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Background Brachial plexus injuries are debilitating injuries resulting in paralyzed shoulder to global paralysis of the upper extremity. Treatment strategies have evolved over the years with nerve transfer forming the mainstay of surgical management. Phrenic nerve provides certain advantages as donor over other options but has been less preferred due to fear of pulmonary complications. In this study, we assess the functional outcomes of phrenic nerve transfer in brachial plexus injuries. Materials and Methods A retrospective study was performed on 18 patients operated between 2012 and 2017. The mean duration of injury to surgery was 4.56 months and mean follow-up was for 3.66 years. Phrenic nerve was used as donor to neurotize either biceps and brachialis branch of musculocutaneous nerve or suprascapular nerve. Assessment was done through Waikakul score for elbow flexion and Medical Research Council grading for shoulder abduction. Respiratory function assessment was done through questionnaire. Results Twelve (80%) patients recovered grade 3 and above elbow flexion with 6 patients having a positive endurance test according to Waikakul and a “very good” result. In phrenic to suprascapular transfer group (3 patients), all patients had more than grade 3 recovery of shoulder abduction. No patient complained of respiratory problems. Conclusion Phrenic nerve can be used as a reliable donor with suitable patient selection with good results in regaining muscle power without any anticipated effects on respiratory function.

Background and objective: Diffuse alveolar hemorrhage (DAH) is a life-threatening condition due to the extravasation of blood in the alveoli, resulting in hypoxemia and even acute respiratory distress syndrome. This study aimed to describe the clinico-radio-pathological profile of patients diagnosed with DAH and classify it into immune and nonimmune DAH. Methods: This was a retrospective analytical study. Of a total of 1000 cases of bronchoalveolar lavage fluids (BALF) received for cytological examination, patients fulfilling the clinical, radiological, and laboratory details of cases satisfying the clinical and cytological criteria of DAH (n=47) were studied. Results: The most common cause of immune DAH was ANCA-associated vasculitis (n=13, 27.6%), and that of nonimmune DAH was infections (n=10, 21.3%). Twenty-nine patients (61.7%) had hemoptysis. The most common radiological finding was ground-glass opacities (n=33, 70.2%). In univariate analysis, female sex, mean hemoglobin at admission, total leucocyte count (TLC), platelet count, and erythrocyte sedimentation rate (ESR) were significantly associated with immune-DAH. However, in multivariate analysis, female sex, higher TLC, high platelets, and high ESR were significantly associated with immune DAH. Patients were treated with corticosteroids (n=25, 46.3%), intravenous cyclophosphamide (n=12, 22.2%), plasma exchange (n=7, 13.0%), intravenous immunoglobulin (n=5, 9.3%) and rituximab (n=5, 9.3%). The overall mortality was 8.5% (n=4). Conclusion: DAH is a life-threatening syndrome that may be classified into immune and nonimmune DAH. Immune-DAH requires aggressive management, whereas nonimmune DAH cases respond best to conservative management.

Background Cavernous haemangioma of the cavernous sinus is an uncommon vascular malformation. It is often confused with other parasellar masses like schwannomas and meningiomas due to overlap in imaging appearance. It is important to pre-operatively diagnose this condition as it is associated with severe intra-operative bleeding. Case presentation Here, we report a case of an octogenarian female who presented with left sided progressive ptosis and diminution of vision for one year. Cross-sectional imaging includes computed tomography and magnetic resonance imaging which were not conclusive of cavernous sinus haemangioma. Digital subtraction angiography was done which showed a vascular blush. After corroborating the findings of these imaging investigations, a diagnosis of cavernous sinus haemangioma was concluded. Patient underwent surgery which showed a hypervascular mass. Histopathology was consistent with the imaging diagnosis. Patient was discharged in good stable condition and doing well and is on follow-up in Neurosurgery Out-Patient Department. Conclusions The cavernous sinus Haemangiomas are uncommon benign vascular masses. They pose a diagnostic challenge when seen in the parasellar region as the imaging findings of a haemangioma, meningioma and schwannoma in this location can have a significant overlap in the imaging findings. Cross-sectional imaging, digital subtraction angiography and nuclear imaging help in pre-operative diagnosis which is a crucial as the surgery is associated with significant blood loss.

Background: Histopathological changes induced by gall stone disease or cholelithiasis are diverse including acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia and carcinoma. Hence, this study was planned to assess gallbladder mucosal changes in patients undergoing laparoscopic cholecystectomy (LC) and it’s correlation with number and types of stone.Methods: A total of 50 patients with symptomatic cholelithiasis scheduled to undergo laproscopic cholecystectomy (LC) after written and informed consent from October 2015 to October 2018 at Teerthanker Mahaveer Medical College and Research Centre, Moradabad were followed prospectively. Preoperative biochemical profile and ultrasonography of whole abdomen of all the patients was obtained. LC was done under the hands of the skilled and experienced surgeons. Morphologic profile of gallstones was recorded and analysed. Gallbladder mucosal tissues were sent to general pathology department for analysis. Histopathological typing of all the gallbladder mucosal specimens was done and was correlated with the number and type of gallstones.Results: In majority (76%) cases, cholecystitis was found. Hyperplasia was seen in 10% patients. Cholecystitis with metaplasia in 10 percent of the cases and carcinoma in 2 percent of the cases. While correlating the gallbladder mucosal response with the number and type of stones, non-significant results were obtained.Conclusions: There might be some association between gall bladder mucosal changes and gall stone. We cannot say an etiologic and effective correlation from the results of this study; possible mechanism may be gall stone erodes gall bladder wall constantly over a period of time which may constitute a risk. While correlating gallbladder mucosal response with the number and type of stones, non-significant results were obtained.

Background: The objective of the present study was to observe prevalence of anatomical variations of cystic artery in patients with the aim of avoiding accidental damage during laparoscopic cholecystectomy.Methods: Patients (n=600) who underwent elective laparoscopic cholecystectomy after written and informed consent between October 2015 to October 2018 at Teerthankar Mahaveer Medical College and Research Centre, Moradabad were followed prospectively. Laparoscopic cholecystectomies were performed with 04 port technique with patients under anesthesia. Cystic artery’s anatomical variations with reference to triangle of calot in each patient undergoing the surgery was visualized through laparoscope and recorded.Results: Several anatomic variations of cystic artery were seen under laparoscope. Our experience with 600 cholecystectomies revealed that in majority of patients (85.67%; n=514), cystic artery was present in the boundaries of triangle of Calot, followed by outside the triangle of Calot seen in 13.33% (n=80) patients, while compound type was found in only 1% patients (n=6).Conclusions: Variations in the anatomy of cystic artery with reference to triangle of calot is seen very often. Knowledge of these variations helps in prevention of accidental hemorrhage during laparoscopic cholecystectomy. Cystic artery is present inside the triangle of calot in majority of cases. We found that classification suggested by You-Ming et al is very useful.