Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.
Wrist drop post-venepuncture is uncommon. There has been reported cases of direct injury to the radial nerve during venepuncture but to our knowledge, there has never been a case of posterior interosseous nerve (PIN) injury. A 34-year female, right hand dominant homemaker, with a newly diagnosed diabetes mellitus, was admitted for diabetic ketoacidosis. There was difficult access with multiple attempts in her blood taking over the antebrachial fossa and forearm. Thereafter, she was unable to fully extend her wrist, fingers and thumb with an intact sensation. The electrophysiological study was suggestive of demyelinating right radial neuropathy at the elbow. Despite the transient blood taking session, patient developed neuropraxia, which only resolved after four months. We wish to report this case of unusual presentation of a PIN palsy post- routine venepuncture, which can result in high morbidity to a patient. Key Words: Posterior interosseous nerve syndrome, venepuncture, neuropraxia, wrist drop.
Oral leukoplakia is the most common potentially malignant oral disorder. Oral leukoplakia's malignant potential is independent of the histopathological grade, and the malignant transformation rate varies greatly from 3% to 50% even in the case of severe epithelial dysplasia. Ethnic & environmental variables may contribute to this variation. C-kit immunohistochemistry was performed on 15 oral leukoplakia (OL), two oral squamous cell carcinoma (OSCC), and two dentigerous cysts (DC). The objective of this study was to evaluate the c-kit expression in oral leukoplakia. The use of various immunohistochemical markers to differentiate between OLs with a high and low risk of malignant transformation has been investigated. Only four OL exhibited a faint cytoplasmic expression in basal cells. Whereas, OSCC and DC were devoid of c-kit expression. Thus, this may not be a unique marker for identifying OL at high-risk. Further research with larger sample size is required. Key Words: CD 117, Disease progression, Oral dysplasia, Oral leukoplakia, Risk prediction.
Ingested foreign bodies (Fb) in children usually pass out in stools without any sequels. However, Fbs like open safety pins, button batteries, and super absorbent polymer (SAP) / jelly toys are associated with complications such as intestinal obstruction, and bowel perforation. Intestinal obstruction in children of uncertain nature should raise a suspicion of foreign body ingestion such as SAP, which may not be obvious at the initial presentation. The study reports two such children, outlining the presentation and management. Key Words: Children, Intestinal obstruction, Foreign body, Health hazard, Bilious vomit, Super absorbent polymer beads.