An abscess of the ligamentum teres hepatis is a very rare cause of acute abdomen and can present a diagnostic dilemma. A 40-year-old diabetic male presented with obstructive jaundice and cholangitis. An ill-defined, sausage-shaped, tender parasagittal supraumbilical mass was palpable on the right side. Murphy’s sign was negative. Laboratory investigations revealed polymorphonuclear leukocytosis (total leukocyte count 19,000 mm–3), elevated alkaline phosphatase (400 IU l–1), conjugated hyperbilirubinaemia (16 mg dl–1) and elevated blood glucose (240 mg dl–1). Ultrasonography and MR cholangiopancreatography revealed cholecystolithiasis, obstructive choledocholithiasis, abscess of the ligamentum teres hepatis and left portal thrombosis. Under ultrasound guidance, pus was aspirated from the abscess and the patient was started on broad-spectrum intravenous antibiotics, insulin and low-molecular-weight heparin. He subsequently underwent endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction. On the tenth day post admission, he underwent laparoscopic cholecystectomy and excision of the ligament. The patient made an uneventful recovery and was discharged on the seventh post-operative day. On follow-up, the patient remained asymptomatic with normal biochemical parameters. This article highlights the importance of suspecting and identifying an abscess of the ligamentum teres hepatis when a patient with acute abdomen presents with a sausage-shaped right parasagittal mass, especially in the setting of cholangitis, cholecystitis or omphalitis.

Atrial myxomas are rare primary cardiac tumours with neurological manifestations being reported in 30% of cases. Though a rare cause of ischemic stroke in young patients, considering it as a possibility in absence of any obvious risk factors can help avoid misdiagnosis at early stages. We present a case of left atrial myxoma in a 36-year-old male with no known co-morbidities, showing an unusual clinical presentation of isolated bilateral painless vision loss. With multiple infarcts on Non Contrast Computerised Tomography (NCCT) and a suspicion of Atrial Myxoma on Transesophageal Echocardiography (TEE), patient was successfully managed surgically with confirmation of diagnosis on histopathology.

The study was done to access the outcome of the factors affecting Atrio-Venous Fistula procedure in Indian subjects. A prospective study based on evaluation for construction of Atrio-Venous Fistula for haemodialysis in Indian patients of ESRD was carried out. Preoperative assessment of both arterial and venous components by physical examination and by CDFI was done and feasibility of construction of AVF was based on the same. Studies on Western subjects have shown the success of AVF with vein diameter more than 2.5mm and arterial diameter more than 2mm plus AVF has maximal flow if the Fistula if the Fistula diameter is 75% more than the diameter of the artery. In this study we incorporated similar guidelines ,however AV Fistulas were constructed even if caliber of vessels were lesser than the above mentioned caliber ,it is a known fact that that Europeans and Western subjects have larger caliber blood vessels as compared to Indian subjects. Of all the radio-cephalic AVF the diameter of radial artery was more than 02 mm, .range 2.1mm-2.5mm and however cephalic vein diameter was less than 2.5mm,range 1.0-2.3mm and in brachio-cephalic AVF the diameter of brachial artery was > 2mm,range 3.7-6.0mm and cephalic vein diameter >2.5mm,range3.9-4.1mm. After one year follow up 38 AVF were functional(01 underwent renal transplant) and 12 AVF were non-functional. The AVF should be constructed even if the vein diameter is less than 2.5mm and arterial diameter is less than 2.0mm in Indian subject, as the patency was 75.6% after 01 year.