High-dose effect is a common phenomenon documented in various immunological and serological assays, which results in false-negative results. Due to limited amounts of reagent antibodies in the coated wells and extremely high concentrations of analyte in the sample leads to decrease in the formation of antigen-antibody complex and ultimately resulting in false low values of the analyte. High-dose hook effect has important medical implications, and simple methods of sample dilution helps in preventing false low concentrations.

Introduction: Tethered cord symptom complex, originally described by Brickner, presents with protean clinical manifestations. It is rare, and we have reviewed our experience in diagnosis, management, and outcome of these patients. Materials and Methods: Patients presented with tethered cord syndrome at our neurosurgery department between 2007 and 2011 were analyzed and reviewed. Results: Thirty cases of tethered cord syndrome were treated surgically over a period of 5 years. The clinical onset was insidious. The main clinical findings were neurological, skeletal, urological, and cutaneous manifestations. M.R.I. was the best diagnostic tool. T1-weighted sagittal and transverse images were useful. Untethering of cord was achieved in 30 cases, in which the filum terminale was divided in 10 patients. There were no serious post-operative complications. The mean post-operative follow-up was 9 months. Most of the patients had an improvement or an arrest of the progress of the symptoms. Patients with shorter duration of symptoms had a better prognosis. Conclusions: Surgery for tethered cord is safe and effective in experienced hands. Early diagnosis and surgery when deficits are less severe the improvement is more likely.

Introduction: Ocular tissues contribute to lesions from inflammation to different types of neoplastic conditions. Histopathology remains the main stay of diagnosis. The study was carried out to know the histopathological diagnosis of various ocular lesions. Materials and Methods: This is a retrospective and prospective study of ocular lesions done on patients who were referred for ocular examination. Cases were analyzed in detail regarding clinical examination and other findings. Results: Ocular lesions from 81 patients were analyzed. Basal cell carcinoma (BCC) was the most common neoplastic disorder. Nevus was the most common non-neoplastic disorder. Among the 81 cases, 47 were male and 34 were female patients with the highest number of cases in the age group of 41-50 years. Conclusion: The most common ocular malignancy was BCC and nevus was the non-neoplastic disorder.

Introduction: Professional liability (PL) is the liability that arises due to professional failure resulting in damages to the client who are required to be compensated monetarily either by the professional or his insurer. In a landmark historical judgment, the Honorable Supreme Court has ruled that doctors should not be held criminally responsible unless there is prime facie evidence before the court in the form of a credible opinion from another competent doctor, preferably a government doctor in the same field of medicine supporting the charges of a rash and negligent act. Materials and Methods: We studied total 34 cases, which were filed in Gulbarga district forum consumers court between 1991 and 2011 (i.e., 20 years). Results: Obstetrics and gynecology is the most PL prone specialty, followed by surgery, pediatrics, orthopedic, urosurgery, ophthalmology, pathology and dental etc. Out of the total 34 cases, 28 cases were dismissed and 6 cases are compensated monetarily. According to Oriental Insurance Company, Gulbarga and Indian Insurance Company, Gulbarga PL claims vary with the specialty. Conclusion: This paper discusses all the reasons and also suggests ways and means to minimize the risk of PL claims in medical practice. It is utmost importance that PL claims should be avoided.

Introduction: Hepatitis C virus (HCV) infection in patients undergoing hemodialysis (HD) is an emerging condition and constitutes a major problem complicating the dialysis process in dialysis units world-wide. Aim: The present study was undertaken to determine the prevalence of HCV infection by antibody testing in hemodialysis patients. Materials and Methods: A total of 102 chronic renal failure patients on HD were studied. All the patients were tested for anti-HCV antibodies. Results: The overall prevalence of HCV infection was 23.5%. The longer the patient is on HD the more susceptible he/she is to HCV acquisition. Conclusion: It is recommended that HD patients should be monitored in order to determine the full risk factors for HCV contamination observed in this study.

Context: Rapid identification of resistant strains is crucial for the early administration of appropriate therapy and to curtail their spread. Genotype MTBDRplus is an assay for rapid detection of gene mutations in sputum samples. Aims: i) To detect the presence of rifampicin and isoniazid associated mutations directly in smear positive sputum samples. ii) Analysis of mutations in the region of North Coastal Andhra Pradesh. Materials and Methods: A total of 151 sputum samples were processed by N-acetyl L-cysteine - sodium hydroxide method. The sediment obtained was used for smear preparation, culture and nucleic acid extraction. Multiplex amplification and reverse hybridization were then performed according to manufacturer's instructions. The presence of a mutation is indicated by the lack of hybridization on one or more of wild-type probes with or without hybridization on the mutation probes. Results: Hundred percent readable results were achieved from sputum samples smear grade of 2+ and 3+. All strips had bands indicating Mycobacterium tuberculosis complex and were also confirmed by culture and biochemical tests. The strains resistant to rifampicin only, isoniazid only and multidrug resistant were 55(36.7%), 42(28%) and 40(26.7%) respectively. The most frequent type of mutation for rifampicin resistance was Serine-531-Leucine. The rate of mutations detected by negative hybridization results with wild-type probes was 17.5%. Conclusions: Potential for testing large number of isolates rapidly and directly from sputum samples makes Genotype MTBDRplus suitable as a first line screening assay for multidrug resistant tuberculosis. Most frequent mutation causing resistance is Serine-531-Leucine.

Background: Opportunistic fungal infections, mainly candidiasis, is common in immunocompromised patients such as those undergoing chemo or radiatiotherapy and pose a great threat. Hence this study was done, attempting to find out the candidal carrier state and species variation, in such patients. Aims and Objectives: To determine the prevalence and speciation of Candida colonizing in the oral cavity of individuals attending to the cancer clinics in south India. Materials and Methods: Study groups comprised of 50 healthy, asymptomatic individuals as controls (Group I); 50 patients on : chemotherapy (Group - II) and 50 patients undergoing radiotherapy for head and neck cancers (Group - III). Mycological tests for the candidal isolation and speciation were done. Results: A total of 49 cases showed candidal culture positivity (32.67%). Candidal carriage was highest in Group II and Group III (38%). C. albicans was the most prevalent species (30%). The culture positivity and the colony forming unit/ml from the subjects of control group and the study group were highly significant, in pair-wise comparisons. Conclusion: Patients undergoing chemotherapy and radiotherapy for head and neck cancers are at a risk of developing oral candidiasis due to immunosuppression. C. albicans is the predominant isolate, but non-albicans species are also emerging as opportunistic pathogens. All may cause a similar spectrum of disease but differences in disease severity and antifungal susceptibility are noted. Hence, speciation can help to target the treatment of the disease in a much better way.

Zollinger Ellison syndrome (ZES) presenting with jejunal perforation is a very rare presentation with very few cases reported worldwide and none with recurrent jejunal perforation. A 40-year-old male came with perforation peritonitis with history of abdomen pain off and on, confirmed radiologically and exploratory laparotomy done. A small jejunal perforation (3 mm) was noted and primary repair was done. Oral pantoprazole was given and patient was discharged after 10 days. He was asked to come after 1 week for follow-up but he didn't turn up. After 6 weeks, the patient again presented with perforation peritonitis and profound shock. Resuscitation was done and on exploration, jejunal perforation was noted with no evidence of any tumor in the duodenum or, stomach wall or, the pancreas. There was no specific swelling in any of the lymph nodes. Biopsy was taken and primary repair was done. Retrospective analysis for this rare presentation was done which suggested ZES.

Gangrene of the stomach is a rare, often fatal disease which may be due to vascular, chemical, mechanical, or infectious etiologies. We report a case of gastric gangrene due to acute necrotizing gastritis in a 60-year-old male. Review of the literature on suppurative gastritis emphasizes the rarity and high morbidity of acute necrotizing gastritis; the patient reported on in this study, however, survived after subtotal gastrectomy and antibiotic therapy. It is our opinion that debridement by gastrectomy must be performed in those patients with transmural, diffusely infected, and nonviable gastric tissue.

We report a case of 28-year-old male patient who was run over by train, which resulted in above-elbow amputation on the right side and hand amputation on the left side. His financial status precluded the use of upper limb prosthesis. In this report, we evaluated the various aspects of the Krukenberg operation. The parameters were functionality, stereognosis, cosmesis, dominance, patient and societal acceptance. In our country interest in Krukenburg operation should be rekindled. Most of the surgeons neglected it favor of expensive prosthesis on grounds of unfamiliarity with the surgical procedure.

Intraosseous ganglia of the proximal humerus are rare and their etiology is unknown. This report describes a case of an intraosseous ganglion of the proximal humerus. The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. There was no communication between the cyst and the joint space. On macroscopic examination, a multiloculated cystic lesion was seen. Microscopically it was clear that it was a cyst of intraosseous ganglia. At 2 weeks after the surgery, the patient was almost free of pain. Though there were few reports earlier, the pathological feaures were not highlighted. We describe here more about the pathologic features of the lesion.

The incidence of intracranial suprasellar arachnoid cysts is 9% of all arachnoid cysts. This case report describes a patient with a suprasellar arachnoid cyst who presented at the age of 4 with a rare bobble-head doll syndrome. Endoscopic ventriculocystostomy was performed. The literature on suprasellar arachnoid cysts is reviewed

Papillary carcinoma of thyroid is the most common type of thyroid malignancy. There are numerous histopathologic variants of papillary carcinoma of thyroid. Each variant shows a combination of specific growth patterns, cell types, and stromal changes. Metastases to cervical lymph nodes are very common. Papillary microtumor (PMiT) is an uncommon variant of papillary carcinoma of thyroid. It is usually an incidental finding at autopsies or in thyroidectomy or lobectomy specimens of benign disease. We report two cases of PMiT s with two different behaviors. The first case stresses the importance of extensive sampling of thyroidectomies for benign disease and the second case questions the nomenclature itself due to its metastatic potential. Whether the renaming of papillary microcarcinoma is justified and the role of ultrasound guided fine needle aspiration cytology (USG guided FNAC) in diagnosis of clinically non-apparent papillary carcinomas is addressed in this report.

Adenoid cystic carcinoma (ACC) of minor salivary glands is an uncommon malignancy. The disease is a paradox with slow, indolent growth; but high local recurrence rates. Late metastasis is a characteristic feature. We present an unusual presentation of ACC of the posterior third of tongue masquerading as trigeminal neuralgia.

Rhabdomyosarcoma (RMS) is the most common form of soft tissue sarcoma in the first 2 decades of life, with a peak age incidence in very young children. Due to the rarity of adult RMS, information regarding its clinical and biologic characteristics is very limited. We report a case of pleomorphic RMS of upper extremity in a 50-year-old man. There was no metastasis of the tumor. The patient underwent surgery with enbloc excision of the tumor. Histopathological examination showed typical features of pleomorphic RMS composed of large polygonal pleomorphic cells with eosinophilic cytoplasm and plenty of large multinucleated tumor giant cells having bizarre nuclei. Postoperatively patient took radiotherapy. There was no recurrence of tumor with follow-up of 2 years.

Primary pulmonary hypertension (PPH) is a rare disease found frequently in women of child bearing age and carries high peripartum mortality. Management of parturient with PPH presents a unique challenge to anesthesiologist, obstetrician, and cardiologist. We present a parturient with PPH who underwent elective cesarean section under epidural anesthesia.

Incidence of coronary artery disease is on rise amongst the population, which is the major underlying pathology for acute coronary syndrome (ACS). So every anesthetist may encounter the patients with ACS and should know how to recognize and manage them. Its earliest detection and proper management can prevent further myocardial damage, thus preventing further morbidity and mortality. The patient described here had an increased risk for perioperative ischemia because of old age associated with history of hypertension, diabetes mellitus, chronic renal failure, and underwent a major surgical procedure (laprotomy). Beta-blockers were not administered and aspirin was discontinued during his preoperative preparation. All these factors might have contributed for the genesis of the myocardial ischemia in this patient.

Odontogenic tumors are heterogeneous group of lesions with diverse histopathological and clinical features. Ameloblastic fibro-dentinoma (AFD) is rare mixed odontogenic tumor composed of odontogenic epithelium, immature connective tissue and are characterized by the formation of dysplastic dentin. Here, we present one such a rare case of AFD occurring in a 5-year-old female patient.