auricular or post-auricular area or high in the neck, which may management of orbital trauma has largely become the domain of become infected. Failure to recognise these unusual cases may

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result in misdiagnosis, inadequate treatment and subsequent recur- od had good symptomatic relief, lesser complication and lesser rence. Further definitive surgery may thus be complicated. A case hospital stay. is reported of a patient who complained of recurrent ear discharge which was subsequently diagnosed as a first branchial cleft anom- Conclusion: Modern methods of management of obstructive aly on CT sinogram. It may be mistaken for for chronic suppura- salivary gland disease though more time consuming and expen- tive otitis media or lymphadenitis. Surgical excision of the tract is sive, they are more conservative and less morbid. treatment of choice. ENTO16 ENTO14 Reasons for Inadequate Usage of Hearing Aids A Case of Labryinthine Fistula, A Rare in Elderly Adults Finding in A Common Complication of Jignesh P. Shah1*, Rajeev Jalvi2 and Sachin Patil3 Chronic Suppurative Otitis Media, Squamosal 1AIMS Hospital, Dombivali, Mumbai, Maharashtra, India. Type 2Ali Yavar Jung National Institute for Hearing Handicap, Bandra, Mumbai, Maharashtra, India. Aarzoo S.*, Swapnil Gosavi and Kalpana Rajivkumar 3Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- MGM Medical College and Hospital, Navi Mumbai, Maharashtra, bai, Maharashtra, India. India. *Corresponding author Email: [email protected] *Corresponding author Email: [email protected] Abstract: Hearing loss is often only of the several problems Abstract: Labryinthine fistula, a complication of chronic sup- with older adults must contend. Most common complaints of purative otitis media, squamosal type have become relatively rare these individuals is that they unable to understand speech. Audi- due to availability of higher antibiotics and as patients seek early ometry is basic investigation done to find out quality and quantity healthcare facility. of hearing loss. Appropriate hearing aid fitting becomes very crucial and viable option for them to understand speech as well as The incidence of labryinthine fistula with CSOM with cholestea- to overcome the psychological aspects which will improve their toma is about 3%. communication and help them in reducing feeling of depression, Lateral semicircular canal is most affected. loneliness, frustration and dissatisfaction. Total 100 hearing aid users were included in the study over 60 to 80 years of age. The Hence, we present a case of 38 year old, male who presented to data was collected from different centre across Mumbai city. ENT Out patient department with complaints of post auricular Questioner were developed which include domains like acoustic abscess with continuous giddiness with vomiting with positive factor, care and maintenance, cosmetic issues and quality of life. fistula test. Incision and drainage of post auricular abscess done Data was statically tabulated and results were discussed in terms on the same day. Patient was subjected to HRCT temporal bone of gender, educational background, working status with four do- which confirmed the diagnosis of labryinthine fistula over lateral mains. Present study shows that there were many reasons, howev- semicircular canal measuring o.5 x 0.2cm er the most common reasons were unclear speech, amplification Such a huge defect is rarely seen. Hence, we choose to present a of other external noise, noise created by hearing aids, needs help rare finding in common complication of squamosal type Chronic in operation, fitment issues, unsatisfactory performance, increase suppurative otitis media. volume control, adjustment of hearing aids, care and maintenance, cosmetic issues, sit closer to listen and many more and also it has given insights in to solutions based on reason acquired. ENTO15 Modern Management of Obstructive Salivary ENTO17 Gland Diseases Unilateral Mucoceles Chaitali R. Chikhale* Vishakha Rane*, Haritosh K. Velankar, Topiwala National Medical College and BYL Nair Charitable Yogesh G. Dabholkar and Merin S. Mathew Hospital, Mumbai, Maharashtra, India. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- *Corresponding author Email: [email protected] bai, Maharashtra, India. Abstract: Introduction: Obstructive Sialadenitis represent *Corresponding author Email: [email protected] about one half of the benign salivary gland diseases. Submandibu- Abstract: Background: Mucoceles are epithelium lined cystic lar gland obstruction accounts for 80-90% of cases followed by masses with accumulation of mucoid secretions and desquamated obstruction of the parotid (5-10%) and sublingual (<1%). Modern epithelium within the sinus. These are benign lesions causing methods of management provide minimal invasive approach. expansion of the paranasal sinuses. Mucocles are most commonly Modern methods include- Sialendoscopy, Extracorporeal shock found in the frontal sinus followed by the ethmoid sinus. Maxil- wave , laser intracorporeal lithotripsy, interventional lary and sphenoid sinus muoceles are rare. radiology, video assisted conservative surgical removal of parotid or submandibular calculi and botulinum toxin therapy. Case presentation: We report a case of 22 years old male who presented to our outpatient department with complaints of bilat- Methodology: Retrospective descriptive analysis of 20 cases eral nasal obstruction predominantly on the right side with occa- with obstructive salivary gland diseases who underwent sialendo- sional frontal headache. He also complained of right sided facial scopic procedures. pain and heaviness with periorbital pain on the same side. Based Summary of results: Patient treated with sialendoscopic meth- on clinical findings and imaging, the most likely diagnosis was

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two separate ethmoid and frontal mucoceles with pansinusitis, ENTO19 which was confirmed endoscopically intraoperatively and was marsupialized. Laryngopharyngeal Reflux Disease: The Silent Epidemic Conclusion: Mucoceles can occur as primary lesions or ap- pear as secondary to some other conditions which might be Deeksha Agrawal* and Prasun Mishra missed on computed tomography imaging, hence it is important to completely marsupialize and drain the mucoceles to look for the Bharati Vidyapeeth Medical College, Pune, Maharashtra, India. presence of secondary mucoceles. Mucocele are prone to recur- *Corresponding author Email: [email protected] rence if not managed adequately. A number of surgical treatment Abstract: Aim and Objectives: To find the prevalence of options are available but endoscopic drainage stands as the treat- Laryngopharyngeal disease in general population and to assess the ment of choice in majority of the cases as it offers a conservative co-relation between its history and videolaryngoscopy findings. minimally invasive treatment avoiding inconveniences of differ- ent external approaches such as recurrence, post operative mor- Introduction: Laryngopharyngeal Reflux Disease (LPRD) is bidity. defined as retrograde flow of gastric contents into the larynx and pharynx. Commonly manifested as coughing, hoarseness, dyspha- ENTO18 gia, globus and sore throat. Most patients with LPRD are diag- nosed clinically by history taking and examination with laryngeal Subhyoid Ectopic Thyroid with A Solitary endoscopy. Colloid Nodule: A Novel Diagnostic Entity Methodology: Prevalence will be obtained by distribution of Sejal Mehta* questionnaire (Reflux Symptom Index[RSI]) to the general popu- lation. Videolaryngoscopy will be done for those with signs of Smt. Kashibai Navale Medical College and General Hospital, LPRD, findings will be scored according to Reflux Finding Score Narhe, Pune, Maharashtra, India. [RFS] and co-related with history. RSI score more than 13 or an *Corresponding author Email: [email protected] RFS score more than 7 is considered suggestive of LPRD. Abstract: Ectopic thyroid is a rare clinical entity with overall Results: In a sample size of 2300 individuals in general popu- prevalence of 1 per 100,000-300,000. Moreover, thyroid nodules lation, the prevalence was found to be 16% i.e they had RSI score are less frequent in children, and recent studies based on ultra- more than 13. From 100 patients with significant RSI score, 53% sound have detected prevalence ranging from 0.2-5.1%. We report had positive RFS score, showing a correlation between history a case of subhyoid ectopic thyroid in a 10year-old girl, the young- and videolaryngoscopy findings. Hence RSI can be used for est age at which it is being reported in literature, and its course screening LPRD. over a span of 3 years. Conclusion: LPRD with its high prevalence, can predispose to many laryngeal diseases such as reflux laryngitis, subglottic ste- A 7 year old girl presented to paediatric-endocrine clinic initially nosis, laryngeal carcinoma, granulomas, contact ulcers and vocal with an asymptomatic midline neck swelling noticed for past one nodules. To minimize the under diagnosis, this study aims to com- year. She was investigated and her thyroid function tests were pare the RFS with RSI in the practice of ENT. within normal limits-TSH 4.62μIU/ml (normal:0.60-6.30μIU/ml), T4:6.97μg/dl (normal:6.40-13.30μg/dl). Antithyroid-antibodies ENTO20 were negative. Ultrasound-neck showed a well-defined hypoecho- ic subhyoid mass measuring 2.8×2.2×0.8cm in midline which was Cochlear Implant Programme: Our a nodule measuring 2.1×0.9×2.8cm was noted. Thyroid fossa was Experience empty. 99Technetium-pertechnetate scan showed an ectopic thy- roid at subhyoid level with no uptake noted in thyroid region. The Sai Belsare* findings were confirmed by computed-tomography scan of the Bharati Vidyapeeth Medical College, Pune, Maharashtra, India. neck. Fine Needle Aspiration Cytology of swelling revealed thy- *Corresponding author Email: [email protected] roid follicular cells filled with colloid with no evidence of atypical or malignant cells. Abstract: Aim: 1) To evaluate outcome of cochlear implant surgery; 2) To evaluate surgical technique of the cochlear implant It eventually increased in size and caused difficulty in swallow- surgery. ing. She also started faltering in her growth velocity due to hypo- Materials and method: Retrospective study of 70 patients who thyroidism developing at the age of 10 years. It was decided to have undergone cochlear implant surgery over last 5 years. surgically remove the thyroid nodule in view of increasing size despite suppressive levothyroxine therapy, discomfort during Discussion: Over 250 million people suffer various degrees of swallowing and increased risk of malignant transformation of the hearing loss globally of which 63 million reside in India. The nodule in this age group. Hence, surgical excision was done and degrees of hearing loss vary from mild to profound. Cochlear child was put on replacement levothyroxine doses. Histopatholog- implant is the preferred treatment for profound hearing loss which is very challenging. It is thus the aim of this communication to ical examination showed a thyroid tissue with varying sized thy- highlight our experience in the management of profound hearing roid follicles filled with colloid. loss. This is a retrospective study of 70 patients of predominantly Postoperatively, her symptoms were relieved. She is currently on children. replacement doses of levothyroxine, maintaining euthyroid status, The pre operative evaluation of cochlear implant patients includes has not shown any recurrence in last 6 months and has document- multiple audiological tests like BERA and aided audiogram and ed normal growth velocity. radiological evaluation like CT and MRI. At our institute vestibu-

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lar evaluation of these patients is also carried out to identify ge- Results: In 10 patients, after 6 months post operatively, there netic cause as a possible reason for the profound deafness. The was a significant improvement in the symptoms. patients receive pneumococcal and meningococcal vaccine along with the routine immunization as post operatively all forms of Sinuplasty was successfully carried out in all these patients with- infection are to be avoided. out any technical difficulties or intraoperative complications. The surgical technique involves skin incision, cortical mastoidec- The balloon sinuplasty equipment can become an important alter- tomy with posterior tympanotomy approach and round window native for surgical management of chronic rhinosinusitis without sinonasal polyposis and an adjuvant in surgical management of insertion of full electrodes. chronic rhinosinusitis with sinonasal polyposis. Activation of cochlear implant is done 2 weeks post implantation A larger sample size and a comparative study with conventional depending upon how fast post operative wound heals. surgical methods is required to judge the real potential of balloon In this study the outcome of the surgery was analysed as – Excel- sinuplasty. lent/ Good/Satisfactory and Non satisfactory and the results were further evaluated. ENTO23

ENTO21 Ectopic Thyroid – Management Dilemmas: A Case Series Retrograde Dissection for Parotidectomy : Review of An Uncommon Approach Keya Shah* Ankur Pareek* Seth AJB Municipal ENT Hospital, Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Asian Cancer Institute, Mumbai, Maharashtra, India. Abstract: Objective: To assess the clinical characteristics of *Corresponding author Email: [email protected] patients with ectopic thyroid seen at a tertiary referral centre and Abstract: Introduction: Salivary gland tumors are relatively discuss the management algorithm. rare tumors, 3-4% of all head neck neoplasms. Parotid tumors are Methods: A retrospective review of 24 patients presenting the most common among them. Surgery for parotid tumors entails with an ectopic thyroid from 2006 to 2018 has been done. The significant complications including facial nerve paralysis, Frey’s clinical presentation, nuclear scan findings, endocrine profile, syndrome, sialocele, salivary fistula. The most common approach clinical management and treatment strategies of these patients used is antegrade dissection. We present our experience with ret- were analyzed. rograde approach for facial nerve dissection for parotidectomy and its nuances. Results: Of the 24 patients,18 with complete records were taken into the study. 8 of those patients were males and 10 were Method: 15 patients underwent retrograde parotidectomy by females, with a mean presenting age of 15 years (range: 12 to 40 retrograde approach. Post operatively, complications of surgery years). The most common site of the ectopic thyroid was a lingual were analysed over a 12 month follow up period. thyroid seen in 14 patients. 4 patients presented with a sublingual thyroid. Most of these patients were incidentally detected to have Results: Superficial parotidectomy was done for all patients an ectopic thyroid. 15 patients presented with an overt or subclini- using retrograde approach. We studied complications including cal hypothyroidism. Medical management was offered to 10 of temporary and permanent facial nerve paresis, frey’s syndrome those patients whereas 8 underwent a surgical excision using ei- and margins of resection. ther cautery or coblation. Conclusion: Superficial parotidectomy by retrograde facial Conclusion: Ectopic thyroid patients can pose a management nerve dissection is an easy technique to carry out with low com- dilemma but each of these patients should be offered individual- plication rate and without compromising surgical outcome. ized treatment options based on their symptoms, thyroid profile and scan findings. ENTO22

Newer Methods in Treating Chronic ENTO24 Rhinosinusitis 10 Cases, Results and Follow Visual Loss: An ENT Perspective Up Ashwathy K.P.* Arjun Singh* Seth AJB Municipal ENT Hospital, Mumbai, Maharashtra, India. *Corresponding author Email: [email protected] Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Abstract: Aim: To study the cases referred to Dept. of ENT of *Corresponding author Email: [email protected] our hospital with complaints of blindness. Abstract: Introduction and Aim: Balloon sinuplasty is one of Methodology: A hospital based Observational Prospective the latest methods used in surgical treatment of patients with si- study was carried out in the ENT department of our hospital for a nonasal inflammatory diseases. It is one of the least traumatic period of 9 months (March 2018–November 2018). Patients pre- methods used for dilatation of paranasal sinuses ostia. Our study senting with blindness requiring ENT intervention were included. aims to review the surgical outcome (symptomatic relief) based A total of 12 patients were studied during the period. A complete on snot score of 10 patients who underwent balloon sinuplasty ophthalmological and neurological assessment were done for the over the past 6 months. patients. High resolution CT and MRI were done to know the

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exact cause of blindness and when needed, a biopsy was taken. ment of sphenoid sinus encephaloceles over conventional trans- Further line of treatment was decided depending on etiology. All cranial and trans-facial approaches. patients were evaluated post operatively for status of vision.

Results: Dramatic improvement in vision was seen in 41% of ENTP3 cases while 33% showed no improvement in vision. Vision was Tuberculous Osteomyelitis of Frontal Bone partially restored in 26% of the cases. with or Ital Involvement - A Rare Case Conclusion: A multi-disciplinary approach and timely interven- Presentation tion can help in restoring vision in these patients thus enhancing their quality of life. Snekha P. Dominic* Topiwala National Medical College and BYL Nair Charitable ENTP1 Hospital, Mumbai, Maharashtra, India. Tuberculous Otitis Media with Facial *Corresponding author Email: [email protected] Paralysis – A Case Report Abstract: Introduction: Tuberculosis is amongst the greatest health problems in India. Skeletal tuberculosis accounts for 1-3% Shilpi Agrawal* of total cases of tuberculosis. Calvarial involvement is seen in 0.2 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- - 1.3% of all cases of skeletal tuberculosis, making it extremely bai, Maharashtra, India. rare. *Corresponding author Email: [email protected] Materials and Methods: We discuss a case of tuberculous oste- Abstract: Tuberculous otitis media is characterised by non- omyelitis of frontal bone with orbital involvement with respect to specific symptoms. Its diagnosis is confirmed with histological its clinical presentation and management. and gene amplification tests. We present a case report of a patient Result: Patient was of effectively managed by anti tuberculous presenting with an ear discharge and facial nerve paralysis who therapy with no need surgical intervention. was treated with facial nerve decompression and anti-tubercular treatment. The objective of this report is to create awareness about Conclusion: Tuberculous involvement of calvarium can be a tuberculous otitis media and that it should always be considered in diagnostic challenge. However with advanced diagnostic modali- the differential diagnosis of chronic otitis media. ties and anti tuberculous chemotherapy, it can be actively tackled. High index of suspicion in atypical cases must be considered.

ENTP2 Sphenoid Sinus (SS) Anterior Medial ENTP4 Temporal Lobe Encephalocoele (aMTLE) Revolution in Bone Conduction Technology – with Spontaneous CSF Rhinorrhea - Case Bone Anchored Hearing Aid Report Sonali S. Dodal* Apoorva Salguti* Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- *Corresponding author Email: [email protected] bai, Maharashtra, India. *Corresponding author Email: [email protected] Abstract: Introduction: Bone anchored hearing aid is type of hearing aid based on bone conduction which uses surgically im- Abstract: Introduction: Cranial encephaloceles are the herni- planted abutment to transmit sound by direct conduction through ation of intracranial meninges and brain tissue through a defect in bone to the inner ear bypassing the external and middle ear. the cranium or skull base. These are rare conditions with an inci- dence of approximately 1 in 35,000 people, and are more common Patients who are candidates for bone anchored hearing aid are in the anterior cranial fossa than those in the middle one. Tem- those with chronic ear infections or allergies, external or middle poral lobe herniation through a middle fossa defect into the lateral ear malformation, single sided deafness. recess of the Sphenoid Sinus is even rarer than its medial repre- Methodology: A retrospective study of 3 cases who underwent sentation. Intrasphenoidal encephaloceles are extremely rare find- bone anchored hearing aid. ings. Spontaneous, or primary, CSF fistula is a separate entity with no underlying cause of the CSF leak. Spontaneous CSF leaks Summary: All the three cases underwent bone anchored hear- are usually associated with a co-existing encephalocele of variable ing aid surgery successfully. size. Conclusion: Bone anchored hearing aid is an excellent bone Case report: We present, in a 54year old female, a case of conduction tool with which patient can experience better sound spontaneous CSF rhinorrhoea in a Sphenoid Sinus Anterior Medi- quality with less distortion and feedback and can regain 360 de- al Temporal Lobe Encephalocele herniating through a clinically gree sound awareness with high wearing comfort thus improving silent lateral craniopharyngeal canal. the quality of life. Conclusion: Anterior Medial Temporal lobe Encephalocele in the lateral recess of the sphenoid sinus is a rare entity which must ENTP5 be suspected in patients who present with spontaneous CSF rhi- Unusual Histopathological Presentation of norrhoea. The endoscopic trans-nasal approach that provides a wide angled or side angled view has a great advantage in the treat- Laryngeal Lesion

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Priyanka Aage* planning surgery and in eventual outcome. Topiwala National Medical College and BYL Nair Charitable Aims and objectives: To study, compare and contrast the role Hospital, Mumbai, Maharashtra, India. of endoscopy and imaging (computerised tomography) in man- *Corresponding author Email: [email protected] agement of laryngotracheal stenosis. Introduction: The larynx is affected by a plethora of condi- Methodology: All patients with varying aetiologies and tions ranging from infections to benign lesions, malignant growth, presentations of laryngotracheal stenosis who were managed at granulomatous disorders and trauma. However in a small percent- our institute were included in this study. After a detailed history age of cases, laryngeal lesions may have atypical clinical, radio- taking, a thorough preoperative assessment was done. Endoscopy logical or histopathological presentations. and computerized tomography were the most important part of the assessment. The results were analysed, compared and contrasted. Method: Here we discuss 2 rare and atypical laryngeal lesions which presented to our institute namely- Plasmacytoma of larynx Results: Endoscopy is better than imaging with respect to and angiofibroma of larynx. grade and site of stenosis, state of mucosa, vocal cord mobility while imaging is better in assessing the status of extraluminal Summary: Several atypical presentations of larynx have been structures. noted in the larynx. Many of these mimic malignancy. A good knowledge of laryngeal anatomy, physiology, functions, a de- Conclusion: Endoscopy and imaging, both are necessary for tailed examination are required. Most important of all among preoperative assessment in management of laryngotracheal steno- them is tissue diagnosis as a pre-requisite for definitive manage- sis, however endoscopy may prove to be superior in planning final ment. management and eventual final outcome in laryngotracheal steno- sis. Conclusion: A small percentage of cases of laryngeal lesions may present as atypical presentation. All available tools of diag- ENTP8 nosis should be used in such cases in an attempt to establish cor- rect diagnosis and to formulate a plan of treatment. Cochlear Implantation in Congenital Malformation of Cochlea: Rare Case ENTP6 Cochlear Implant Surgery in Waardenburg Manisha Sharma* Syndrome Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India. Chaitali R. Chikhale* *Corresponding author Email: [email protected] Topiwala National Medical College and BYL Nair Charitable Abstract: Introduction: Cochlear implantation of congenitally Hospital, Mumbai, Maharashtra, India. deaf children with inner ear malformations is gaining special in- *Corresponding author Email: [email protected] terest. The decision for implantation needs thorough radiological investigation and pre-operative audiological evaluation. Surgical Abstract: Waardenburg Syndrome is a rare genetic disorder approach and post-operative follow up can be a real challenge in most often characterised by varying degrees of deafness, minor this kind of case as compared to children with normal cochlea. defects in structures arising from neural crest and pigmentation changes. It accounts for 2%-5% of patients with congenital hear- Materials & Methods: We present a case of 4 year old female ing loss. child with a history of inability to hear and speak since childhood and not benefitting with hearing aids devices. HRCT Temporal Methodology: A retrospective study; 3 cases of Waardenburg bone and MRI Brain was done which was suggestive of Bilateral Syndrome who underwent cochlear implant surgery. common cavity syndrome. Patient was taken up for right cochlear Summary of Result: All three cases underwent cochlear im- implantation as per preoperative reports and discussion with radi- plant surgery successfully. ologist. Conclusion: Children with certain Syndromic disorders too Results: We encountered with cerebrospinal fluid leak during can be good candidates for cochlear implant surgery. procedure which was managed with fascia lata graft. Rest of the procedure was uneventful.Intra-operative NRT was responsive. ENTP7 Patient is under intensive auditory verbal therapy and responses seem encouraging. Role of Imaging Vs Endoscopic Assessment of Conclusion: Inner ear malformations cannot be accepted as a Airway in Management of Laryngotracheal contraindication for cochlear implantation except cochlear or Stenosis vestibulocochlear nerve agenesis. Although there can be difficul- ties during the surgery or in the postoperative period, patients with Sreena Dev* inner ear malformations can also benefit from cochlear implanta- tion. Parents counselling about possible complications and post Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India. operative performance is very important in such cases. *Corresponding author Email: [email protected] RADO1 Abstract: Introduction: Laryngotracheal stenosis is a circum- ferential narrowing of the airway. It can pose a challenge to head Role of Cervical Elastography in Assessing neck surgeon for a successful management. Preoperative assess- ment of the airway with endoscopy and imaging is necessary for Induction of Labour

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Prajwith J. Rai*, Sherine Mariam and Prasad Hegde benign and neoplastic lesions/ masses in the neck. 3) To demon- strate different unusual presentations of the neck masses/lesions. AJ Institute of Medical Sciences Mangalore, Karnataka, India. *Corresponding author Email: [email protected] Methods: This retrospective study was conducted over a peri- od of 6 months, in the department of radiodiagnosis, D. Y. Patil Abstract: Introduction: Induction of labour is a judicious School of Medicine and Hospital, Navi Mumbai. procedure for mother and foetus when the physiological process of labour becomes unnatural. A ripe and favourable cervix is a 100 cases of different neck masses were evaluated by cross sec- prerequisite for successful induction of labour. Cervical ripening tional CT imaging. assessment is necessary before any regimen is selected. Till date GE optima 128 slice ct scanner and 1.5 tesla ge mri scanners were bishop score is standardly utilized to predict induction of labour. used for the evaluation of neck masses. Bishop score is more of an subjective technique of evaluation of labour. Present study helps us to understand a more objective Results: Out of the hundred cases of neck masses examined: method in prediction of induction of labour that is cervical elas- tograpgy. Spectrum: Neoplastic etiology - 50 %; Infective etiology - 20 %; Benign etiology - 15 %; Others - 15% Methodology: The study was conducted from October 2016 to October 2018. Data was collected during this period from 50 pa- Conclusion: Numerous neoplastic, inflammatory and infective tients who are between 36-40 weeks of gestation after considering conditions may present as neck masses, however neoplastic le- the inclusion and exclusion criteria. Ultrasonic cervical elas- sions far outweighs any other etiology in our study. Thus cross- tography was done at A J Institute of Medical Sciences, Manga- sectional imaging technique (CT) plays an important role in aid- lore. ing the extent, characterization and diagnosis of neoplastic mass- es. Collected findings are analyzed by correlating it with follow-up. Data was entered in Microsoft Excel sheet and was analyzed us- RADO3 ing SPSS version 11.0 statistical software. Data is depicted in the form of tables and charts. Statistical correlations are analysed. Encephalocele: A Pictorial Assay Results: In our study out of 50 patients 9 of them had prema- Harshvardhan Singh Rathore*, Shyam Sobti, Nilesh Ingale ture rupture of membrane. Out of remaining 41 subjects 21(%) of and Harsha Jeswani them had successful induction of labour and 20(%) of them had failed induction of labour. Cervical elastography showed At the Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- level of internal os, out of 41 subjects, 9(22%) hard cervix, 16 bai, Maharashtra, India. (39%) firm and 16(39%) soft cervix. Out of 9 hard cervix only 1 *Corresponding author Email: [email protected] (11.1%) had successful induction, out of 16 firm cervix 7 Abstract: Background: Encephalocele is the herniation of (43.75%) had successful induction and out of 16 soft cervix 13 brain tissue and overlying meninges through a defect in cranium. (81.25%) had successful induction of labour. It showed a linear It can be present both congenitally or in adults. Congenitally it correlation with statistical significance (p=0.003). This was very occurs due to neural tube defect and in adults its mainly traumatic, significant compared to the bishop score and cervical length. iatrogenic or rarely it may be idiopathic. Its incidence is one of every 4,000-5,000 live births. Congenitally it may have various RADO2 syndromic associations. There is no recognized gender predilec- tion. Spectrum and Incidence of Neck Masses on Aims and Objectives: To determine the incidence of encepha- Cross Sectional (CT) Imaging locele in sample size of 2000 patients; To evaluate its various Ashish M. Vidhate*, Ankur Pramanick, Pratik Patil, patterns and radiological features. Arnab Marick and Madan Manmohan Materials and Methods: The study was carried at Dr. D.Y. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Patil Hospital, Navi Mumbai from year July 2017 to December bai, Maharashtra, India. 2018. *Corresponding author Email: [email protected] Patients with suspected neurological symptoms were admitted during the mentioned period and were evaluated for their clinical Abstract: Introduction: Computed tomography with its features. Complete investigations were performed including CT unique capacity for displaying bone, soft tissue and airway details scan and MRI of brain. Other congenital anomalies (if any) were has rapidly becoming the imaging modality of choice in the evalu- also noted. Written consent was taken from patients and their ation of patients with neck masses. guardians (in cases of minors). Operative and postoperative (if Although many of these conditions may cause significant morbid- performed) records were maintained. ity and mortality if left untreated, the prognosis is generally excel- Results: Total of 8 encephaloceles patients were evaluated lent with multidisciplinary evaluation and treatment. Further the during the study period from year July 2017 to December 2018. age of their presentation and clinical examination narrow down Out of these 5 (62%) were male and 3 (28%) female. Age range the differential diagnosis. In this paper, we provide a comprehen- was 1 day to 55 years. The most common type of encephalocele sive, contemporary review of the pertinent cross-sectional imag- was occipital. ing features of numerous inflammatory, infective and neoplastic conditions noted in the region of neck. Conclusion: The most common type of encephalocele was occipital in our study. Early diagnosis and management of en- Aims: 1) To evaluate, characterize and assess lesions/ masses cephalocele is not only for cosmetic reasons but also helps to observed in neck region. 2) To differentiate between infective, avoid confusion with malignant lesions, thus assisting in appropri-

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ate management and preventing future complications. Materials and methods: In this hospital based prospective study 160 pts [n = 122 male n=38 female] who came to the radiol- RADO4 ogy department for venous duplex Doppler study were included. The patients were screened for venous diseases like varicosities Percutaneous Radiofrequency Ablation of etc and a detailed study of short saphenous vein, its course, termi- Osteiod Osteoma: Principle, Cases and nation, any diseases present etc was made in both the limbs using Technique both gray scale imaging and colour Doppler assessment. Results: In the current study, a wide range of variations exist- Ammar S. Modi*, Kishor Rajpal and Ravi Varma ed with regard to ssv drainage. Out of 320 limbs assessed during TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India. the study period, 174 limbs (54.37%) terminated into the popliteal *Corresponding author Email: [email protected] vein forming a normal sapheno-femoral junction, 146 limbs (45.63%) showed termination of ssv at locations other than the Abstract: Learning objectives: To describe the technique for popliteal vein. In the study, 64 limbs presented with varicosities performing radiofrequency ablation (RFA) in osteoid osteoma and of them 32 showed termination of ssv into the saphenous vein involving appendicular skeleton with the rest terminating at other sites. The chi-square test was not Background: Osteoid osteoma is a benign skeletal tumour significant. seen in young individuals with male: female ratio 2:1. It can be Conclusion: The current study highlights the fact that inclu- observed in almost any bone region, but has a higher incidence in sion of ssv variation on the basis of the site of drainage should be long bones, mainly in the diaphyseal region of the tibia and femur. included as a component of routine pre-operative lower limb dop- Clinically, it presents with a persistent, long-lasting and vague pler studies. The study has been put forth to draw attention to pain, worsening at night that is sometimes relieved with non- these ssv variations for better surgical outcomes. steroidal anti-inflammatory drugs (NSAIDs) particularly aspirin. Surgery is the definitive treatment, but difficulty in lesion locali- RADO6 zation and extensive dissection is a problem. Radiofrequency ablation (RFA) has been found to be a safe, fast, minimally inva- Role of Magnetic Resonance Imaging in the sive and reliable method of treating osteoid osteomas. Evaluation of Articular Cartilage in Painful Imaging findings: Osteoid osteoma shows radiolucent nidus Knee Joint with surrounding reactive bony sclerosis and cortical thickening with nidus usually <1cm in diameter. When radiographs are nega- Ayesha Hadi* tive, CT scan are necessary to identify lesion. The main radio- Dr. D.Y. Patil Medical College, Hospital and Research Center, graphic differential diagnoses of osteoid osteoma are brodies ab- Pune, Maharashtra, India. scess, bone infarction, chronic osteomyelitis, and chondroblasto- *Corresponding author Email: [email protected] ma. CT-guided radiofrequency ablation is a percutaneous tech- nique in which the use of electrodes connected to an energy Abstract: Aim: To study changes in the articular cartilages of source leads to protein denaturation and coagulative necrosis. articular surfaces of knee joint in painful knee by use of Magnetic Resonance Imaging (MRI). Conclusion: CT-guided radiofrequency ablation is a safe, quick, minimally invasive option for the management of osteoid osteo- Methods and Materials: Our study was carried out on total of ma, presenting good results. 150 cases in Dr. D. Y. Patil Medical College and Hospital and Research Center, Pimpri, Pune. RADO5 MRI was done with SIEMENS 1.5 Tesla MAGNETOM AVAN- Variations in Short Saphenous Vein On TO Machine. Ultrasound and Doppler Inclusion criteria: All age groups, both male and Female, non- traumatic knee joint pain. Gurrala A. Reddy* and Siddesh M.B. Exclusion criteria: K/c/o fractures/dislocations, post operative Department of Radio-Diagnosis, JJM Medical College, Da- cases, bony pathology around knee joint, severe deformity. vangere, Karnataka, India. Result: In our study, 60 patients (40% ) had no cartilage de- *Corresponding author Email: [email protected] fects, 25 patients (16.7%) had Grade 1 lesions, 15 patients (10%) Abstract: Introduction: Variations in the course of short sa- had Grade 2 lesions, 20 patients (13.3%) had Grade 3 lesions and phenous vein and its abnormal termination other than popliteal 30 patients (20%) had Grade 4 lesions. In our study, complete vein are very common. A prior knowledge of the abnormal termi- ACL ruptures was found in 7 patients (4.6%). nation of the short saphenous vein is very essential for the treating Conclusion: MRI allows accurate and reliable assessment of surgeons in patient management of diseases of short saphenous articular cartilage. Provides better opportunity to examine and vein and prevent its recurrence. understand preclinical and very subtle early abnormalities in artic- Aim: To ultrasonologically evaluate the short saphenous vein ular cartilage. Enables quantitative assessment of cartilage matrix and its normal and abnormal termination either into popliteal vein composition. or other than it and to know the incidence of its abnormal termina- In conclusion, atraumatic knee pain cases should be subjected to tion, which could be of particular help while reporting cases by a MRI study of the knee provided radiographs are non-informative radiologist and help the surgeon in patient management with a or non-diagnostic. This study not only outlines the tendons, liga- particular attention to the abnormal termination of the short saphe- ment and cartilage status but also demonstrates subtle underlying nous vein. bony pathologies causative for patient complaints.

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RADO7 was in ACA followed by MCA with no side (left/right) prepon- derance. In our study 57% of aneurysms were single lobed. 28.6% MRI Brain in Perinatal Hypoxia - A Case bilobed and 14.3% multilobed. In our study 78.6% aneurysms Series were narrow necked and 21.4% were wide necked. It could be concluded that aneurysms larger than 5 mm have significant risk Avinash Bansal* and Sanjay Khaladkar of rupture however no size is safe from rupture. Most preferred Department of Radiodiagnosis, Dr. D Y Patil Medical College, technique for treatment was using balloon assisted technique in Pimpri, Pune, Maharashtra, India. 28.6 % patients of our study. Most common complication was *Corresponding author Email: [email protected] post procedure pain followed by puncture site hematoma. 78.6% survival rate at three months is noted. Abstract: Background: HIE is one of the most common cause of neonatal deaths and morbidity in children. Due to limited facili- Conclusion: Endovascular treatment of intracranial aneu- ties in India, many a times HIE goes undetected only to present in rysms is shown to improve clinical outcome after SAH and the later stages of life as handicapped children. treatment of ruptured aneurysms is likely to improve life expec- tancy. Endovascular intervention with detachable platinum coils Aim and Objectives: To study the Magnetic Resonance Imag- in patients with ruptured intracranial aneurysms can improve the ing (MRI) brain findings in children having suffered perinatal chances of independent survival as compared to no intervention. hypoxia, to analyze MRI findings in brain based on time of peri- (As per MONICA trial 30 day mortality at 42%). Although endo- natal hypoxia. vascular management is costlier, in long term it is feasible with Materials and Methods: A prospective Study was conducted shorter hospital stay, improved survival and decreased dependen- on 100 patients suffered with perinatal hypoxia on Siemens 1.5 cy. Tesla MAGNATOM AVANTO machine. Patterns of hypoxic ischemic brain injury in preterm and term infants of were evaluat- RADO9 ed. CT Angiography Versus Digital Subtraction Results: Out of 100 cases, 72% were abnormal and 28% were normal studies. 36 %patients were preterms and 64% had term Angiography for Evaluation of Intracranial delivery. In patients with term delivery, 28.1 % were normal and Vascular Pathologies 71.8 % were abnormal. In patients with preterm delivery, 72.3% cases were found to be abnormal while 27.7 % cases did not show Kanchan Dhanokar*, Aarti Anand and Amit Disawal any significant abnormality. Govt Medical College and Hospital, Nagpur, Maharashtra, India. Conclusion: MRI was a definitive diagnostic modality in peri- *Corresponding author Email: [email protected] natal hypoxia. Patterns of brain injury were determined by nature, Abstract: Aims and Objectives: 1) To determine the level of timing and severity of insult. Imaging appearances were influ- diagnostic accuracy between CTA and DSA, in the evaluation of enced by sequences used and time from injury. intracranial vascular pathologies. 2) To determine the preferred interventional option according to the vessel involved in the dis- RADO8 ease process. 3) To observe procedural and immediate post proce- Endovascular Management of Intracranial dural complications and its management. Aneurysms – Various Methods, Efficacy and Materials and Methods Complications 1) No. of Patients: 40 Prateek Gandhi*, Aarti Anand, Amit Disawal and 2) Place of Study: Department of Radiodiagnosis, GMCH Nagpur Jawahar Rathod 3) Duration: Jan 2018 – Jan 2019 Govt. Medical College and Hospital, Nagpur, Maharashtra, India. 4) Machines: i) Philips brilliance iCT 256 slice CT machine; ii) *Corresponding author Email: [email protected] Philips Allura Xper FD 20/20 Biplanar DSA machine Abstract: Aims and Objectives: 1) To study safety and effica- Results: Out of these 40 patients, 32 had no discrepancy be- cy of endovascular management of intracranial aneurysms. 2) To tween the CTA and DSA reports, 8 patients whose CTA and DSA study various hardware used for endovascular management of reports showed discrepancies. The most common encountered intracranial aneurysms. 3) To observe procedural and immediate intracranial vascular pathology detected in the study was intracra- post procedural complications and its management. nial aneurysm. The next most common tumour was intracranial Methods & Materials: Machines: AVM. The preferred interventional options considered were endo- vascular management using coils followed by surgical exploration 1. Philips brilliance ict 256 slice CT machine & clipping for aneurysm and liquid embolization agent followed 2. Philips Allura Xper FD 20/20 Biplanar DSA machine by surgical excision for AVM. Incidence of complications follow- ing CTA was nil whereas complications following DSA included Study Duration: 1 Year Oct 2018- Oct 2019; most commonly post procedure pain followed by puncture site Sample Size: 14 hematoma. Results and Observation: Aneurysms are significantly more Conclusion: It is imperative to be aware of not only the bene- common in Females. Only 10-15% of unruptured intracranial fits of CT, but also its limitations; further DSA evaluation is sug- aneurysms are symptomatic. Most common aneurismal type was gested should there be strong clinical suspicion and inadequate saccular followed by fuisiform. Most common aneurysm location evaluation of intracranial pathology.

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RADO10> and inferior longitudinal fasciculus showed displacement most commonly. cingulum, fornix and superior longitudinal fasciculius To Assess the Role of MRI in Evaluation of remained uninvolved in most cases. Significant correlation was Orbital Pathologies observed with peritumoral white matter showing decreased FA, increased ADC and increased MD when compared to control. The Tarun Dharme* and Amit Disawal predominant pattern of involvement in high grade tumours was Govt. Medical College and Hospital, Nagpur, Maharashtra, India. destruction whereas low grade tumours showed both destruction *Corresponding author Email: [email protected] and displacement. Abstract: Aim: To assess the role of MRI in evaluation of or- Conclusion: MR tractography could visualize the white mat- bital pathologies ter tracts in 3D reconstructed format which can help in pre opera- tive planning of surgical resection of the brain tumours, decreas- Methods: This observational, prospective hospital based study ing post operative morbidity at the same time ensuring adequate of 60 patients was carried in Department of Radiodiagnosis resection. Peritumoral MD can be used to distinguish high-grade GMCH Nagpur. gliomas from normal appearing white matter. Peritumoural FA Patients from all the age groups with of or- was decreased in all tumours with significant decrease noted in bital pathologies and patients with abnormal CT scan or B-scan high grade gliomas when compared to meningiomas. This could findings were included in the study. Patients who are MRI non help in detection of involvement in otherwise normal appearing compatible, with intraocular foreign body and patients with isolat- white matter. ed involvement of eyelid or conjunctiva without intraorbital ex- tensions were excluded from studies while those with secondary RADO12 involvement of orbit were included. Utility of MRI in Neonatal Hypoglycemic Results: Of 60 biopsy proven scanned cases, we had 21 cases Brain Injury (NHBI) of infective &inflammatory,18 were due to neoplastic, 3 were due to vascular causes, 4 were traumatic, 9 congenital & Developmen- Avinash Bansal* and Sanjay M. Khaladkar tal, 5 were due to lacrimal gland and systemic conditions. Out of Dr. D.Y. Patil Medical College and Hospital Pimpri, Pune, Maha- 60 cases, it was possible to reach a single specific diagnosis corre- rashtra, India. sponding with final diagnosis in 56 cases. *Corresponding author Email: [email protected] Conclusion: Imaging plays an important role in the evaluation Abstract: Background: Neonatal encephalopathy is a syn- of orbital diseases. Evaluation of optic nerve, other cranial nerves, drome which results from disturbed neurological function in early and intracranial extension of lesions can be diagnosed more confi- neonatal life in the term infants. It can occur due to cerebral dys- dently with MRI and hence it has become initial imaging modality genesis, congenital infections, hypoxia and hypoglycaemia. It of choice for the same. occurs in 1 to 6 per 1000 live term births and can result in signifi- Discussion: General advances in techniques of MRI have also cant morbidity and mortality. had a positive effect on MRI of orbit, to demonstrate the orbital Aim and Objectives: To assess the role of MRI in neonatal anatomy including all major vessels and nerves. Advanced MRI hypoglycemia, a prospective study was done on 10 neonates in the techniques like DWI, Spectroscopy can provide in vivo physio- Department of Radiodiagnosis in Dr. D. Y. Patil Medical College logical and metabolic information, complementing morphologic and Research Centre, Pimpri, Pune, who were clinically suspected findings from conventional MRI thus helping in tissue characteri- to have hypoglycaemia. zation. Materials and Methods: A prospective Study was conducted RADO11 on 20 term infants (36-42weeks) who were clinically suspected with hypoglycaemia and/ or recorded low blood sugar on Siemens Diffusion Tensor Imaging and Tractography 1.5 Tesla MAGNATOM AVANTO machine. Sequences taken in Brain Tumours were: Axial T1WI, T2WI, FLAIR, DWI with ADC, GRE; coronal T2WI and sagittal T1WI. Kalyani Wani* and Parate Result: Out of the 10 cases examined : 4 patients showed re- Govt. Medical College and Hospital, Nagpur, Maharashtra, India. stricted diffusion in parieto-occipital lobes involving both grey *Corresponding author Email: [email protected] and white matter, 1 patient showed restricted diffusion in spleni- Abstract: Purpose: To delineate the 3D anatomy of the white um of corpus callosum, 1 patient showed multiple small areas of matter tracts and its mode of involvement by tumours whether hemorrhage in both cerebral hemispheres, 2 patients showed corti- displacement, edema, infiltration or destruction to help in better cal laminar necrosis with restricted diffusion of splenium, 1 pa- preoperative planning for surgical resection of brain tumours. tient showed restricted diffusion in splenium and parieto-occipital lobes with hemorrhage in cerebral hemispheres, 1 patient showed Method: We did cross sectional observational study on 15 restricted diffusion in splenium with hemorrhagic foci in cerebral patients of brain tumours over a duration of 6 Months using 1.5 T hemispheres. 2 of these patients also showed unmyelinated poste- Philips MR Achieva machine and took DTI sequence (Single Shot rior limb of internal capsule. Echo Planar Imaging) in every patient along with routine brain sequences. Conclusion: Neonatal hypoglycaemia can occur in preter m infants, small-for-gestational-age infants and infants of diabetic Results: Destruction and displacement were the most common mothers. Posterior white matter abnormalities, cortical injury, phenomenon in corticospinal and corticopontine tracts, thalamic white matter haemorrhage, injury of the basal ganglia and thalami radiation most commonly showed destruction, corpus callosum and PLIC are commonly observed in NHBI. Restricted diffusion

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in the occipital lobes, parieto-occipital grey and white matter, Abstract: Aims & Objectives: To study and analyze the MRI corpus callosum and optic radiation are the other patterns of brain findings in children suffered from perinatal hypoxia accord- NHBI injury. MRI is a sensitive and a specific screening method ing to the brain maturity, severity and time of the ischemic insult. for diagnosing NHBI. DWI and ADC images can detect early brain injury, within 24 hours, while conventional MRI sequences Materials and Method: A prospective Study conducted on 50 patients of pediatric age group (birth to 12 years of age) who re- take 5–6 days to detect them. ferred for MRI and suffered from perinatal hypoxia. RADO13 Machine: Siemens 1.5 Tesla MAGNATOM AVANTO. Assessment of Thyroid Lesions with High Sequences: Axial T1WI, T2WI, FLAIR, DWI with ADC, Resolution Ultrasonography and Colour GRE, IR Doppler: A Case Series Coronal T2WI Sagittal T1WI Ronak N. Savani*, Sanjay M. Khaladkar and S.G. Gandage Observation: Accurately diagnosed lesions by MRI included Dr. D.Y. Patil Medical College and Hospital Pimpri, Pune, Maha- pathologies such as germinal matrix hemorrhage, white matter rashtra, India. hyperintensities, periventricular leukomalacia, cystic encepha- *Corresponding author Email: [email protected] lomalacia, cerebral and cerebellar atrophy and agenesis and de- Abstract: Background: Diffuse and focal thyroid disease is layed myelination. common thyroid disorder. Incidence of nodularity within thyroid Conclusion: MRI is able to analyze the patterns of brain inju- is high. Ultrasound is the most sensitive imaging test available for ry, according to the brain maturity, severity and time of the is- the examination of the thyroid gland. It confirms presence of a chemic insult. In our case series, patients presenting late are more thyroid nodule when the physical examination is equivocal and than that of those presenting with acute symptoms. This repre- differentiate between thyroid nodules and cervical masses from sents a lack of public sector awareness. Maternal health improve- other origin. ment and regular antenatal checkups should be emphasized. Also, follow up in the affected children is extremely important to know Aim and Objectives: To evaluate the role of high resolution Ultrasonography and Doppler in clinically enlarged thyroid gland; the prognosis. in various diffuse & nodular thyroid disease; in differentiating benign and malignant thyroid nodules & to correlate with FNAC RADO15 in relevant cases. Endometrial Evaluation on Infertility Material and Methods: Prospective analysis of 100 patients of Arnab Mandal* and Dahlia Chowdhury clinically enlarged thyroid was done on USG (Gray scale and color Doppler). Narayana Superspeciality Hospital, Howrah, Kolkata, West Ben- gal, India. Results: 30% were male and 70% were females with high *Corr. author Email: [email protected] incidence in 3rd decade. 67% cases had diffuse thyroid disease while 33% cases had nodular thyroid disease. Out of 67 cases of Abstract: Endometrium plays a huge role in the implantation diffuse thyroid disease, 46(68.65%) were multinodular goiter, 10 process of the human embryo. A lot of work has been done to (14.92%) were Grave’s disease and 11(16.41%) were Hashimo- have a grip over the regulation of the Abstract endometrium and to’s thyroiditis. Out of 33 cases of nodular thyroid disease, 10 its clinical implications in embryo implantation both naturally and (30.30%) were colloid cyst & hyperplastic nodule each, 8 non-naturally. A major cause of infertility is due to reduced endo- (24.24%) had solitary benign adenoma, 4(12.12%) were carcino- metrial receptivity, rather an inadequate endometrium is consid- ma & 1(3.03%) was of focal thyroiditis. Thin complete peripheral ered a main factor for the determination of fertility. Here comes halo (48.48%), well defined margins (84.84%), egg shell calcifi- the role of ultrasound in the stepwise monitoring of endometruim cation (3.03%), hyperechoic (33.33%) nodules, peripheral and and the clinical evaluation of endometrial receptivity. internal vascularity (33.33%) favored benign etiology. Thyroid Ultrasound has played a key role in precisely determining the inferno (100% cases) favored Graves disease, micronodular pat- morphological changes undergone by the endometrium prior to tern (58.33%) in diffuse thyroid disease favored Hashimotos’ implantation in order to reduce the chances of failure to a consid- thyroiditis. erable degree. Conclusion: B-Mode and Color Doppler helps in differentiating Clinical evaluation of the endometrium through 2D/3D ultrasound diffuse and nodular thyroid disease with characterization of soli- followed by therapeutic treatment has undoubtedly over the years tary nodule. resulted in a better success rate in the treatment of infertility. RADO14 Therefore this review has highlighted on the different aspects of endometrial research, which in turn lead to the evaluation of endo- To Study and Analyze the MRI Brain metrial function and dysfunction. Findings in Perinatal Hypoxia USG with its specialised subtypes e.g. Sonohistosalpingography Nikita Nemade* SIS), Transvaginal Sonography (TVS), GelSonography evaluate even where cause is Primary or Secondary of Infertility. Primary Dr. D.Y. Patil Medical College and Hospital Pimpri, Pune, Maha- are such as Anatomical Subtypes of Uterus with total or subtotal divided Endometrium (ET), Endometritis leading to Adenomy- rashtra, India. omatosis etc. On other hand Secondaries are ET Hyperplasia, *Corresponding author Email: [email protected] Adhesions due to Pelvic Inflammatory Disease and Invasive P/V

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Instrumentation etc. solitary arterial trunk that supplies blood to the paramedian thala- mi and the rostral midbrain bilaterally. The diagnosis of an acute USG evaluation comes to rule out even Ascending Extra Uterine ischemic infarction, where the damage of brain tissue may still be cause of Infertility such as Recurrent Cervicitis,Cervical Stenosis reversible, enables selection of appropriate treatment and contrib- due to Mass lesion or Fibrosis in terms of Adhesion. utes to a more favorable outcome. Even in ruling out IntraUterine but Extra Endometrial reasons e.g. Objective: Role of imaging in diagnosing unusual stroke Large Myomas compressing ET, Uterine ArterioVenous Malfor- presentation, Artery of percheron infarction. mation and others. Materials and methods: Here we report two cases of artery of Case study performed in Infertility Clinic and SuperSpeciality Percheron infarct. First case a 40-year male, had complains of Corporate Set up over Individuals who came for Routine and giddiness, acute onset diplopia, left lower limb weakness, slurred Targeted Scan prior to ART or willing for natural conception in speech and second case a 38-year female had complained giddi- ways of Folliculometry or TVS at Day 2 of M-Cycle.Some cases ness, drowsiness tremors in both the hands and legs. Diffusion- are of repeated failure of ART and Natural Conception after treat- weighted magnetic resonance imaging (MRI) of the brain showed ing conservatively on completion of Follicular scan and AFC focal areas of restricted diffusion in the medial part of the thalami evaluation. bilaterally, first case also showed restricted diffusion in the upper part of mid-brain (bilateral paramedian thalamic with mid-brain RADO16 pattern). Dural Artrio-Venous Fistula - A Rare Entity Discussion: The artery of Percheron (AOP) is a variant of the Priti Komatwar*, Akshit Gangwal, Pooja Kakani, paramedian thalamic vasculature that supplies blood to the medial aspect of the thalamus and the rostral midbrain. The presentation Ashu Dixit and Shashank Kolge of an infarct in this territory is variable with diversity of clinical Vasantrao Pawar Medical College, Nashik, Maharashtra, India. presentations and becomes challenging for clinicians to diagnose *Corresponding author Email: [email protected] in the acute setting. Lacking the classic signs of stroke, many of these patients experience a delay in recognition and treatment, Abstract: Introduction: Intracranial dural arteriovenous fis- with the majority of diagnoses occurring outside the tissue plas- tula (DAVF) is a unique vascular malformation that is supplied by minogen activator (tPA) window. This case highlights the unusual dural arteries and drains into venous sinuses or meningeal veins presentation and diagnostic difficulty of a patient with an AOP Venous drainage patterns are a major determinant of clinical out- infarct, and serves as a reminder to include thalamic pathology in come in intracranial dural arteriovenous fistula (DAVF) patients. patients presenting with vague neurological symptoms and no Objective: Role of interventional radiologist in management obvious signs of stroke. of dural artrio-venous fistula. RADO18 Material and methods: Here we are presenting a case of 21 yrs old male with c/o headache and right sided deviation of angle of A Rare Case Report of Pyloric Atresia mouth. On investigations MRI shows dilated vascular channels in Epidermolysis Bullosa Aplasia Cutis left fronto-parietal region and passing over left temporal cortex and sylvian fissure. Syndrome Discussion: Dural artrio-venous fistulas are fistulas connecting Mallikarjuna C.M.* the branches of dural arteies to veins or venous sinus. It may de- Department of Radio-Diagnosis, J.J.M. Medical College, Da- velop as a result of a process of thrombosed sinus recanalization. vangere, Karnataka, India. MR imaging findings included flow void cluster, engorged oph- *Corresponding author Email: [email protected] thalmic vein/proptosis, white matter hyperintensity, intracranial Abstract: The aim is to study the imaging features of pyloric hemorrhage, dilated leptomeningeal or medullary vessels, venous atresia-epidermolysis bullosa -aplasia cutis syndrome. In the pre- pouch, and leptomeningeal or medullary vascular enhancements. sent study G3P2L2 female presented with 8 months of amenor- MRA findings included identifiable fistula, venous flow-related rhea with pain abdomen. History of consanguineous marriage enhancement, and prominent extracranial vessels. It differs from present. Previous two pregnancies were uneventful and babies pial arteriovenous malformation, in that “nidus” is not present in were healthy. GE LOGIC s9 ultrasound machine was used for the parenchyma and feeders should include the dural arteries. imaging. The results showed that Antenatal ultrasound Antenatal Treatment includes endovascular embolization. Post embolization, ultrasound showed fetus corresponding to 30 weeks gestation with it shows complete obliteration of fistulous communication. features of single bubble sign, bilateral hydronephrosis, echogenic amniotic fluid and a thin bullous lesion in the chest region. Abor- RADO17 tus examination - revealed skin blisters, localized absence of skin Case Report: Artery of Percheron Infarction (aplasia cutis congenita),nail dystrophy, hypotrichosis. Akshit Gangwal*, Pooja Kakani, Priti Komatwar and RADO19 Ashu Dixit Salvaging of Hemodialysis AV Fistula - A Vasantrao Pawar Medical College, Nashik, Maharashtra, India. Single-Center Experience *Corresponding author Email: [email protected] Vikram Shende* Abstract: Introduction: The artery of Percheron is a rare variant of the posterior cerebral circulation characterized by a KEM Hospital Mumbai, Maharashtra, India.

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*Corresponding author Email: [email protected] tion by CT had sensitivity and specificity of 100% in our study. Abstract: If the kidneys fail and a transplant is unavailable, then dialysis is necessary to survive. An AV fistula is an abnormal RADO22 connection between an artery and a vein, and is sometimes surgi- MRI Imaging Features of Hypertrophic cally created to help with haemodialysis treatment. the majority of Olivary Degeneration patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically Preeti Chaure* created access sites. This study is about our experience as inter- vention radiologist coming in to rescue of the thrombosed diaysis Apollo Hospital, Chennai, Tamil Nadu, India. fistula, in a tertiary care centre. *Corresponding author Email: [email protected] Abstract: Hypertrophic olivary degeneration (HOD) is a RADO20 unique form of transneuronal degeneration that usually appears at Superior Rectal Artery Embolization - around 3-4 weeks after a disruption of the triangle of Guillain- Mollaret. Treatment of Hemorrhoid Clinically, patients classically present with symptomatic palatal Vikram Shende* myoclonus. KEM Hospital Mumbai, Maharashtra, India. The triangle of Guillain-Mollaret is involved in fine voluntary *Corresponding author Email: [email protected] motor control and consists of both the inferior olivary nucleus and the red nucleus on one side and the contralateral dentate nucleus. Abstract: Quest of safety and effectiveness of superior rectal artery embolization as a treatment option for hemorrhoid has been The typical magnetic resonance imaging findings include T2- generated since the procedure's introduction in about a decade hyperintensity and enlargement of the inferior olivary nucleus time. This review will focus on the key articles representing the evolving over time to atrophy with residual T2-hyperintensity. best evidence to summarize the outcomes of superior rectal artery In this article, we provide a case-based illustration of the anatomy embolisation and comparing them with our experience at KEMH of the Guillain-Mollaret-triangle and the typical imaging findings Mumbai. of hypertrophic olivary degeneration. RADO21 Our purpose was to describe those MRI features linking them to their corresponding neurological manifestations and possible prior MDCT Evaluation of Abdomen: A Cross- location of brain insults based on our own experience. Sectional Study of Blunt Trauma Cases RADO23 Chetan Shetty*, Jeevika M.U. and Joish Upendrakumar Correlation Between Clinical Features and Department of Radio-Diagnosis, JJM Medical College, Da- vangere, Karnataka, India. Magnetic Resonance Imaging Findings in *Corresponding author Email: [email protected] Lumbar Spondylosis Cases Abstract: Blunt abdominal trauma makes up 70% of all blunt Guruprasad C.* trauma. CT evaluation of Abdomen has become the mainstay of management of all types of trauma to abdomen, in particularly Department of Radio-Diagnosis, JJM Medical College, Da- blunt trauma abdomen. This change is mainly attributable to the vangere, Karnataka, India. ability of CT scanning to produce most detailed images of the *Corresponding author Email: [email protected] areas of study or interest. The detection rate sensitivity and speci- Abstract: Aims: The purpose of study is to identify and local- ficity of solid organ injury by CT with on correlating with surgical ize the specific pathology on MRI which will correspond to the findings were 97.5% and 100%. Meanwhile the PPV and NPV clinically identified level and type of low backache in patients were 100% and 94.74% respectively. Bladder injuries were ana- with Lumbar Spondylosis and guide the management. lysed separately and we found out the sensitivity, specificity, NPV and PPV of 100%, 91.9%, 50% and 100% respectively on com- Overview of literature: MRI is primary imaging modality in parison with surgical findings. All false positive cases were sus- assessing low back ache. Many of the findings identified are not pected to have extra-peritoneal type of bladder injury. On ascend- symptomatic. Nerve root and Cauda Equina compression, Posteri- ing urethrogram evaluation 3 cases were found to have urethral or Annular tear, Facetal arthropathy are more likely to be sympto- injury. Of the 56 cases admitted during the period of study 49 matic whose management vary accordingly. cases were discharged on improvement of General condition and Methods: The study done included 100 patients who were follow up done subsequently shows no further complications in referred for MRI of Lumbosacral spine with history of debilitating any of these patients. 6 patients died within 48 hours post admis- back ache for more than 6 weeks. Patients with history of trauma, sion. About 83% of the deceased patients had either a major or suspicion of vertebral metastases, infections, spinal cord tumours, minor vessel injury with active bleed, all of which were detected spinal cord oedema/lesions, myelomalacia, traumatic injury de- by CT evaluation. One case had isolated pancreatic fracture, with- tected on MRI and any contraindications for MRI were not in- out duodenal injury. This was confirmed by surgery. So pancreat- cluded in the study. ic injury was the rarest reported injury in our study. It attributed to 1.7% of total cases. Meanwhile adrenal injury was second least Results: The study included 55 ladies and 45 men. The mean common type of injury reported, was reported in two cases attrib- age of the cases was 45.5 years. The youngest was aged 24 years uting to 3.5% of total. Both adrenal and pancreatic injury detec- and the elder most was of 85 years.

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Limitations: In 14 cases, the causative pathology could not be which on further sonographic imaging with color Doppler imag- matched and localised on MRI. This could be due to paraspinal ing was diagnosed as cross-fused renal ectopia. muscle spasms, inappropriate posture, inability to accurately lo- calize the distribution of pain on clinical examination, reduced Case report: A 25-year-old parous woman presented to the Chi- threshold for pain, physiological changes, especially in females gateri General Hospital at 35 weeks' gestation for a routine fetal etc. survey, obstetric course thus far was uncomplicated. The fetal anatomic survey revealed empty right renal fossa. Doppler imag- Conclusion: Not all disc herniations identified on MRI cause ing of renal vessels confirmed absent vascular flow to the right low back ache. Therefore, it is essential to identify the pathology renal fossa. No other fetal anomalies were noted on the examina- that corroborates with the clinical symptomatology of the patient. tion. Uncomplicated prior pregnancies with no significant family It aids in guiding the patient towards specific management strate- history. On Doppler imaging, separate vascular supplies from the gies. descending aorta to the normal left kidney and to the cross-fused right kidney. the separate vascular supplies to the left kidney and RADO24 cross-fused kidney were well delineated. The constellation of An Overview of MRI Artifacts findings lead to diagnosis of cross-fused renal ectopia. Chetana S. Kalburgi* Conclusion: Although silent, and mostly detected in autopsy specimen. Routine prenatal sonography is performed in prenatal Department of Radio-Diagnosis, JJM Medical College, Da- care to screen for fetal anomalies. Although cross-fused renal vangere, Karnataka, India. ectopia is an uncommon anomaly, prenatal diagnosis using Colour *Corresponding author Email: [email protected] Doppler imaging during the workup of an empty renal fossa may Abstract: Aims and Objectives: An artifact is a structure that aid with postnatal evaluation by pediatricians. Moreover, detailed is not anatomically present but is visible in MRI examination. prenatal sonography is recommended to evaluate for any other When present in MR images it tends to affect them. Artifacts in associated congenital abnormalities. magnetic resonance imaging may be caused by the MR scanner

hardware itself or by the interaction of the patient with the hard- RADP1 ware. The main aim of the study is to illustrate the various com- monly encountered artifacts and to know how to overcome such Magnetic Resonance Imaging of the problems in order to obtain the best possible images. Developmental Malformations of Paediatric Methods and Materials: MRI images of all patients attending Brain the Radiology department at Department of Radio-diagnosis J.J.M. Medical College, Davangere, Karnataka were assessed for Siddhant Bhardwaj*, Madan Manmohan, Kunal Arora, a duration of 2 months for various artifacts. All the parameters Nilesh Ingale, Pratik Patil and O.J. Tavri related to the images with artifacts were assessed and evaluated. Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- Results: 1) Dependent on physiological processes (breathing, harashtra, India. heart beat, flow in vessels): Movement artifacts & Flow artifacts *Corresponding author Email: [email protected] 2) Inherent to the physical processes used in MRI: Chemical-shift (1st and 2nd type) Aliasing & Magnetic susceptibility artifacts 3) Abstract: Learning objectives: To illustrate the imaging find- Inherent to the software and hardware of the MRI machine: Cross ings of various common developmental conditions affecting the -talk artifact & Zipper artifacts. paediatric brain and serve as a learning tool for radiology trainees. Conclusion: Artifacts in magnetic resonance imaging may be To enumerate and differentiate these conditions into groups and in caused by the MR scanner hardware itself or by the interaction of a tabulated format. the patient with the hardware and to know how to overcome such Background: Paediatric brain is a complex structure which problems in order to obtain the best possible images. can be affected by multitude of disorders. Clinical features of many these conditions are nonspecific and they pose a challenge RADO25 for the physician in reaching a rational diagnosis. Thus imaging Prenatal Diagnosis of Fetal Cross Fused forms the mainstay to evaluate these lesions. Ectopic Kidney: A Case Report Magnetic resonance imaging is the modality of choice for paediat- ric neuroimaging owing to its ability to provide important infor- Subodh D.* mation about the anatomic location, size, shape of the lesion and Department of Radio-Diagnosis, JJM Medical College, Da- pattern of signal intensity. However imaging features of various vangere, Karnataka, India. disorders tend to overlap which makes the diagnosis difficult. *Corresponding author Email: [email protected] Common developmental conditions discussed include microceph- Abstract: Prenatal sonographic examinations performed dur- aly, polymicrogyria, focal cortical dysplasia, heterotopia, lissen- ing prenatal care, screen for fetal anomalies. Estimated severe cephaly, schizencephaly and chiari malformations. structural fetal anomalies affect approximately 1% of pregnancies, 20% involve the genitourinary system. Prenatal detection of an Conclusion: Pathologies involving the paediatric brain have empty renal fossa may arise from renal agenesis, renal ectopia, or always been a diagnostic dilemma for neurologists as well as fusion anomalies, may be associated with chromosomal abnor- radiologists. Hence this presentation helps to simplify the ap- malities or other congenital anomalies. We report an interesting proach towards these common disorders and helps narrow down case of a fetus initially suspected to have unilateral renal agenesis, the differentials to reach a radiological diagnosis.

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RADP2 Material and methods: X-ray images of the patient were taken on a portable Siemen’s machine shifted to the NICU; Computed Imaging Spectrum of Spinal Dysraphism on tomography was performed on a Siemen’s Sensation 64 slice Magnetic Resonance machine with non-ionic oral contrast. Abhishek Das* and Madan Manmohan Results: Computed tomography revealed: 1) Significant trache- al atresia with complete laryngeal agenesis. 2) A large carino- Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- oesphageal fistula. 3) Oral contrast aspiration into bilateral lung harashtra, India. fields. *Corresponding author Email: [email protected] Conclusion: Tracheal atresia and laryngeal agenesis are ex- Abstract: Background: Spinal dysraphism refers to the heter- tremely rare and uniformly fatal pathologies. Because of the lack ogeneous group of anomalies involving the spinal column and of a normal continuous airway, affected newborns survive only if neuraxis. Magnetic resonance imaging (MRI) is now considered an alternate pathway for ventilation (eg: a patent broncho- the imaging modality of choice for diagnosing these conditions. esophageal fistula) exists. Although operative techniques are The imaging of spinal dysraphism is complex, it requires a sys- available to correct such pathologies, they have yielded poor re- tematic approach and clinical correlation to make correct diagno- sults, essentially making them non-correctable. sis. MR classification of spinal dysraphism helps in surgical plan- ning and prognostication. In this study there was a patent carino-oesophageal fistula which helped the patient survive for a few hours. However, dyspnoea Learning objectives: To summarize the basic concepts about due to significant tracheal agenesis and complete laryngeal agene- normal and deranged spinal cord embryogenesis; To describe the sis coupled with bilateral lung aspiration, anaemia, prematurity clinical-neuroradiological classification of different spinal dysra- (32.4 weeks) and low birth weight (1.62 kg) finally took her life phism; To describe the principal malformations of the spine and spinal cord seen most frequently. Take home message: Conditions like tracheal atresia, larynge- al atresia, congenital high airway obstruction (CHAOS) are in- Material & Methods: Spinal dysraphism were studied and compatible with life and hence their antenatal diagnoses is highly identified different spectrum of dysraphism and classified them. desirable; While it might be difficult to give a confirmative diag- Relevant history age, sex, birth history, developmental history, nosis; hyperinflated, enlarged and echogenic lungs with dilated presenting complaints and radiological findings were recorded. fluid filled tracheobronchial tree, inverted or flattened diaphragm, The MRI was performed with GE OPTIMA 1.5 TESLA machine. decreased cardio-thoracic ratio, maternal polyhydramnios with or The findings of MRI spine were assessed and analyzed. without and pleural effusion seen antenatally on USG Our standard spine imaging sequences included: should raise the suspicion of an airway obstruction and the patient should be forewarned and counseled regarding the poor prognosis.  Sagittal T1-weighted image (WI) : craniospinal axis, delineate vertebral body marrow, cord size, lipomatous tissue. RADP4  Sagittal, axial and coronal T2WI: cord parenchyma, delinate Atypical Presentation of Uremic cerebrospinal fluid (CFS), extradural interface, associated intraspinal masses, fetal evaluation. Encephalopathy  Sagittal and axial planes. Coronal planes are useful in diaste- Divya B. Desai*, Sanjay Pasoria and Arnab Marik matomyelia. Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- Discussion: Spinal dysraphism is one of the most common harashtra, India. congenital disorders associated with significant morbidity and *Corresponding author Email: [email protected] mortality with estimated incidence of approximately 0.05 to 0.25 Abstract: Aims and objectives: To analyse the MRI findings per 1000 births [1]. Spinal dysraphisms are categorized into open in atypical presentation of uremic encephalopathy. spinal dysraphisms (OSDs), in which there is exposure of abnor- mal nervous tissues through a skin defect, and closed spinal dysra- Materials and methods: Multi-planner multi-echo MRI was phisms (CSD), in which there is a continuous skin coverage to the performed in patient of altered sensorium and elevated serum underlying malformation. A basic knowledge of embryogenesis of creatinine and urea levels. the spine and spinal cord is a must in order to understand the wide Results: Uremic encephalopathy is typically seen in patients spectrum of abnormalities seen in cases of spinal dysraphism. with diabetes. The typical MRI findings including bilateral vaso- genic or cytotoxic edema at cerebral cortex or basal ganglia. Cor- RADP3 tical involvement can cause reversible posterior leukoencephalo- Tracheal Atresia with Laryngeal Agenesis: A pathy syndrome. Involvement of basal ganglia is rare, typically occurring in uremic-diabetic patient. Atypical type of uremic en- Rare but Fatal Pathology cephalopathy is rarest and involves WM. It typically occurs in non Roopali Bansal* -diabetic uremic patient with very high serum urea levels and a variety of neurologic symptoms. Moreover non- diabetic uremic Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- encephalopathy shows unique and atypical imaging findings. harashtra, India. *Corresponding author Email: [email protected] Conclusion: Non diabetic patients with uremic encephalopa- thy present with atypical clinical presentation and show atypical Abstract: Aims and objectives: Evaluation of a case of a new- imaging findings and their knowledge can lead to early diagnosis born presenting with breathlessness and multiple failed attempts and expedited treatment which can provide complete neurological of intubation and other resuscitative measures. and radiological recovery.

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RADP5 The imaging findings are of particular concern because they fre- quently mimic malignancy, which makes accurate histological The Double Panda Sign of Wilson's Disease, as diagnosis all the more important. Seen on MRI Brain Aims: 1) To differentiate from skull base malignancies which Roopali Bansal*, Thahir V.U. and Madan Manmohan can mimic infections of the skull base. 2) To highlight the diversi- ty of clinical presentations to avoid misdiagnosis. 3) To guide Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- prompt commencement of antibiotic therapy to lower the risk of harashtra, India. potential sequelae, which can prove to be fatal. *Corresponding author Email: [email protected] Methods: GE optima 128 slice CT scanner and 1.5 Tesla GE Abstract: Aims and objectives: Evaluation of a case of a MRI scanners were used. young female presenting with generalized weakness, bilateral upper and lower limb numbness, tremors and slurring of speech Findings: A middle aged man left otomastoiditis with exten- since 1 year. sive erosions involving the left petrous temporal bone and both halves of the skull base with involvement of the facial nerve with Material and Methods: MRI brain (plain) was performed thrombosis of left cavernous sinus and supraclinoid portion of left using a GE 1.5 Tesla machine. internal carotid artery, with extension into the paranasal sinuses, Results: Magnetic resonance imaging revealed: 1) Bilaterally left infra temporal and pterygo palatine fossa, orbital apex, naso- symmetrical T2W and FLAIR hyperintensities in the thalamus pharynx and hard palate. and lentiform nuclei. 2) Hyperintense tegmentum with normal red Conclusion: Recognition and prompt diagnosis of skull base nuclei and lateral portions of substantia nigra in axial T2W imag- osteomyelitis is prudent to lower the risk of potential sequelae. es of the midbrain. 3) Otherwise normal cerebrum and cerebel- Therefore thorough knowledge will help differentiate between lum. 4) No restriction on diffusion weighted images and no skull base osteomyelitis and skull base malignancies, increase blooming on gradient images. diagnostic yield, guide appropriate and timely management of Discussion: The midbrain ‘face of giant panda sign’ seen is such patients. due to high signal in the tegmentum, normal signals in the red nuclei and lateral portion of the pars reticulata of substantia nigra, RADP7 and hypointensity of the superior colliculus. In addition, a “face of panda cub or face of miniature panda” is seen within the dorsal Hypermelanosis of ITO – From A part of pons where the eyes represent the relative hypointensity of Radiologist’s Point of View the central tegmental tracts, nose and mouth represent the hyper- intensity of the aqueduct opening into the fourth ventricle and the Ankur Pramanick*, Omprakash Tavri, Smita Borale, cheeks represent the superior cerebellar peduncles. Thus, together Pratik Patil and Nilesh Ingale they are called the “Double panda” sign. Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- Another rare sign seen is the ‘trident sign’ or ‘Mercedes Benz’ harashtra, India. sign due to the diffuse hyperintensities in pons. Retrospectively *Corresponding author Email: [email protected] we called the patient for USG abdomen to see the liver and sent Abstract: Introduction: Hypomelanosis of Ito is the third most her for ophthalmic evaluation too. common neurocutaneous syndrome (1), the other two being Neu- A picture of liver cirrhosis with early signs of portal hypertension rofibromatosis and Tuberous sclerosis. HI is thought to be un- was seen on sonography. known etiology, however some attribute it to the chromosomal instability – mostly mosaicism (2) and some attribute it to the Bilateral KF rings were noted in the ophthalmic evaluation. autosomal dominant inheritance. However, its reported cases are Conclusion: Wilson's Disease is an autosomal recessive inher- very rare in radiological literatures. ited disorder affecting the copper transport by ceruloplasmin Materials and methods: MRI brain study was done using GE where it’s biliary excretion is impaired and body copper progres- OPTIMA 1.5 Tesla scanner in the Department of Radiology at Dr. sively increases, especially in the liver, kidneys, brain and cornea. D.Y. Patil Medical College, Navi Mumbai. Clinical examination was done by the Department of Dermatology in the same hospital.

RADP6 Case report: We present to you a case of a fifteen year old Skull Base Osteomyelitis: A Diagnostic female child having a history of long standing seizures since Dilemma twelve years of age. Discussion: Hypomelanosis of Ito is the third most common Lekha Sachdev* and Nilesh Ingale neurocutaneous syndrome (1), the other two being Neurofibroma- Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- tosis and Tuberous sclerosis. HI is thought to be unknown etiolo- harashtra, India. gy, however some attribute it to the chromosomal instability – *Corresponding author Email: [email protected] mostly mosaicism. Characteristics of HI are hypopigmented areas with irregular borders, streaks, whorls, or patches and it is com- Introduction: Skull base osteomyelitis is a life-threatening in- monly associated with neurological abnormalities. It is multisys- fection. It typically occurs in elderly diabetic or immunocompro- tem disorder and affects almost all the systems of the body. How- mised patients. The most common pathogen is pseudomonas aeru- ever, apart from the cutaneous and neurological manifestations (5) ginosa; other pathogens are rarely reported. This report documents others are quite rare. a case of a middle aged man with methicillin sensitive staphylo- coccus aureus of the skull base, presenting with left facial palsy. Conclusion: Although Hypomelanosis of Ito is the third most

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common neurocutaneous disorder, still the numbers of its reported of all entities, although it is difficult to distinguish from other non cases are very less. This is probably due to the fact that there is chordomatous lesions. not enough clinical correlation happening during the daily report- ing hours, and most of these cases are being reported as mucopol- MRI is the imaging modality of choice to detect bone marrow ysaccharoidoses. Therefore the possibility of this entity should be involvement and soft tissue extension in such cases. kept in mind in such unusual cases and a thorough clinical evalua- Aims and objectives: To illustrate the imaging features of the tion and correlation should be performed. clival chordoma on magnetic resonance imaging; To differentiate clival chordoma from other common clival lesions. RADP8 Material and methods: Magnetic resonance imaging of the Meningeal Hemangiopericytoma and Its brain with administration of intravenous contrast was performed Intracranial Complications on a 1.5 T GE scanner. Zeny A. Vyas*, Pratik Patil and Arnab Marik Clival involvement was seen in 3 cases and their characteristic features were described and histopathological confirmation was Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- obtained. harashtra, India. *Corresponding author Email: [email protected] Findings: Introduction: Meningeal haemangiopericytoma (HPC) is a Case 1: Clival Chordoma: Large T1 isointense and T2 hyper- rare intracranial tumour. Until 1993 HPC was considered as an intense expansile lesion was seen involving the clivus. Hetero- angioplastic variant of meningioma. The recently published WHO genous post contrast enhancement with surrounding soft tissue classification of central nervous system (CNS) tumour classifies extension characteristic of chordomas was seen. HPC as mesenchymal non-meningothelial tumour combined with Case 2: Clival Meningioma: Large homogeneously enhancing solitary fibrous tumour (SFT), graded 1–3. While these are highly mixed signal intensity lesion was seen in the petroclival region vascular tumour, it often present with mass effect. Presentation displacing the brainstem. Characteristic feature of meningioma with haemorrhage is also well described in literature, but not com- the dural tail sign was seen in this case. monly seen in clinical practice; this is partly due to the rarity of this tumour. Case 3: Pituitary adenoma extending to clivus: Large mixed intensity heterogeneously enhancing lesion was seen involving the Aim and objective: To analyze the intracranial features in clivus. Superior extension of the lesion and involvement of the varying presentations of hemangiopericytoma. pituitary was characteristic feature of this case. Materials and methods: CT and MRI were performed in patients Conclusion: Differentiating clival mass lesions can be chal- having clinical features of raised intracranial pressure. Patients lenging, however after having proper knowledge of their charac- with imaging findings of HPC were analyzed. teristic MRI features its diagnosis can be made with high yield. Results: We present two cases of HPC. 1) A 60-year-old female who came with complaints of giddiness since one year RADP10 (Uncomplicated). 2) A 62 year-old female presented with acute Radiation Protection: Let’s Talk About right sided weakness with altered GCS (Complicated). Surroundings Conclusion: Haemangiopericytoma (HPC) is rare intracranial vascular tumour that can occasionally present with haemorrhage. Ammar S. Modi*, Ravi Varma, Ankita Jadhao and It should be included in the differential of dural based non- Sachin Khatakalle hemorrhagic and haemorrhagic masses. Massive hemorrhage is a life-threatening complication which may require emergent treat- Topiwala National Medical College and BYL Nair Charitable ment. Awareness of this presentation is very important for early Hospital, Mumbai, Maharashtra, India. intervention. *Corresponding author Email: [email protected] Abstract: Medical application of ionizing radiation is increas- RADP9 ing worldwide day by day. While the use of ionizing radiation benefits the patients diagnostically and therapeutically, the associ- Magnetic Resonance Imaging of Clival ated risks due to stochastic and deterministic effects make it nec- Chordoma and Its Differential Diagnosis essary to protect patients as well as radiologists and other health professionals from potential harm. The cumulative lifetime occu- Harsha Jeswani*, Madan Manmohan, Nilesh Ingale, pational radiation dose experienced by radiologist and potential Thahir V.U. and Kunal Arora resulting adverse effects have been a concern to the profession since beginning. Currently, radiologists in clinical practice, partic- Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- ularly those who routinely perform image guided procedures (CT harashtra, India. and DSA guided), may be exposed occupationally to continuous *Corresponding author Email: [email protected] low-dose radiation above background levels. There is variability Abstract: Introduction: Clivus is a sloping structure that in occupational radiation dose to which radiologists are exposed, forms the anterior portion of the posterior cranial fossa, in the depending on the type of procedure. In the tertiary care hospital, it center of the skull base. Due to its strategic location some disor- is possible to provide adequate protection to insure the safety of ders typically affect the clivus. Clival lesions are rare and repre- personnel occupied with one or another of the forms of radiation. sent a wide range of pathologies, including non- tumoral lesions, Despite this fact, one cannot but be alarmed at the number of radi- benign and malign neoplasms. Chordomas account for about 40% ation injuries which are being reported in apparently well-

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equipped and well controlled radiological departments. All types Department of Radiology, Topiwala National Medical College of radiation produce essentially identical effects. X-rays, gamma and BYL Nair CH Hospital, Mumbai, Maharashtra, India. rays, and alpha and beta particles differ from one another in the *Corresponding author Email: [email protected] distribution and magnitude of the damage produced. The risk of injury associated with long-term occupational exposure to ioniz- Abstract: Learning objectives: To discuss neuroimaging find- ing radiation is low. The purpose of this poster is to create aware- ingsof Arnold-Chiari malformation. ness in radiologists and other health professionals about radiation- Background: Arnold-Chiari malformation is a spectrum of con- related effects and measures to protect themselves to which they genital hindbrain abnormalities affecting structural relationship are potentially susceptible. between cerebellum, brain stem, upper cervical cord and bony cranial base. Austrian pathologist Hans Chiaridivided them into RADP11 three types: Chiari 1-3.The frequency and importance of the eval- uation of the posterior fossa have increased significantly over the Non-Ketotic Hyperglycemic Hemichorea past 20 years owing to advances in neuroimaging. Neuroimaging Hemibalismus Syndrome techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa and hindbrain malformation. Harshvardhan Singh Rathore*, Arnab Marik, Madan In this review, we discuss the neuroimaging findings of chiari 1-3 Manmohan and Kunal Arora malformation. Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Ma- Imaging findings: The hallmark in Chairi 1 malformation is harashtra, India. caudal displacement (>5mm) of pointed peg like cerebellum ton- *Corresponding author Email: [email protected] sils below the level of foremen magnum with angled cerebellar Abstract: Background: Non-ketotic Hyperglycaemic Hemicho- folia. There will be crowding of foramen magnum, effaced CSF rea Hemibalismus, also known as diabetic striatopathy or Chorea, spaces and diminished CSF flow at posterior foramen magnum. Hyperglycemia, Basal Ganglia (C-H-BG) syndrome, is a rare Chairi 2 is hindbrain malformation with myelomeningocele. Im- cause of T1 bright basal ganglia and one of the neurological com- aging findings include lacunar skull, myelomeningocele, small plications of non-ketotic hyperglycaemia. It is frequently seen in posterior fossa, abnormal dura, inferiorily displaced medulla and elderly female patients, typically Asian, who have type 2 diabetes. vermis, cervicomedullary kink, medullary spur, towering cerebel- It is a rare but dramatic complication of nonketotic hyperglycemia lum, hydrocephalus and callosaldysgenesis. in patients with uncontrolled diabetes. The clinical features vary in severity, typically waning rapidly with restoration of glucose Chairi 3 is rarest of chiari malformation. Small posterior fossa control. with causally displaced brain stem is seen on neuroimaging. Also, there is low occipital or upper cervical bony defect through which Findings: A 58-year-old woman presented to the emergency de- there is herniation of meninges, dysplastic brain and ventricles. partment with C/o left sided weakness & deviation of face since 15 days and headache. Relevant medical history included hyper- Conclusion: The interpretation of Arnold-chiari malformation tension and insulin dependent type 2 diabetes. Headaches were is challenging. Neuroimaging is often the initial and mandatory intermittent with loss of coordination in the left upper extremity. step in order to obtain a diagnosis when an abnormality is suspect- Review of systems was positive for mild dysmetria. Blood sugar ed, and this is when an imaging anatomical approach aids the levels were elevated (560 mg/dl), but secondary laboratory find- interpretation. ings including urine examination were negative for diabetic ke- toacidosis. Blood pressure, glucose control and supportive care RADP13 was initiated. Cerebrotendinous Xanthomatosis – The At admission, the patient underwent Non Enhanced Computed Spectrum of Imaging Findings Tomography (NECT) brain and MRI of brain. NECT done at admission demonstrated mildly increased density within the right Jagadish K. Pawara* basal ganglia, involving the caudate and lentiform nuclei. Subse- Grant Government Medical College and Sir J J Group of Hospi- quently, a MRI scan was performed, demonstrating corresponding tals, Mumbai, Maharashtra, India. increased T1 signal and minimally decreased T2 signal within the *Corresponding author Email: [email protected] right lentiform nucleus and caudate nucleus. Diffusion restriction and blooming were absent. Abstract: Introduction: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disorder charac- Conclusion: In a patient with history of uncontrolled diabetes, terized by accumulation of cholesterol and cholestanol in various C-H-BG syndrome should be on the top of the differential list tissues, predominantly the central nervous system (CNS), tendons, when the characteristic MRI findings of a hyperintensity in the lungs, liver, and kidneys. basal ganglia are observed. Overall, the prognosis of NKH chorea has been reported to be excellent. It depends on the prompt identi- Background: A 28 years male presented with headache since 2 fication of undiagnosed diabetes and proper control of the blood years, inability to talk since 2 months, volume of voice is gradual- sugar in the previously diagnosed patients. ly lost to present level, one episode of convulsion in last 2 years and swelling behind bilateral ankles.

RADP12 Findings: CT brain plain reveals: Symmetrical ill defined Review of Neuroimaging of Arnold-Chiari hypodense areas in bilateral cerebellar hemisphere involving den- Malformation tate nuclei and peridentate white matter. MRI brain reveals: T2/FLAIR hyperintense and T1 hy- Vikash Rustagi*, Sanika Patil and Aakash Ramteke pointense non enhancing lesions in bilateral cerebellar white mat-

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ter and dentate nucleus and bilateral posterior limb of internal Conclusion: Diagnosis of CLIPPERS is challenging and re- capsule. quires careful exclusion of alternative diagnosis in the form of normal CSF parameters for other CNS disorders. Bilateral eye globe show post operative iatrogenic posterior cham- ber intra ocular lenses. So it is of paramount importance for the radiologists to be aware of this differential for the benefit of the patient. Plain radiograph ankle reveals: Bilateral soft tissue elongated mass behind tibia and fibula in the region of Achilles tendon. RADP15 MRI screening of bilateral ANKLE reveals: Enlarged bilateral Achilles tendon appearing hypointense on T1WI and T2WI with Not Just Trauma – Fat Embolism Syndrome few hyperintense linear areas within. Imaging in Non-Traumatic Patients These findings were confirmatory for CTX. Pankaj Kumar Nanda* Discussion: Cerebrotendinous xanthomatosis (CTX ) is a po- Grant Government Medical College and Sir J J Group of Hospi- tentially treatable condition with replacement therapy, and hence tals, Mumbai, Maharashtra, India. early diagnosis before neurological deterioration is important. *Corresponding author Email: [email protected] Diagnosis is based on the typical clinical history and findings, the presence of normal or low cholesterol in association with raised Abstract: Introduction: Fat embolism syndrome (FES) is an cholestanol levels, and the characteristic imaging findings which emergency that arises from the systemic manifestations of fat are conclusive for the diagnosis of CTX. emboli within the microcirculation. Non traumatic causes of fat embolism are rare and sickle cell anemia is one cause among them. RADP14 Background: A 24 year old boy with history of sickle cell dis- Eyes Can See What Brain Knows- The ease presented with chest and back pain followed by respiratory Peppering Pons insufficiency and altered sensorium. Suresh Sahani* Findings: Initial CT brain was nor mal. Chest radiograph showed bilateral upper, middle and lower zones opacities predom- Grant Government Medical College and Sir J J Group of Hospi- inantly in peri hilar distribution. CT Thorax showed extensive tals, Mumbai, Maharashtra, India. ground glass opacities with consolidation, smooth interlobular *Corresponding author Email: [email protected] septal thickening in bilateral lung fields predominantly in lower lobes and peri hilar region (Bat Wing configuration) suggestive of Abstract: Introduction: CLIPPERS syndrome is recently de- pulmonary edema and moderate bilateral pleural effusion with scribed disease with debilitating CNS manifestations with a boon passive atelactasis of underlying of lung parenchyma. MRI brain in the form of near total reversibility if treated in early stages. In was done and it showed multiple discrete foci of diffusion re- spite of having a characteristic MRI appearance, can be diagnosed striction on DWI with corresponding low value on ADC and only if brain knows what eyes are looking at. blooming on SWI in bilateral cerebral hemispheres, basal ganglia, Background: A 53 year old male with CNS symptoms of thalami, brainstem and cerebellum(Star field pattern) suggestive weakness and stiffness in both lower limbs, imbalance and sway- of hemorrhagic micro infarcts. Then CT of pelvis with hip joint ing and paresthesia in bilateral lower limbs since 15-20 days. was performed showing few geographic areas of hyperdensity surrounded by a serpentine sclerotic rim on both iliac bones sug- Findings: Initial CT brain was nor mal. MRI brain with con- gestive of bone marrow infarcts. Both femoral heads shows sub- trast study showed multiple discrete punctuate foci of T2W & chondral sclerosis with subchondral cysts suggestive of avascular FLAIR hyperintensities in bilateral fronto-parietal white matter necrosis. involving centrum semiovale, and bilateral periventricular re- gions; corpus callosum, bilateral basal ganglia, brainstem, cervico Discussion: Trauma is most common cause of fat embolism -medullary junction and bilateral cerebellum, spinal cord with syndrome. Other non-traumatic causes are sickle cell anemia, intense nodular enhancement. following bone marrow transplantation, osteomyelitis, pancreati- tis, alcoholic fatty liver, and even liposuction. Sickle cell disease Repeat MRI brain with contrast study after 2 months post steroid presents with bone marrow infarction and the resultant fat parti- treatment, showed complete resolution confirming the previous cles embolise and occlude the pulmonary and intracranial capillar- suspicion of CLIPPERS Syndrome. ies. Discussion: Chronic lymphocytic inflammation with pontine Conclusion: Fat embolism occurs in patients without trauma peri-vascular enhancement responsive to steroids (CLIPPERS) as as well. It is important for radiologist and physician to keep dif- the name suggests is an inflammatory central nervous system ferentials of fat embolism syndrome in non-traumatic patients (CNS) disorder with involvement of brainstem, particularly the also. pons and is responsive to treatment with steroids with total to near total resolution if initiated early in the course of the disease. RADP16 The characteristic MRI appearance: Punctate and curvilinear Pictorial Essay: B-Scan Ultrasonography in gadolinium enhancement 'PEPPERING' the pons and adjacent Orbital Tumors structures like cerebellar peduncles, cerebellum, medulla and the midbrain. The lesions may extend inferiorly into the spinal cord, Shriram B. Mate* superiorly into the thalamus, basal ganglia, internal capsule, cor- Grant Government Medical College and Sir J J Group of Hospi- pus callosum and the cerebral white matter. tals, Mumbai, Maharashtra, India.

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*Corresponding author Email: [email protected] Discussion: CTT hyperintensities are seen among children between 1-5 years of age suffering from conditions including Abstract: Introduction: Ultrasonography (USG B mode scan) epilepsy, cerebral palsy and various neurodevelopmental disor- of the eye is a useful tool in diagnosing conditions of the ocular ders; also in various metabolic disorders comprising nonketotic globe. It is cheap, easily accessible, innocuous, easy to perform, hyperglycinemia, mitochondrial disorders, methionine adenosyl and accurate, and it may be performed in real time. It does not use transferase deficiency, leukoencephalopathy with vanishing white radiation. It can detect ocular globe lesions such as posterior wall matter and 6-pyruvoyl-tetrahydropterin synthetase deficiency masses. signifying an increased susceptibility of the CTT to external or Objectives: Discuss common and uncommon orbital mass internal injurious agents. lesions and their appearance on USG. Conclusion: CTT hyperintensities are found in neurological Findings: Orbital neoplasms in adults comprise a broad spec- conditions, one of them being West syndrome. Even though, the trum of benign and malignant entities. USG imaging plays a valu- pathophysiology of CTT alteration is not completely understood able role in diagnosis of these lesions, supplementing clinical and needs more research, radiologists, and clinicians should be ophthalmologic examination and providing information beyond familiar with the pathologies associated with CTT hyperintensi- what can be seen at fundoscopy. As with imaging evaluation of all ties. orbital disease processes, a general approach should consider the anatomic compartment of involvement. RADP18 Vasculogenic lesions were the most common, followed by lym- Oliers Disease phoid, lacrimal gland, optic nerve and meningeal, metastatic, peripheral nerve, and primary (retinoblastoma and melanoma). Poonam Mali* US features of the important orbital mass lesions like retrorbital Terna Medical College and Research Centre, Nerul, Navi Mum- and choiroidal hemangioma, melanoma, hemangioma, metastasis, bai, Maharashtra, India. retinoblastoma, dermoid, retrorbital areteiovenous malformation *Corresponding author Email: [email protected] have been discussed. Abstract: 60 year old male Referred to radiology department Conclusion: The cystic nature of the eye, its superficial loca- for x ray hand in view of large swelling in the region of left thumb tion, and high-frequency transducers make it possible to clearly which had been increasing in size since the past 6 months. show normal anatomy and pathology such as tumors. X ray hand revealed large expansile lytic lesion of left first Meta- It is possible to characterize the orbital masses on USG depending carpal with associated soft Tissue component. Few of his phaleng- on their anatomical location and USG imaging features. es and other metacarpals revealed areas of metaphyseal expansion with chondroid matrix amd foci of calcifications. Skeletal survey RADP17 revealed multiple similar lesions with chondroid matrix in the ribs,Humeri, Femur and tibia. Two Dots in The Brainstem-What Are They? MR T1, T2 and PD Fat sat sequences of the hand revealed large Bhagyashree Bhoir* well Defined Expansile lytic lesion replacing entire 1st metacarpal with a large associated soft tissue component. Grant Government Medical College and Sir J J Group of Hospi- tals, Mumbai, Maharashtra, India. Lobulated lesion which is hypointense on T1, Heterogenously *Corresponding author Email: [email protected] hypointense on PD. Abstract: Introduction: The central tegmental tract (CTT) Multiple hypointense linear signals noted within the lesion on PD hyperintensities seen on T2-weighted images (T2-WI) of the brain Fat sat magnetic resonance imaging (MRI) is an unusual neuroimaging PET CT revealed Metabolically active lesion in the thumb and finding of unclear etiology. CTT predominantly comprises of the various osseous findings are confirmed. extrapyramidal tract connecting red nucleus and inferior olivary nucleus. Normal CTT cannot be identified on T2-weighted or Radiological possibility of multiple Enchondromatosis with sec- diffusion weighted image after birth.CTT is one of the earliest ondary neoplastic changes (? Chondrosarcoma) was suggested. regions in which myelination begins. Core biopsy of the lesion revealed fibrohylinised Areas with Background: A 1 year old boy presented with seizure disorder blood vessels alternating with cartilagenous islands composed of since 2.5 months of age and developmental delay with clinical polygonal cells having pleomorphic nuclei and indistinct nucleoli, suspicion of epileptic disorder. binucleation and multinucleation was seen in few cells suggestive of enchondromatous lesion with dysplastic changes. Findings: Initial computed tomography (CT ) scan brain was This is in favour of oliers disease. normal. MRI brain was done and it showed T2 /FLAIR hyperin- tense signal along the entire course of bilateral central tegmental RADP19 tracts in midbrain, pons and medulla. Diffusion restriction with corresponding low ADC values were also seen along the tracts. Dyke–Davidoff–Masson Syndrome with Similar areas of T2 WI /FLAIR hyperintensity with corresponding Crossed Cerebellar Atrophy areas of restricted diffusion were noted in bilateral posterior cin- gulate gyri. Differential diagnosis of West syndrome and other Ronak N. Savani* and Sanjay M. Khaladkar metabolic disorders was given. Review of EEG confirmed the Dr. D.Y. Patil Medical Collage, Hospital and Research Centre, diagnosis of West syndrome. Pimpri, Pune, Maharashtra, India.

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*Corresponding author Email: [email protected] Trauma – A Case Report Abstract: Dyke–Davidoff–Masson Syndrome With Crossed Cer- Rubab Kaur Sekhon* and Rajesh Kuber ebellar Atrophy- case history, discussion and imaging features by MRI brain Dr. D.Y. Patil Medical Collage, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. Case: A 6-year-old female child presented with giddiness for 4 *Corresponding author Email: [email protected] days. She had a history of right-sided hemiparesis and right sided focal convulsions for 3½ years. Abstract: Basal ganglia stroke following minor trauma in infants is a distinct clinico-radiological entity termed mineralizing Birth history was normal with full term normal vaginal delivery; angiopathy. Healthy infants with no previously known systemic baby cried immediately after birth with no neonatal intensive care illness Present with hemiparesis and facial paresis following a unit (ICU) stay. MRI - Axial T1 sequence of the brain showed trivial injury. Neuroimaging reveals non-hemorrhagic focal infarct atrophy of the right cerebellar hemisphere with prominence of the in basal ganglia. We report a case of a 1-year old male child pre- cerebellar folia. Axial fluid attenuation inversion recovery se- senting with left-sided hemiparesis following trauma. The neuro- quence showed small sized left cerebral peduncle because of Wal- logical outcome is usually good in most children. lerian degeneration with left cerebral hemiatrophy. Coronal T2 sequence showed gliosis in left parieto-occipital region with left cerebral hemiatrophy and ex-vacuo dilatation of the left lateral RADP22 ventricle. Coronal T2 sequence showed gliosis in the left parietal Role of Imaging in Mayer–Rokitansky–Kuster region with left cerebral hemiatrophy, ex-vacuo dilatation of the left lateral ventricle and right cerebellar atrophy. Magnetic reso- –Hauser Syndrome nance angiography showed attenuation and reduced signal intensi- Bethireddy Nagireddy* and Sanjay M. Khaladkar ty of the M2 and M3 segments of the left middle cerebral artery (MCA). Conclusion: Dyke–Davidoff–Masson syndrome with Dr. D.Y. Patil Medical Collage, Hospital and Research Centre, ipsilateral or CCA is a rare entity, which can be diagnosed on CT Pimpri, Pune, Maharashtra, India. and MRI. The timing of the insult can be predicted from the pres- *Corresponding author Email: [email protected] ence of ipsilateral or CCA. Abstract: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus and upper 2/3 RADP20 rd of vagina with a normal 46, XX karyotype and normally devel- oped secondary sexual characteristics. It affects 1:4000 women. It Misleading Lung Masses may be isolated (Type I) or frequently associated with renal, ver- Swati Raut*, S. Sangani and B. Suprabhat tebral anomalies and less frequently associated with auditory, cardiac defects (Type II). It presents with primary amenorrhea in Terna Medical College and Research Centre, Nerul, Navi Mum- young women with normal external genitalia and normal develop- bai, Maharashtra, India. ment of secondary sexual characteristics with normal functioning *Corresponding author Email: [email protected] ovaries and karyotype 46, XX without visible chromosomal Abstract: An elderly asymptomatic lady with cataract was anomaly. It was considered as sporadic anomaly but an increasing referred for a Preop chest x-ray. Her frontal chest Radiograph number of familial cases is suggestive of genetic cause in whom it reveals opacity in the right mid lower zone obscuring the right is transmitted as autosomal dominant trait with incomplete pene- cardiac silhouette. The opacity revealed a sharp convex upper trance and variable expressibility. This is suggestive of involve- margin with no Mediastinal shift. The right dome of diaphragm ment of mutation in a major development gene or a limited chro- was not seen through the opacity. The possibility of voluminous mosomal imbalance. Etiology of MRKH syndrome is still unclear. RML consolidation v/s a pleural based pathology (abutting the In order to allow sexual intercourse, treatment is aimed at creation minor fissure) and diaphragm was consider. Her CECT chest of neovagina. Patients and their families must attend counseling surprisingly revealed a near midline defect in diaphragm Anterior- before and throughout treatment as psychological distress is very ly. Intraabdominal Mesenteric fat with Mesenteric Vasculature important in young women with MRKH. We hereby report a rare and non Dilated colonic loop were seen Herniating through the case of MRKH syndrome in a 19-year-old married female patient defect into the anterior thorax on either side of the midline, more presenting with primary amenorrhea, coital difficulty and no other on right. the final diagnosis therefore turned out to be Morgagni's clinical disorder. hernia. The upper convex margin of the opacity seen on CXR possibly represented the wall of the sac and was mistaken for RADP23 mildly elevated right minor fissure on CXR. The contents were Autosomal Recessive Infantile Osteopetrosis occupying the anterior most Portion of the thorax and Hence were not causing any Mediastinal shift. The large defect with no Dilata- Sharana Prabhu* and Tushar Kalekar tion of the herniated colonic loop and absence of any pinching of Dr. D.Y. Patil Medical Collage, Hospital and Research Centre, the Mesenteric fat were responsible for asymptomatic state of the Pimpri, Pune, Maharashtra, India. patient. As there was no air fluid level seen in mass effect on *Corresponding author Email: [email protected] chest X-ray it was misleading To RML Instead of Morgagni's Hernia as confirmed on CT. Abstract: Autosomal recessive type of osteopetrosis or infan- tile malignant osteopetrosis is a rare congenital disorder of bone

RADP21 resorption characterized by generalized skeletal densification. Mineralizing Angiopathy Causing Basal Divided into three types: autosomal recessive malignant osteo- petrosis, intermediate osteopetrosis and autosomal dominant oste- Ganglia Stroke in Infant Following Minor opetrosis.

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Bone marrow failure, fractures and visual impairment are the like craniopharyngiomas, infective granulomas (tuberculomas) classical features of the disease, which begins in early infancy or can mimic optic chiasmatic-hypothalamic gliomas radiologically in fetal life. It results from the failure of osteoclasts to resorb im- and it is not possible to diagnose them with certainty on the basis mature bone.1 This leads to abnormal bone marrow cavity for- of radiological findings alone. On previous studies MRI was mation and to the clinical signs and symptoms of bone marrow shown to have a sensitivity of 83.33% and a specificity of 50% for failure. It is accompanied by hepatosplenomegaly due to compen- diagnosing optic chiasmatic-hypothalamic gliomas. Biopsy and satory extramedullary hematopoiesis, a characteristic macroceph- tissue diagnosis should always be sought before instituting radio- aly with frontal bossing, exophthalmus, bone fractures, and failure therapy or chemotherapy for optic chiasmatic-hypothalamic glio- to thrive. mas. Hypothalamic glioma poses a diagnostic dilemma with cra- niopharyngioma and other hypothalamic region tumors, when RADP24 they present with atypical clinical or imaging patterns. Here we report a case of 1-year-old female brought by relatives with com- Imaging in Neurofibromatosis-Type 2 plains of irritability, continuous blinking of eyes and developmen- tal delay with h/o caesarean section birth and NICU stay i.v.o Chetan Shetty* and Jeevika M.U. meconium aspiration. On MRI, a well defined T1 iso to hy- J.J.M. Medical College, Davangere, Karnataka, India. pointense and T2 hyperintense solid lesion with moderate inho- *Corresponding author Email: [email protected] mogeneous enhancement was noted in the suprasellar involving optic tracts, optic chiasma and hypothalamic region with no areas Abstract: Neurofibromatosis type 2 is an autosomal dominant of blooming on GRE sequence and no areas of diffusion re- neurocutneous disorder manifesting as a development of multiple striction. Mild edema was seen in bilateral hypothalamic and in- CNS tumours. The disease is rare with an estimated prevalence of ternal capsular region, more on left side. The pituitary gland was 1:50,00. Usually presents in young adults (age 18-24years). It is seen separately appeared normal. due to mutation of NF2 gene on the long arm of chromosome 22. A 28-year-old female patient came with history of bilateral hear- ing loss, giddiness and headache since 1 month which aggravated RADP26 over 1 week. Contrast enhanced MRI Brain with whole spine Unique Associations of Pneumosinus Dilatans screening was done. NF2 is characterized by multiple schwanno- mas, meningiomas and ependymomas. Presence of bilateral Meenu Zacheriah* schwannomas is pathognomonic of NF2. Multiple meningiomas J.J.M. Medical College, Davangere, Karnataka, India. are 2nd pathologic hallmark of NF2. Found in 50% of patients. *Corresponding author Email: [email protected] NF2 associated schwanomas are considered as WHO grade I tu- mours (grow and spread slowly). NF-1 (chromosome 17 muta- Abstract: The purpose of this study is to document a useful tion) is usually common than NF-2 (chromosome 22 mutation). but little-known and frequently overlooked sign of meningiomas Cutaneous lesions are common (>95%) in NF-1 whereas they are and arachnoid cysts i.e. the pneumosinus dilatans (PSD). Case less common in NF-2. CNS lesions are less common (<20%) in reports of incidentally noted PSD in patients of meningioma and NF-1 whereas they are seen in all cases in NF-2, Definitive diag- arachnoid cyst. Pneumosinus dilatans (PSD) refers to an abnor- nosis of NF2 is established genetically. Bilateral vestibular mally enlarged, airfilled paranasal sinus without radiological evi- schwanomas are diagnostic of Neurofibromatosis II but care dence of localized bone destruction or hyperostosis Pneumosinus should be taken because bilateral internal acoustic meatus masses dilatans occurs most frequently in the frontal sinuses, followed by are not specific for vestibular schawanoma. Early diagnosis and the sphenoid, ethmoid, and maxillary sinuses. Pneumosinus dila- management is necessary to prevent complete deafness and seri- tans should not be confused with a pneumocele, which is an ex- ous consequences. pansile and cystic lesion of the sinus with the presence of bone erosion.stimulus for pneumatization of the paranasal sinuses is RADP25 thought to be growth of the mucosal lining into bone. There is a wide variability in "normal pneumatization" of the sinuses, with Case Report: Optic Pathway Glioma the sphenoid sinus showing the most variability. The etiology of pneumosinus dilatans is unknown, although many hypotheses Pooja S. Kakani* and Akshit Gangwal have been offered about the pathogenesis of this condition. Some Vasantrao Pawar Medical College, Nashik, Maarashtra, India. authors have postulated the theory of a one-way valve, which *Corresponding author Email: [email protected] would allow aeration of the sinus, creating a pressure gradient, and thereby increasing the outward pressure on the sinus wall Abstract: Introduction: Optic pathway gliomas are relatively dilatans could also be explained by the traction exerted by the uncommon tumors, with a variable clinical course and usually tumor on the underlying dura mater. This theory is not yet proven. seen in the setting of neurofibromatosis type I (NF1). Hypotha- Early recognition of the PSD and accompanying disorders is nec- lamic glioma account for 10-15% of supratentorial tumors in chil- essary to effectual treatment to prevent the worse pathologies that dren. They usually present earlier (first 5 years of age) than crani- may develop later. Besides the cranial deformity and cosmetic opharyngioma. problems, early PSD formation may also cause an intracranial space- occupying effect, hence it must not be considered as an Objective: Role of imaging in diagnosing optic pathway glio- unimportant radiological finding and patients must be carefully mas. evaluated, clinically and radiologically. Discussion: Optic chiasmatic-hypothalamic gliomas are sellar- suprasellar lesions with variable radiological features. They are RADP27 characterized by imaging by an enlarged optic nerve seen either A Rare Case of Rudimentary Horn Pregnancy on CT or MRI. Usually showing low T1 and a high central T2 signal on MRI images with variable enhancement. Various lesions Moinuddin A. Mulla*

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J.J.M. Medical College, Davangere, Karnataka, India. MR angiography showed diffuse attenuation of calibre of left *Corresponding author Email: [email protected] middle cerebral artery with paucity of its cortical branches. Hyper intensity in left anterior frontal lobe on T1WI with foci of bloom- Abstract: Aim: 1) To describe the imaging findings of preg- ing on Susceptibility weighted images (SWI) suggested possibility nancy in rudimentary horn of uterus. 2) To know common differ- of cortical laminar necrosis. entials of pregnancy simulating rudimentary horn pregnancy. 3) To conclude the final imaging modality which helps in diagnosing Conclusion: MRI of the brain in diffusion-weighted sequences rudimentary horn pregnancy. are the only means of proving the initial brain lesion. In infants and young children with clinical course and characteristics of Objective: Rudimentary horn pregnancy (RHP) is rarer, with hemiconvulson hemiplegia epilepsy syndrome, neuroimaging a reported incidence of1 in 76,000–1 in 150,000. There is limited abnormalities using MRI helps in proper diagnosis. literature to guide the antenatal diagnosis before rupture which will aid in planning optimal surgery as well as reducing blood loss and consequential morbidity/ mortality. Our objective is to ex- RADP29 plain imaging findings which helps us to diagnose this condition Rare Case Report: Telangiectatic Materials and Methods: USG was done with Philips IU 22 Osteosarcoma machine available in our hospital and axial and sagittal images were obtained. MRI was done with Philips 1.5 Tesla machine. Avi V. Jain* Intraoperative images were taken and the specimen is sent to pa- J.J.M. Medical College, Davangere, Karnataka, India. thology department to confirm our diagnosis. *Corresponding author Email: [email protected] Results: USG is the initial imaging modality to confirm preg- Abstract: Aim: To study the imaging features of Telangiectat- nancy and many times will be diagnosed as adnexal ectopic preg- ic osteosarcoma. nancy. MRI, is a better diagnostic tool can be used for diagnosing uterine anomaly, communication of the uterine cavity and horn, Objective: 1) Telangiectatic osteosarcomas (TOS) are an uncom- and to plan surgery by localizing the position of its attachment mon variant of osteosarcoma that represents 2.5 - 12% of all oste- osarcoma. 2) To know the differentials and study the imaging Conclusion: The common misdiagnosis on ultrasound includes features and differentiating criteria. 3) To conclude the final im- bicornuate uterus with pregnancy in one horn, uterus didelphys, aging modality and explain imaging findings which helps in diag- abdominal pregnancy. The reasons for misdiagnosis include a low nosing Telangiectatic osteosarcoma. index of suspicion or inappropriate skill at radiologic diagnosis. So, understanding the proper imaging findings of USG and MRI Materials and Method: A 22 yrs female patient came with help us in diagnosing the condition before the operation and thus complaints of swelling and pain over left mid-thigh since 3 help in proper planning of surgery. months. MRI scanner PHILIPS Achieva 1.5 Tesla and 16 slice Multidetector CT (Toshiba Activion) were used for diagnosis.

RADP28 Results: Plain radiograph showed mild sclerosis of left femo- Hemiconvulsion Hemiplegia Epilepsy (HHE) ral diaphysis with periosteal reactions. Scalloping of the cortex was observed with break in cortex posteriorly. And large soft Syndrome: MRI of Brain with Diffusion tissue component was seen displacing the fat planes and associat- Weighted Sequences: A Case Report ed with matrix mineralisation (calcifications). NECT left thigh revealed intramedullary lesion in the left femoral diaphysis caus- Meghana S.* ing posterior cortical breach with extraosseous extension into J.J.M. Medical College, Davangere, Karnataka, India. surrounding musculature and displacing adjacent neurovascular *Corresponding author Email: [email protected] bundles. The extraosseous lesion showed multiple fluid-fluid levels within it. Areas of peripheral and septal calcifications were Abstract: Aims and Objectives: 1) To discuss a rare case of noted. MRI left thigh – T1-W and T2-weighted fat saturated im- hemiconvulsion hemiplegia epilepsy syndrome. 2) To describe its ages exhibited well defined hyperintense intramedullary lesion MR imaging findings. 3) Outline the symptomatology, pertinent with extraosseous extension showing multiple prominent fluid- imaging findings of HHE which will help in clinching the diagno- fluid levels. On Gadolinium-enhanced images, peripheral and sis. septal enhancement was noted. Methods and Materials: 1) 1.5 T MRI machine is used. 2) T1, Conclusion: CT and MR imaging findings of telangiectatic T2 AND FLAIR images along with other dedicated T2 based osteosarcoma often include thick nodular tissue (and matrix min- sequences such as GRE and DWI. 3) Cerebral circulation is evalu- eralisation at CT) in a largely haemorrhagic and/or necrotic osse- ated by 3D TOF MRA images. ous lesion with an associated soft-tissue mass, which allows dis- tinction from aneurysmal bone cyst. History and Examination: A 10months old female infant pre- sented with complaints of high grade fever since 10days and an RADP30 episode of status epileptics which lasted for 20minutes. There was decreased tone and power in her left upper and lower limb. Imaging in A Case of Dysgerminoma of Bilateral Ovaries Results: Extensive areas of TRUE RESTRICTED DIFFU- SION on diffusion weighted images (DWI) were seen in left cere- Guruprasad C.* bral hemisphere, left peduncle of midbrain, left basal ganglia. Partial effacement of sulci was seen along the left cerebral hemi- J.J.M. Medical College, Davangere, Karnataka, India. sphere. *Corresponding author Email: [email protected]

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Abstract: Case: A 20 year old female, who attained menarche presenting with pelvic mass/pain along with symptoms related to at 14 years with regular cycles, presented with intermittent spas- menstrual and urinary abnormalities. Awareness of the syndrome modic type of abdominal pain since 1 month with loss of weight would aid in early diagnosis and initiation of patient management and appetite. There was no significant family history. On exami- which shows minimal complications with restoration of patient’s nation, there was a 18 x 12cm palpable mass occupying right iliac psychosexual wellbeing. fossa and hypogastrium, with regular margins, smooth surface and firm in consistency. Another, separate 8 x 10cm palpable mass RADP32 was occupying left iliac fossa and hypogastrium, firm to cystic in consistency, smooth surface and regular margins. Imaging Features of Aneurysmal Bone Cyst in A Rare Site Ultrasound showed Large mixed echogenic solid/ cystic mass lesions in bilateral adnexa (R>L) extending from iliac fossa to Abdul K. Shareef* hypochondrium on right side and iliac fossa to flank on left side causing hydronephrosis bilaterally (R>L). Coarse internal calcifi- J.J.M. Medical College, Davangere, Karnataka, India. cations and solid areas showed vascularity with RI between 0.3 – *Corresponding author Email: [email protected] 0.4 in both lesions. There was minimal ascites. USG diagnosis Abstract: Aim: To study the imaging features of aneurysmal features suggestive of malignant neoplastic tumour from both bone cyst in rare site. ovaries, likely Germ cell tumour. Materials and Methods: A 20 yr old male was admitted to Findings on Slice MDCT using Wipro GE Medical Systems Elite Bapuji Hospital with a chief complaint of left infrascapular swell- showed large heterogenously enhancing soft tissue density mass ing since 2 months. MRI scanner PHILIPS Achieva 1.5 Tesla and lesions with cystic and solid areas, displacing adjacent bowel 16 slice Multidetector CT (Toshiba Activion) were used for diag- loops with mild infiltration of bladder wall by right sided lesion nosis. and left sided lesion appearing hypervascular. Findings were high- ly suggestive of malignant lesion arising from both ovaries likely Results: Chest radiograph showed expansile lytic lesion in- Germ cell tumour. USG guided biopsy was performed. volving the posterior aspect of left 10th rib. CT chest revealed a fairly defined soft tissue density lesion measuring 10x5 cm seen Conclusion: Dysger minomas are rare ovarian neoplasms in arising or involving the left 10th rib. There was evidence of calci- young women (2nd and 3rd decade) & adults and one of the most fication in the lesion. Expansile lytic lesion noted in the 10th rib. common lesions to have bilateral presentation. CECT is the imag- MRI chest revealed T2 hyperintense heterogeneously enhancing ing modality of choice to evaluate the disease extension and stag- mass lesion arising/involving the left 10th rib. Lesion consist of ing. multiple small cystic spaces Surgical resection of the lesion was done and diagnosis was confirmed based on multiple cystic spac- RADP31 es, few with hemorrhagic fluid. OHVIRA Syndrome- An Unusual Case Discussion: ABC is not a true neoplasm, cyst or aneurysm. The typical radiographic appearance of ABC is that of an eccen- Presentation tric, lytic, "blow out" type of lesion, demarcated by a thin shell of Jeevika M.U. and Pranav Srinath Reddy E.* subperiosteal new bone. There is often expansion into the adjacent soft tissues. Computed tomography and magnetic resonance imag- J.J.M. Medical College, Davangere, Karnataka, India. ing (MRI) are useful in the diagnosis of ABC. Ideal treatment *Corresponding author Email: [email protected] option is total excision, as it has the lowest risk of local recur- rence. Abstract: Introduction: OHVIRA syndrome, or Obstructed hemivagina and ipsilateral renal anomaly is a rare Mullerian duct Conclusion: ABCs are difficult to distinguish from malignant abnormality consisting of uterine didelphys, unilateral obstructed lesions in some locations. It may mimic a sarcoma in the ribs, hemivagina, and ipsilateral renal agenesis. The syndrome is also especially when associated with a large soft-tissue component. CT known as Herlyn-Werner-Wunderlich syndrome. Patients with and MRI are necessary for differential diagnosis and in preopera- OHVIRA syndrome primarily present with complaints of pelvic tive evaluation. pain or a mass in the peripubertal period and rarely, with primary infertility in older patients. A 16 year old girl presented to the RADP33 OPD with complaints of dysmenorrhea since the past 4 months. The patient attained menarche a year back with regular cycles Computed Tomographic Appearances of since. She had complains of increasing dysmenorrhea and lower Pancreatic Pseudocysts: A Case Series On abdominal pain even during the intermenstrual period since past 4 Unusual Presentations of Pancreatic Pseudo- months. A routine clinical examination of the patient did not re- veal any abnormalities. On ultrasonography, it was observed that cysts there were 2 uterine horns with left horn communicating caudally Sahana C.M.* with an ovoid fluid collection. Additionally, the USG study showed that the patient had an absent left kidney. MRI study con- J.J.M. Medical College, Davangere, Karnataka, India. ducted on the patient confirmed the didelphic uterus with hemi- *Corresponding author Email: [email protected] haematocolpos and absence of left kidney, thus a final diagnosis Abstract: Background: Pancreatic pseudocysts are fluid-filled of OHVIRA syndrome was provided. cavities containing collection of amylase-rich, lipase-rich, and Conclusion: The case has been presented here to infor m fellow entero-kinase-rich fluid. It is most frequently located in the lesser radiologists and contemplate the possibility of OHVIRA syn- peritoneal sac in proximity to the . The most common drome among their differential diagnoses in pre-pubertal women aetiologies for pancreatic pseudocysts include acute pancreatitis,

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chronic pancreatitis, and pancreatic trauma. SURO1 Aims and Objectives: To describe the imaging features of Negative Pressure and Oxygen Therapy unusual presentations of pancreatic pseudocysts and to re- Dressing in Chronic Non - Healing Ulcer emphasize the role of contrast enhanced computed tomography in the diagnosis and planning the management in pseudocysts of Rontgen Rajakumar*, Abhishek Mahadik and Nida Khan pancreas. Methods and Materials: Contrast Enhanced Computed Tomography of relevant anatomical locations were performed Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- using Toshibha Activion Multi-Detector 16 slice CT machine bai, Maharashtra, India. based on our hospital protocol. We reviewed 8 cases of pancreati- *Corresponding author Email: [email protected] tis with pseudocyst. Abstract: Aim: Negative pressure and oxygen therapy dress- Results: ing in management of chronic non- healing ulcer. CASE 1: Subcapsular pseudocyst anterior to left lobe of liver Introduction: Chronic non healing ulcer remaining a chal- lenge to the practitioner and pain and discomfort to the patient. CASE 2: Intra hepatic pseudocyst Chronic non healing ulcer is an ulcer which doesn't improve over CASE 3: Lesser sac pseudocyst, subdiaphragmatic pseudocyst a period of 4- 8 weeks. Co-morbid condition increases the dura- extending into perinephric and intra renal pseudocyst tion and hampers the healing of an ulcer. Negative pressure CASE 4: Mediastinal pseudocyst as an extension from lesser (Vacuum) dressing and positive pressure (oxygen) dressing com- sac pseudocyst with multiple gastric pseudocysts pared to the conventional dressing method has been done in 40 CASE 5: Pseudocysts in posterior wall of stomac subcapsular patients over a period of 1.5yrs. region of spleen perisplenic region Methodology: An observational study with prospective design. CASE 6: Splenic and perisplenic pseudocyst splenic artery The role of vacuum and oxygen therapy dressing was studied in pseudoaneurysm 40 patients with non-healing ulcers including ulcers of DM, ve- CASE 7: Lesser sac pseudocyst lesser curvature of nous, arterial, traumatic and idiopathic origin. Malignant ulcers, pseudocyst mediastinal pseudocyst upto root of neck untreated osteomyelitis, fistula to organ and body cavity and pa- tient with coagulation disorder were excluded. CASE 8: Splenic hilar pseudocyst, posterior perirenal pseudo- cyst Procedure involved wound preparation, placement of white foam (PVA- polyvinyl alcohol) and black foam (PUE- polyurethane Conclusion: Large pseudocysts can extend into various loca- ether) and sealing with drapes and applica- tion of vacuum or tions especially the mediastinum, sub-capsular regions of solid oxygen delivery device. Material of our modification included adjacent solid organs, para-colic gutters, the pelvis, rarely, the sponge (auto- claved), ryles tube, nasal prongs, jelonet, Ioban. neck or scrotum. CECT plays a vital role in the clear delineation of its extent, re-emphasizing its importance in the management. Observation: There was a faster wound resolution and signifi- cant decrease in wound size in vacuum and oxygen therapy dress- RADP34 ing compared to the conventional saline wet to moist dressing group. Significant decrease in wound infection, bacterial growth, Scimitar Syndrome and Its Mimics local and systemic reaction and pain was observed. Dain Davis* It prepares the wound for closure via split skin graft or secondary closure in lesser time leading to less morbidity, emotional stress J.J.M. Medical College, Davangere, Karnataka, India. and decreased hospital stay. *Corresponding author Email: [email protected] Conclusion: Appropriate use of negative and positive therapy Abstract: Aims and Objectives: 1) To present imaging find- dressing in chronic non healing ulcer as an alternative to conven- ings of scimitar syndrome and to differentiate it from other anom- tional dressing has shown faster granulation of the wound bed and alous pulmonary vessels 2) To stress the importance & role of prepares for surgical closure of problematic ulcer. MDCT and CT pulmonary angiography in diagnosis of scimitar syndrome. SURO2 Materials and Methods: Initially, chest X-Ray was taken in the department. Later MDCT thorax with pulmonary angiography Traumatic Dislocation of Testis - A Diagnostic was performed with 16 slice Multidetector CT (TOSHIBA AC- Enigma TIVION). Pragati Singhal* Results: Scimitar syndrome –rare complex congenital abnormal- ity of chest, diagnosed on chest X-ray by scimitar sign. MDCT Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- with multiplanar and three dimensional reconstructions helped us bai, Maharashtra, India. to identify vascular anomalies and known associations. *Corresponding author Email: [email protected] Conclusion: Scimitar sign and scimitar syndrome are not syn- Abstract: Introduction: Traumatic dislocation of the testis onymous. Pseudoscimiter syndrome, scimitar variants may be also known as the “Fuel Tank injury” is a rare occurrence where mistaken for scimitar syndrome on chest X ray. MDCT with mul- one or both the testis are dislocated to a position other than the tiplanar and three dimensional reconstructions demonstrates the scrotum. It occurs following a forceful direct impact on the scro- anatomy of various vascular anomalies and known associations. It tum. Diagnosis of this disease is a challenge, usually overlooked helps in precise planning for surgery and avoids invasive proce- in a case of polytrauma. Prompt treatment is required to maintain dures like cardiac catherization and conventional angiography. the normal spermatogenesis of the displaced testis.

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Aims & Objectives: To diagnose testicular trauma on clinical Conclusion: The exact etiology of adult IHPS is unclear. The examination in a case of polytrauma presenting in emergency. most widely accepted etiologic classification includes a primary type with no apparent underlying disease and a secondary type. Methods: A 28 year old male motorcyclist presented to the This is a rare cause of gastric outlet obstruction and can be misdi- emergency department with polytrauma. The patient sustained a agnosed as other proliferations in the gastric wall such as a gastro- blunt scrotal trauma following a high velocity head on collision intestinal stromal tumor or other spindle cell neoplasms. Manage- with a car. At presentation the patient was hemodynamically sta- ment is surgical. ble, conscious and oriented. He complained of excruciating, in- tractable pain over the pubis and inguinal region. On physical SURO4 examination there was contusion over the inguinal region, empty right hemiscrotum, left testis palpable. An ovoid shaped tender, Ileal Tuberculosis Presenting as a Case of soft mass was palpable in the right inguinal region. Abdominal Massive Rectal Bleeding ultrasound confirmed the presence of right testis in the superficial inguinal pouch with intact vascularity. X-ray pelvis revealed a Attman P. Velani* pubic symphysis diastasis. Immediate surgical exploration with Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- right sided orchidopexy was done. bai, Maharashtra, India. Results: The patient recovered well post operatively with im- *Corresponding author Email: [email protected] mediate relief of inguinal pain. A follow up after 2 weeks showed Abstract: Introduction: Massive rectal bleeding is an uncom- both the testicles in the anatomical position. mon presentation of ileal tuberculosis. Fewer cases reported in Conclusion: Traumatic dislocation of the testis is an uncom- literature. We report case of ileal TB presenting at Emergency mon condition. A meticulous clinical evaluation of trauma pa- department with severe rectal bleeding. The case of massive rectal tients must be made for early diagnosis and treatment of such bleeding could be identified only after an exploratory laparotomy. cases to prevent testis from becoming non-functional. Case report: A 5 year old female patient presented to us with persistent rectal bleeding at emergency department. Rectal exami- SURO3 nation showed fresh blood in stool. Emergency investigation Case Report-Idiopathic Hypertrophic Pyloric showed HB 2.1 gm % PCV 6.7. Hence decision to explore the patient in view of persistent rectal bleeding was undertaken with Stenosis in an Adult Female adequate blood transfusion. We found 3 longitudinal bleeding Nida Khan* ulcer at terminal ileum. Recetion anastomosis was done. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Histopathology of specimen showed tubercular etiology. Patient bai, Maharashtra, India. was started on antitubercular drug and had an uneventful post *Corresponding author Email: [email protected] operative recovery. Abstract: Introduction: Primary or idiopathic hypertrophy of Conclusion: Massive rectal bleeding is an uncommon presen- the pyloric muscle (IHPM) in adults is a relatively rare, yet well- tation of ileal tuberculosis. Intestinal tuberculosis can be consid- established entity. The incidence of congenital hypertrophic pylo- ered as a differential diagnosis of massive rectal bleeding. ric stenosis is reported between 0.25% and 0.5% of all live births. The adult variant, however, is even more uncommon with less SURO5 than 200 cases reported in the English literature. Although, it is Rhomboid Flap for Pilonidal Sinus – A Case unclear what causes this condition, theories have been proposed such as the persistence of a mild manifestation of a juvenile form Series into adulthood. IHPM appears to be far more common in middle Shantanu Chandrashekhar* aged males. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Aims and objectives: A 16-year-old female presented to the OPD bai, Maharashtra, India. with complaints of vomiting since 3 months. She had lost a signif- *Corresponding author Email: [email protected] icant amount of weight over the course of her presentation. Vomi- tus contained food particles and was nonbilious or bloodstained. Introduction: Pilonidal sinus describes a condition found in Vomiting typically followed every meal, irrespective of the type the natal cleft overlying the coccyx, consisting of one or more, of food or the amount consumed. She had no past medical or sur- usually non-infected, midline openings, which communicate with gical history. She had regular menstrual cycles. On physical ex- a fibrous track lined by granulation tissue and containing hair amination, abdomen was soft, mildly distended. There was a pal- lying loosely within the lumen. A common affliction among the pable lump in the epigastrium. Ogdscopy revealed lots of solid military, it has been referred to as ‘jeep disease’. Various treat- and liquid food residue. Antrum showed narrowing of pyloric ment modalities include, laying open of all tracks with or without opening causing stenosis, scope could not be advanced further, marsupialisation, the excision of all tracks with or without prima- hence duodenum could not be evaluated. ry closure, and the excision of all tracks and then closure by some other means designed to avoid a midline wound (z-plasty, karyda- CT Scan revealed an over distended stomach with fluid and a few kis procedure, rhomboid flap). hyperdense food contents. Circumferential thickening of pylorus causing luminal compromise. Aims and Objectives: To study the outcome of rhomboid flap for pilonidal sinus surgery Exploratory laparotomy with antrectomy was performed. On his- topathology features were consistent with Idiopathic Hypertrophic Material and Method: 5 cases of pilonidal sinus, that came to Pyloric stenosis. the OPD, MRI sinogram was performed. Patients underwent sur-

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gical treatment with a rhomboid flap construction, systemic anti- Kailash Jawade and Jefeena Rontgen biotic is routinely used. there were no restrictions on postopera- tive activity, although patients are encouraged not to lie on their Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- backs for the first twenty four hours. bai, Maharashtra, India. *Corresponding author Email: [email protected] Results: Patients were followed up post operatively. All wounds healed with primary intention without sepsis. Abstract: Background: Postoperative surgical site infection are an important healthcare associated infection (HAI) and one of Conclusion: Rhomboid flap for pilonidal sinus has good pri- the most frequent causes of post operative morbidity. In high in- mary healing, with low recurrence rate and a better cosmetic scar come countries approximately 2% of surgeries are affected by and should be routinely adapted for treatment of pilonidal sinuses. SSI’s and 20% of the HAI. World Health Organisation (WHO) shows that SSI’s are most frequently reported type of HAI in low SURO6 and middle income countries. An episode of SSI doubles the cost Incidence and Risk Factors for Post-Injection of care and triples the risk of re-admission. Phlebitis in Patients Undergoing Peripheral IV Aims and objectives: 1) To study incidence of SSI in patients with subcutaneous negative suction drain; 2) To compare inci- Catheterization in a Tertiary Care Hospital dence with international benchmark; 3) To develop guidelines for Pranjal Rai* and Vinaykumar Thati indications of subcutaneous drain placement. Methodology: An observational study with prospective design. Dept. of General Surgery, HBT Medical College and Dr. R.N. The role of negative pressure subcutaneous drain post surgery was Cooper Municipal General Hospital, Mumbai, MH, India. studied in 20 patients with different surgeries including laparoto- *Corresponding author Email: [email protected] mies and exploratory procedures. A detailed consent was taken Abstract: Due to lack of common knowledge, reasonable care from the patient. Surveillance for SSI was based on the centre for and skill, phlebitis has emerged as a common complication of disease control (CDC) definition and methodology. peripheral IV administration in the in-patient department. Phlebi- Results: There was a significant reduction of SSI in patients tis not only increases the nursing cost and time and puts patient’s with subcutaneous negative suction drain as compared to patients safety at risk, but can also be used as a crude indicator to assess without a subcutaneous drain. Comorbid medical condition, poor the level of healthcare being provided at that institute. hygiene, obesity, inappropriate antibiotic prophylaxis, prolonged This study aims assess the incidence and the potential risk factors hospitalisation etc. increases the chances of acquiring SSI. that can be implicated for the development of phlebitis. In patients with subcutaneous negative suction drain, there was no In this prospective observational study including 106 patients, we complications as compared to patients with conventional closure. compared 53 cases and age and sex matched controls. After taking Out of the 20 patients with conventional closure, 5 had complica- permissions from the institutional ethics committee, the study was tions. 2 had seroma, 1 had wound gapping and 2 patients had SSI. conducted over 2 months, in the General Surgery Ward. The data of patients fulfilling our eligibility criteria was noted in the case Conclusion: The incidence of SSI was comparatively lower for record form. patients with subcutaneous negative suction drain compared to the conventional group. The study identified multiple risk factors for The results showed the incidence rate of phlebitis to be 6.4% SSI’s. Some of the risk factors are amendable through interven- which was more than that suggested by the CDC (5%). Most cas- tions. es were level 1 phlebitis. There was direct correlation between times IV line was changed throughout hospitalization, administra- SURO8 tion of KCl and piperacillin + Tazobactam with phlebitis develop- ment. It was also found that over half the cases weren’t provided Commonest Cause of Lymphadenopathy in with any remedial measure. No association was found between Lateral Neck Swelling gender, vein visibility, whether catheter inserted in first attempt, whether flushed, catheter dwell time, cannula size and chronic Kavit Shrishrimal* and Ali R. Shojai disease with development of phlebitis. MGM Medical College and Hospital, Navi Mumbai, Maharashtra, Level 1 Phlebitis was identified in 64.15% cases, level 2 in India. 33.96% and Level 3 in 1.88%. Only 22 patients out of 53 were *Corresponding author Email: [email protected] given ice pack, heparinoid ointment or both. Abstract: Introduction: Diagnosis of a neck swelling is always Our study has tried to project multiple risk-factors related to phle- been very difficult and challenging. Systemic approach is the key. bitis in the setup of a developing country. More than half cases Neck swellings quite often is the first clinical presentation of up- were not administered any treatment, which only points to lapse in per gastro-intestinal tract and respiratory tract malignancy. Neck health-care administration at our hospital, thus calling for sensiti- swellings are a cause of higher morbidity and mortality in India. zation among nurses and establishment of an institutional man- FNAC is the primary diagnostic investigation in cases of LNS. agement algorithm. Aim: To find the commonest cause of lateral neck swellings SURO7 Materials and Methods: This study included patients who presented to MGM hospital from the time period of May 2017 to Impact of Subcutaneous Negative Suction November 2018 with lateral neck swellings. After taking approval Drain to Prevent SSI from the Institutional Ethical Committee and subsequent verbal and written consent from the patient, a complete history and clini- Rontgen Rajakumar*, Meena Kumar, Abhishek, cal examination of the patient was done. This was followed by

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blood investigation, radiological investigation and histopathologi- lithiasis, obstructive jaundice cholangitis were excluded. the pri- cal investigation was done and findings were evaluated. mary outcomes were operative time, intraoperative complications, conversions to open surgery and secondary outcome was postop- Observations: In our study we observed that 21 patients had a erative complications clinically palpable lymph node. We observed that tuberculous lymphadenitis (57.14%) was the most common diagnosis. Other Result and conclusion: 33 cases enrolled Laparoscopic chole- observations were cold abscess (4.76%), metastasis (9.52%), lym- cystectomy in acute calculus cholelithiasis appear to be a safe phoma (14.28%), reactive lymphadenitis (9.52%) and schwanoma procedure with gradual decrease in open conversion rate and com- (4.73%). plication as the surgical experience of surgeon increases. Conclusion: Tuberculous lymphadenitis was the most com- mon cause of cervical Lymphadenopathy. SURO11 Unusual Occurrence of Two Sister Tumours

SURO9 in the Same Patient Gastrointestinal Stromal Malignant Phyllodes: A Case Report Tumour and Gastrointestinal Autonomic Divya Daga* Nerve Tumour Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Yashraj Shah* and Abhijit Bagul bai, Maharashtra, India. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- *Corresponding author Email: [email protected] bai, Maharashtra, India. Abstract: Background: Malignant phyllodes are rare. They *Corresponding author Email: [email protected] account for less than 1% of all breast cancer. The tumor was ini- Abstract: Gastrointestinal stromal tumours (GIST) account tially called cystosarcoma. They are classified as benign, border- for less than 1% of gastrointestinal tumours whereas gastrointesti- line and malignant based on the stroma. nal autonomic nerve tumour (GANT) is a rare variant of GIST Case: A 40year old female presents to the surgical opd of the and occurs at an estimated frequency of 1% of all malignant gas- DY Patil hospital with complaints of lump in right breast since 4 trointestinal tumours. We report the case of a 38-year-old male years which was slowly growing in size and now associated with which represents the rarity in the incidence of a gastrointestinal pain since last one year. It measured about 18*20*20cms. A sono- stromal tumour as well as the occurrence of a gastrointestinal mammography and trucut biopsy was done. Both were significant autonomic nerve tumour together in the same patient which pre- of benign phyllodes. The tumor had destroyed the entire breast sented as a jejunal lump along with a terminal ileocolic in- and replaced normal breast tissue. Hence a simple mastectomy tussuception. Multiple GISTs are associated with familial or he- was done. Sent for histopathology examination this was signifi- reditary syndromes are described only in few case reports whereas cant of malignant phyllodes. multiple sporadic gists have been rarely reported. This review aims to report the multiple sporadic occurrence of two types of Discussion: Clinically phyllodes are rapidly growing tumors. gists as well as discuss highlight the features and prognosis of The tumor generally had round or oval margins with lobulated gants as surgeons and gastroenterologists are unaware of the exist- margins. A total mastectomy was done with negative margins. There were no reactive axillary lymph nodes. Patient is kept in ence of such an entity. closed follow up since these tumors have distant metastasis and reoccurrences. SURO12 Chronic Pancreatitis and Its Management - A SURO10 Study of 50 Cases Laparoscopic Cholecystectomy in Acute Pragati Singhal* and Dipesh Goel Calculus Cholecystitis Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Shashwat Kumar Singh* and Ajay Gujar bai, Maharashtra, India. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- *Corresponding author Email: [email protected] bai, Maharashtra, India. Abstract: Introduction: Chronic pancreatitis adversely affects *Corresponding author Email: [email protected] the quality of life. The impact of chronic pain causes great distress Abstract: Introduction: Acute calculus cholecystitis was tradi- to physical, emotional and social well being. Improving overall tionally treated conservatively followed by open interval chole- quality of life should be an important outcome of interventions. cystectomy. Laparoscopy has Revolutionized abdominal surger- This motivated us to study optimal management of chronic pan- ies. laparoscopic cholecystectomy is gold standard in management creatitis. of cholelithiasis. role of laparoscopic in acute calculus cholecysti- Aims: To study etiology, natural history, clinical presentation tis is still controversial. this study is evaluating the role of laparo- and optimal management of chronic pancreatitis. To study clinical scopic cholecystectomy as treatment of acute calculus cholelithia- and investigative methods for assessing severity of chronic pan- sis. creatitis. To assess surgical and conservative methods in its man- Methodology: An observational study was conducted with agement. To study impact of interventions on quality of life, en- total 33 patients enrolled. inclusion criteria all patients with acute docrine and exocrine insufficiency. pain in abdomen with clinically and Use diagnosed as acute chol- Results and Conclusions: Most common etiology is alcoholic ecystitis. all patients with a Calculus cholecystitis choledocho- pancreatitis and pain is the most common presentation affecting

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quality of life. Majority of patients of chronic pancreatitis can be SURO14 managed medically, life style changes and have long follow up. Some require intervention and persistent pain is the most common Role of Vaccum Assisted Healing in Diabetic/ indication for intervention. Chronic Ulcers - An Ongoing Study at Railway Hospital, Pettah, Trivandrum SURO13 Sobha Jasmine S.* Outcome of Postnatal Management of Department of Surgery, Railway Hospital, Trivandrum, Kerala, Antenatally Diagnosed Hydronephrosis India. Dipesh Goel*, S.S. Borwankar, Hemant Lahoti and *Corresponding author Email: [email protected] Bharati Kulkarni Abstract: Purpose of Study: To assess the effectiveness as well Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- as economic viability of vaccum assisted closure in chronic dia- bai, Maharashtra, India. betic and other chronic ulcers including ischaemic ulcers *Corresponding author Email: [email protected] Methodology: All chronic/non healing ulcer patients, availing Abstract: Introduction: With widespread use of antenatal treatment as outpatient or admitted at Railway Hospital Pettah, ultrasonography, hydronephrosis are presenting in neonatal peri- Trivandrum and not responding to conventional treatment modali- od. However, all the dilated systems need not be obstructed. The ties were subjected to VAC therapy. This is an ongoing study non-obstructed systems resolve spontaneously. Rest have urinary which commenced in July 2016. tract obstruction of which pelvi-ureteric junction (PUJ) obstruc- Conclusion tion is the commonest cause. The distinction between obstructive and non-obstructive dilatation of pelvis remains a challenge. Abil- 1) VAC therapy is Highly effective for closure of chronic diabetic ity of different diagnostic tests to define obstruction accurately is ulcers with at least moderate vascularity. also debated. Ultrasound is the first line investigation to diagnose 2) VAC therapy is economically viable in terms of reduced stay in hydronephrosis. To assess the severity of obstruction radioisotope hospital for large ulcers. renal scans, IVU and CT IVU are other diagnostic investigations. 3) VAC therapy prevented many potential amputations. This has lead to increased risks of radiation exposure and health 4) Very good patient satisfaction as patients do not have to endure care cost. Therefore, efforts are being made to assess severity of daily painful and prolonged dressings. obstruction on ultrasonography. Various ultrasonographic param- eters used to determine the severity of hydronephrosis are antero- 5) VAC therapy is not recommended for ischemic ulcers as it posterior diameter (APD) of the renal pelvis, Society for Fetal causes worsening. Urology (SFU) grading systems based on ultrasound and degree of renal parenchymal thinning as determined by Onen, s alternate SURO15 grading system (AGS). Each parameter has its own limitations. Case Report of Orchidopexy in 22-Year-Old These findings encouraged us to study diagnostic efficacy of vari- ous Ultrasonographic parameters, refine the criteria for severity of Adult hydronephrosis and to establish optimal guidelines of manage- Budigi Manish Kumar* ment. Dr. D.Y. Patil Medical College, Nerul, Navi Mumbai, Maharash- Aims and Objectives: To assess the outcome of antenatally tra, India. diagnosed hydronephrosis in our study. To study Onenʼs alterna- *Corresponding author Email: [email protected] tive grading system (AGS) based on ultrasonography findings in an attempt to establish optimal treatment and follow up guide- Abstract: Introduction: Undescended testis (UT) is a frequent lines. congenital disease that is often diagnosed and treated during childhood. However, Undescended testis sometimes escapes de- Results: There were 84 neonates with primary UPJ – type of tection until adulthood, and some of these patients consult at hydronephrosis, who were studied prospectively. Of them 64 were adulthood. Undescended testis is the most common disorder of boys and 20 were girls. There were total 96 hydronephrotic units. sexual differentiation and the most common disease of an endo- 72 were unilateral and 24 were bilateral. 46 (47.9%) underwent crine organ in humans. pyeloplasty and 50 (52.1%) were conserved. 22 of the conserved showed complete resolution of hydronephrosis, and the rest 28 are Aims and objectives: In case of testes nor mal with good vascu- still on surveillance. lar and structure chances of orchidopexy preferred over orchi- doectomy in adults. Conclusions: 52.1% of antenatally diagnosed hydronephrosis did not require operation in this series. 47.9% of antenatally diag- Result: In this case of 22 year old male with left Undescended nosed hydronephrosis required operation. Onenʼs alternate grad- testis at superficial inguinal ring, orchidopexy is done. ing system (AGS) is safe, accurate and noninvasive diagnostic Conclusion: Orchidopexy can be done in adults whos with tool for management of antenatally diagnosed hydronephrosis. normal testis. Increase in grade of hydronephrosis on AGS and obstructive pat- tern curve on DRS are the criteria for operative intervention. AGS SURO16 can be used for assessment of improvement in hydronephrosis in postoperative follow up. Parents of antenatally diagnosed hydro- Pre-Operative Scoring System for Difficult nephrosis can be counseled for prognosis based on findings of Laparoscopic Cholecystectomy AGS.

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Aniket Ray* and Ajay Gujar We have included 85 isolated blunt chest trauma patients. As part of the study protocol, patient data was collected at the time of Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- admission and re-assessed periodically in the Emergency Depart- bai, Maharashtra, India. ment. *Corresponding author Email: [email protected] The Chest trauma score was applied at the time of admission after Abstract: In this study we device a scoring system to predict detailed assessment of all injuries. Patient was followed up at preoperatively difficult laparoscopic cholecystectomy and also regular intervals upto 30 days. The Chest trauma score and out- asses the conversion rate of laparoscopic to open cholecystectomy come measurements was analysed from the data collected. in the preoperatively assessed difficult cases. Patients were cate- gorised into low risk, moderate risk and high risk according to the Discussion: Out of the 85 study subjects, majority were males scoring system. We concluded that it is an effective scoring sys- (80%).Most common age group involved was 55-70 (47%). The tem and should be used as a screening procedure. most common chest wall injury involved rib fractures. Pulmonary contusion was seen in 85.9%, Pleural injury was seen in 71.8%.

SURO17 The area of Receiver Operating Characteristic (ROC) curve was An Unusual Case Presentation of Lower found to be 0.979 which was statistically significant (p=<0.001). The chest trauma score cut off value was more than or equal to Oesophagus Malignancy 11.5 with a sensitivity of 89% and specificity of 95%. Sonal B. Chavan* and N.L. Vyas Number of rib fractures, Pulmonary contusion and PaO2/FiO2 MGM Medical College and Hospital, Navi Mumbai, Maharashtra, ratio were found to be significant independent predictors of mor- India. bidity. *Corresponding author Email: [email protected] Conclusion: Chest Trauma Score has shown a significant cor- Abstract: Background: An unusual case of lower oesophageal relation with the occurrence of morbidity and complications. Pa- malignancy extending to fundus of stomach. Resection of mass tients with increasing scores, had increasing incidence of morbidi- with Oesophagogastrostomy done laproscopically. The incidence ty, making it a useful tool to predict the outcome of patients. In of esophageal malignancy is increasing by the day. Even though summary, Chest Trauma Score utilised in this study has shown a the cause for this rapid rise is unknown, it is well noticed that significant correlation with the occurrence of morbidity and com- nearly all cases of esophageal adenocarcinoma arise from a plications. Patients who sustained isolated blunt chest trauma and premalignant lesion of the , known as Barrett's esopha- together with increasing scores, had increasing incidence of mor- gus. Barrett's esophagus is recognized as a precursor lesion, the bidity, complications and mortality making it a useful tool to pre- etiology, prevalence, and malignant risk of this lesion are still not dict the outcome of patients admitted to Emergency Department known. The relative risk seen with genetic and environmental with thoracic trauma. factors together. A plethora of hypotheses have been advanced, implicating tobacco and alcohol consumption, obesity and diet, SURO19 and the changing pattern in use of medications that affect the up- Post-Operative Pulmonary Complications in per . The following text will review an unusu- al case of lower esophageal malignancy. Open Upper Abdominal Surgeries Case Discussion: An unusual presentation of oesophageal ma- Akshay Rao* and Ravi Kharat lignancy for which esophagogastrostomy was done with resection Bharati Vidyapeeth University, Dhankawadi, Pune, Maharashtra, of mass. India. *Corresponding author Email: [email protected] SURO18 Abstract: Introduction: Pulmonary complication is a frequent Analysis of Scoring System to Identify High condition following open upper abdominal surgery. Risk Patients in Blunt Chest Trauma and Aim & Objectives: The aim of this study is to evaluate postop- Their Outcome erative pulmonary complications in open upper abdominal surger- ies and to determine the factors which can modify the outcome. Annrish T. Baby* and Ashok N. Oommen Material and Methods: The cross-sectional observational study Department of Surgery, Jubilee Mission Medical College and was conducted from July 2015 to September 2017 on a total of 60 Research Institute, Thrissur, Kerala, India. patients who underwent open upper abdominal surgery. A number *Corresponding author Email: [email protected] of parameters were taken into consideration till the day of dis- Abstract: Background: Chest trauma is an important public charge to determine the specific association between the parame- health problem accounting for a substantial proportion of all trau- ters and development of pulmonary complications. ma admissions and death. No current national guidelines exist to Discussion: There was significant association between the assist the management of this patient group unless patient has incidence of development of postoperative pulmonary complica- severe immediate life threatening injuries. This study was done tions and parameters like smoking, ASA score, length of incision, for the analysis of a scoring system to identify patients with isolat- duration of anaesthesia, prolong intubation, duration of NGT in- ed blunt chest trauma at higher risk for morbidity and mortality, in situ, initiation of ambulation and spirometry. order to prioritise intervention and improve the outcome. Conclusion: By knowing the co-relation, the outcome can be Methods: Single centred, observational analytical study con- modified by early ambulation, early initiation of spirometry, limit- ducted in Jubilee Mission Medical College & Research Institute. ing the number of days of NGT in-situ, limiting the duration of

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intubation and limiting the duration of hospital stay. Problem Statement: Major drawbacks in rural surgery in- clude erratic power supply, lack of proper sterilization, poor ac- SURO20 cessibility for the remote population in addition to lack of infra- structure and training. Delay in diagnosing, addressing emergen- To Study the Effect of Liver Flushing with cies and proper first aid for trauma are also crucial loopholes. Olive Oil and Lemon Juice on the Strategy: In an innovative approach ‘container OTs’ can be Lithogenicity in Gall Bladder Stone Formation constructed and transported to remote areas, thus ensuring stand- ardized manufacturing. They will be solar powered, with a light Draun Upadhyay* and N.L. Vyas weight stainless steel modular workspace to minimise area, and MGM's Medical College & Hospital, Navi Mumbai, Maharashtra, ease sterilization. Stationed near a healthcare facility, they will be India. equipped with portable USG, ventilators, C arms, endoscopes, *Corresponding author Email: [email protected] GPS and video conferencing to communicate with the nearest tertiary center. Abstract: Introduction: Cholelithiasis is found in 10-15 % of the adult population on an average, with majority of the affected To deal with the inaccessibility aspect, comes the idea of ‘mobile individuals being asymptomatic, almost more than 80 %. Liver OTs’ (ambulances customised as OTs) serving as pseudopods of flushing is a conservative method for flushing of gall bladder ‘container OTs’. These will transport surgeons to rural settings, stones from the body. A liver flush involves consumption of a bring patients to nearest hub, provided with O2 delivery, intuba- combination of olive oil and lemon juice for a course of ten or tion kits, life saving drugs, to perform emergency procedures, more days along with dietary restrictions. The prevalence of gall- minor routine surgeries. These shall also have basic diagnostic stones is related to many factors, including age, gender and eth- facilities like portable x-ray, ECG, ABG and blood grouping. nicity. To reduce SSIs, disposable instruments made of recyclable mate- Aim and Objectives: To study the effect of liver flushing with rials can be used. olive oil and lemon juice on the lithogenicity in gall bladder stone Skill development in the form of training camps before posting formation. MBBS grads and general practitioners, to deal with cases ranging Materials and Methods: Gall bladder stone is detected by an from hydrocele, fibroadenoma, lipoma, phimosis, hernia etc. to ultrasonography scan. After detection, patient is given 100 ml handling emergencies like compartment syndrome, fractures, or olive oil and 10 ml lemon juice daily in fasting, for 12 days and performing episiotomy, etc could yield benefits because a com- then the ultrasonography scan is repeated. Size of stone and pres- partment syndrome can cost the patient her/his dear limb if not ence or absence of sludge before and after 3 cycles of 12 days of given a simple incision to counter the building pressure experimentation is compared. SURO22 Observations and Discussion: Maximum number of subjects – 31 subjects out of 50 showed an absence of gall bladder stones Limberg Flap for Multiple Epidermoid Cysts after the flushing procedure. Rohith Pillai*, Nida Khan and Karan Cheda The number and especially the size of the stone found in the gall bladder has an important bearing in the liver flushing method used Dr D.Y. Patil Hospital, School of Medicine, Nerul, Navi Mumbai, in the conservative treatment of gall bladder stones. Maharashtra, India. *Corresponding author Email: [email protected] Conclusion: Size of the gall bladder stone is important in con- servative management of gall stones by liver flushing technique. Abstract: Introduction: Epidermoid cysts are derived from Stones less than 15 millimetres in size are found to have been hair follicles and are usually filled with altered keratin. They rep- more effectively flushed from the gall bladder. resent one of the most common skin lesions, occurring at any age after childhood. They are often multiple and occur at any hair Age, gender, presence of comorbidities and presence of smoking bearing site, on the body, commonly the trunk, face, neck, and or alcohol consumption do not play a role in the effectiveness of particularly the scalp and scrotum. They do not occur on the the liver flushing technique. palms and soles. Treatment is wide excision. However for multi- ple epidermoid cysts in close proximity, wide excision with pri- SURO21 mary closure may not be possible with poor cosmesis. An alterna- Improving Surgical Care in Rural Areas tive approach is a limberg or rhomboid flap. It is versatile in that a random pattern flap can be raised from any one or all corners of Akash Satpathy* the rhomboid. The defect is filled with tissue of the same thick- ness and color and with good vascularity. SCB Medical College and Hospital, Cuttack, Odisha, India. *Corresponding author Email: [email protected] Aims and objectives: Epidermoid cysts are conventionally treated by wide surgical excision. Limberg flap can be used for Abstract: Introduction: With about 50,000 deaths due to acute excision and reconstruction of multiple epidermoid cysts in close abdominal conditions every year, surgery has faced a poor fate in proximity where primary closure is difficult. rural India. Studies have found that lack of access to basic healthcare and emergency surgeries is to be blamed. This results A 45 year old man presented to the out patient department with in tertiary healthcare centers brimming up with patients, directing multiple swellings over his left thigh since 3 years. On examina- considerable amount of time and energy towards cases which tion, there were multiple(5) epidermoid cysts of 2×2cm(smallest) could have been treated elsewhere. It has not only increased the to 3×3cm(largest) in size, adjacent to one another. Limberg flap or waiting time for patients but also deprived them of services during Rhomboid flap was used to reconstruct the conglomer of epider- the ‘golden hour’ which could have saved lives. moid cysts after excision. Patient was followed up for 6 months.

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Conclusion: Limberg flap yields with superior cosmesis and and excess skin cut. Plicating suture taken from the crura of cor- healing by primary intention in reconstruction after excision of pora till the body till the mucosa of coronal sulcus with prolene 3- multiple epidermoid cysts. 0 and tightened. Skin approximated near the coronal sulcus and to the labia.

SURO23 Observations: Patients followed up regularly. It was observed Laparoscopic Repair of Morgagni’s that there was good cosmesis without any perioperative complica- (Anteromedial) Diaphragmatic Hernia tions. Discussions: The key points of this new technique are : 1) less Shrikrishna Parab* and Rajinder Singh operative time 2) minimal blood loss 3) preservation of neurovas- Department of Surgery, HBT Medical College and Dr R.N. cular bundle 4) good cosmesis. Kaplan in 1967 reported a tech- Cooper Hospital, Mumbai, Maharashtra, India. nique of splitting the 2 corpora and performing closure in a trans- *Corresponding author Email: [email protected] verse fashion. Kogan and associates reported subtunical excision of erectile tissue by incising laterally through Buck fascia to re- Abstract: Morgagni’s hernia is characterized by an anterome- sect the erectile corpus cavernosa. dial defect in diaphragm with herniation of abdominal contents into thoracic cavity. Morgagni’s hernia is uncommon variety of The blood loss in these techniques is much more as compared to congenital diaphragmatic hernia and comprises of 3-5% of all this new technique. Also the operative time for the conventional diaphragmatic hernia. It occurs due to failure of fusion in the ante- techniques is 3-4 hrs as compared to this new technique which rior part of the pleuroperitoneal membrane. Most of the patients takes around 1 hr. are asymptomatic and are diagnosed incidentally. Results: The patients obtained good cosmesis with this tech- Chest x ray shows presence of mass or air fluid interface in tho- nique as the end result closely simulated the clitoral anatomy. racic cavity. Diagnosis is confirmed by CT scan or MRI. Conclusions: This novel technique of neurovascular bundle Treatment is surgical closure of the defect and this has been tradi- sparing reduction clitotoplasty seems to be a reliable and a safer tionally performed by laparotomy or thoracotomy. Recently vari- method with excellent cosmesis and good satisfactory results. ous laparoscopic or thoracoscopic techniques have been described for repair of Morgagni’s hernia which include primary closure of SURO25 the defect with intracorporeal suturing, stapler or mesh. Study of Diagnostic Accuracy of Modified Here, we report a case of right sided Morgagni’s hernia inci- Alvarado Score with Post-Operative Findings dentally diagnosed in a 63 year old female. The aim of this report is to present a video presentation of laparoscopic Morgagni’s in Acute Appendicitis in Rural Population hernia repair. Neha Kumari*

SURO24 Department of General Surgery, Pravara Rural Hospital, Loni, Maharashtra, India. A Novel Technique of Reduction Clitoroplasty *Corresponding author Email: [email protected] Shravya Shetty* Abstract: Introduction: The usual picture of appendicitis is often not classical, leaving many cases a diagnostic problem. It is Smt. Kashibai Navale Medical College and General College, Pu- well known fact that nothing can be so easy, or so difficult, as the ne, Maharashtra, India. diagnosis of appendicitis, it is because the clinical features and *Corresponding author Email: [email protected] special investigations which are all nonspecific and the list of Abstract: Introduction: Clitoroplasty is one of the most im- differential diagnosis are too long. portant component for genital reconstruction in the patients of Methodology: It was prospective clinicopathological study Congenital Adrenal Hyperplasia. While performing clitoroplasty with 100 patient sample size conducted at Pravara rural hospital every effort is made not only to provide excellent cosmesis but and rural medical college, Loni. Institutional ethical committee also retain normal clitoral innervation for optimal sexual gratifica- clearance was taken before commencement of the study. Written tion. Various techniques have been described in the literature right and informed consent were taken for open . This from total clitoridectomy to resection of the enlarged clitoris. study included randomly all operated patients (100) suspected of Various drawbacks of these techniques are: 1) Blood loss 2) Long acute appendicitis between June 2012 to October 2014 in the De- operative time 3) Unsatisfactory cosmesis 4) damage to pudendal partment of surgery. nerves 5) need for revision clitoroplasty. To avoid these disad- Results: Our results and observations were discussed and vantages a modified technique with good cosmesis while still compared with various other studies. The age group in which preserving the dorsal neurovascular bundle has been described in acute appendicitis occurred commonly was between 21 to 30 this paper. years. It is clear that incidence is less in younger and older age Duration of study: 2016 - 2018. groups with peak incidence in 2nd and 3rd decade. In the present series the males outnumbered females in the ratio of 1.8:1.pain Objective: To describe a novel technique of reduction clitor- was the commonest presenting symptom and has been observed in oplasty. all the cases (100%) in the present series. The classical shifting of Methodology: Ten patients known case of Congenital Adrenal pain from umbilical region to RIF was Seen in 86%. Hyperplasia with clitoromegaly were selected for this technique. Conclusion: The modified Alvarado score is a fast, simple, Prepucial adhesions released and phallus degloved till the base reliable, non invasive, repeatable and safe diagnostic modality

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without extra expense. working in the farms and also works as a laborer digging wells. on clinical and radiological examination a differential diagnosis of SURO26 dracunculiasis was made. WHO has declared Dracunculus medi- nensis or "Guinea-worm" causing dracunculosis as eradicated in Surgical Treatment of Scrotal Calcinosis: 1986, however there are reports of the few cases cropping in Su- Report of Two Cases and Review of Literature dan & Chad.

Kailash Jawade, Shweta Verma and SURP2 Shantanu Chandrashekhar* Open 3D Mesh Repair in a Case of Sliding Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Inguinal Hernia Involving the Urinary *Corresponding author Email: [email protected] Bladder Abstract: Introduction: Scrotal calcinosis is an idiopathic Yashraj Shah* and Abhijit Bagul benign condition of skin of scrotum characterised by presence of multiple nodular swellings on scrotal wall. After first description Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- of this condition by Lewinski in 1983, very few cases have been bai, Maharashtra, India. reported in the literature. We presenting report of two cases pre- *Corresponding author Email: [email protected] sented and managed by doing surgical excision and scrotal wall Abstract: An inguinal hernia is a protrusion of abdominal reconstruction. contents into the through an abdominal wall defect. Methods: Retrospective study of clinical records of both the The sac of an ordinary indirect hernia is lined by parietal peritone- cases was done. Medical literature was searched using various um, but when the wall is formed by a viscus, the hernia is called terms like scrotal calcinosis, multiple scrotal swellings, strawberry sliding hernia. An inguinal hernia involving the bladder is a very scrotum etc. Review of literature was done for incidence, eti- rare presentation and observed is less than 4% of all inguinal her- opathology, surgical treatment and outcome. nias. Case reports: Case 1: 29-Yr male patient with albinism was 54 year old male patient presented with complaints of swelling in presented with increasing number of multiple nodular swelling in the right groin, history of increase in size, associated with pain the scrotal skin. He was investigated for surgical intervention. En- above swelling just before micturition and increase in size on block excision of scrotal skin and all nodular swellings was done. retaining his urine. Skin flaps were raised to get shin approximation and tension free Clinical diagnosis: Right sided complete indirect inguinal her- closure. His post operative course was uneventful. Histopathologi- nia. cal examination of excised skin revealed presence of scrotal cal- cinosis. Investigations: USG and retrograde cystogram. Case 2: 35-Yr male patient presented with multiple scrotal swell- Surgical management: A case of inguinoscrotal hernia involv- ings since five years with pain in one of the swelling. On exami- ing the bladder managed by open 3D mesh repair. nation he had multiple nodular swellings mostly present around Conclusion: The aim of this poster is to highlight the success- the mid-raphe of the scrotum. One of the swellings was tender ful surgical management of a rare sliding complete inguinal hernia with signs of inflammation around it. He was treated with antibi- involving the urinary bladder using the suture less 3D mesh re- otics and anti-inflammatory drugs. After recovery he was taken up pair. for surgery. Skin flaps were raised to get tension free skin closure. His postoperative recovery was uneventful. Histopathology con- firmed the diagnosis of scrotal calcinosis. SURP3 Conclusions: Scrotal calcinosis is a rare clinical entity. Its A Case Report on Steatocystoma Multiplex of association with albinism require further studies. Raising skin Scrotum flaps is required to achieve tension free primary repair. Ashwanth Krishna Kumar* SURP1 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Fossilised Tombs Under the Skin of Those *Corresponding author Email: [email protected] Who are Extinct: Dracunculiasis – A Case Abstract: Steatocystoma Multiplex is a hamartomatous mal- Report formation of the pilosebaceous duct, characterized by the develop- Pankil K. Mota*, Abhijit Bagul, Nandkishor and Khilchand ment of numerous sebum-containing dermal cysts. Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Here I am reporting a 25/M with multiple non tender, cystic bai, Maharashtra, India. swellings with a yellowish creamy discharge in the scrotum for *Corresponding author Email: [email protected] the past one year. There was no family history of similar lesions. The diagnosis was based clinical and histological findings. Abstract: A 50 yrs old female resident of Parbhani district of Maharashtra, came to D Y Patil hospital with a chief complain of A successful partial scrotectomy with en-masse excision of the swelling over the right hip since 4 years which went on increasing sebaceous cysts was done followed by primary closure without gradually over a period of 4 years. the initial symptoms were mild any complications. itchiness at foot and low grade fever. The patient is a labourer This case is presented for its rarity and its unusual manifestation.

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SURP4 bai, Maharashtra, India. Scrotal Calcinosis in A 29-Year-Old Male - *Corresponding author Email: [email protected] Case Report Abstract: Introduction: Lymphangioma is a rare, benign tu- mor that typically develops during childhood. The tumor usually Nida Khan* develops in the neck, with the axillary tumors the second most common site. It is rarely seen in the mediastinum and, less than Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- 1% of cases occur in the mesentery and retroperitoneum. We re- bai, Maharashtra, India. port our experience with a rare case of mesenteric lymphangioma *Corresponding author Email: [email protected] in 4 year old female. Abstract: Introduction: Scrotal calcinosis is a rare, benign Case Report: 4 year old female came to old with chief com- and localized condition that presents with single or multiple, pain- plain of lump in abdomen right side. She had history of fever with less and hard nodules over the scrotum in the absence of any sys- jaundice 1 month back which was managed conservatively. So temic disease. Age of presentation is 25-65 years. Etiology is decision was made to explore the patient. Intraoperative finding believed to be idiopathic, although there is increasing evidence showed mas in ileal mesentery. We resected mass from mesentry suggesting that it could be due to dystrophic calcification. and sent for histopathology. Report showed lymphangioma of Aims and objectives: To create awareness of this rare patholo- mesentery. Patient was discharged post operative day 13. Recov- gy, that has an undetermined pathogenesis that is often misdiag- ery was uneventful. nosed. Conclusion: We report a rare case of mesenteric lymphangio- Method: A 27 yr old male came to the OPD with complaint of ma in a child. So lymphangioma of mesentry can be differential multiple painless, hard lumps over his scrotum since 2-3 years. diagnosis for lump in abdomen. They had gradually increased in size and number. SURP7 On examination, he had multiple hard nodules over the scrotum that were non tender and not associated with any discharge. He Retractile Testis with Testicular Torsion had no systemic disease, his serum calcium and phosphorus were normal. Shantanu Chandrashekhar* Surgical excision was performed. Patient was followed up for one Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- year without any recurrence. bai, Maharashtra, India. *Corresponding author Email: [email protected] Histopathology was suggestive of chronic inflammatory cells with foreign body cells and calcified nodules in dermis. Abstract: A retractile testis is one that retracts intermittently from the normal scrotal location to an extrascrotal position, usual- Conclusion: Scrotal calcinosis is a rare, benign and often mis- ly into the inguinal canal or along the normal pathway of testicu- diagnosed condition. Treatment is surgical. lar descent. the case reported here is that of a 13-year-old boy with right sided retractile testis with testicular torsion who was SURP5 initially refered to our institute with the provisional diagnosis of right inguinal hernia. the purpose of this poster is to draw atten- Diverticuli of Diverticulum Causing Acute tion to a not uncommon condition that may have Disastrous reper- Small Bowel Obstruction cussions if misdiagnosed or the diagnosis is delayed.

Budigi Manish Kumar* SURP8 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- Recurrent Achalasia Cardia bai, Maharashtra, India. *Corresponding author Email: [email protected] Bharat Sharma, Samriddhi Sharma*, Prasad P.C., Gupta S. Abstract: Diverticuli of are rare causes of in- and Panchal A. testinal obstruction. A 16 years male patient presented with acute Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- abdominal Distension associated with 6 episodes of vomiting, no bai, Maharashtra, India. premorbid illness. Patient was febrile and dehydrated, Distended *Corresponding author Email: [email protected] abdomen With rigidity. Total counts increased(25000),x ray Ab- domen shows multiple air fluid levels. Working diagnosis Acute Abstract: Achalasia cardia is a primary oesophageal motility small intestinal obstruction. Operative findings are Small bowel disorder, rare condition with an incidence of 1-3 cases per 100000 obstruction, dilatation distal to ileocolic junction, diverticulum populations in the western world. The exact etiology for achalasia with diverticuli is identified on Ileum. Surgery – excision of di- is not completely understood but histopathological hallmark of the verticulum done. Histopathology s/o ileal diverticulum. disease is near complete or total loss of myenteric plexus ganglion cells with recent studies suggesting the role immunogenic mecha- SURP6 nism. The patient presents in second to fifth decade of life with dysphagia, regurgitation and weight loss along with other symp- Lymphangioma of Mesentery Presenting as toms e.g. Heartburn, choking etc. Patient is diagnosed on the basis Case of Lump in Abdomen of clinical history and investigations like Barium swallow show- ing classical bird beak appearance, Oesophagogastroscopy and Attman P. Velani* manometry is the gold standard. Management includes medical, endoscopic and surgical interventions. Our patient is a 50 yr old Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- female patient who underwent surgery for achalasia 20 yrs back

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with asymptomatic course post operatively, now since 6 months’ fection or haemorrhage. We present a case-report of 2 year old patient complaints of dysphagia, regurgitation and weight loss. male with gradual abdominal distention with no associated pain or Patient was treated with PPI, Prokinetics and Calcium channel obstructive symptoms. Ultrasound showed multi-septate gross blockers and then Endoscopic balloon dilation three times which ascites and CT abdomen demonstrated 28 cm mass filled with could not relieve the symptoms, so patient was taken up for lapa- fluid. Large omental cyst usually are mistaken for gross ascites rotomy and re-cardiomyotomy, Intraoperative there were dense and can delay the appropriate treatment and subject the patient to adhesions and fibrosis at the lower esophageal sphincter and no unnecessary tests. His diagnosis was confirmed intraoperatively antireflux procedure was evident, Cardiomyotomy was performed and on histopathology of the excised specimen. A 27.5 cm with proximal myotomy of 8-10 cm and distally upto 3-4 cms omental cyst was excised and confirmed to be a cystic lymphangi- from gatroesophageal junction. Patient was observed in the ward oma. The patient’s abdominal girth decreased postoperatively. and diet was started gradually then patient was discharged and This case was a rare presentation of omental cyst with massive followed up on outpatient basis. abdominal distention. It is important to consider various differen- tial diagnosis for abdominal distention inconclusive on imaging. SURP9 Omental cyst is a rare condition and can present with only disten- tion of abdomen and thus should be considered while formulating Ectopic Thyrothymic Parathyroid Adenoma the differential diagnosis. Sharma S.*, Sharma B., Singh V.K. and Panchal A. SURP11 Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. A Case Report of Non -Penetrating Right *Corresponding author Email: [email protected] Ventricular Rupture Following Railway Abstract: Parathyroid adenoma is benign functional encapsu- Accident lated neoplasm responsible for 80- 85% cases of primary hy- Vidhi Minakin Mehta* S. Prabhakar and Pallavi Shambhu perparathyroidism. This is not an uncommon condition with prev- alence of 17 cases/ 100000 population. There are 2 pairs of para- Lokmanya Tilak Municipal Medical College and Government thyroid glands in human body, superior parathyroid are usually Hospital, Mumbai, Maharashtra, India. constant in position and are located on posteromedial aspect of *Corresponding author Email: [email protected] thyroid gland and inferior parathyroid glands vary in position but Abstract: Traumatic Cardiac tamponade is life threatening usually found in relation to inferior thyroid artery. Few of these and time-critical emergency that requires early recognition and patients have ectopic parathyroid and can be found as ectopic prompt management often alongside other resuscitative considera- inferior gland, intrathymic, intrathyroidal, thyrothymic, mediasti- tions. Structural cardiac injuries including chamber or vessel rup- nal etc. Due to ectopic location chances of failed exploration are ture carry a high mortality rate and patients usually die at scene or more and this contributes to increased morbidity to the patient. in-transit. The small remainders of patients who survive to hospi- Patients with parathyroid adenoma may present with skeletal, tal have tears under relatively low pressures and immediate diag- renal, gastrointestinal, neuromuscular and psychologic manifesta- nosis and surgery can help the survival. High grade of clinical tions. Nowadays patients are diagnosed in an asymptomatic con- suspicion is required. Any patient with severe blunt chest trauma, dition while routine investigations or while investigating for any disproportionate hypotension that is not responding to fluid resus- other medical or surgical conditions. In our patient there were citation along with elevated central venous pressures should be multiple fractures involving humerus and femur non-union as a thoroughly evaluated for cardiac tamponade. complication, due to immobility patient also had pressure sore. On investigation patient had hypercalcemia (12.5mg/dl) and during Case: A 25-year-old male presented at trauma emergency depart- sitting patient sustained clavicle fracture on right side. Patient also ment at LTMGH within 1 hour of a railway accident with blunt had other manifestation in form of asymptomatic bilateral renal chest and abdominal trauma along with head injury. On admission stones and loose teeth. Patient was evaluated with hormone assay - (1803 U/mL) and Sestamibi scan and USG neck for localisation Patient was drowsy of tumor. Patient was operated and adenoma removed which was Pulse: 120 bpm confirmed with intraoperative ultrasound and parathormone assay, hormone concentration in peripheral blood decreased following B.P.: 70/40 mmHg parathyroidectomy. Biopsy report also confirms parathyroid ade- Heart sounds were auscultated to be normal noma. Air entry was decreased on the right side Per abdomen on palpation was soft without hematuria SURP10 Management: 1) Fluid resuscitation was started was immedi- A Rare Case of a Large Omental Cyst ately after securing 2 wide bore iv lines. 2) Chest x-rays was sug- Asmita Patil* gestive of 2/3/4th rib fractures along with pneuthorax on the right side. ICD inserted immediately. 3) Blood transfusion was started. Smt. Kashibai Navale Medical College and General College, Pu- 4) Vasopressor support was started 5) Ultrasonography (FAST) ne, Maharashtra, India. was suggestive of mild free fluid in abdomen with few echoes. 6) *Corresponding author Email: [email protected] Echocardiography suggested mild pericardial effusion of 6mm thickness with EF- 55-60% 7) Central venous pressure of 8-10 Abstract: Omental cysts are rare intraabdominal lesions in cmsH2O was noted. paediatric population with an incidence of approximately 1 in 140,000. They can usually remain asymptomatic. Increasing ab- Patient was immediately taken up for emergency exploratory dominal mass usually present with symptoms of obstruction, in- laparotomy with midline sternotomy with evacuation of 500ml of

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pericardial tamponade with repair of right ventricular wall rent. Suturing in Minimally Invasive Surgery Conclusion: Traumatic cardiac tamponade is rarely encoun- Deepika Hamav* tered and requires high degree of clinical suspicion. With prompt management, many cases are salvageable. Echocardiography can Watumull Institute of Electronics Engineering & Computer Tech- be helpful in confirming the diagnosis but is not completely relia- nology, Mumbai, Maharashtra, India. ble. *Corresponding author Email: [email protected] Abstract: Laparoscopic Instruments are special surgical tools SURP12 that allow the surgeons to move, cut and stitch organs during min- A Rare Case of Pleuro-Pulmonary Blastoma imally invasive surgery. in A 2-Year-Old Male Child In this paper, the development of a guidance system for suturing procedure in laparoscopic surgical training is presented. With this Aniket Patil* system, the expectation is to facilitate the training process at the Smt. Kashibai Navale Medical College and General College, Pu- first stages of training in laparoscopic surgery and to contribute to ne, Maharashtra, India. an objective evaluation of surgical skills. Normally, the needle is *Corresponding author Email: [email protected] grasped with the needle driver at a right angle to the needle, ap- proximately half-way to two-thirds of the way back from the tip. Abstract: Introduction: Pleuro-pulmonary blastomas are rare In special situations, you may want to grip the needle a little clos- aggressive malignant tumours, virtually unique to childhood. er to the tip, and sometimes you will want to angle the needle a They are thought to arise from immature, primitive tissues that small amount. To achieve this, two laser modules are incorporated persist as embryonal elements on histology. The incidence is 0.25 on the needle driver prototype where one laser module is mounted to 0.5% of all primary lung malignancies in paediatric population. on the instrument and the other laser module is attached away They are thought to arise from pulmonary parenchyma, mediasti- from the instrument in such a way that the distance between the num, diaphragm or the pleura. second laser and the needle driver’s tip is in the range of 8mm to The patient presentation often mimics respiratory tract infection 19mm in accordance with the common port sizes. with or without fever along with mild to moderate respiratory The procedure shows that the two laser beams make a right angle distress. only when the needle tip is perpendicular to the tissue. Case report: A 2 year old male child presented with com- plaints of fever and cough since 8days. Patient also had history of SURP14 rapid breathing not associated with pain. A Rare Case of Non Hodgkin's Lymphoma in On general examination the patient was averagely built and vitally Parotid Swelling stable. Ajinkya S. Kale* and Ajay Naik On examination of the respiratory system, the patient had de- creased air entry over the right side of the chest with dull note Smt. Kashibai Navale Medical College, Narhe, Pune, Maharash- over the entire right side of the chest. tra, India. *Corresponding author Email: [email protected] The following investigations were done: Abstract: Introduction: Non-Hodgkin’s lymphoma is a group of Chest X-ray- showed haziness in the right lung with blunting of blood cancers, however incidence of NHL in parotid gland as a the cardiopulmonary angle. primary disease is <2% in India. Clinical presentation is not char- USG Thorax showed evidence of thick loculated pleural collec- acteristic and disease is often overlooked resulting in misdiagno- tion in right hemi thorax with collapse of underlying lung, sugges- sis and treatment. tive of Right empyema. Most common tumour of the parotid gland is pleomorphic adeno- HRCT Thorax was suggestive of a well defined, heterogenous, ma (80%). Here I present a case of parotid gland tumour diag- soft tissue density occupying the right hemi-thorax, most likely nosed post-surgery on HPE report as Non-Hodgkin’s lymphoma. neurogenic in origin- Neuroblastoma. Discussion: A 32 years old male presented to SKNMC General Management- Patient underwent right open thoracotomy with surgery OPD with chief complaints of swelling over left cheek excision of tumour with right lower and middle lobectomy. since 10 months, gradually increased in size over time. Patient had no other complaints. The postoperative course of the patient was uneventful. On examination an approximately. 3x4cms swelling over left The Histopathological report was suggestive of pleuro-pulmonary parotid region was found, mobile, non -tender and with no signs blastoma type III of the right lung lower and middle lobes. of facial nerve involvement. No regional lymph nodes palpable. IHC markers revealed: Vimentin- Positive; SMA S-100- Nega- Oral cavity was unremarkable. tive; Desmin- Negative. On investigation USG left parotid region suggested of enlarged The patient is currently undergoing chemotherapy as advised by superficial lobe of left parotid gland. CT Face and Neck suggested the paediatric oncologist. of mildly enlarged lesion in the superficial lobe of left parotid gland of benign aetiology. FNAC suggested of benign adenoma in the left parotid gland. SURP13 Left superficial parotidectomy was performed and specimen sent Laser-Based Guidance System for Training in for HPE, which suggested of Non-Hodgkin’s Lymphoma.

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Second opinion was taken of histopathological reporting which sia of the superficial dermal vessels and hyperkeratosis of the suggested of the same. IHC markers were suggestive of NHL-B overlying epidermis. The dilated blood vessels are lined by a thin cell type. layer of endothelial cells. A narrow zone of collagen separates the vascular ectasia from the overlying epidermis. Hyperkeratosis is Medical oncologist opinion was taken for the same and patient typically mild or absent. Acanthosis varies with the age of the was advised PET-CT and it suggested of no other abnormality lesion. hence no chemotherapy was advised and patient was advised eve- ry 6 monthly follow-up. In 1896, Fordyce reported the first case of atypical angiokeratoma of scrotum followed by Imperial and Helwig in 1967. Only two Salient Features: Primary Non-Hodgkin’s Lymphoma is a rare- reports are available in Indian literature. ly found in the parotid gland most often misdiagnosed clinically and radiologically. Aims and Objectives: To create awareness on this rare pathol- ogy.

SURP15 Method: 23 Yr old male came to opd with complaints of swell- Unusual Presentation of Multiple ing and itching over scrotum since 2 years. On examination, he had a 5x3x4cm thickening over left scrotal skin with local redness Fibroadenoma in Bilateral Breasts and hyperpigmented areas Lesion was excised and sent for histo- Neha Kumari* pathology which was suggestive of angiokeratoma of Fordyce. Department of Surgery, Pravara Rural Hospital, Loni, Maharash- Conclusion: Angiokeratoma of fordyce is a rare, benign condi- tra, India. tion. Treatment is surgical. *Corresponding author Email: [email protected]

Abstract: We report an extremely rare case with a total of 8 SURP17 fibroadenomas simultaneously present in B/l breasts upto 3 CM in Meckel’s Diverticulum size in a 17 yrs old Indian woman. The histopathologic and im- munophenotypic features of the fibroadenomas are described and Anvitha Manoj* possible underlying pathogenesis is discussed. To our knowledge, HBT Medical College and Dr. R.N. Cooper Municipal General this is the first case with such a large number of B/l multiple Hospital, Mumbai, Maharashtra, India. breast fibroadenomas in a young female reported in the literature. *Corresponding author Email: [email protected] The patient was a 2nd year college student and had never taken any oral contraceptives or other medications. Based on her Abstract: Johann Friedrich Meckel first described the embry- knowledge, she had not been exposed to any chemicals or harmful ological origin of congenital diverticulum of the mid-gut in 1809. materials. She underwent an excisional biopsy for a fibroadenoma Meckel’s Diverticulum (MD) is well known diverticular disease of the right breast 5 years ago. 2 years later, she presented with often misdiagnosed as appendicitis on routine clinical setup. numerous mass lesions in B/l breasts. Physical examination re- Meckel’s diverticulum (MD) results from incomplete obliteration vealed two grossly enlarged breasts with symmetrical nipples and of the most proximal portion of the vitelline or omphalo- no retraction or haemorrhage. The overlying skin demonstrated no mesenteric duct occurring during weeks five to seven of fetal peau d ' orange appearance. Within the breasts, there were many development. Histologically, all four intestinal layers are present palpable masses throughout all quadrants, ranging from less than within MD, and the mucosa may contain ectopic gastric, pancreat- 1.0 to 3.0 cm in size. The masses were well circumscribed and ic, jejuna, or duodenal epithelium in up to 50% of specimen. The mobile, and had a firm, rubbery texture. Ultrasonography showed most common childhood complication is rectal bleeding. Intesti- solid masses in B/l breasts that had a distinct, clean envelope like nal obstruction is the more common presentation in adults. Rarer appearance and relatively uniform echoes. Colour flow imaging complications include MD perforation with foreign bodies, stran- showed short strip -shaped colour flow signals that were visible in gulation in Littre’s hernia, primary neoplasms, or vesico- the breast masses. Routine laboratory testing showed the levels of diverticular fistulae, axial torsion. Mucocoele is an extremely rare sexual hormones within normal ranges. The patient did not have complication with last reported case studied in 1969 (Won K in any mass lesions elsewhere outside of her breasts. There was no archives of surgery Vol.98 Feb 1969). This might be the second family history of breast lesions including fibroadenoma. The pa- case reported till now if not reported previously. The management tient underwent enucleation of bilateral breast masses. of symptomatic MD is surgical resection – simple resection or wedge resection.

SURP16 My Patient a 36 years old lady presented with complaints of pain Angiokeratoma of Fordyce- Case Report in right flank and right iliac fossa with associated h/o fever and vomiting. On examination she had tachycardia and severe tender- Nida Khan* and Dipesh Goel ness in right iliac fossa. On ultrasonography, she was diagnosed to have appendicitis. After proper pre-anesthesia fitness and evalua- Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- tion, she was posted for surgery. Right Grid iron incision was bai, Maharashtra, India. taken and abdomen was opened in layers. Appendix was traced, *Corresponding author Email: [email protected] and found to be non-inflamed. Appendicectomy done and distal Abstract: Introduction: Angiokeratoma is a vascular der ma- ilium was traced. Evidence of dilated, cystic, pedunculated struc- tosis characterized by telangiectasia with a horny overgrowth. The ture arising from distal ilium was seen. This was Meckel’s diver- term 'angiokeratoma' is derived from three Greek words meaning ticulum with secondary Mucocoele formation. It had a narrow vessels, horn and tumour respectively, although it is not a tumour base and was twisted around the vertical axis along the pedicle. in its true sense. These vascular lesions may be single and discrete Since the base was obliterated, we did a simple excision of diver- or arranged in clusters. Angiokeratomas are characterized by ecta- ticulum by ligating the base of diverticulum. Hemostasis was

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confirmed and incision was closed in layers. Post-operative period SURP20 was uneventful. Patient was started on orals from Post-operative day 1 and was discharged on post-operative day 3. Ectopic Splenic Pregnancy: A Case Report Rahul Borude* SURP18 A Right Superior Lumbar Hernia: A Rare Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- bai, Maharashtra, India. Case Report *Corresponding author Email: [email protected] Dineshbhai M. Chaudhary* and Sanjeev Agrawal Abstract: Background: Ectopic pregnancy in the upper ab- Geetanjali Medical Collage & Hospital, Udaipur, Rajasthan, In- dominal organs is very rare but has been known to occur in the dia. liver, spleen and lesser sac. Primary splenic pregnancy is consid- *Corresponding author Email: [email protected] ered the rarest form of extrauterine pregnancy, with only few well -documented cases reported. Abstract: Lumbar hernia is a rare hernia which accounts for less than 1.5% of total hernia incidence. These occur more com- Case: 26yr old female presented to the ED with complains of monly in males & are twice as common on left than right side. severe pain in abdomen for past 4 hours. There is no history of Lumbar hernia herniates through the superior or inferior Trauma or fall. Patient is 6 weeks amenorrhic. She was hypoten- (herniation more because due to variable attachment of external sive with BP of 80/50 mm of hg and a pulse rate of 122/min. USG oblique & latissimus dors into iliac crest. If they closely attached, of abdomen showed gross hemoperitoneum. She was taken up for then this triangle absent & no hernia occurs) lumbar triangle. 45 emergency exploratory laparotomy. There was no evidence of soft years old male patient from Banswara, Rajasthan having com- organ perforation or bleeding. During routine sweep of spleen a plaint of swelling right lumbar region since 5 months from June, single fetus was discovered which was found to be the source of 2018 & associated with pain, swelling enlarging gradually & en- bleeding. larged in size on coughing & straining having significant history Conclusion: Primary splenic pregnancy usually presents with of smoking since 15 years & trauma with stick at right superior severe left hypochondrium pain and intraperitoneal bleeding. it lumbar triangle region 4 years before the swelling in right lumbar region was approx. 4*3.5 cm size, partially reducible with bowel requires an emergency splenectomy and should be considered in sounds & cough impulse present. Ultrasonography & CT scan the differential diagnosis of acute abdomen in reproductive-age confirmed right lumbar hernia in diagnosis as well as anatomical women. extent. The patient underwent lumbar herniorraphy, with identifi- cation of contents coming from superior lumbar triangle, reduc- SURP21 tion of omental content & adequate closure of defect. Post opera- Right Lobectomy for Giant Liver tive follow up was made & no recurrence till date. A good history & general physical examination can rule out most of the differeti- Hemangioma al diagnoses. CT scan should be done as a routine prior to plan- Shweta R. Verma*, Meena Kumar, Kailash Jawade, ning surgical approach unless the patient presents with life threat- ening complications. Operative technique should be planned Abhishek M. and Shweta based on size of hernia, location, contents etiology, chances of Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- recurrence. surgical expertise with timely surgical management bai, Maharashtra, India. can provide excellent outcomes. *Corresponding author Email: [email protected]

SURP19 Abstract: Introduction: Hemangioma is the most common benign Liver Tumor and affects 0.4 to 20% of general population. Plantar Dermal Skin Grafting in Management But giant Liver Hemangioma >10 cm is a rare entity. So we are of Plantar Ulcers in Patients with Hasen's presenting a case of patient with giant Liver Hemangioma and Disease right Lobectomy For Giant Liver hemangioma. Methods: We perfor med right Lobectomy in a 52years old Shashwat Kumar Singh* female, Malatabai madam came to D.Y. Patil hospital suffering Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mum- with right upper abdominal pain. On CT scan she had a giant he- bai, Maharashtra, India. mangioma in right lobe of Liver. It was around 14cm in size ex- *Corresponding author Email: [email protected] tending up to opening of right hepatic vein insertion into IVC. As hemangioma was extending up to right hepatic vein into IVC Abstract: Aims and objectives: 1) To study the use of plantar enucleation was not possible, hence right Lobectomy was done. dermal skin grafts in management of plantar ulcer in patients with Hasen's disease. 2) To evaluate the result of dermal skin grafts: Results: Harmonic was used to do hepatic resection to mini- limitations and complications. 3) To document the eventual out- mize blood loss. She had 1.5 liters intraoperative blood loss. Her come in terms of function, donor site acceptability and morbidity. postoperative stay was uneventful and recovered well. Result: Plantar der mal skin graft is very useful for early heal- Conclusion: Although hemangioma is common radiological ing of chronic uncomplicated plantar ulcer in patients with Han- diagnosis but giant Hemangioma >14cm is a rare entity. Success- sens disease. It has good durability, inconspicuous donor site and ful right Lobectomy done for Giant Liver hemangioma at Dr. minimal donor site morbidity. D.Y. Patil hospital, Nerul.

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SURP22 HBT Medical College and Dr. R.N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India. A Rare Case Report – Extra-Cranial Vagal *Corresponding author Email: [email protected] Nerve Schwannoma Abstract: In India, skin cancers comprise less than 1% of the Anand Doshi, Ravi Kharat and Akshay Rao* malignancies which makes them rather rare. Tightly worn tradi- tional Indian garments such as “sari” and “salwaar-kameez” can Bharati Vidyapeeth University, Dhankawadi, Pune, Maharashtra, cause a type of frictional dermatitis called drawstring dermatitis. India. Both Sari and Salwaar are held up at the waist with drawstrings or *Corresponding author Email: [email protected] an elastic band, and while Sari is worn with a petticot, Salwaar is a baggy pant. The resulting chronic friction at the waist can lead Abstract: Schwannomas are benign tumours that arise from to lichenified grooves, post inflammatory depigmentation/ the nerve sheath of peripheral nerves. A vagal nerve schwannoma leukoderma and aggravating pre-existing dermatoses like vitiligo is a rare neoplasm. It is usually asymptomatic until signs of nerve and lichen planus. Sweating and humid environment of tropical involvement appear. MRI scan of neck is usually diagnostic of countries like India, combined with persistent friction, may pre- this condition. Complete surgical resection is the treatment of dispose to fungal infections and/or bacterial infections. Rarely, choice. Here we report a case of 22-year-old female patient came squamous cell carcinoma has been reported. This can be avoided with complaints of cough while swallowing, regurgitation and by reducing weight, wearing the drawstrings loosely, especially in hoarseness of voice since 2 months. She was investigated & diag- those individuals prone to develop isomorphic responses. nosed to have a jugular foramen tumour which was intraoperative- Saree cancer is a rare type of squamous cell carcinoma (SCC). ly and later histopathologically confirmed to be a vagal nerve Constant wear of clothing such as saree and dhoti, which are schwannoma. unique to India, tightly around the waist results in skin scaling, scarring, pigmentation, ulceration and consequently gradual onset SURP23 malignant change. The process of repeated trauma over a long time and consequent interference with the healing process may be Review of Literature - Rare Case of Nauvari the reason for malignant transformation. We are presenting a rare Saree Causing Skin Cancer case of saree cancer in a 68-year-old woman, with distant ul- ceroproliferative growth in left loin, along the waistline, which Geeta Ghag, Saurabh Sanjanwala, Vinay Thati, showed well-differentiated SCC on biopsy. Wide excision with Rishabh Jain, Ishan Merchant and Pranjal Rai* primary closure was done.

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