Costoclavicular Syndrome and MRI Evaluation, Our Experience at Tertiary Care Hospital, SKIMS Srinagar, J&K

Introduction: Cervical rib is a supernumerary rib springing from one of the cervical vertebrae, usually the seventh. About 1 in 200 people are born with cervical rib. About 1 in 10 people who have a cervical rib develop symptoms of thoracic outlet syndrome (TOS). Aims: The aim of this study was to identify normal and abnormal anatomy of thoracic outlet using MRI in symptomatic costoclavicular compression syndrome and to plan them for surgery thereafter. Methods: This was a prospective hospital based study. All the symptomatic cases of cervical rib syndrome admitted in the department of Cardiovascular and thoracic surgery SKIMS, Srinagar from May 2011 to May 2015 were taken up for the study. Results: A total of 40 cases of symptomatic cervical rib syndrome were reported from May 2011 to May 2015. Mean age of presentation was 26.3. The most prevalent age group was 21 - 30 years (47%). Majority of patients were females (83%) with male female ratio of 1:5. 67% had bilateral cervical rib, more in females (72%) than males (40%). 97% had neurogenic thoracic outlet syndrome and 3% had vascular thoracic outlet syndrome. 35% of cases with neurogenic thoracic outlet syndrome had subclavian artery compression on MR Angio of thoracic outlet after subjecting them to postural maneuvers. All the patients with subclavian artery compression were subjected to surgery. Conclusion: Costoclavicular compression syndrome affects mainly young females. MR Angio is complementary in finding vascular compression in cases presenting mainly with neurogenic symptoms of thoracic outlet syndrome.

Clinic Pathological Profile of Neuroblastoma, Our Experience at Tertiary Care Hospital;Government Medical College Hospital Srinagar J &K

Introduction: Pediatric tumors account for a small proportion of all cancers;amongst them neuroblastoma is the most common solid tumor as well as malignant tumor. They have varied clinical presentation. Recent advances in diagnostic methods and multidisciplinary treatment approach have resulted in early diagnosis, treatment, better prognosis and survival. Aims and Objectives: To study the clinical profile, histopathology, grading and correlate that with clinical diagnosis, efficacy of various investigations for early diagnosis, and management of neuroblastoma in our hospital. Material and Methods: A total of nine patients of neuroblastoma were studied from May 2013 to January 2015. All the nine patients were operated. Neuroblastoma was staged according to the International Neuroblastoma Staging system. Follow-up was carried in all the patients. Results: Two patients in our study were Stage 1, two were Stage 2A and 5 patients were Stage 4S. In Stage 1, pre-operative chemotherapy was not given. Tumor was excised in toto. Post-operatively, no adjuvant therapy was given. Patients are alive till date. In Stage 2A, patients were operated and received post-operative chemotherapy. One patient is alive and disease-free. Other patient died in post-op. period while on chemotherapy. Patients in Stage 4S were operated after receiving pre-op radiotherapy of 500 - 1000 radians and adjuvant chemotherapy. One patient expired in follow-up while four patients are still alive. We have achieved 100% survival rate in Stage 1, 50% in Stage 2 and 80% in Stage 4S.