Dr. S. Aravinda Kumar*

Chief Consultant Interventional Cardiologist, Department of Cardiology, Trichy – Heartcity, Tamilnadu, India

*Correspondence: aravindgowri@yahoo.co.in


A 73-year-old gentleman was diagnosed to have of Hypertrophic cardiomyopathy with Left Ventricular Outflow Tract Obstruction (LVOTO) on straining, of 38 mm hg gradient, Systolic Anterior Motion (SAM) of Mitral Valve, grade 2, with moderate Mitral Regurgitation and severe Pulmonary Artery Hypertension.

Plan was to do coronary angiogram (CAG) and demonstrate Brockenbrough sign for significant LVOT (Brockenbrough-Braunwald-Morrow Sign is an evaluative hemodynamic maneuver for LVOT and refers to an an intensified gradient observed after a premature ventricular contraction).

If significant, plan was alcohol septal ablation.

There was no Brockenbrough sign and his CAG showed a significant lesion which was fixed. Hemodynamic tracing showed systolic augmentation due to reflected waves in radial artery blood pressure with wide pulse pressure compared to central aortic pressure.


Dr. G. Amarnath1,2,*

1Senior Consultant and Head, Clinical and Radiation Oncology, HCG Cancer Center, Chennai, Tamilnadu, India

2Visiting Consultant, Kauvery HCG Cancer Institute, Chennai, Tamilnadu, India

*Correspondence: amarnathg24@gmail.com


Dermatitis anterior part of leg especially over the shin. Itching present Age 38 male, Type 1 Diabetes detected eight months back.

What is your diagnosis?

Diagnosis: Necrobiosis Lipoidica

Necrobiosis lipoidica (NL) is rare, appearing in 0.3-1.6% of people with type 1 diabetes, more often in women than men. Typical lesions of NL occur in young and middle-aged patients and present most commonly on the pretibial skin as irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery. The lesions are usually multiple and bilateral. Lesions may ulcerate spontaneously or from trauma. Of the patients with NL, 11–65% have type 1 diabetes at the time of cutaneous diagnosis. Ninety percent of people with NL who do not have diabetes eventually develop diabetes (mostly type 1 diabetes). Glycemic control has no effect on the course of NL.

NL is a benign condition, and dermatology referral is not usually necessary. The cause of NL is currently unknown. Proposed causes are localized trauma, microangiopathy, immunoglobulins and fibrin deposition, and metabolic changes. Although NL is benign, its appearance is cosmetically distressing to patients.


Dr. M. Vijayakumar*

Visiting ENT Consultant, Kauvery Hospital, Tennur-Trichy, Tamilnadu, India

*Correspondence: drvijayent@gmail.com


A 24 years old lady swallowed a multivitamin tablet which got obstructed. Video laryngoscopy was normal. X-ray neck, lateral view showed foreign body. Referred to medical gastroenterology for Upper Gastro Intestinal endoscopy and removal.

What is your diagnosis?

Diagnosis: Foreign body at lower end of Esophagus (Tablet)