The present issue of the Chettinad Health City Medical Journal showcases a variety of articles and reports from various medical specialities. The issue opens with an interesting pair of perspective articles. Endometriosis is a challenging problem for the gynecologists and its pathogenesis is not clear. There is an increased incidence of endometriosis among infertile women.This fact has been analyzed and a new hypothesis for the cause of endometriosis has been put forward by the authors.

To compare the serum sodium levels in patients with senile cataract, and age matched individuals without cataract. Materials and Methods : A prospective case control study was conducted from November 2016 to February 2017, and included 300 patients aged 50 years and above. Patients were grouped into those having cataract and those without cataract. Mean serum sodium and potassium levels were measured in the cataract group and the non cataract group and compared. All patients were screened for presence of nephropathy and had normal functioning of kidneys. Hence any variation in the sodium levels were solely because of dietary influences and not due to abnormal kidney function.

The aim of the present study is to Evaluate the use of subgaleal drain in the drainage of Chronic Subdural Hematomas(CSDH) and to study the incidence of recollection, infection and other complications in these cases. Materials and Methods : This is a prospective observational study.All the cases of chronic subdural hematomas diagnosed and operated at the Department of Neurosurgery,Chettinad Hospital and Research Institute,Chennai during the 2 year study period were included. All CSDH cases excluding recurrent CSDH and coagulopathies were excluded. Standard 2 burr hole craniotomy and evacuation done with subgaleal drain near posterior burr hole.

Stroke is a focal neurological deficit of sudden onset which lasts for more than 24 hours and has a vascular cause. Various prognostic indices have been used to predict the prognosis of patients with acute ischemic stroke.

A young woman presented to our hospital following Multi drug suicidal poisoning. The patient’s condition deteriorated and she developed severe Metabolic Acidosis and Refractory cardiogenic shock on conventional therapy. In order to prevent the Multi organ failure, Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was initiated. The patient’s hemodynamics improved significantly after the application of ECMO. She was weaned successfully after 69 hours.

Solitary neurofibroma is a benign neoplasm of neurogenic origin i.e. Schwann cell and perineural fibroblasts. We report a case of solitary neurofibroma in the oral cavity with the unusual occurrence of osseous metaplasia within the tumour. It is important for the pathologist to recognize these secondary features of metaplastic bone formation in the soft tissue tumours to avoid erroneous diagnosis.

Capitellum bone is an integral part of distal humerus and it is located within the elbow joint. Fractures of the capitellum are rare. The incidence is 0.5 to 1 percentage of all elbow fractures, 6 percentage of all distal humerus fractures, and accounts for less than 1 percentage of all fractures. Being an intra articular fracture, anatomical reduction and a stable internal fixation during surgery are mandatory for achieving fracture union and to regain normal elbow function. We present one such displaced fracture of capitellum bone in a 26 year old lady who reported to us following a fall from a two wheeler. She underwent surgery – open reduction and internal fixation of the fracture capitellum with headless compression screws in our hospital. At the last follow up 3 years post surgery, patient had a pain free, stable elbow joint with full range of movement. She is able to perform her activities of daily living comfortably. This case is published for its rarity and the good functional outcome following surgery, in terms of elbow range of movements.

Transient hearing loss following subarachnoid block, though reported, is a rare entity1.The relation between subarachnoid block and hearing loss is not well understood. We report one such case, where the patient experienced sudden sensorineural hearing loss after receiving subarachnoid block for an elective urological procedure.

Mesenteric ischemia is an acute abdominal vascular emergency that has various causes, which carries a high mortality rate ranging from 60% - 80%, and in which prognosis depends on the pathologic findings. Prompt diagnosis of this cause of acute abdomen requires a high index of suspicion. Rapid restoration of blood flow is the goal in these patients. We hereby report a 61-year hypertensive, dyslipidemic female on treatment also having coronary artery disease and past history of rheumatic mitral stenosis having undergone mitral valvotomy twice. Once as closed mitral valvotomy andsecond as balloon mitral valvotomy in 2015. She was admitted for dyspeptic symptoms and fever. She developed acute abdominal pain while on evaluation for pain. On evaluation, patient was found to have complete occlusion of the superior mesenteric artery and was diagnosed as a case of acute-on- chronic mesenteric vascular occlusion due to cardiac emboli.

On November 16th 2016, cardiac surgery lost the last of its pioneering surgeons. Denton Cooley (Fig 1) who was present at the ‘dawn of cardiac surgery’. This was when Dr. Alfred Blalock performed the “blue baby” operation. He strode like a colossus through the meteoric rise of cardiac surgery. He was at the forefront of every new development, stringing together a number of firsts and adding to the cardiac and vascular surgical literature. He has been described by one cardiologist as being the most productive cardiac surgeon as well as the most skilled technician and innovator.

A 47 year old smoker presented with low grade fever and loss of 10 kg weight over a one month period. He had also noticed progressive change in the contour of his nails for the past two years, with recent onset of pain in both wrist and ankle joints.

Endometriosis is the most challenging and intriguing gynecological enigma. The true incidence of pelvic endometriosis in women still remains largely unknown, despite several studies quoting variable figures. Chronic pelvic pain and infertility have been the most common features in women with endometriosis. However the cause/effect relationship is a subject of debate. Endometriosis is found to be more in nulliparous women & women with pelvic pain and rare among fertile women and women with amenorrhoea. We now believe that retrograde menstruation is probably the cause for the occurrence of pelvic endometriosis. We here propose that infertility or non conception with persistent menstruation most likely leads to endometriosis and not the other way around as is commonly believed.

Trigeminal neuralgia is one of the worst pain that can occur to the mankind and causes enormous suffering to the affected person. It is not without reason that it is also named ‘Suicide Disease’. The exact pathogenesis of trigeminal neuralgia is still unclear. Various theories and hypotheses have been put forth, but the most popular one being the micro-vascular compression theory and it forms the basis for the Jannetta’s micro-vascular decompression surgery (MVD).