Cochin Clinical Society

Last Meetings

                                                                                                                                                                                                                                                                                                           

MEETINGS of 2002  , MEETINGS of 2003, MEETINGS of 2004 MEETINGS of 2005 MEETINGS of 2006 MEETING of 2007 MEETINGS 2008 MEETINGS 2009 MEETINGS 2010 MEETING 2011

 

 

Meeting 12

 

Hosted by Lisie Hospital .and chaired by Dr. Joseph Kurien. Dr. Grace Maria George (Anaesthesia) presented a 35 yr old Jehovah’s Witness with marfanoid habitus and aortic dissection. As the patient would not accept blood transfusion, he was prepared for surgery with EPO and oral Iron. Surgery was performed with autologous transfusion with success. Dr. Babu Francis (Nephrology) discussed a case of renal transplantation. Dr. Girish Bachar (Medicine) presented a 52 year old with acute respiratory distress presumed to be from a Pneumonia, who could not be weaned off the respirator. Myaesthenia Gravis was diagnosed and after IV immunosuppressants etc, the  patient had a thymectomy. Dr. Sharon Roshin Reginald(Neurology) discussed a case of “Reversible cerebral Vasocnstriction Syndrome” in a postpartum lady, which improved dramatically with Nemodipine. The classic features of the syndrome on MRI was presented. Dr. Abdullakutty (Cardiology) presented a 45 year old female  with what appeared to be an acute coronary syndrome. However, CAG was normal and symptoms resolved with IV diuretics, betablockers and ACEI. The diagnosis was “Tako-Tsubo Cardiomyopathy”, which is characterized by myocardial stunning from stress associated profuse release of catecholamines .This condition can mimic acute MI, however disproportionate TropT elevation and lack of reciprocal STT changes are characteristic .It is completely reversible and in the patient presented, the occurrence followed the death of her spouse.This case was judged as the best presentation of the evening.

Meeting 11

The Cochin Clinical Society met at the Specialists Hospital, on 15.09.2011. Dr. Jayakumar, Head, Microvascular and Plastic Surgery from the same Institution chaired the session. Dr. Vijayan (Urology) highlighted the technique of repair of Epispadias in a 32 year old male. A 35 year old male with Brachial Plexus injury was presented by Dr. Senthil Kumar (Plastic Surgery) who had reconstructive surgery with recovery of function. A case of hair transplantation was illustrated by Dr. Guild (Plastic Surgery) done with the help of a Folliscope under local anaesthesia, results evident by 3 months. Dr. Geo Paul(Anaesthesia) presented a case of hand injury in a 26 year old, where US guided Brachial Plexus block was used, a recently introduced from of regional anaesthesia. Dr. Cherian Kovoor presented a 4 year old with right forearm swelling, which, on imaging showed a sclerotic/lytic lesion in the ulna eroding the bone. The patient underwent a wide excision. A novel method of reconstruction was done to create a single forearm bone. Histology revealed a rare disease, “Pigmented Neuroepidermal Tumour of Infancy”. Full range of motion returned after a few months. This case was selected as  the best presentation of the evening. 

Meeting 10

Held at IMA House on 24.08.2011. Dr. Sudheendran, Transplant Surgeon and Consultant in G. I. Surgery, AIMS, chaired the session. Dr. Thomas Varghese, Oncology Surgeon (Lakeshore)  presented a novel lateral approach for thyroidectomy which produce a relatively avascular field. Dr. Johnny Cyriac(Gastroenterology, PVSM Hospital) presented a 53 year old male with intractable vomiting which resulted in hydropneumothorax requiring thoracotomy , drainage and subsequent stenting. Bleeding into the thoracic cavity continued requiring repositioning of the stent with improvement. Dr. George Varghese (ENT, Cochin Hospital) then discussed nasal endoscopic approach for removal of a nonfunctioning pituitary macroadenoma. This approach, as against the conventional transsphenoidal route claims better visualization and possibility of complete removal. Dr. Sandhya (Giridhars Eye Hospital) presented a 26 year old pregnant lady who experienced visual loss following vomiting and was found to have a large subhyaloid hemorrhage in the right eye. Since retinal detachment and visual loss could ensue, she underwent hyaliodectomy with YAG laser with considerable clearing of the bleed and improved vision. This complication is known to occur in pregnancy. 15/15 cases managed at the Centre had shown recovery. Dr. Krishna Kumar (Orthopedics, AIMS) presented an elderly male with fever and severe back pain, gouty tophi and raised uric acid with L4-5 destruction and cord compression. Infection was suspected. However, at surgery, chalky material was found instead of pus making a diagnosis of Gouty Spine. A rare disorder, treatment consists of medical therapy decompression and stabilization. The latter two cases shared the prize for the best presentation of the evening. 

 

Meeting 9

Held at KIMS Hospital, Kochi, on 11 August, 2011, chaired by Dr.Jose Chacko Periyappuram, Senior CVT Surgeon, Lisie Hospital. Dr Kukale presented a 14 yr old with a neck mass at birth from fibromatosis within the sternomastoid muscle, causing torticollis, not associated with other musculoskeletal anomalies. Although the presentation was late, full range of neck movement was achieved by surgery. Need for early referral was highlighted. Dr. Jojo Kurien John  discussesed an 18 year old male with organophosphorus poisoning who did poorly with atropine and Naloxone..Clinical features were in keeping with Serotonin syndrome and with Cyproheptadine, he recovered. This was the considered as best presentation. Dr. Mathew Punnechalil presented 3 rare cases of lymphadenopathy in children-a 3 year old with bilateral hilar lymphadenopathy from Langerhans Histiocytosis, a 6 year old with fever and hilar adenopathy from Kikuchi Fugimoto disease which is a self limiting entity and a 4 year old with intermittent bilateral lymphadenopathy and strawberry tongue. from Kawasaki Disease The need to consider entities other than infection as a cause of lymphadenopathy was emphasized as well as the importance of chest xray in diagnosis. Dr Jose Thomas discussed computer assisted bilateral knee replacement in a lady with bowed legs where alignment of the prosthesis was possible with computer aid. Dr. Ramachandran presented a 50 year old with a jejunogastric intussuseption , a rare cause of intestinal obstruction, where recovery took place with surgery.

 

Meeting 8

 Held on 14.07.2011 at the Medical Trust Hospital. Dr. Ganapathi Rao, Head ,Internal medicine, AIMS, Kochi chaired the session. Dr. Sujith Philip(Gastro Surgery) presented a 67 year old lady with symptomatic G.I blood loss after anti-inflammatory intake. Initially only gastric erosions were noted on OGD scopy,. When she bled again, she was found, on intraoperative enteroscopy, to have multiple jejunal ulcers and diverticuli. A resection anastomosis led to resolution of symptoms. A 15 year old girl with primary amennorhoea,abdominal pain and swelling was then presented by Dr. Sarika (ObGyn).She had secondary sexual characteristics appropriate for age. US revealed hematocolpos consequent to an imperforate hymen. Dr.Jayakrishnan(Urology) discussed a case of a testicular swelling in a 16 year old male. Initially considered to be a hematoma post trauma, it turned out to be a Testicular sarcoma .CT abdomen revealed multiple vertebral metastases. Dr. Patil (Neurosurgery) discussed 3 cases briefly, fever, headache and seizure from Neurocysticercosis of the brain, sciatica, hesitancy and perianal anaesthesia from an Epidural Angiolipoma at L3-L4 level and sensory loss and difficulty walking from an Ependymoma at the C1-C4 level, all of which recovered by prompt surgical intervention. Dr. Pradeep (Gastroenterology) presented a 31 year old male with recurrent bouts of pancreatitis associated with alcohol binges. A normal calcium level raised the suspicion of Hyperparathyrodism. 3 months later he returned when Pancreatic and duodenal Neuroendocrine tumours were diagnosed. Pituitary work up was normal. The diagnosis was MEN type 1.This case was considered the best presentation of the day.

 

Meeting 7

Held at Sunrise Hospital. Dr. Sudheer, GI Surgeon, AIMS chaired the session. Dr Saheed (Urology) presented a 46 yr old female, who, after having undergone partial nephrectomy for a Renal cell carcinoma, developed an AVM at the site of surgery. The kidney could be saved after a coil embolization was done to stop the leak from the AVM. Dr Biju (Orthopedics) discussed a 5 yr old with osteogenesis Imperfecta, who had experienced multiple fractures. A new device was used to treat the femur fracture – the “Sheffield Rod” which claims to grow along with the growth of the child. This works on a telescoping principle. It made a dramatic change to the child’s life. Ileal Transposition for DM in a lean type 2 diabetic was discussed by Dr  Padmakumar (Lap Surgeon) where there was resolution of Diabetes after surgery. Discussion ensued on the different bariatric/metabolic surgeries and their benefits. The next case was one of a 2 yr old child with fever, diarrhea and a retropharyngeal mass,  presented by Dr. Sabitha (Pediatrics). Although surgical drainage was performed, she went on to develop empyema. With further drainage and aggressive antibiotic therapy, the child improved. Complications of deep neck space (Ludwigs Angina like) infection was discussed for which prompt diagnosis and treatment would be life saving. Dr Subramanium then discussed an intracranial mass lesion in an 81 year old male. A malignant Glioma was diagnosed after surgery and he was given RT. 1 year later, he developed a lesion in the opposite hemisphere, considered to be recurrence. Since patient did not opt for a second surgery, he was started on steroids. When he agreed  for the operation 3 months later, the imaging was repeated .The mass had then disappeared .A third lesion appeared later and at surgery turned out to be a primary CNS Lymphoma. It was believed that the tumour that disappeared on steroids could have been a lymphoma only, as this is known to happen. This case was judged as the best presentation of the day.

Meeting 6

Last meting was held on 19.05.2011 at the Ernakulam Medical Centre, Dr N S D Raju, senior Ophthalmologist chaired the session. Dr. Rahul (Critical Care & Anaesthesia) discussed a case of Myaesthenia Gravis for which Thymectomy was performed, and where anaesthesia and intensive care management turned out to be challenging. A rare case of pathological fracture was presented by Dr. Shaji Varghese (Orthopedics) in a 25 year old female, who had recurrence of Giant Cell Tumour , usually a slow growing disease. Wide excision and use of Ilizarov’s frames led to complete reunion in 10 months. Although benign, GCT can be aggressive. Dr Pradeep Kumar presented two cases of stridor in children from bilateral Adductor Vocal Cord paralysis, one acquired and the other congenital. Both children underwent surgery with uneventful recovery. Dr. Sindhu (Pediatrics) presented a 1 year old child with diarrhoea and vomiting, virilization and an abdominal mass. Testosterone was elevated for age and CT scan showed a non enhancing left flank mass. Surgery revealed an Adrenal Cortical carcinoma. The need for close follow up for recurrence/metastasis was emphasized. This was adjudged as the best presentation of the evening.


Meeting 5

Held in conjunction with the local chapter of IMA was held at IMA House on 28.4.2011. Dr. Mathew Philip, senior consultant in Gastroenterology chaired the session. Dr.Sandhya (Giridhar Eye Institute) presented a 44 year old lady who developed vision loss while on Tamoxifen in high doses for invasive Pelvic Fibromatosis. This “Tamoxifen maculopathy” was characterized by deposition of refractile crystals around the disc. Pathophysiology and diagnostic modalities were discussed especially the value of SD-OCT. Caution was advised of using large doses of the drug and yearly eye check recommended. A 14 year old girl was presented by Dr. Abraham K. Paul (Cochin Hospital). She was evaluated for short stature and anemia and found to have Inflammatory Bowel Disease, treatment of which yielded good response. Maintaining a Growth Chart in children was advised for early diagnosis of growth retardation. Dr Anvar (IRIS Scans) discussed two cases of unresolving Pneumonia where CT Scans helped to resolve the dilemma. Dr Ramachandran (HOD, Department of Radiology, AIMS) cautioned against the use of CT Scans in children, unless absolutely necessary, in view of the radiation exposure. Dr. Tom Babu (Silverline Hospital), discussed the case of a 47 year old male who presented with seizures from hypocalcemia due to Hypoparathyroidism, probably idiopathic in origin. This was considered the best presentation of the day.

 

Meeting 4

Held at Lakeshore Hospital on 7.4.2011. Dr. G. N. Ramesh chaired the session. Dr. Bijoy presented a 49 year old female with intermittent fever and anemia and a SOL in the liver. This turned out to be an isolated Actinomycosis lesion, which was considered unusual. The need to consider an inflammatory lesion was highlighted if such masses showed infiltration, inhomogeneous contrast uptake and raised inflammatory markers. She recovered fully with oral penicillin. 2 cases were discussed by Dr Iqbal, where simple, adequate physical examination and history taking were not performed which would have easily led to the diagnoses and avoided the extensive work up -Takayasu Arteritis and a schwannoma causing cauda equine symptoms. He emphasized the need for proper initial evaluation of cases. Dr Anand presented a case of recurrent pulmonary edema and renal failure  from bilateral renal artery stenosis for which bilateral stenting was required  resulting in resolution of symptoms. Dr Krishnadas showed the tough surgical procedure that was required for correction of an  eroded vaginal Mesh. A diagnostic dilemma was then presented by Dr Suresh. A 15 yr old boy with back pain who was started on ATT for the presumptive diagnosis of spinal TB turned out, on further evaluation, to have a localized Eosinophilic Granuloma of the D10 vertebra, confirmed by IHC. The prize for the best presentation went to Dr. Ameen presented a 60 year old victim of a traffic accident, who had a rare blood group “The Bombay Phenotype”, discovered by a physician from Bombay, occurring in 1/7600 people. Despite aggressive management , the patent could not be saved. He cautioned against transfusions without testing blood groups, that can be fatal in a patient with this rare group.

Meeting 3

Held on March 2011 by the Sree Sudheendra Medical Mission at the Hotel International on 10th Dr. Sumukhan, Consultant Pediatrician chaired the session. Dr. Anju Alex presented a 76 year old male with a scalp swelling, initially diagnosed as Non Hodgkins Lymphoma. When the expected response did not occur with CHOP regimen, a re-look with Immunohistochemistry suggested Angiosarcoma as the diagnosis. Dramatic shrinkage of the mass occurred with appropriate chemotherapy. A complex case of lower extremity weakness was discussed by Dr. Ammu Bhaskaran with learned remarks from Dr Mathew Abraham, the Neurologist. Extensive work up produced no definitive diagnosis and despite many treatments, the disease progressed. A “Psychosocial autopsy” was conducted by Dr. S. D. Singh on 2 cases of severe depression and he highlighted the need for prompt pharmacotherapy and psychological support which may avert suicides in such situations. Dr. A. K. Bhat then presented an unfortunate complication of Cautery burns that developed during the course of a hernia repair despite all precautions. He pointed out the need for extreme care in the operating room to avoid such mishaps. Dr Vinod Padmanabhan, who showed a new method of fracture fixation by transosseous suturing, which was the first of its kind in Kerala and which, in properly selected patients, is less invasive, avoids the need for expensive implants and assures early recovery of function. This was considered the best presentation of the day. Active discussion followed each presentation with significant contribution from the Chair

 

Meeting 2

Held at Lourdes Hospital, Kochi. Chairperson was Surg Cmdre Girish Gupta, Officer Commanding in charge, Naval Base Hospital. Dr. Dhanya Pillai presented a 26 year old lady with muscle weakness, diarrhea and quadriplegia who developed cardiorespiratory arrest requiring ventilation. She had severe hypokalemia, from Distal Renal Tubular Acidosis  secondary to Sjogrens Syndrome. She recovered with K supplementation and steroids. Dr Joison Abraham presented a 45 yr old male diabetic with vomiting and altered sensorium. He had Diabetic Keto Acidosis. Respiratory arrest necessitated ventilatory support. In view of persistent tachycardia and difficulty weaning off the ventilator, Thyroid Function Tests were done, confirming hyperthyroidism. He was subsequently treated for thyroid storm with steroids, Propyl Thio Uracil, Beta blockers with complete recovery.
Dr. Preethy Peter discussed a young male with fever from bone and soft tissue infections, requiring multiple antibiotics and surgical drainage. She highlighted the testing for PVL toxin that would have helped to narrow down the requirement for antibiotics. Immune deficiency state could not be totally ruled out. Dr. Thomas Mathew showed xrays of a 32 year old lady with of swelling of the left hand and limitation of movements. He pointed out the classic xray findings of osteoclastoma, a malignant tumour, in the head of the 2nd metacarpal bone. This was resected and the 4th metatarsal bone was used for replacement .Eventually full recovery of function took place. The need for removal of this tumour well before it spreads to the soft tissues was emphasized as well as the need for vigilance for recurrence/ metastasis on an ongoing basis. The award for the best presentation of the day went to Dr. Deshmukh who presented a rare form of Encephalitis in a 13 yr old, where the diagnosis was established by the finding of NMDAR antibodies
(sample tested in U.K.). With IV immunoglobulins and methyl prednisolone, the child improved and was attending school by 3 months. The neurologist at Lourdes, Dr. Bobby Varkey shared the laurels with Dr Deshmukh. The write up of the case was accepted for publication in the journal “Neurology India”

 

Meeting 1

The Cochin Clinical Society meeting for the month of January, 2011 was conducted by PVS Memorial Hospital. A welcome address was given by Dr (Col).B. Ramesh, the Medical Superintendent. The scientific session was chaired by Dr Sujit Vasudevan. Dr.Monish Thomas (Pediatrics) presented a rare case of shock in a 3 year old child that, after appropriate investigations, turned out to be Adrenal Insufficiency. There was remarkable recovery with steroid therapy. Dr.Sooraj (Nephrology)discussed a child with renal failure and encephalopathy where a kidney biopsy confirmed the diagnosis of Thrombotic Microangiopathy. With heparin and therapeutic plasma exchange, the patient fully recovered. Dr. Paul V. Joseph(Maxillofacial Surgery)) then discussed management of dental deformities in childhood and highlighted the need for early intervention to avoid permanent defects. Dr. Krishna Mohan(Urology) presented a rare entity of multiple tumours in a solitary kidney .Video presentation of the surgery was shown. This case was already
accepted for publication in an international Nephrology Journal. The last case, presented by Dr. N. P. Kamalesh (Surgical Gastroenterology) was one of obstructive jaundice, caused by Adenocarcinoma of the Pancreas, where sclerotic pelvic bone lesions raised the possibility of metastasis. However, bone biopsy showed the lesion to be from Pagets Disease. Brief discussion followed on the rare bone disease. The meeting was attended by a large number of doctors from various hospitals and disciplines, who participated actively in the discussions.