No abstract

We describe a patient with cerebellar and mandibular arteriovenous malformations who initially presented with oral haemorrhage and then subsequently had a cerebellar haemorrhage. This is the second reported case of cerebrofacial arteriovenous metameric syndrome type III (CAMS III) in the literature and we discuss the role of homeobox genes in craniofacial development and angiogenesis.

Objectives: Modified Early Warning Score (MEWS) is a reliable, safe, instant, and inexpensive score for prognosticating patients with acute pancreatitis (AP) due to its ability to reflect ongoing changes of the systemic inflammatory response syndrome associated with AP. Our study sought to determine an optimal MEWS value in predicting severity in AP and determine its accuracy in doing so. Methods: Patients diagnosed with AP and admitted to a single institution were analyzed to determine the value of MEWS in identifying severe AP (SAP). The highest MEWS (hMEWS) score for the day and the mean of all the scores of a given day (mMEWS) were determined for each day. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were calculated for the optimal MEWS values obtained. Results: Two hundred patients were included in the study. The data suggested that an hMEWS value > 2 on day one is most accurate in predicting SAP, with a specificity of 90.8% and PPV of 83.3%. An mMEWS of > 1.2 on day two was the most accurate in predicting SAP, with a sensitivity of 81.2%, specificity of 76.6%, PPV of 69.8%, and NPV of 85.9%. These were found to be more accurate than previous studies. Conclusions: MEWS provides a novel, easy, instant, repeatable, and reliable prognostic score that is comparable, if not superior, to existing scoring systems. However, its true value may lie in its use in resource-limited settings such as primary health care centers.

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.