Cochin Clinical Society


Last Meetings




Meeting at Lourdes Hosp

The meeting commenced with a welcome address by director of Lourdes father Sabu NedunilathThe meeting was chaired by Dr V N Unni. Dr Rojo Joy consultant neonatologist presented a case of neonatal seizures following meningitis. The need for look into other causes of intraventricula haemorrhage in new born especially pin term babies were emphasised. Dr Anup Nair from neurosurgery presented a patient with multiple cervical vertebra following fall. He told about the role for surgical intervention and conservative managed in lateral fraxtures of the cervical vertebra. Dr Parthasarathy from department of medicine presented a case of dural venous thrombosis due to protein s deficiency. This was adjudged the best presentation. Dr. Rahul Patel presented a patient with congenital myesthenic syndrome and generalised muscle weakness. He was treated with salbutamol and symptoms improved. The last case was presented by Dr Unnikrishnan from the department of orthopaedics. He showed two cases a of hip joint arthritis who underwent knee arthroscopy. One had chronic synovitis due to rheumatoid and other had tuberculosis of the hip The meeting came to end at 9:00PM ... by co-ordinator, Dr. Binu Upendran

Meeting at Sanjeevani

The Cochin Clinical Society met at Amrita Institute of Medical Sciences, Kochi on 07.11.2013. The Meeting was chaired by Dr. Babu John Mathews, President, IMA Kochi Branch and senior physician, Medical Trust Hospital, Kochi. Dr.Vineeth(ENT) presented a 37yr old male with progressive proptosis of the right eye and diplopia. Nasal endoscopy revealed a bulge in the middle meatus on the right, and CT showed an expansile lesion with bony destruction. Sinonasal malignancy was suspected. Biopsy taken from the bulge in the right nasal cavity ,however,revealed a Giant cell lesion. Serum Calcium and PTH were elevated. On further work up,he was found to have a right inferior parathyoid adenoma, excision of which led to significant relief of symptoms. The maxilla is one of the rarest locations for Brown tumour to occur, the commonest being the mandible in the head and neck region, hence the rarity of the case. Dr Praveen(MedOnco and Hematology) discussed a 12 yr old girl with asymmetric large joint pains involving lower limbs & lack of appetite for 6 months. She had past history of recurrent respiratory infections. She had lost her elder sister around the same age following similar illness. She had hepatosplenomegaly and pancytopenia and a hematological malignancy was considered. Further extensive investigations led to the diagnosis of Autoimmune lymphoproliferative syndrome (ALPS) , a rare condition due to failure of apoptotic mechanisms to maintain lymphocyte homeostasis, permitting accumulation of lymphoid mass and persistence of autoreactive cells that often manifest in childhood with chronic nonmalignant lymphadenopathy, hepatosplenomegaly, and recurring multilineage cytopenias. She was managed with prednisolone & mycophenolate sodium to which she responded dramatically both clinically & in terms of laboratory parameters with improvement sustained thereafter. She had been bed bound & following treatment she walked out of hospital on discharge. Currently she is under follow up & her cytopenias have improved. There have been only two case reports of ALPS from Indian subcontinent previously & this is the third case. Dr.Yeeshu Singh(Pediatric Neurology, Genetics and Pediatric Endocrinology) discussed a 7 month old baby with seizures and recurrent posturing of both upper and lower limbs since birth. On further work up, a skeletal survey showed osteosclerotic changes with obliteration of medullary cavity consistent with Osteopetrosis. Few x rays were associated with rickets like changes consistent with rare diagnosis of infantile Neuropathic Osteopetrorickets. Dr.Aziz(Pulmo Med) presented a 53 years old male with cough, left sided chest pain and breathing difficulty for 12 months. His chest radiograph showed left sided loculated pleural effusion. CT chest showed narrowing of left lower lobe bronchus causing left lower lobe collapse – consolidation and left sided massive pleural effusion. fiberoptic borncho scopy (FOB) was done to elucidate the cause of endobronchial narrowing as visualized in CT chest. Fiberoptic bronchoscopy showed a 3.5cm long, sharp object projecting from left lower lobe posterior basal segmental bronchus. It was retrieved with bronchoscopic biopsy forceps. It was a small bone which patient would have accidentally aspirated, although he could not recall any such incident. Unsuspected aspirated foreign body is an uncommon cause of unresolved pneumonia or empyema. A high degree of suspicion is mandatory to avoid the delay in diagnosis and to decrease in the rate of procedure-related complications. Dr Karthik(int Med) presented a 33 year old resident of Sudan with history of fever, malaise and generalised body pain since 20 days.Initial evaluations elewhere did not reveal a cause for the fever and as his condition worsened, he was referred to AIMS. discoloration of his feet and hence was referred to us. On admission, he was in altered sensorium, septic shock, DIC, hepatosplenomegaly with splenic infarct, acute renal failure and symmetrical peripheral gangrene of both feet. A Peripheral smear showed mixed malarial infection – Falciparum + Vivax. A diagnosis of Algid malaria (with cerebral malaria and malaria lung) along with Symmetrical peripheral gangrene due to capillary adhesion and thrombosis by falciparum was made and he was started on Artesunate – doxycycline therapy, along with steroid supplementation. Due to low GCS and respiratory distress, he had to be intubated and ventilated. He was also subjected to multiple sessions of haemodialysis. Patient improved with the above therapy, is currently off ventilator and dialysis and is on the path to recovery. This case was considered the best presentation of the evening.