NPPLWEB's Latest Articles

WJMSCR Article No. 3: Metachronous Dual Primary Tumors; Thymoma with Papillary Thyroid Carcinoma: Report of a Case and Review of Literature.

8/21/2021

Final Article is Under Production.

WJP Article No. 1: Metastatic deposits of squamous cell carcinoma cervix in the small bowel- A surprise finding in a case of acute abdomen.

8/21/2021

Final Article is Under Production.

WJMAS Article No. 2: Corrigendum: Fibrin Sealants, A Tool to Reduce Biliary Fistula After Laparoscopic Exploration of Bile Duct.

Material and methods

We present a retrospective analysis of 110 patients diagnosed with choledocholithiasis who underwent LCBDE between September 2006 and April 2020. The study population was divided into two groups: patients with choledochorrhaphy covered with fibrin sealant adhesive (FS) and patients with uncovered choledochorrhaphy (NSF). We present the analysis of incidence of postoperative biliary fistulas.

Results

WJSR Article No. 5: Current Spectrum and Mortality in Trauma Surgery- A Level 1 Trauma Center In North India

Introduction

Intestinal obstruction occurring in a Spigelian hernia is an uncommon event in a rare entity. A high index of clinical suspicion is needed to clinch the diagnosis.

Case Report

We report a case of obstructed Spigelian hernia in a 47 year old lady presenting in emergency with a history of swelling in right lower abdomen for four months and non passage of flatus and stool for three days. Contrast-enhanced computed tomography (CECT) of the abdomen was the most accurate radiological investigation. Emergency laparotomy and a tension free mesh hernia repair were done. Post operative course was uneventful.

Conclusions

Spigelian hernia is a rare ventral hernia. The symptomatology is vague but any complication like incarceration or obstruction warrants an emergency exploration. Open or laparoscopic mesh hernioplasty is the treatment of choice.

Keywords:

Spigelian hernia, CECT, Mesh, Hernioplasty

WJMSCR Article No. 2: An ambiguous type of primary internal hernia as the cause of small bowel obstruction a case report

5/28/2020

Introduction

Internal hernia is an important rare cause of small bowel obstruction especially, in a virgin abdomen, without previous abdominal surgery.

Clinical symptoms and signs are nonspecific, and preoperative diagnosis is rare even with modern diagnostic methods.

Clinical presentation

Herein, we report a case of a 60-year- old man who complained of a severe abdominal pain, nausea and obstipation. His clinical examination revealed distended abdomen and high-pitched bowel sounds indicating bowel obstruction. After resuscitation of the patient, laparotomy was done to discover an internal hernia through filmy adhesions in peri -hepatic region, as a new type of primary internal hernia. Next, reduction was done and the patient was discharged after 3 days to be on follow up.

Conclusion

Although there are several common causes of intestinal obstruction (post-surgery adhesions, inguinal hernia, malignancies etc.), other rare causes should be suspected.

Keywords

filmy adhesions, virgin abdomen, obstipation, abdomen distended.

WJSR Article No. 1: Anterior Neck Giant Atypical Lipoma: A Case Report and Review of Literature

5/28/2020

Background

Lipomas are benign mesenchymal tumour. They constitute 5% of all benign tumors of body and can be found anywhere in the body, 13% of lipomas are seen in head and neck region, Anterior neck lipoma is a rare one specially of hanging like bell is extremely rare. A lipoma is considered to be of giant when it’s size greater than 10 cm in length (in any dimension) or weighs over 1000 gm.

Case report

We are reporting a case of 50 year old male who presented with a huge swelling in the anterior neck region for last 20 year and sudden increase in size from 6 month. FNAC and sonography confirmed the diagnosis of lipoma. Enucleation of lipoma with redunded skin from neck was done and followed up for 1 year without any complication.

Conclusion

Giant pediculated lipoma of the anterior neck is extremely rare. Surgical management of this tumor is challenging and should be performed by an experienced surgeon due to the need for meticulous dissection with respect to the underlying blood vessels and nerve.

Key words

Giant pediculated lipoma, anterior neck lipoma, mesenchymal tumour

WJP Article No. 1: Corrigendum: Correction of Author name and affiliation: Laboratory Information Services: A brief review

4/9/2020

Final Article is Under Production.

WJMSCR Article No. 1: Laparoscopic gastric bypass in patients with unexpected intestinal malrotation: report of 2 cases and review of literature

1/24/2020

Background

Intestinal malrotation is a rare congenital abnormality that occurs as a result of an arrest of normal rotation and fixation of the embryonic gut. In adult age, it is extremely difficult to diagnose due to the non-specificity or lack of symptoms and is most commonly found intraoperatively.

Case Presentation

Two bariatric female patients were admitted for surgical treatment after multidisciplinary evaluation. Both of them underwent laparoscopic Roux-en-Y gastric bypass during which were found to have complete intestinal malrotation, unknown before surgery. None had experienced episodes of intestinal obstruction or other symptoms that suggested intestinal malrotation before. The postoperative period was uneventful and both were discharged on postoperative day 3, after an oesophagogastroduodenal transit that confirmed the diagnosis and excluded any other complication. The result in weight loss was identical to that of patients without anatomical abnormality.

Conclusions

aparoscopic Roux-en-Y gastric bypass is a bariatric treatment that can be successfully performed in patients with intestinal malrotation without the need of conversion to open operation, even if it is recognised only during surgical intervention. Nevertheless, before transecting the stomach or the intestine, the whole abdominal anatomy of the patient must be carefully explored to identify if modification of the surgical technique is necessary and feasible.

Keywords

Intestinal malrotation, gastric bypass, laparoscopy, obesity.

WJP Article No. 5: Primary Ewing’s Sarcoma of Kidney in Infant: a Rare Case Report

12/31/2019

Primary Ewing’s Sarcoma (EWS) of kidney is a very rare tumor and very few cases have been reported in literature. The clinical presentation of this tumor is not specific and is characterized by an aggressive course and poor prognosis.We presents a case of 6 months old female presenting with abdominal distension and hematuria for past 1 month. On clinical examination, the lump was palpable in right lumbar and iliac fossa. Contrast Enhanced Computerised Tomography (CT) scan findings were suggestive of Wilm’s tumor. Radical nephrectomy was performed .On histopathological examination; diagnosis of Ewing’s sarcoma was made. Primary Ewing’s Sarcoma of kidney is very rare and extremely aggressive. To the best of the knowledge, this is the first case of primary renal EWS reported in infant.

Keywords:

Ewing’s Sarcoma; Renal; Infant

WJMAS Article No. 1: A descriptive study of laparoscopic ergonomics: operating table height and its prediction

12/31/2019

Introduction

Laparoscopic surgery inconveniences surgeons by restricting their freedom of movement, causing prolonged static body postures, extreme joint positions and repetitive movements, leading to health issues among surgeons. These can be minimised by critical ergonomic adjustments. Better application of the knowledge of principles of ergonomics will provide better surgeon comfort and thus better patient results. This study aims to determine the ideal height of the operating table with respect to surgeons’ height, for maximum comfort and least strain.

Study Design

Descriptive study

Materials and methods

0 surgeons were included in the study. Heights of the tables at which they were comfortable operating and using endotrainers were measured and was tabulated against their heights. The ratio of operating table height to the surgeon’s height was calculated. Pearson coefficient was used to determine the relationship between OT (operating theatre) table height and surgeons’ height.

Results

The maximum surgeon height was 185cm and the least was 154 cm (mean = 169.47cm;SD= 8.41). The maximum height of the OT table used was 88 cm and the least was 67cm, (mean = 75.57 cm; SD= 5.91). A linear correlation was noted between surgeons’ heights and OT table height. OT table height can be predicted with the surgeon’s height by using the formula:

OT table height = -0.199+ 0.45 x surgeon’s height

Conclusion

he OT table should ideally be placed below the level of the surgeon’s umbilicus for maximum comfort. The height can be predicted, and this is to be applied by the surgeons in order to produce least strain and to provide maximum comfort.

KEYWORDS

OT table height, ergonomics, surgeons’ height

WJP Article No. 4: Laboratory Information Services: a brief review

12/31/2019

Abstract

Laboratory information services are software services which aid the recording, archiving as well as retrieval and processing of patient records. The use of electronic health/medical record has reduced the duration of hospital stay and mortality. A basic awareness and knowledge of informatics as well as information management topics can go a long way in meeting the challenges of holistic laboratory management.

WJMR Article No. 1: Pregnancies in cancer survivors

12/27/2019

This article has no abstract

WJECP Article No. 1: Prevalence of HPV is low in oral mucosa

12/26/2019

Final Article is Under Production.

WJSR Article No. 1: Relationship of ABO Blood Group and Oral Cancer: A Study in Selected Group of North Indian Patients

11/4/2019

Final Article is Under Production.

WJMSCR Article No. 3: Osteomyelitis as a rare complication of laparoscopic cholecystectomy: a case report

10/30/2019

Introduction

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures worldwide. A small percentage of patients revisit the hospital or outpatient clinic with post-operative complications such as infection, bleeding, biliaryor bowel injury. In this case report, we describe a very rare complication.

Case presentation

A 71-year-old male presented at our outpatient clinic with abdominal pain and fatigue. The patient had been admitted abroad, two months before,with biliary pancreatitis and cholangitis due to choledocholithiasis for which laparoscopic cholecystectomy wasperformed. However, the abdominal pain increased. Additional imagingshowed intra-abdominal abscesses. After one month of treatment the patient visited the emergency room with a painful swelling of the right lower thoracic cavity. Follow up CT-scan showed reduction of the sub-hepatic abscess but swelling surrounding the 11thrib suggestive of osteomyelitis. Therefore, thepatient was operated and the rib was partially resected. Intravenous antibiotics were continued based on tissue cultures.

Conclusion

An intra- abdominal abscess is a rare complication after laparoscopic cholecystectomy (<1%). Spillage of stones or bile increase the risk of abdominal abscesses. In this case report the sub-hepaticabscess migrated towards the rib resulting in osteomyelitis. Given the therapeutic difficulty of osteomyelitis, aggressive treatment is necessary to prevent this complication and limit further harm.

Keywords

bile stones, bile spillage, postoperativecomplication.

WJMSCR Article No. 2: Caecal epidermoid cyst in an otherwise healthy young man: A case report and review of literature.

7/6/2019

Introduction

Epidermoid cysts of the abdominal organs (spleen, liver, and kidney) are known pathologies. Two varieties of epidermoid cyst are described, acquired and congenital. These lesions are diagnosed all the time after pathological evaluation.

Case Presentation

Hereby, we report a case of a 23-year-old man, with an unremarkable previous medical history, who presented for chronic vague lower abdominal pain of several weeks duration associated with generalized fatigue and a non-significant weight loss. On physical exam a palpable right lower quadrant mass was noted which turned to be caecal epidermoid cyst on final pathology after surgical excision.

Conclusion

Caecal epidermoid cyst is an extremely rare entity with only few reported cases have been described in the literature. On radiological imaging (computed tomography, magnetic resonance imaging) these lesions look like a cystic mass and can be mistaken as mesenteric cyst, cystic lymphangioma or gastro intestinal stromal tumor.

Keywords

Caecum, epidermoid cyst, hemicolectomy

WJMSCR Article No. 1: Novel Method for Drainage of a Biliary Cystadenoma

6/4/2019

Introduction

Biliary cystadenomas and cystadenocarcinomas are rare cystic neoplasms that represent <5% of all hepatobiliary cystic masses and are extremely difficult to differentiate by non-invasive modalities. Aspiration of these cysts to alleviate patient symptomology and obtain a definitive diagnosis is suggested; however, due to the possibility of seeding during drainage, and with metastatic potential, aspiration is discouraged and surgical resection is recommended.

Case Presentation

The patient presented with a possible biliary cystadenoma through inconclusive imaging. The centrally located mass obstructed visualization of the hepatic vasculature eliminating the possibility of en bloc resection.A nasal trumpet was surgically adhered to the surface and drainage was accomplished through the lumen of the trumpet. There wasno possibility of leakage, allowing for mass removal.

Conclusion

This innovative surgical resection of a centrally located biliary cystadenoma that obstructed visualization of the hepatic vasculature and created a difficult and potentially dangerous procedure, avoided any seeding and leaking, resulting in successful surgical removal of the biliary cystadenoma.

Keywords

drainage of large abdominal cyst, resection

WJSMRO Article No. 1: Prophylactic use of Granulocyte Colony Stimulating Factor (G-CSF) in Febrile Neutropenia- A Single Institutional Study

5/24/2019

Background

Breast cancer is the most common cancer among women in India and most of the patients need chemotherapy (CT) as a part of multimodal management. CT induced febrile Neutropenia (FN) causes unnecessary treatment interruptions which may have negative impact on disease outcome, besides unwanted hospitalization, treatment costs and high mortality rates.

Methodology

Sixty-six female breast cancer patients with early and locally advanced disease were started on various chemotherapeutic (CT)regimens after excluding 11 patients .The various regimens used were having risk of FN hence, were started on prophylactic granulocyte colony stimulating factors (G-CSF) (Filgrastim) 5 microgram/ KgBW subcutaneously (SC) after 24hours of completion of CT consecutively for five days. The main purpose of the study was to prevent neutropenia (febrile or afebrile) and its associated morbidity. Also the intention of the study was to complete CT on scheduled time, without unnecessary treatment delays and dose reductions which could have strong impact on disease outcome, patient’s survival, costs and hospitalizations as well as mortality associated with it.

Results

The mean age of the patients was 48.77± 9.69 years. Four of 27 (14.81%) patients on TAC protocol developed FN out of which three had grade 3, and only one had grade 4 FN and required hospitalization. Three of 39 (7.69%) patients on other CT protocols, developed FN and was of grade 3, making a total of seven (10.6%) out of 66 patients. Conclusion: This study concluded that although 10.6% patients showed FN despite of G-CSF prophylaxis, the grade of FN was less severe (grade 3) in majority of patients and were managed and recovered well from the neutropenia on outpatient basis. Hence, we recommend the prophylactic use of G-CSF as it decreases the incidence and severity of life threatening neutropenia.

Keywords

febrile neutropenia, myelosuppression, breast cancer, chemotherapy, granulocyte colony stimulating factor

WJP Article No. 3: Prevalence Of Unsuspected Thyroid Lesions : A Histologic Study Of Thyroid Gland At Autopsy

3/26/2019

Introduction

Patients without clinical history of thyroid disease can harbour unsuspected thyroid lesions. The study of the gland at autopsy has been described as the gold standard in the determination of the true prevalence of thyroid lesion. This study was conducted to determine the prevalence and frequency of different thyroid lesions in our environment.

Methods

This is a prospective study of 150 consecutive autopsies of patients with no clinical history of thyroid disease between July 2016 and June2017. The Haematoxylin and Eosin sections of the dissected thyroid gland were examined under light microscopy. The data analysed using IBM SPSS version 20 are presented using tables, pie chart and figures. Test of statistical significance was set at p value < 0.5.

Results

There were 88 males and 62 females with a male to female ratio of 1.4:1 with age range of 18 and 80 years. The prevalence of thyroid lesion in the study was 39.3% (59/150). Nodular hyperplasia was most common lesion with prevalence of 24.7% (37/150) followed by follicular adenoma (10.0%) while lymphocytic thyroiditis had the least prevalence (4.6%). No thyroid malignancy was seen. There females have more thyroid lesions than the males (71.6% vs 45.2%).

Conclusion

There is relatively high prevalence of unsuspected thyroid lesion in our environment with the female gender more commonly affected. There is therefore need to increase awareness and institute thyroid screening tests to reduce the thyroid lesion in our environment.

Keywords

adenoma, follicular, thyroiditis, lymphocytic, nodular hyperplasia

WJPSO Article No. 1: A Stage Wise Comparison of Psychological Distress and Quality of Life in Breast Cancer: A Cross-Sectional Study

3/11/2019

Introduction

In India, breast cancer has been found to be the most frequently diagnosed cancer in women, accounting for almost 25% to 31% of all cancers. The impact of a cancer diagnosis may lead to several emotional consequences leading to changes in the functional, social and psychological aspects of the patient’s life. The aim of the current study was to compare Psychological distress (depression, anxiety and trauma) and Quality of life in the initial, middle and advanced stages of breast cancer. Study design: A cross-sectional observational comparative study.

Materials and methods

Purposive sampling was used to study 30 women (28 to 59 years old) with breast cancer in the initial, middle and advanced stages (10 in each stage). The Clinical Outcomes in Routine Evaluation and WHOQOL-BREF was used. Results: Fifty three percent of the women were found to have symptoms of depression, anxiety and trauma; however the three stages did not differ with respect to the studied variables. Psychological distress was found to be associated with reduced quality of life.

Conclusions

Results show that psychological interventions are needed to aid the overall cancer experience irrespective of the stage at diagnosis in order to improve patient’s quality of life.

Keywords

cancer staging, anxiety, depression, trauma

WJP Article No. 2: Glucan supplementation ameliorates some health problems related to the development of Lyme disease

2/23/2019

Background

Lyme disease is a multiphasic systemic disorder caused by pathogenic infection with Borrelia burgdorferi. Despite intensive research, the adequate treatment of this disease is problematic.

Material and Methods

In our study, we focused on testing the hypothesis that oral supplementation with glucan might ameliorate the Borrelia infection. We measured the ankle swelling, cytokine production, cell infiltration and level of specific antibodies.

Conclusions

Glucan, one of the most studied natural immunomodulators, was found to contribute: 1) reducing bacterial load, 2) suppressing arthritis severity, 3) stimulation of immune reactions, particularly Th2-related cytokines.

Keywords

Immunity; arthritis; cytokines; glucan

WJP Article No. 1: Histopathological Spectrum of Lesions in Gastrointestinal Endoscopic Biopsies: A Retrospective Study in A Tertiary Care Center

2/19/2019

Introduction

Lesions of Gastrointestinal tract (GIT) are commonly seen in the surgical department patients. These patients are subjected to endoscopic examination and biopsy is taken for further evaluation. Both upper and lower parts of gastrointestine can be accessed through endoscopy. A wide spectrum of lesions occurs in the whole of GIT. This study is done to statistically analyse the various histopathological lesions and to evaluate the usefulness of endoscopic biopsy to the clinicians for effective management.

Study design

A total of 180 cases received in the histopathology lab were analysed.

Materials and methods

All endoscopic biopsies from upper and lower GIT were received and processed. Paraffin blocks were made and sections were cut at 4 micron thickness and stained with routine Hematoxylin and Eosin stain.

Results

Out of total 180 endoscopic biopsies, the most commonly encountered were gastric biopsies, accounting to 103 cases, followed by colon-rectum (40), esophagus, duodenum and ileum. Malignancy was the most common lesion in the esophagus, chronic non-specific gastritis was the most common lesion in stomach. Among the malignant cases, esophagus was found to be the most common site, followed next by stomach.

Conclusion

Hence in this study, various non-neoplastic and neoplastic lesions were found in the whole of GIT. This study is done to emphasize the usefulness of endoscopic biopsy in diagnosing the conditions, thus helping the surgeons to decide further management prior to resection, especially in malignant cases.

Keywords

Gastro-intestinal lesions, endoscopy, malignancy, non-neoplastic lesions.

WJSMRO Article No. 3: Brachial Plexopathy Due to Breast Cancer Metastasis: Report of a Case and Systematic Review of Literature

11/14/2018

Background

Metastatic Brachial plexopathy is a rare and significant cause of morbidity in patients with breast cancer that is increasingly being diagnosed with use of FDG PET scanning.

Case Report

A 55 year old women presented with pain in the shoulder and arm 5 years after undergoing bilateral mastectomy for infilterating ductal carcinoma. MRI and PET scan confirmed metastasis to brachial plexus and liver. Biopsy from the brachial plexus and immunohitochemistry confirmed it to be metastasis from breast cancer. Patient was treated with chemotherapy and is alive with disease.

Methods of review

A literature search was carried out on Pubmed using a definite search strategy.

Results

Using the Prisma guidelines and after the review of abstract 23 relevant studies were identified. Six studies were identified by back reference and cross references from these articles. Thus identified total 29 articles are reviewed.

Conclusions

Metastatic involvement of brachial plexus is rare and is often part of disseminated disease elsewhere. Radiotherapy and systemic therapy is the treatment of choice. The prognosis is often poor and pain control is optimum with use of multimodal treatment.

Key words

Breast cancer; metastasis; chemotherapy; PET scan; radiotherapy; prognosis; imaging

WJMSCR Article No. 6: Atypical radiological aspect of intacerebral tuberculoma: A case report and literature review

11/2/2018

Introduction

Cerebral tuberculoma is the most severe form of extra-pulmonary tuberculosis. It is a rare disease representing only 1% of all tuberculosis cases. the authors describe a case of cerebral tuberculoma with atypical radiological aspect initially mimicking a tumor lesion.

Case report (May 12,2017)

A 28-year-old woman, without a specific antecedent, immunocompetent, was originally addressed for an intracranial hypertension syndrome. On admission the patient was apyretic with a general state preserved. The ophthalmological examination found a papillary edema stage II, and the neurological examination was normal. His first cerebral MRI revealed a cortico-subcortical right occipital lesion with an intense enhancement to the injection of gadolinium, producing a serpiginous appearance; we evoqued on an arteriovenous malformation, reason why a cerebral angiography was requested which was normal. A brain MRI Spectroscopy was made afterwards to look for the nature of the lesion, and the spectroscopic aspect was in favor of a malignant glioma. The diagnosis of glioma has been retained, and the decision of surgical excision is taken. But histological examination of the surgical specimen revealed tuberculosis. The patient was treated with anti-tuberculosis drugs. The CT scan shows an occipital porencephalic cavity, it did not show any new lesions.

Conclusion

The diagnosis of intracerebral tuberculoma is based on anatomopathological examination. It must be suspected in front of any single brain lesion.

Key words

intracerebral tuberculoma; atypical; radiological aspect.

WJECP Article No. 1: Epidemiology of Gallbladder Cancer: An Update

10/30/2018

Background

Carcinoma of the gallbladder is relatively rare tumor. It is characterized by selective geographical distribution and female preponderance. The disease is often detected late and has poor prognosis.

Methods

An extensive search of literature was carried out on Pubmed to identified epidemiological studies on gallbladder cancer. The studies were subdivided by various known factors or those who have been investigated.

Results

A total of 338 articles were reviewed. The proposed and investigated factors identified are chronic cholecystitis and cholelithiasis, racial ethical and genetic factors, dietary and life style factor, menstrual factor, carcinogens, occupational exposure, obesity, body mass index and many others.

Conclusion

The results of the present review show that there is no consensus on the cause of gallbladder cancer. Most of the studies lack sufficient power to decisively conclude any of the factors studied as the cause.

Key words

Gallbladder, cancer, carcinoma, neoplasm, epidemiology, gall stones, obesity, BMI, race, Diet

WJMSCR Article No. 5: Diaphragm Disease: Unique Small Intestinal Pathology Associated with Non-Steroidal Anti-Inflammatory Drugs (NSAID) – A Case Report with Review of Literature

9/19/2018

Nonsteroidal anti-inflammatory drugs(NSAIDs) induce a spectrum of intestinal lesions in which diaphragm disease (DD) is a rare occurrence, which usually occurs after consuming these drugs for prolonged periods. Nonspecific clinical features and vague symptoms makes difficult to diagnose this disease clinically as well as by radiological investigations. Hence, it is quite difficult to differentiate DD from small intestinal tumours and inflammatory bowel disease. The diagnosis is made on final histopathology after surgical resection and anastomosis of the affected segment which is the approved treatment. Herein, we report a case of diaphragm disease presenting with sub-acute intestinal obstruction with characteristic gross and histological pathognomonic findings.

Keywords

Diaphragm disease (DD), Nonsteroidal anti- inflammatory drugs (NSAIDs)

WJMSCR Article No. 4: Congenital Aggressive Angiomyxoma of the Vulva: A rarity

9/8/2018

Background

Aggressive angiomyxoma (AA) is an uncommon locally invasive mesenchymal tumor in females of reproductive age group. Rarely, seen in young children and clinically misdiagnosed because of nonspecific radiological features, low cellularity on FNAC and superficial location, less amenable to trucut biopsy.

Case

We report a 7 year old girl who presented with a swelling in the left labia majora, since birth. It was excised and was diagnosed as an aggressive angiomyxoma on histopathology.

Conclusion

AA is an important differential in cases of slow growing vulvar masses in children. Histopathology and immunohistochemistry can differentiate its morphological mimics. Long term surveillance is needed in view of high recurrence rates.

WJMR Article No. 1: A Single Group Study into the Effect of Intralesional Tetra-O-Methyl Nordihydroguaiaretic Acid (M4N) in Oral Squamous Cell Carcinoma

9/5/2018

Background:

Oral squamous cell carcinoma is the most common cancer among males and third commonest among females in India. Conventional treatment is by surgery or radiotherapy either alone or in combination. Survival still remains poor with nearly 50% recurring within 2-years of treatment.

Patients and Methods:

Between November 1999 and April 2000, 21 patients with oral squamous cell carcinoma were recruited. Of these, 3 patients did not complete the intended treatment and were excluded from analysis. After obtaining an informed consent, intralesional tetra-O-methyl nordihydroguaiaretic acid (M4N, currently under development as EM-1421) was injected in doses of 20 mg/day for 3 or 5 days. After completion of this treatment, patients underwent surgical resection of the tumor followed by adjuvant radiotherapy if indicated. Toxicity was monitored by WHO toxicity criteria. Response was recorded as change in surface area, tumor necrosis, pathological response, molecular response complication and recurrences. Overall, disease free and event free survival were calculated using the Kaplan-Meier method and were compared using log-rank testing. Survivin and Cdc2 expression in a preoperative biopsy and postoperative surgical specimen was documented using immunohistochemistry. The survivin and Cdc2 data was analyzed using a Chi square test and the effect of change of survivin and Cdc2 expression on survival was evaluated by the Kaplan-Meier method and log-rank test

Results

Of the 18 patients, 7 (38.9%) had pT2 disease, 4 (22.2%) had pT3 disease while 6 (33.3%) had pT4 disease. 9 (50%) of the patients were node negative while 3 (16.7%) had pN1 disease and 4 (22.2%) had N2b disease. Over a period of 5 years, 4 patients died. Two died (11.1%) of non-tumor related causes. Six (33.3%) patients recurred at primary site, neck node or developed second primary tumors. Two of these (11.1%) died due to second primary tumors at sites distinctly separate from the treated tumor. The other four (22.2%) who relapsed were either salvaged or were on palliative treatment. There were no acute or deferred toxicities in any of the patients. Disease free and overall survival at 5 years was 10/18 (55.6) % and 14/18 (71.7%) respectively. Down-regulation of Cdc2 was observed in 9/18 (50%) and of survivin in 10/18 (55.6%) patients. Tumor stage at presentation (p=0.01) and down regulation of survivin (p=0.01) were found to significantly correlate with disease free survival.

Conclusions

Intralesional tetra-O-methyl nordihydroguaiaretic acid (M4N) appears to be well tolerated using an intralesional dose of up to 100mg (20mg / day) with no evidence of acute or deferred toxicity. M4N has demonstrated significant inhibition of cellular production of Cdc2 and survivin, a potent pro-apoptotic response. This effect translated into tumor necrosis and shrinkage even with this short exposure in association with concomitant surgery and / or radiation.

Key words:

Oral cancer; squamous cell carcinoma; M4N, EM-1421, intralesional administration, cdc2, survivin, apoptosis, caspase, cyclin.

WJMAS Article No. 1: Laparoscopic Port Site Complications: A Multicentre Prospective Descriptive Study from North India

9/5/2018

Background

The laparoscopic port site complications are less common. Mainly, they include infections, bleeding, port site hernia and metastasis. Aim of this study is to determine the morbidity associated with port-site and to identify risk factors for complications. It is setting and design- prospective descriptive study.

Material and method

In the present study, a total of 656 patients who underwent laparoscopic surgeries for various ailments between Sept 2013and Sept 2016 at three tertiary institutes, from North India, were observed for port site complications prospectively and the complications were reviewed. Descriptive statistical analysis was carried out. The SPSS 13.0 was used for the analysis of the data.

Results

Of the 656 patients undergoing laparoscopic surgery, 31 (4.72%) had developed complications specifically related to the port site during a minimum follow-up of three months; port site infection was the most frequent (n = 21, 3.2%), followed by port site bleeding (n = 4, 0.6%), omentum-related complications (n = 1; 0.15%), and port site metastasis (n = 2, .30%). One patient had port site tuberculosis. 13(1.98%) patients developed hypertropic scar also.

Conclusions

Laparoscopic port site complications are less. In our multicentre study, most complications are easily manageable except in metastasis and can be further minimized with meticulous surgical techniques.

Keywords

Laparoscopy, ports ,port-site hernia

WJSMRO Article No. 2: “Introduction of Case Based Learning for Teaching Common Gynecological Malignancies in Undergraduates"

7/31/2018

Introduction

Research and education are the two pillars of progress of medical science. While research helps in understanding diseases and treating them better, it is education of the younger minds of the fraternity which carries on the research and forms the bedrock of high quality of health care. Keeping this in mind we introduced the concept of case based learning in the final year MBBS students.

Aim & Objective

To introduce Case Based Learning method of teaching in final year students of M.B.B.S. Comparison of performance of students, taught by didactic method and CBL method of teaching. Students’ perception and acceptance of CBL method of teaching.

Methodology

Students of final year MBBS of IGIMS, Patna were selected for this study. The topic of cervical cancer was divided into 4 classes and the teaching goal of each class was predetermined. The class of 86 students was divided into 4 groups for each class two groups were taught by traditional didactic lecture and the other two by CBL method. For the next class the groups were interchanged. Students were assessed through multiple choice questions and short answer type questions at the beginning and end of each class.

Results

There was statistically significant improvement in the knowledge of students about the topic in both the CBL and Lecture groups but the improvement was significantly better in the groups taught by CBL method. The feedback of students for this method was highly acceptable; it improved their understanding, knowledge and performance compared to traditional didactic lectures.

Conclusions

Statistical analysis of the pre and post class multiple choice questions and short answer type questions showed a statistically significant improvement in the knowledge of students taught by CBL method. In addition the response of students to the feedback questionnaire showed a high acceptability of CBL method.

Keywords

Case based learning (CBL), gynecological malignancy, high acceptability, teaching learning methods.

WJP Article No. 3: RELIABILITY OF DIFFERENT RBC INDICES TO DIFFERENTIATE BETWEEN BETA THALASSEMIA TRAIT AND IRON DEFICIENCY ANEMIA DURING ANTENATAL SCREENING

6/4/2018

Thalassemia and related hemoglobinopathies affect the quantity and quality of haemoglobin. High performance liquid chromatography (HPLC) is considered the gold standard for diagnosis of hemoglobinopathies. This test is not available at many peripheral centers. Many formulae or indices based on complete blood counts are available that can aid in the diagnosis. The aim of the study was to analyze the reliability of these indices in distinguishing between the most common causes of microcytic hypochromic anemia i.e. iron deficiency anemia (IDA) and hemoglobinopathies. A retrospective study was performed on 2000 women who underwent antenatal screening for beta thalassemia trait (b - TT) and related hemoglobinopathies. Nine indices were calculated among both the groups using complete blood count parameters. Sensitivity and specificity of these indices to detect beta -TT versus IDA was compared. Likelihood ratio, accuracy and youden’s index for these indices were calculated. Sensitivity of Shine and Lal index was highest (98.4%) followed by Kerman 1 index (66.7%). Mentzer index, England and Fraser index, RDW index and Ehsani index each, showed high specificity (99.66%). Kerman 1 index could point towards the correct diagnosis in 97.5% of the patients. Youden index was highest for Kerman 1 index (65.4) followed by RDW index (63.1). None of the index was 100% sensitive or specific.

Keywords

Haemoglobin,RBC indices,High performance liquid chromatography,antenatal screening

WJSMRO Article No. 1: Synchronous tumor of colon presenting with a collision tumor of ovary: An unusually rare combination and a diagnostic challenge

5/28/2018

Introduction

Multiple primary tumors identified pre-operatively, intraoperatively or a second tumor diagnosed within 6 months of resection of primary tumor are termed as synchronous tumor. Collision tumors are rare neoplasms in which two distinct tumors co-exists together in the same organ but are histologically different with no histological intermixing. We are presenting a case report of a very rare combination of synchronous adenocarcinoma of colon coexisting with a collision ovarian tumour i.e. fibroma with serous cystadenoma. To the best of our knowledge, there are no reported cases of synchronous tumor of colon with collision tumor of ovary reported in literature by far.

Case Report

A 60 years oldwoman presented with left sided abdominal mass with altered bowel habits and bleeding per rectum. Computed tomography (CT) scan showed a densely adhered solid cystic mass in the left ovary with a colonic mass. A clinical diagnosis of colon carcinoma with metastasis to left ovary or vice versa was made. On histopathological examination, final diagnosis of fibroma and serous cystadenoma of left ovary with adenocarcinoma colon was made.

Conclusion

We hope that this case helps to increase surgeon’s awareness of the adnexal masses they may come across during surgery.

Keywords

Synchronous tumor, collision tumor, colon carcinoma, fibroma, serous cystadenomamor, colon carcinoma, fibroma, serous cystadenoma

WJP Article No. 2: Expression of MUC1 and MUC2 in Colorectal Adenocarcinoma

5/11/2018

Background

Throughout the world Colorectal cancer is a major cause of morbidity and mortality. It is the most common cancer and the fourth most frequent cause of cancer death worldwide. The annual incidence rates (AARs) for colon cancer and rectal cancer in India in men are 4.4 and 4.1 per 100000, respectively.MUC1 is normally expressed on the apical borders of various glandular and luminal epithelial cells. MUC1 represents the best characterized membrane-associated mucin. The expression of MUC1 is up-regulated in Colorectal cancer. MUC2 is expressed by intestinal goblet cells. The expression of MUC2 is down-regulated in non-mucinous adenocarcinomas arising within adenomas.

Methods

A descriptive and cross-sectional study was conducted in Department of Pathology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun on 30 surgical specimens and biopsies of Colorectal adenocarcinoma after signed informed consent of patients. Immunohistochemical expression of MUC1 and MUC2 were studied. Results: Maximum number of the cases were in fifth decade with male to female ratio of 0.8:1. The most common presenting complaint among the cases of CRC was pain in abdomen (n=26 ; 86.66%) followed by rectal bleeding (n=18 ; 60%), constipation (n=11 ; 36.66%) and weight loss (n=10 ; 33.33%). Maximum number of CRC cases (60%) were in T3N0 TNM stage. Both MUC1 and MUC2 overexpression was observed in 50% of the cases. 30% of the cases expressed only MUC1 while 13.3% of the cases expressed only MUC2.

Conclusion

Expression of MUC1 was more than MUC2 in CRC cases. Although data obtained in the present study on prognostic importance of MUC1 and MUC2 is not statistically significant, yet both MUC1 & MUC2 were overexpressed in CRC.

Key words

Colorectal carcinoma (CRC), MUC1, MUC2.

WJP Article No. 1: Myelodysplastic Syndrome (MDS) with Isolated 5q Deletion (5q –Syndrome): Report of two cases with review of literature

5/10/2018

Cytogenetics is frequently seen in myelodysplasia and deletion of the long arm of chromosome 5, del (5q) is the most frequently observed cytogenetic abnormality in patients with myelodysplastic syndrome (MDS). This distinct hematologic phenotype with5q- deletion as the solekaryotypic abnormality is termed as 5q- syndrome. The World Health Organisation in 2001 recognized MDS with isolated del (5q) as a unique, narrowly defined distinct entity. The 5q-syndrome is the most distinct of all the myelodysplastic syndromes, and the molecular basis of this disorder still remains unknown. Herein, we present two cases of 5q-syndrome. Both the cases were elderly males who presented with refractory anemia. Bone marrow aspirate smears and bone marrow biopsy showed morphological features suggestive of 5q-syndrome FISH was performed to confirm 5q syndrome. Advances in the understanding of the pathogenesis of 5q deletion syndrome have suggested that it is actually a highly heterogeneous disease with variable prognosis. We discuss clinical and morphological features as well as new evolving therapies for reversal of anaemia and treatment of 5q syndrome.

Key words:

Myelodysplastic syndrome, Lenalidomide, 5q deletion

WJCM Article No. 1: A Case of moderate Burn associated with Toxic Shock Syndrome and followed by Hemophagocytic Lymphohistiocytosis.

4/2/2018

A 60-year-old man was injured by flame burn on his hands and legs, after explosion of the lacquer- can which he handled at his work place. The dermal wound affected 10% of his body surface area. On day 3 of injury, he developed diarrhea and high fever, and fell into septic shock. The patient was treated for shock with fluid resuscitation and administered catecholamine. Renal replacement therapy was also initiated for acute kidney injury. Gram-positive cocci were cultured from his wound exudate and blood samples. He was diagnosed with toxic shock syndrome (TSS), and was administered Daptomycin, recombinant Thrombomodulin, Antithrombin and intravenous immunoglobulins (IV-IG). These therapies were effective. As pancytopenia appeared on day 11 of injury, we performed bone marrow analysis by aspiration. The bone marrow analysis indicated that the patient had developed Hemophagocytic Lymphohistiocytosis (HLH). We administered IV-IG and Corticosteroid, which were effective. TSS and HLH have a similar in onset mechanism, i.e. the immunological hyper-response to septic stress. However, there are few publications of cases associated with TSS and HLH either simultaneously or sequentially. This clinical report discusses the relationship among burn, TSS and HLH.

Key words

Toxic shock syndrome (TSS), Hemophagocytosis, Burn wounds, Staphylococcus Aureus

WJSR Article No. 3: Reconstruction in a patient with Giant Cell Granuloma

3/30/2018

Giant Cell Granuloma is a rare benign disease. We present a case of Giant Cell Granuloma involving mandible in a 7 year old boy. Rarity of the disease, difficulty in diagnosis along with surgical treatment including reconstruction employed in this case is discussed.

Keywords

Mandible, giant cell granuloma, reconstruction.

WJCM Article No. 3: A pediatric case of burn associated with Kawasaki Disease

3/28/2018

Introduction

Kawasaki disease is known as mucocutaneous lymph-node syndrome. This paper present and discuss a rare case of burn associated with Kawasaki Disease.

Case presentation

The case was an 8 months-old female who was injured by scald burn on her jaw, chest, and right thigh. On day 5 of injury, she had high fever without any symptoms of wound sepsis. At the same time, she had systemic rash with conjunctival inflammation, red tongue, swollen lips and erythema of the peripheral extremities. We diagnosed that the fever was caused by KD. Intravenous immune globulin and aspirin were administered, which lead to her clinical condition to improve and she was discharged on day 21 of injury.

Conclusions

While some agents have been suspected, the cause of KD is still unknown. It is not so easy to diagnose KD on pediatric burn patients. It is necessary to rule out infection-related disease before applying the diagnostic criteria for KD. One should bear in mind the possibility of KD if we find pediatric burns with fever and systemic rash regardless of wound infection.

Keywords

wound sepsis, pediatric burn, systemic rash, intravenous immunoglobulin

WJMSCR Article No. 3: Laparoscopic Atypical Gastrectomy For Symptomatic Gastric Lipoma

3/18/2018

Introduction

Gastric lipoma is a rare benign gastric tumor, usually found incidentally. Although most gastric lipomas are asymptomatic, they can cause abdominal pain, gastrointestinal bleeding and obstruction.

Case Presentation

A 51-year-old male patient presented with complaints of epigastric pain and haematemesis. The endoscopy showed an ulcerated polypoid lesion in the anterior gastric wall, 4cm in diameter, endoscopically unresectable. The computed tomography scan revealed no other lesions and the endoscopic ultrasound suggested a lipoma of the gastric wall. Preoperatively the lesion was marked with china ink. The patient underwent a laparoscopic atypical gastrectomy, and the histology showed a gastric lipoma.

Discussion

Despite its rarity, gastric lipoma should be diagnosed histologically. Symptomatic benign gastric lesions not amenable to endoscopic removal should be excised by surgery. Laparoscopic atypical gastrectomy is an effective, safe and minimally invasive technique.

Key words

Gastric Lipoma; Laparoscopy; Atypical Gastrectomy

WJMSCR Article No. 2: Anal canal gastrointestinal stromal tumour (GIST) – A rare primary location

2/26/2018

Background

A gastrointestinal stromal tumour (GIST) is a mesenchymal neoplasm that can arise in any part of the digestive tract. Anorectal location represents 5 to 10% of all GISTs and nearly 2 to 8% of anorectal GISTs arise from the anal canal.

Case Presentation

A 75-year-old woman was referred to our Institution due to a perianal mass that was growing in the last two years. A pelvic MRI documented a large mass in the intersphincteric space of well-defined limits with central necrosis. A local excision was undertaken while preserving sphincter function, since the mass showed well circumscribed limits without invasion. The histological diagnosis of high-risk GIST was made. The patient completed 3 years of adjuvant chemotherapy with Imatinib and has had 5 years of follow-up without local recurrence or distant metastases.

Conclusions

The objectives of sphincter preservation and optimal quality of life must be weighed against the risks that are associated with the highly variable recurrence behaviour of anorectal GISTs.

Keywords

Gastrointestinal stromal tumour, anal canal, KIT gene

WJSR Article No. 2: Fas Ligand as a Circulating Apoptosis Marker in Carcinoma Breast

2/24/2018

Background

Circulating apoptosis markers such as soluble Fas receptors and Fas ligand, are a new set of blood parameter that might affect tumor growth and aggressiveness as well as being able to monitor the effect of antitumor therapy. We evaluate serially by ELISA the levels of FasL in the serum of breast cancer patients at presentation, post surgery, and post chemotherapy and also correlate levels of apoptosis markers with tumor response.

Methods

This prospective study undertaken on 24 patients of carcinoma breast of any stage in Department of General Surgery, IMS BHU in collaboration with the Department of Pathology, IMS, BHU between July 2012 to July 2014. Informed and written consent was obtained from all patients. Recist criteria were used to determine objective tumor response for target lesions (complete response, partial response, progressive disease and stable disease). Circulating levels of Fas Ligand in the sera of breast cancer patient was studied by ELISA technique.

Results

The mean age of the patients was 44.75 years (ranging from 25 to 75 years). In cases, the median Fas level at the time of presentation was 73.0 (35.76-90.00), at post surgery 58.0 (40.0-85.0) and at post-chemotherapy was 64.85 (26.75-89.50). As compared to control group, Fas level is significantly increased in patient of carcinoma breast at different time interval (p=0.004, 0.001, 0.010). In our study FasL levels were comparable in ER, PR and HER-2 positive and negative cases. There was no difference in serum levels of FasL among triple negative and non triple negative cases. Patients with lymph node positive status had a higher FasL level compared to those who had no lymph node status. The difference was greatest among patients who had 1–3 lymph nodes compared to N0 patients (p<0.01).

Conclusion

Our study indicates a considerable prognostic potential for FasL in breast cancer patients. Lack of these molecules is related to a significantly worse prognosis. This is the result of resistance of FasL deficient breast tumors to the mechanism of apoptosis.

WJSR Article No. 1: Submental Intubation in Maxillofacial Trauma Patients: Our Early Experience and Lessons Learned

1/30/2018

Introduction

Trauma is the most common cause of mortality in productive age group across the world children. Complicated maxillofacial injury averting nasal intubation & requiring maxilla mandibular fixation pose a significant challenge with regards to airway access management. The aim of this retrospective analysis of our maxillofacial trauma patient is to present the results of submental intubation and to discuss the indications and result of this procedure.

Material & methods

A retrospective study, involving maxillofacial trauma patients of the single maxillofacial unit over a one year period from July 2015 to June 2016. The study included all patients with maxillofacial trauma requiring submental intubation during surgery for maxillofacial trauma. Data were collected from patient’s records for age, gender, mode of injury, type of maxillofacial trauma, associated trauma, intraoperative and postoperative complications regarding submental intubation.

Results

A total of 11 patients with maxillofacial trauma admitted during the study . Submental intubation was successfully performed in 10 patients. Mean disconnection time in other patients was 1.2 ± 0.63 minutes. The mean procedure time was 9.6 ± 3.34 minutes. None of the patients had any motor or sensory disturbance or any complaints regarding salivary gland or duct damage. One patient with diabetes mellitus and uncontrolled blood sugar level developed a post-operative wound infection.

Conclusion

Submental intubation offers an adequate, easy and minimally invasive alternative for polytrauma patients though patients with co-morbidities should be screened to avoid complications.

Key Words

Submental intubation, maxillofacial trauma, wound infection, polytrauma

WJMSCR Article No. 1: Takayasu’s Arteritis Presenting as Hypertensive Encephalopathy

1/27/2018

Introduction

Takayasu’s arteritis (TA), a form of vasculitis of unknown etiology affects the aorta and its main branches and present with varied clinical presentation. Hypertensive encephalopathy as an initial clinical presentation of Takayasu’s arteritis is a rare manifestation.

Case report

We present a case of 20 year female patient presenting with fever and altered sensorium, with asymmetrical upper limb blood pressure. She was suspected of having arterial occlusive disease and on investigation was found to have narrowing of aorta and its branches suggestive of type V Takayasu’s arteritis. We present this case on account of rare presentation of takayasu’s arteritis as hypertensive encephalopathy.

Conclusion

Takayasu’s arteritis can present with varies features. A high clinical suspicion, prompt diagnosis and treatment along with managing complication associated with it can help in decreasing the mortality and morbidity associated with this vasculitis.

Key words

arteritis; vasculitis; vascular disease; autoimmune; hypertension; encephalopathy

WJSR Article No. 8: Arteriovenous Malformation of Upper Extremity with Multiple Hemangioma: A Case Report

12/7/2017

Infantile hemangiomas (IH) are the most common vascular tumors of infancy, usually presenting at birth or during the first few months of life and affecting 1-2% of neonates.

Prevalence of arteriovenous malformation is about 1%, out of which 40% AVM appears at birth and most of them are sporadic. We report a rare case of vascular anomalies in an infant which both arteriovenous malformation of left upper extremity and multiple infantile hemangiomas were present.

Key words:

Hemangioma, Arteriovenous malformation, vascular anomalies, Neonate.

WJSR Article No. 7: Diaphragmatic hernia in children following blunt trauma abdomen: our experiences and lessons learned.

12/3/2017

Introduction

Acquired diaphragmatic hernias are rare, life-threatening clinical conditions occurring after an abrupt increase of intra-abdominal pressure. We present our experience with post traumatic diaphragmatic hernia in children following blunt abdominal trauma.

Material and methods

This retrospective study was conducted in the Department of Paediatric surgery and Level I pediatric trauma centre of northern India. All the patients with suspected diaphragmatic hernia following blunt abdominal trauma admitted in the department of paediatric surgery and trauma centre between April 2011 and March 2017 were included in the study. The case records were used to collect the data.

Results

Total seven cases of were suspected to have post traumatic diaphragmatic hernia out of 142 patients managed during the study period. Out of these, three were cases of congenital asymptomatic eventration of diaphragm. Four cases were of post traumatic diaphragmatic hernia, three on left side and one on right side. Mode of injury was fall from height in all cases with a mean age of 4.54±1.44 years. All cases hemodynamically stable had abdominal distension and respiratory distress at time of presentation. Contrast enhanced computed tomography showed, diaphragmatic defect in all the patients. All four patients were operated after initial resuscitation.

Conclusion

Acquired diaphragmatic hernia is a rare entity in children following blunt abdominal trauma and a very high index of suspicion should be there to rule out congenital asymptomatic eventration of diaphragm in order to avoid unnecessary laparotomies.

Key words

abdominal trauma, liver atrophy, Post traumatic diaphragmatic hernia, right diaphragmatic hernia

WJSR Article No. 6: A Rare Case of Acardiac Twin in Postterm Pregnancy

11/23/2017

Introduction:

Acardiac twinning is a rare congenital anomaly of monozygotic twin pregnancy. It results from abnormal placental vascular anastomoses. This leads to twin reversal arterial perfusion with complex pathophysiology. Here we present a case report of acardiac twin with late presentation. This case report shows the need for early ultrasonographic diagnosis of chorionicity and detailed ultrasonographic follow up of twin pregnancies and treatment for salvation of the normal twin.

Case Report:

Here we present a case of acardiac twin with late presentation. This case report shows the need for correct and early ultrasonographic diagnosis of chorionicity and detailed ultrasonographic follow up of twin pregnancies.

Conclusions:

Early and accurate antenatal diagnosis is essential to improve the prognosis.

Key Words

Acardiac twin, Twin Reversed Arterial Transfusion, Monozygotic twin, Ultrasound.

WJSMRO Article No. 4: Lymphoplasmacyte –rich meningioma –A rare case report and review of literature

11/20/2017

Background

Lymphoplasmacyte –rich meningioma is a very rare pathological entity which is included under WHO grade -1 meningiomas .These meningiomas are characterised by abundant lymphoplasmacytic infiltrate which overshadows the underlying the meningothelial component.

Case Presentation

:A 27 year old lady who presented with headache of 15 days duration and generalised tonic clonic seizures of one day duration. Her clinical, haematological and biochemical profile showed no abnormality. However MRI brain revealed a well –defined extra axial dura based mass in the right fronto-parietal convexity, possibly a meningioma. She was subsequently diagnosed as a case of lympho plasmacyte-rich meningioma,WHO grade -1 after histopathological examination.

Conclusions

Lymphoplasmacyte –rich meningiomas can have varied clinical manifestations and must be distinguished from other entities like idiopathic hypertrophic pachymeningitis and inflammatory pseudotumor which commonly affect the meninges and display a similar histopathological picture. Therefore correlation with MRI findings and further evaluation in the form of immunohistochemistry markers is required to reach a definitive diagnosis. However, neoplastic versus inflammatory nature of these meningiomas has to be ascertained and requires further research on the subject.

Key words

lymphoplasmacyte , meningioma , MRI, neoplasm, inflammatory

WJSR Article No. 5: Surgical Treatment of Cyst of the Canal of Nuck: Report of a case

Keywords:

Fine-needle aspiration; Nodular hidradenoma; Eccrine; Adnexal tumour.

WJSR Article No. 4: Food Mutagen and Thyroid Cancer

6/30/2017

This article reviews the role of food mutagens in mutagenesis and carcinogenesis for thyroid cancer; it also discusses how to evaluate the effects of food mutagens. We tried to illustrate new scientific knowledge regarding food related factors by picturing and integrating new genotoxicological findings for food-borne mutagens/carcinogens and detailing contributions of modulation in thyroid cancer.

This review reports the association between dietary factors and thyroid cancer risk. Iodine-rich food such as fish and shellfish may provide a protective role in populations with insufficient daily iodine intake. The consumption of goitrogenic food, such as cruciferous vegetables, showed a positive association with risk.

The relationship between acrylamide, N-nitroso compounds, Polycyclic Aromatic Hydrocarbons, Alcohol intake and thyroid cancer has been the subject of many studies. Digestion, absorption, metabolism and excretion of fat deposits require oxidative metabolism, which create free radicals capable of causing DNA damage.

When considering the human diet, it should be recognized that foods contain both mutagens and components that decrease cancer risk such as antioxidants. Thus nutritionally related cancers ultimately develop from an imbalance of carcinogenesis and anticarcinogenesis. The best way to assess nutritional risks is through biomarkers, but there is no single biomarker that has been sufficiently validated.

Key words

Thyroid; cancer; food; mutagens; metabolism; anti oxidents; fibre; genetics;

WJP Article No. 11: Pleomorphic Sarcoma in Paratesticular Region

6/17/2017

Background

Primary tumors of the paratesticular region are rare, with paratesticular sarcomas constituting a major proportion of these tumors, particularly in the elderly. The paratesticular region consists of mesothelial, various epithelial and mesen¬chymal cells and may therefore give rise to a number of tumors with various behaviors.

Case presentation

We present a case of a 63-year-old male with a paratesticular mass clinically diagnosed as Epididymal cyst. Histopathological examination finally led to the diagnosis of undifferentiated pleomorphic sarcoma.

Conclusions

We report this case due to its rarity and due to the limited nature of data and definitional variations.

Key-words

Pleomorphic sarcoma, sarcoma, paratestis

WJSMRO Article No. 2: Retraction: Atypical Presentation of Capillary Hemangioma of Upper Eyelid near the Medial Canthus: A Case Report

Key Words

Direct immunofluorescence, Discoid lupus erythematosus, Lupus band test.

WJMSCR Article No. 7: Primitive Neuroectodermal Tumor of Adrenal Gland

4/23/2017

Primitive neuroectodermal tumor is a rare malignancy of the Ewing`s sarcoma family of neoplasms, constituted by small round malignant cells. They more often occur in children and young adults, and the prognosis is more favorable than in older adults. The occurrence of this tumor in adrenals is exceeding rare and case studies are scarce. A 27-year-old man is herein described with the adrenal tumor confirmed by immunohistochemistry and FISH methods.

Key words

Adrenal gland, diagnosis, primitive neuroectodermal tumor, young adult

WJMSCR Article No. 6: Endometriosis of the sigmoid colon presenting as acute intestinal obstruction

4/22/2017

Endometriosis is a relatively frequent condition, but the intestinal involvement is uncommon and evolves asymptomatic in up to 37% of cases, whereas complete obstruction rarely occurs. Two case studies of intestinal bowel obstruction due to endometriosis are herein commented, with emphasis about the diagnostic challenges related to abdominal malignant conditions.

Key Words

endometriosis, bowel endometriosis, intestinal obstruction

WJP Article No. 9: Molecular Analysis of X-Linked Inhibitor of Apoptotic Protein (XIAP) and Caspase -3 in Oral Cancer

4/22/2017

Introduction

Over-expression of anti-apoptotic proteins such as X-linked inhibitor of apoptotic protein (XIAP) leads to defects in caspase-3 mediated apoptosis regulation and is one of the main causes of cancer development and is associated with poor clinical outcome. Targeting of XIAP in conventional cancer therapy has the potency to significantly improve success rates of cancer treatment and the survival of patients. Our study is a preliminary effort to study the gene expression of less studied XIAP and caspase -3 in oral cancers by amplification of these genes through PCR method and 8-oxodG, a marker of oxidative damage.

Material and Methods

This Prospective pilot study is based upon the expression of XIAP and caspase protein among patients with oral cancer. PCR- gel electrophoresis was performed to analyze the gene expression and level 8-oxo dG was measured by performing ELISA.

Results

Out of the 11 samples, 7 pure DNA samples showed amplification of caspase-3 and β-Actin gene as internal control. The median value of 8-oxodG was 9.47 nM (interquartile range: 5.64–41.13 nmol).

Conclusions

We have optimized the protocol for the molecular analysis of these genes through PCR and propose to continue the study on a larger sample size with suitable controls and also include real time PCR and Western blot techniques for evaluating the expression of XIAP protein and caspase -3 and its role in future target therapy in oral cancer patients.

Keywords

Apoptosis; oral cancer; XIAP; caspase-3; oxidative stress.

WJP Article No. 8: Non – Functioning Adrenocortical Carcinoma – Report of a Case and Review of Literature

4/11/2017

Introduction

Adrenocortical carcinomas (ACC) are rare aggressive tumors with poor prognosis. Their annual incidence is 0.6 – 1.67 cases per million population per year.

Case Presentation

A 48 yrs old male presented with pain per abdomen and a palpable mass on the left hypochondrium with radiating pain in the left lower limb and left side of scrotum. US, CT abdomen and pelvis revealed well defined heterogeneous mass lesion measuring 14 x 12 cms noted in the left suprarenal region. Adrenal gland was not visualized separately. Left kidney was displaced inferiorly. Hormonal assay, renal function test were normal. Left adrenalectomy was done and histopathologic examination revealed adrenocortical carcinoma – non functional.

Conclusion

ACC is a rare aggressive tumor with poor prognosis. In the present case pressure symptoms was an early manifestation. Any patient presenting with the pressure symptoms should be investigated and treated at the earliest, as early diagnosis increases the chances of long time survival.

Key Words

Left hypochondrium, adrenocortical carcinoma, heterogeneous

WJCM Article No. 2: The Treatment of Sever Juxtahepatic Venous Injury

4/11/2017

The crucial factors in the operative management of juxtahepatic venous injuries are early identification and urgent control of bleeding. Adequate resuscitation after hepatic packing is fundamental. Failure to control bleeding after Pringle maneuver and hepatic packing confirms a retrohepatic venous injury. Total vascular isolation of the liver with veno-veno bypass or not provides an effective techniques for juxtahepatic venous injury.

Key words

Juxtahepatic venous injury, Pringle maneuver, Total vascular isolation of the liver with veno-veno bypass or not, Atrio-caval shunt

WJMSCR Article No. 5: Adult Intussusception- A Rare Diagnostic and Therapeutic Dilemma

4/11/2017

Background

Intussusception is one of the most common causes of acute abdominal pain. The majority of cases are idiopathic and ileocolic in location. This entity is highly common in paediatric age group than the adults. Colocolic intussusception is an uncommon type of intussusception that is usually associated with a pathologic lead point.

Case presentation

A 57 year-old male patient presented with the complaint of dull aching pain in his right lower abdomen since 1 month. Investigations revealed a submucous lesion near hepatic flexure. Intra operatively colo-colic intussusception was noted with a submucosal lipoma.

Conclusions

Uncommon age group, where malignancies are common and also the uncommon type, makes this entity a difficult situation to manage. Here, we tried to highlight some aspects which are important for its management.

Keywords

Adults; Colo-colic; Intussusception; Lipoma; Pain abdomen.

WJMSCR Article No. 3: Publication Ethics: Publishing without Explicit Consent of the Patient or Institutional Authorities. Ignorance or Misconduct?

3/31/2017

With increasing emphasis being placed on scientific publications by the universities and Institutions, the authors are under great duress to publish or loose recognition and research funding. As publication requires intensive intellectual inputs, it is not possible to convert ones office into a paper mill, and churn out papers after papers. In this compulsion to publish more, the ethics are taking back seat as more and more authors are cutting corners. This is evident from increasing cases of violation of publication ethics and rising misconducts. Somewhere along the line, the trust that existed between the scientists and the editors is being lost.

WJMSCR Article No. 4: A Case of Pulmonary Artery Pseudoaneurysm Secondary to Epithelioid Choriocarcinoma

3/31/2017

Background

Pulmonary Artery psuedoaneurysms (PAP) can cause significant morbidity and mortality in case of a complication and rupture. PAP caused by the malignant tumours is rare.

Case Presentation

We present a case of 35 year old Chinese women who presented with spontaneous left sided chest pain imaging revealed cavitating lesion in the anterobasal segment of her left lower lobe. She underwent thoracotomy and lobectomy. Histology revealed it to be metastatic choriocarcinoma.

Conclusion

This case illustrates that metastatic carcinoma could be a possible etiology for PAP. Proper pre-treatment evaluation of PAP and pulmonary artery aneurysms necessitates surgical biopsy to rule out malignancy.

Keywords

thoracic, pulmonary artery, pseudoaneurysm, choriocarcinoma

WJP Article No. 7: Generalized lymphadenopathy including supraclavicular lymph node involvement: A rare presentation of urothelial bladder carcinoma. A case report with Fine-Needle Aspiration Cytology and review of the literature.

2/24/2017

Introduction

Urothelial carcinoma of the bladder typically metastasizes to the regional lymph nodes and to visceral sites including bones, lung and liver. Metastasis to supraclavicular lymph nodes is extremely rare.

Case Presentation

We describe a 62-yr-old female with a rare manifestation of disseminated urothelial bladder cancer, with an extensive nested component, who presented with generalized lymphadenopathy. This clinical picture would be most compatible with a malignant lymphoma. The primary diagnostic approach was fine-needle aspiration cytology performed on a palpable mass on the left supraclavicular region.

Conclusion

Fine-needle aspiration cytology, in conjunction with immunocytochemistry, can successfully guide the clinicians to identify the primary site of a neoplasm, especially in unusual cases such as ours.

Key Words

FNAC, Urinary bladder, Urothelial carcinoma, nested, Supraclavicular lymph node, Metastasis

WJP Article No. 6: Retraction: A review of Carcinoma ex Pleomorphic Adenoma of the salivary glands

2/21/2017

It was brought to the attention of the Editor-in-Chief that the article “A review of carcinoma ex-Pleomorphic adenoma of the salivary glands” published in World Journal of Pathology 2016, 5:2 [1] on September 8, 2016 is exact copy of the article published by the same author in Int J Pathol Clin Res 2016, 2:043 [2] with the same title that was published on August 31, 2016. It is apparent that this is a case of duplicate submission leading to duplicate publication, hence, it has been decided by the World Journal of Pathology editorial board to retract the article published in World J Pathol [1].

WJBAS Article No. 1: Menace of Simultaneous Duplicate Submissions: A Consensus Statement

Results

Among lichen planus (LP), DIF positivity at dermoepidermal junction (DEJ) was seen in 25/33 (75.6%) cases followed by deposit at cytoid bodies in 18/33 (54.5%) cases. The immunoreactivity at DEJ was most commonly seen with fibrinogen in 24/33 (72.7%) cases. DIF positivity at cytoid bodies was most commonly seen with C3 in 12/33 (36.3%) cases. Among lichen planus pigmentosus (LPP), DIF positivity was seen in 9/13 (69.2%) cases. The deposit at DEJ was noted in 2/13 (15.3%) cases while deposit at cytoid bodies was seen in 8/13 (61.5%) cases. Most common immunoreactant at cytoid bodies was C3 in 5/13 (38.4%) cases. The sensitivity of histopathology and direct immunofluorescence for the diagnosis of lichen planus including lichen planus-like lesions was found to be 100% & 74.5% (LP-87.9% and LPP-69.2%) respectively.

Conclusions

The study showed that DIF is helpful in diagnosis of LP and LP like lesions. In LP, the shaggy fibrinogen deposit alone at DEJ & C3 alone or in combination of other immunoreactants at CB was found to be most characteristic

Key words

Direct immunofluorescence, Lichen planus, skinskin, pathology,

WJMSO Article No. 1: Menace of Simultaneous Duplicate Submissions: A Consensus Statement

2/1/2017

This article has no abstract

WJCM Article No. 1: Menace of Simultaneous Duplicate Submissions: A Consensus Statement

2/1/2017

This article has no abstract

WJSR Article No. 2: Retraction: Role of Imaging in Female Infertility

1/31/2017

This article has no abstract

WJMAS Article No. 1: Laparoscopic and Laparoscopic Assisted Management of Intra- Abdominal Cystic Lesions in Infants and Children

1/31/2017

Background

Intra-abdominal cystic lesions in infants and children are relatively common and complete excision of the cyst is the treatment of choice. With the development of laparoscopy, pediatric laparoscopy is being applied to diverse conditions. The aim of this study was to evaluate the laparoscopic management of intraadominal cystic lesions in infants and children using the Tan Bianchi approach.

Material and Methods

Infants and children with different types of intra-abdominal cystic lesions were included in the study. After establishing the pneumoperitonium by open technique, cysts were decompressed and partially or completely dissected depending upon the nature of the cyst. Using the Tan Bianchi approach, cyst was delivered out for final excision or resection.

Results

The age of patients ranged from 4 months to 6 years with mean age of 2.7 years. Fourteen patients were included in the study, which included 6 mesenteric cysts, 3 duplication cysts, 3 omental cysts and 2 ovarian cysts. No intraoperative or postoperative complication was encountered. The mean hospital stay was 3 days.

Conclusion

Laparoscopic or laparoscopic assisted management of intra-abdominal cystic lesions combining withTan Bianchi approach is good alternative to open surgery. It is safe, simple and effective technique even for surgeons with less experience in intracorporeal suturing.

Keywords

Intraabdominal cystic lesions, Laparoscopic, Tan Bianchi umbilicotomy, Infants and children.

WJMSCR Article No. 2: Spontaneous Bone Regeneration after Resection of an Unusually Aggressive Recurrent Central Giant Cell Granuloma in a Nigerian Adolescent

1/29/2017

Background

Aggressive variant of Central Giant Cell granuloma (CGCG) is rare and is characterized by the presence of pain, rapid growth, expansion and / or perforation of the cortex, and a high tendency to recur based on clinical and radiographic findings. It account for about a third of all cases of CGCG.

Case Presentation

A case of aggressive CGCG with early recurrence, rapid growth associated with pain and spontaneous bleeding is presented. Spontaneous bone regeneration with no evidence of recurrence was noted after 2.5 year follow-up. The factors responsible for spontaneous bone regeneration (SBR) are discussed.

Conclusions

This case illustrates the need for radical surgery in aggressive CGCG. High osteogenic potential in a growing mandible offers the possibility of bone regeneration.

Key words

Spontaneous bone regeneration, aggressive central giant cell granuloma, case report.

WJP Article No. 3: Menace of Simultaneous Duplicate Submissions: A Consensus Statement

1/29/2017

Menace of Simultaneous Duplicate Submissions: A Consensus Statement

¹Mridula Shukla, ²Monika Roychowdhury, ³3Shailesh Singh,⁴Christine Caygill, ⁵James W. Lillard, Jr,⁶Seema Singh, ⁷Satyendra K. Tiwari, ⁸8Vishwajit Verma, ^9,100Manoj Pandey

¹Editor-in-Chief, World Journal of Pathology
²Editor-in-Chief, World Journal of Medical and Surgical Case Reports
³Editor-in-Chief, World Journal of Basic and Applied Science
⁴Editor-in-Chief, World Journal of Epidemiology and Cancer Prevention.
⁵Editor-in-Chief, World Journal of Medical Research
⁶Editor-in-Chief, World Journal of Minimal Access Surgery
⁷Editor-in-Chief, World Journal of Surgical Research.
⁸Editor-in-Chief, World Journal of Trauma and Critical Care Medicine
⁹Editor-in-Chief, World Journal of Psycho-Social Oncology
¹⁰Editor-in-Chief, World Journal of Surgical Medical and Radiation Oncology

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Ethical publication practices are essential for integrity in science. Any attempt at compromising the ethical practices, leads to suspicion of the honesty and integrity of the authors and the validity of the data that is generated from the authors’ institution. Some of these ethical violations are severe and punishable in law whilst others are not so serious but annoying, and need to be frowned upon. One such common ethical publication malpractice is duplicate submission or simultaneous submission. The ‘International committee of Medical Journal Editors’ (ICMJE) has prepared extensive guidelines now called recommendations [1] and the ‘Committee on Publication Ethics’ has also released a ‘Code of conduct’ and ‘best practice guidelines’ for journal editors [2] to help them to tackle the ethical issues.

Duplicate submission is submission of the same or substantially similar manuscript by the same author(s) to more than one journal at the same time or at intervals without acknowledging the prior submission and without the permission of the copyright owner of the first journal where it was submitted. Addition of a new title or superfluous changes in the content does not make it a new manuscript. It is recommended that “authors should not submit the same manuscript, in the same or different languages, simultaneously to more than one journal [1].”

Duplicate submission is a problem as it may lead to duplicate publication of the article. Which in turn distort the empirical evidence as other authors doing reviews and meta analyses may erroneously count the evidence twice [3]. Beside it leads to wasting of precious editorial and peer review resources. Leopold SS [4] in his editorial analysed the impact and noted as to why the duplicate submissions need be discouraged. Beside data duplication and wastage of resources, it also violates copyright law and breaks the trust of the readers [4]. Most universities also consider it as academic misconduct and there could be serious implications.

Though the problem of simultaneous submission is big, there is no concrete data available. Most of these cases comes to light only when one manuscript is published or if the two manuscripts from two different journals reach the same reviewer. The data on duplicate publication, on the other hand is available and figures are shocking. Cheung et al., [5] studied the prevalence of duplicate submissions in otolaryngology journals and found 75 out of 358 (20.9%) as possible duplicates. On further detailed analysis they found one (0.8%) duplicate publication and 27 (7.5%) being more or less redundant. The duplication rate in the Bailey’s series was 1.8% [6].

The authors responsibility and do’s and dont's for the authors have been enumerated numbers of times and are available freely online [1;7-11], hence repeating them here would be redundant. This is also being added to our respective website in ‘the instructions to authors’.

Through this consensus statement we the editors once again wish to emphasize that duplicate submission or simultaneous submission is a menace that need be discouraged. The six cases that came to light last year have been suitably investigated and explanations have been called from authors. If it comes to light that this was anything other than a genuine error, the cases will be referred to their respective head of the institutions for investigation and action as per institutional rules. We once again reiterate that the editors will follow a “policy of zero tolerance” for scientific and ethical misconducts. We may publish less but we will publish ethically and will make all attempts to uphold the science and evidence based ‘best practice’.

Conflict of Interests

The authors declare that there are no conflicts of interest

Reference List

[1].International Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. 2017. 23-1-0017. http://www.icmje.org/recommendations/ [Last accessed January 20, 2017]

[2]Comittee on Publication Ethics. Code of conduct and best practice guidelines for journal editors. 2011. 23-1-2017. http://publicationethics.org/files/Code_of_conduct_for_journal_editors_Mar11.pdf [Last accessed January 20, 2017]

[3].Eliasson M. [Duplicate publication a way of embellishing research results. Unethical misuse which threatens the validity of systematic reviews and meta-analysis]. Lakartidningen 2000; 97(32-33):3454-3456. [Pubmed]

[4].Leopold SS. Editorial: Duplicate submission and dual publication: what is so wrong with them? Clin Orthop Relat Res 2013; 471(5):1401-1402 [Pubmed]

[5].Cheung VW, Lam GO, Wang YF, Chadha NK. Current incidence of duplicate publication in otolaryngology. Laryngoscope 2014; 124(3):655-658. [Pubmed]

[6].Bailey BJ. Duplicate publication in the field of otolaryngology-head and neck surgery. Otolaryngol Head Neck Surg 2002; 126(3):211-216 [Pubmed]

[7].Bailey BJ. Publication in otology and neuro-otology: dos and don'ts. Ann Acad Med Singapore 2005; 34(4):281-284.[Pubmed]

[8].Uzun C. Multiple submission, duplicate submission and duplicate publication. Balkan Med J 2013; 30(1):1-2.[Pubmed]

Changes in ovarian morphology is assessed at histopathological level followed by the confirmation of bioaccumulation of Au-NPs using Transmission Electron Microscopy. Using comet assay, strand breaks in DNA of ovarian cells are investigated.

Results

The damage due to accumulated Au-NPs in these cells was found to be statistically significant as compared to those of controls.

Conclusions

In conclusion, Au-NPs of size range 10-50nm are capable of gaining access to ovaries of female zebrafish and potential enough to cause strand breaks in ovarian cells. The present study highlights the adverse effects of these NPs to female reproductive system.

Keywords

Histology, bioaccumulation, gold nanoparticles, zebrafish, ovaries

WJMSCR Article No. 1: Giant Cell Arteritis – A Medical Emergency in Elderly

1/5/2017

Giant Cell Arteritis is the most frequent vasculitis in elderly and represents a potentially reversible cause of blindness in this population. The prognosis depends on how quickly the therapy is initiated, that is why a high index of suspicion is important to the diagnosis, allowing the immediate initiation of appropriate treatment. We present a typical case of Giant Cell Arteritis in a patient who arrived four days after the onset of symptoms in the emergency room. The delay in presentation may have dictated his prognosis despite prompt onset of corticosteroid therapy.

Keywords

Giant Cell Arteritis, Temporal Arteritis, Anterior Ischemic Optic Neuropathy

WJP Article No. 3: EGFR Over-expression in Head and Neck Squamous Carcinoma & It's Correlation with Etiological Factors like Alcohol and Tobacco

12/27/2016

Objectives

The present study was carried out to investigate the possible association of EGFR expression with personal habit as possible risk factors for development of HNSCC.

Study design

Immunohistochemical analysis was performed on the samples obtained from 103 patients with HNSCC, 25 patients with pre-cancerous condition and 116 healthy controls. The data was analyzed using parametric and non parametric tests. The categorical data was analyzed by chi square test. Correlation analysis was also performed.

Results

In our study in carcinoma group, correlation coefficient for personal habit status of the patient with EGFR expression was -0.031 and p=0.755 which is not significant. The EGFR expression intensity is higher in cancer patients compared to the normal subjects. This difference is statistically significant (p=0.000).

Discussion

EGFR expression was high in patients with oral cancer compared to premalignant and malignant diseases. However, our study does not show any association of risk of development of HNSCC due to the consumption of cancer causing products to personal habits of the subjects.

WJP Article No. 4: Melanotic neuroectodermal tumour of infancy - a case report of a rapidly enlarging maxillary mass.

12/27/2016

Introduction

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm that primarily affects the maxilla of infants during their first year of life. It is a rapidly growing lesion, clinically aggressive and surgery is the mainstay of treatment with proven efficacy.

Case Presentation

A case of maxillary MNTI in a 5-month-old male infant treated by radical surgery is reported here. Both extraoral and intraoral findings showed a massive swelling with multiple ulcerations of the overlying mucoas. Radiographs showed an ill defined mixed radiolucent radiopaque lesion. Histopathological examination showed biphasic microscopical presentation consisting of aggregates of small neuroblastic cells surrounded by the larger pigmented cells.

Conclusions

MNTI is a rare, rapidly progressive pigmented lesion that commonly affects the anterior maxilla. Other differentials should be carefully considered in arriving at a diagnosis. Wide surgical excision with margin of normal tissue is the mainstay of treatment.

Key Words

Melanotic neuroectodermal tumor of infancy, Surgery

WJSR Article No. 6: Role of Imaging in Female Infertility

12/23/2016

Imaging plays key role in diagnostic evaluation of female infertility. Infertility has many causes – tubal and peritubal disorders, uterine disorders including mullerian duct anomalies, ovarian disorders, cervical disorders. There is increase in incidence of female infertility in association with that there is increase in demand for female imaging modalities. Although HSG is gold standard investigation but USG is first line investigation for female infertility.Sonosalpingography differentiate among uterine synechiae, endometrial polyps and submucosal leiomyomas. Pelvic MRI is very sensitive for detection of endometriosis. It is also used for detection of adenomyosis, leiomyomas, mullerian duct anomalies. Cervical stenosis is referred as failure or difficulty in cervical canulation in HSG. Ovarian disorders are usually diagnosed by USG. Multimodality imaging approach with appropriate selection of imaging modality is necessary to know exact cause of infertility because it direct subsequent management of infertility.

Sonosalpingography differentiate among uterine synechiae, endometrial polyps and submucosal leiomyomas. Pelvic MRI is very sensitive for detection of endometriosis. It is also used for detection of adenomyosis, leiomyomas, mullerian duct anomalies. Cervical stenosis is referred as failure or difficulty in cervical canulation in HSG. Ovarian disorders are usually diagnosed by USG. Multimodality imaging approach with appropriate selection of imaging modality is necessary to know exact cause of infertility because it direct subsequent management of infertility.

Key words:

infertility, hysterosalpingography, ultrasonography, magnetic rasonance imaging

WJSR Article No. 5: Cranioplasty : Routine Surgical Procedure or Risky Operation?

12/21/2016

Cranioplasty is a surgical procedure performed to restore a defect on the cranial vault after a previous decompressive craniectomy made for traumatic brain injury, ischemic or hemorrhagic disease, or even after the removal of cranial tumors. Although apparently it may resemble an easy and routine surgical procedure, cranioplasty has a rate of complications up to 41% of cases. The most frequently reported complications are infections, autologous bone flap resorption, and hematomas. Other possible complications are wound dehiscence, seizures, hygroma, and poor cosmetic results. In this paper we report an overview of the possible complications deriving from cranioplasty. The most evident causes of complications are discussed, suggesting, when possible, solutions to avoid or limit them.

Key Words

Cranioplasty Complications, Infection, Bone Resorption, Haemorrhage, Seizures, Cosmetic Result

WJSR Article No. 4: Rhabdomyosarcoma of Biliary Tract Misdiagnosed as Choledocal Cyst-Two Cases and Review of Literature

11/25/2016

Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor. It is a rare tumor in children but the most common cause of malignant obstructive jaundice in them.We present two cases of children who presented to us with obstructive jaundice and palpable liver. They were misdiagnosed as choledochal cyst on imaging studies; however, intraoperative and histopathological features confirmed the diagnosis of rhabdomyosarcoma. Mass excision and Roux en Y portoenterostomy was performed. Post operatively, the patients were put on multimodal chemotherapy. This, being an uncommon entity, is being reported with a review of the available literature.

Keywords

Hepatic rhabdomyosarcoma, Choledochalcyst, Rhabdomyosarcoma in choledochal cyst,VAC

WJMSCR Article No. 4: A Case of Wristwatch Ingestion in a 7 Year Old

11/25/2016

Ingestion of foreign objects is very common in children and must be dealt with caution. Early intervention can be avoided by serial monitoring. The case of ingesting an entire wrist watch are scarce, although smaller button batteries and coins do top the list. Careful assessment and proper decision making to the time of surgery is crucial for appropriate management.

Key Words

Foreign Body, Paediatric patients, plain x-ray, endoscopy.

WJCM Article No. 3: Epidemiology of Cervical Spine Lesions in the Multiply Injured Patient – Recent Data of the Traumaregister DGU®

11/24/2016

Introduction

A cervical spine lesion (CSL) is common among polytrauma patients. Injuries may be life threatening. The clinical impact of CSL in multiple injured patients is the focus of this study.

Methods

A retrospective investigation on a total of 62,903 patients of the Trauma Register DGU® from 2009 and 2014 was performed. Preclinical and clinical data were analyzed.

Results

The cohort depicted the typical severity in polytrauma (mean age 51 ±21; mean ISS of 22 ± 12). 1,321 patients sustained a CSL with an AIS 4-6 including complete spinal cord syndrome. The number of male patients was more than twice as high as of female patients. Leading causes for CSL were car accidents, falls from <3m height and falls from >3m height. 12,023 patients were unconscious (GCS ≤8). The majority had a CSL of AIS <2. 406 unconscious patients suffered from a CSL with an AIS 4-6. Cardiopulmonary resuscitation (CPR) was performed in 2,000 patients in the preclinical setting and 1,003 patients received CPR in the resuscitation bay. Severe CSL (AIS 4-6) had a significantly lower blood pressure (102mmHg ± 46) and a significantly lower heart rate (74/min ± 34) than patients with less severe CSLs (AIS <2). Hospitalization was extended with the severity of CSL. Early mortality was high. More than half of the patients with CSLs (AIS 2-6) died within the first 24 hours. 404 patients were transferred to a rehabilitation facility.

Conclusion

Cervical spine lesions imply a peculiar element among polytrauma patients. Early mortality correlates with the severity of CSL. Rehabilitation facilities are mainly the end point.

Keywords

Cervical spine lesion, spinal cord injury, Glasgow Coma Scale, multiple trauma, TraumaRegister DGU® (TR-DGU)

WJSMRO Article No. 2: Expression of X-Linked Inhibitor of Apoptosis Protein (XIAP) Correlates with the Lymph Node and Receptor Status in Breast Cancer and Reduces Survival

11/5/2016

Background

X-linked inhibitor of apoptosis protein (XIAP), also known as MIHA/hILP/BIRC4 is a novel member of the inhibitors of apoptosis (IAP) family located on chromosome Xq25. XIAP has the most potent anti-apoptotic effect in cells and, is able to inhibit the effector caspases -3,-7 and -9. This case control study reports the mRNA and protein expression of XIAP, apoptosis and its effect on the survival in breast cancer.

Materials and Methods

XIAP expression was measured by immunohistochemistry, western Blotting and RT PCR method in 29 controls and 90 patients with breast cancer. Apoptosis was detected by using based on in situ labelling of the fragmented DNA (terminal deoxynucleotidyl transferase mediated UTP nick end-label (TUNEL)) staining.

Results

XIAP protein expression was seen in 62.1% of controls and 86.7% of breast cancers, while mRNA expression was seen in 51.7% of controls and 87.8% of breast cancer. The differences were statistically significant. past history of abortion (p=0.002), metastasis (p=0.002) and oestrogen receptor (p=0.04) were found as independent and significant predictor for overall survival in breast cancer. XIAP negative patients had higher survival; however, the difference was not statistically significant.

Conclusion

XIAP is an important biomarker of breast cancer. Its expression significantly correlates with expression of hormone receptors, and prognosis is better in XIAP negative breast cancer.

WJCM Article No. 2: Management of Arterial Hemorrhage by Pseudoaneurysms Following Pancreaticoduodenectomy

10/20/2016

Bleeding pseudoaneurysms are among the most serious and fatal complications after pancreaticoduodenectomy.Sentinel bleeding after pancreaticoduodenectomy indicates local sepsis and anastomotic dehiscence. Therefore, I think recognition of the significance of “sentinel bleeding” and prompt response may prevent exsanguination. Therapeutic embolization should be the initial procedure. This is technically easier for the patient and the surgeon, and there is less chance of rebleeding in septic field.

Key words

Pancreaticoduodenectomy, Sentinel bleeding, Pseudoaneurysms, Embolization

WJP Article No. 2: A review of Carcinoma ex Pleomorphic Adenoma of the salivary glands

9/8/2016

Introduction

One of the malignant forms of pleomorphic adenomas (PA) is carcinoma ex pleomorphic adenoma (CA-ex-PA). Carcinoma ex pleomorphic adenoma is an uncommon malignant tumor with high aggressive behavior and poor prognosis. However, there are a few studies in this topic in the recent literature. Furthermore, the lesions are uncommon and often have a difficult diagnosis by clinicians and pathologists, because the residual small PA component and various malignancy subtypes may be present. In this study, we reviewed the recent studies in about clinical, radio graphical, histopathological and molecular features of CA-ex-PA.

Methods

In this review article, the studies were identified by researches on three databases- Pubmed, MEDLINE, and Google scholar- from 2005 through 2015 in the English language for the carcinoma ex pleomorphic adenoma. We used the following search terms: "carcinoma ex pleomorphic adenoma, salivary gland tumors". We included original studies and review articles.

Results

Recently, much research have been performed to study, a review of development and progression of carcinoma ex pleomorphic adenoma which have been identified already.

Conclusion

CA-ex-PA is an uncommon malignant tumor with the particular biological behavior in contrast to the other salivary gland neoplasm. It is important to be aware of the tumor and early detection of pleomorphic adenoma is important for the prevention of CA-ex-PA.

Keywords

Salivary gland tumors, Carcinoma ex pleomorphic adenoma, Histopathology

WJSMRO Article No. 1: Adrenal Metastasis from Gallbladder Cancer: Report of a Case and Review of Literature.

9/2/2016

Background

Cancer of the gallbladder spreads primarily by local invasion and lymphatic spread, vascular metastasis is rare. Adrenal is a common site of metastasis from cancer of the lung, colon and renal carcinoma, however, metastasis from other cancers is rare.

Case presentation

A 32 year old woman presented with painless progressive jaundice and on imaging was found to have primary carcinoma of the gallbladder with liver invasion, lymphatic metastasis and adrenal mass. Fine needle cytology proved it to be a metastatic lesion from the gallbladder. Patient was treated with palliative chemotherapy.

Conclusions

Adrenal metastasis from cancer of the gallbladder is rare with only two cases being reported in literature previously. Solitary metastasis in resectable tumor should always be surgically removed, however, palliative care is recommended if primary tumor is locally advanced and surgically non resectable.

Key words

Gallbladder; adrenal; metastasis; adenocarcinoma; surgery; adrenalectomy; PET, cytology

WJP Article No. 1: Encysted variant of papillary carcinoma breast associated with DCIS – a rare case report

8/27/2016

Background

Encysted variant of papillary carcinoma (EPC) is a rare malignancy accounting for 0.5% - 1% of all breast cancers. It is more frequent in elderly postmenopausal women. Patient presents with a lump in the breast, with or without bloody nipple discharge.

Case Presentation

A 60 yrs old female presented with lump in the breast. USG andFNAC findings was inconclusive. So, surgical excision of the cyst along with that surrounding tissue was removed. Histopathologically, a diagnosis of encysted papillary carcinoma of the breast associated with DCIS was made.

Conclusions

The residual palpable mass after a bloody aspirate at FNA is a strong indicator of carcinoma in cystic lesions of the breast.

Key Words

encysted, ductal carcinoma, invasive carcinoma

WJCM Article No. 1: Trauma Induced Coagulopathy

8/22/2016

Coagulopathy is frequent present in trauma. Acute coagulopathy associated with trauma (ACoT) has been recognized as a distinct entity associated with increased mortality, morbidity and transfusion requirements. Uncontrolled bleeding is the most frequent preventable cause of death in trauma patients reaching hospital alive. Coagulopathy in trauma has been long thought to develop as a result of hemodilution, acidosis and hypothermia often related to resuscitation practices. The lack of well defined diagnosis criteria for ACoT impedes early identification and treatment. Prolongation of prothrombin time (PT) and activated thromboplastine time (APTT) have been used by most author to diagnosis ACoT. Mechanisms contributing to ACoT include anticoagulation, consumption, platelet dysfunction and hyperfibrinolysis. Early administration of tranexamic acid ,recombinant factor Ⅶ and aggressive blood product transfusional management for ACoT with a red blood cell: plasma: platelets ratio close to 1:1:1 could result in decreased mortality from uncontrolled bleeding. This article will review the pathophysiology and management of ACoT.

Key words

Acute coagulopathy associated with trauma (ACoT); tranexamic acid; recombinant factor VII

WJMSCR Article No. 3: Primary Leiomyosarcoma of the Breast with Axillary Nodal Metastasis : A Case Report and Review of Literature

8/21/2016

Primary leiomyosarcoma of the breast is an extremely rare tumor, accounting for less than 1% of all breast tumors and only 24 cases have been reported in the English medical journals. It is quite difficult to diagnose leiomyosarcoma preoperatively. Establishing an accurate diagnosis is very important in planning treatment. When preoperative diagnosis can be achieved before or during the operation, wide resection should be performed. There is no need for axillary lymph node dissection. In this case report, we present a case involving primary leiomysarcoma of the breast in a 48-year-old woman and we discuss optimal treatment options.

Key words

Breast, Leiomyosarcoma, Mastectomy

WJMSCR Article No. 2: Perforated Duplex Vermiform Appendix: A Rare Emergency

8/20/2016

Duplex appendix is a rare congenital problem which may remain asymptomatic but sometimes presents as acute abdomen. Peroperative identification of both the appendices is essential, otherwise the unattended appendix may lead to serious life threatening and medico legal consequences in the future. We report a case of 26 years male who presented to the emergency with acute pain abdomen for 10 days and high grade fever. On exploration, two inflamed vermiform appendices were identified, one of them having perforation and both were attached to a single caecum. Appendicectomy of both the appendices was done. Postoperative period remained uneventful.

Keywords

Duplex appendix,Appendicitis, Laparotomy, Acute abdomen

WJMR Article No. 1: Comparison of Spinal with Paravertebral Block for Elective Open Inguinal Hernia Repair

8/20/2016

Background

The inguinal hernia surgery is one of the commonest surgical procedures. There are many modalities of anaesthesia for the procedure but the desirable would be one having prolonged analgesia with less motor block.

Aim

to compare the hemodynamic changes, procedure time, time taken for onset of effect and time till there is persistence of effect (hence the requirement of analgesics) between PVB and SA for inguinal hernia repair.

Material and Method

The study included total 6o patients undergoing elective inguinal hernia repair; randomized into two groups having 30 each. Group 1 received paravertebral block and group received spinal anaesthesia. The parameters like age, mean arterial pressure (before and after block), heart rate (before and after block), procedural time, time taken to onset of effect and time for appearance of post operative pain were noted. Statistical Analysis was done for the final correlation.

Results

The mean arterial pressure and heart rate after the block was significantly higher in group 1. The procedural time and time for the onset of effect was also significantly more in group 1. However there was no motor blockage and significantly prolonged post operative analgesia in group 1.

Conclusion

The paravertebral block is certainly better aesthetic modality for the inguinal hernia repair but requires more expertise and time taken in procedure.

Key words

Spinal, Paravertebral, inguinal hernia, Anesthesia

WJSR Article No. 3: Gossypiboma Presenting as Persistent Post Operative Sinus

8/20/2016

Retained foreign bodies can lead to various complications as sepsis, intra abdominal abscess, fistula or sinus formations, intestinal obstruction, chronic abdominal pain etc. Detection of these cases became possible with advancement in the imaging techniques available. Mostly presentation is in the form of intraperitoneal effects and persistent postoperative sinus is an extremely rare manifestation of Gossypiboma. We suspected foreign body inside abdominal wall leading to persistent sinus. Sinogram and sonogram suggestive of foreign body which was confirmed on exploration.

WJECP Article No. 1: Corrigendum: Second Malignancy of the Oral Cavity after Brachytherapy for Tongue Cancer in Long-term Follow-up Patient

4/12/2016

In the article [1] the period of the study in the section abstract and material and method was written wrongly the correct period of study is 1959 to 2000 (instead of 1965 to 2000). Hence the first line of abstract will read as “A retrospective review of 281 patients who had been treated with brachytherapy for stage I or II tongue cancer between 1959 and 2000 was performed.” The first line of material and method will read as “Between 1965 and 2000, 281 patients with stage I or II tongue cancer were treated with interstitial brachytherapy using low-dose-rate sources and, thereafter, were followed-up for more than 10 years at the Department of Diagnostic Radiology and Oncology, Tokyo Medical and Dental University Hospital.”

WJSR Article No. 2: Food Mutagen and Lung Cancer

4/12/2016

This article reviews the role of food mutagens in mutagenesis and carcinogenesis for lung cancer; it also discusses how to evaluate the effects of food mutagens. The relationship between nitrosamine, polycyclic aromatic hydrocarbons, alcohol intake and lung cancer has been the subject of several studies. Many epidemiological studies have identified several risk and protection factors for lung cancer [1, 2, 3], and some have proved that changes in the exposure to these factors may have an influence on incidence and mortality due to this kind of pathology.Diet and nutritional factors are one of several major causes of carcinogenesis. Carcinogenic processes themselves are known to involve multi steps process (initiation, promotion, progression) and influenced by various factors. Human beings are often being exposed to carcinogenic factors during their life, whether they realize it or not. These factors are divided into endogenous (genetics, immunologic disturbances, endocrine imbalance) and exogenous factors (environment, physical, biologic, or chemical agents, nutrition and lifestyle) [4]. The field of investigation of the role of nutrition in the cancer process is very broad. It is becoming clearer as research continues that nutrition plays a major role in cancer [5]. Dietary constituents reduce the risk, in some cases by decreasing the effects of food mutagens, or through carcinogenic detoxification, or protection of DNA from electrophilic carcinogen. Futher more, nutritionally related cancer ultimately developed from an imbalance of carcinogenesis and anticarcinogenesis process [6]. Consumption of certain foods containing Nitrosodimethylamine (NDMA) was associated with a higher risk of developing lung cancer. This was particularly evident with the consumption of salted meat. This food item has been associated with an increased risk of oropharyngeal and laryngeal cancer in humans [7, 8]. We tried to illustrate new scientific knowledge regarding food related factors by picturing and integrating new genotoxicological findings for food-borne mutagens/carcinogens and detailing contributions of modulation in lung cancer.

Key Words:

Carcinogenesis, Lung Cancer, Diet, Nutrition, Nitrosamine, Polycyclic Aromatic Hydrocarbons, Alcohol,

WJMSCR Article No. 1: Cecal Perforation Secondary to Appendicitis-But not at the Base of Appendix

2/7/2016

Introduction

Acuteappendicitis is the most common surgical emergency. It is associated with a variety of complications among which cecal perforation is a rare and technically difficult condition. Usually cecum perforates at the base of the appendix.

Case presentation

A 19 year old female came with complaints of fever and vomiting since 5 days; and pain abdomen since 1 day. On examination, she was toxic and had features of peritonitis. Radiological investigations confirmed the presence of peritonitis. On exploration, appendix was found inflamed and perforation was found at the posterior wall of cecum. Primary omental patch repair was performed. Histopathology report confirmed that the perforation was due to periappendicitis.

Conclusion

Cecal perforation, itself is a diagnostic and therapeutic challenge to all surgeons and is associated with a high mortality. Here we sensitise the medical fraternity to such a challenging case and the therapeutic options.

Keywords

appendicitis, cecal perforation, acute abdomen, right hemicolectomy

WJSR Article No. 1: Role of Computed Tomography Imaging in Evaluation of Neurofibromatosis Type -2

Background

Closure of palatal fistulas requires meticulous attention to detail as well as sound understanding of relevant anatomy. Tongue flaps of various design based on defect location, size and confounding patient factors, have been proven to be effective in closing intraoral defects.

Case Description

A 37 year old Hispanic female presented to our hospital with a palatal pleomorphic adenoma. After initial resection, a split thickness skin graft was performed to the operative site, and prosthesis was fabricated. The patient could not tolerate her obturator secondary to a severe gag reflex, and was left with residual 3x2cm oro-nasal defect.Reconstruction of the defect was planned with the use of an anteriorly based tongue flap due to concerns that the patient’s severe gag reflex would make a traditional posteriorly based flap intolerable.

Practical Implications

The purpose of this article is to describe the options available for closure of an oro-nasal fistula, and describe our use of an anteriorly based dorsal tongue flap to close a large posterior soft palate defect in a patient with a severe gag reflex.The exaggerated reflexes might have otherwise been considered a contraindication.

WJSR Article No. 4: Bouveret's Syndrome-Radiological Findings

9/25/2015

We present a case report with radiological findings in a patient of 63 years old with findings highly suggestive of Bouveret’s Syndrome on abdominal radiograph, USG and CT scan.

Key Words

Gallstone, ileus, cholecystoduodenal fistula ,Gastric outlet obstruction.

WJP Article No. 8: The Relationship of p16, Ki-67, Bcl-2, P53 and CK20 Immune Expressions with Recurrence in Superficial Bladder Tumors

8/3/2015

Background

Superficial urothelial carcinoma of the urinary bladder account for 70-80% of all newly diagnosed bladder cancer cases. Of these, approximately 50-75% will experience a recurrence in 12 months and 20 to 25 % will progress to invasive types during the person's lifetime.

Aim

In the present study, we investigated the relationship between the recurrence rate and the expressions of various genes via immunohistochemical analysis in order to assess their applicability as prognostic factors for clinical behavior and differential diagnosis.

Material and Methods

Methods The antibodies that were used in this study; tumor suppressor gene P53, apoptosis activity determinant bcl-2 cell proliferation marker Ki-67, CK20 cytokeratin isotope and tumor suppressor gene P16. Fifty eight cases diagnosed with primary superficial bladder cancer were investigated.

Results

Recurrence was detected in 62.1% of the cases. Progression to a higher grade tumor was detected in 38.9% of the 36 cases that showed recurrence. A marked statistically significant relationship was found between recurrence and diffuse or no staining with CK20, more than 50% heterogeneous expression with P16, and more than 1% expression with bcl-2. Evaluation of the effect of the CK20, bcl-2 and P16 parameters with logistic regression analysis showed that the model was significant (p<0.05) and more than 1% staining with bcl-2 had an explanatory power of 8.057 times on the recurrence rate. A significant relationship was found between the pathological stage and histological grade of the cases and the CK 20 and Ki 67 expressions.

Conclusion

In conclusion, determining CK20, bcl–2, and p16 expressions with immunohistochemical methods can provide guidance in predicting the recurrence of superficial bladder tumors. Abnormal CK20 staining and Ki-67 expression is related to tumor grade and can be used to support the diagnosis in controversial cases.

Keywords

superficial urinary bladder cancer, recurrence, immunohistochemical analysis

WJMSCR Article No. 9: Persistent Left Sided SVC Found Incidentally on Central Line Insertion

8/3/2015

Persistent Left Sided Superior Vena Cava (PLSVC) is a rare vascular anomaly however; it is the most common venous anomaly of the thoracic venous system. It is present in 0.3 to 0.5% of the population [1, 2]. PLSVC is the result of persistence of the embryonic left anterior cardinal vein and is usually considered a normal variant. In this case report, we present a case of persistent left sided SVC in a 64 year old man associated with anterior cerebral artery aneurysm.

Keywords

Persistent Left Superior Vena Cava, Persistent LSVC, Anterior Cerebral Artery Aneurysm, Thoracic Vascular Anomalies.

WJP Article No. 7: Cytodiagnosis of Sinonasal Aspergillosis - A Case Report with Brief Review of Literature

7/22/2015

Background

Aspergillosis of head and neck region primarily affect nose and paranasal sinuses. Mycotic infections are raising globally both in immunocompetent and immunocompromised individuals. These infections mimic malignancy clinically and radiologically. They pose a diagnostic and therapeutic challenge to the physician. In such cases, aspiration cytology plays a crucial role in early and definitive diagnosis of mycotic infections.

Case Presentation

We herein present a case of 75-year-old male presented to the surgical department of our hospital with right maxillary region swelling with a discharging sinus since 2 months. Clinically suspected as sebaceous cyst/malignancy. Fine needle aspiration cytology (FNAC) was advised and showed giant cell lesion with fungal hyphae, morphologically suggestive of Aspergillosis.

Conclusions

Early diagnosis with aspiration cytology will help the clinician for prompt and appropriate management and follow up in order to reduce the morbidity and mortality associated with its destructive nature. The goal of this case report was to highlight the importance of FNAC in diagnosing subcutaneous mycotic infections promptly and to avoid further complications of the disease.

Key words

Aspiration cytology, aspergillosis, mycotic infections.

WJSMRO Article No. 7: Metabolic Syndrome (Mets) and Risk of Colorectal Cancer (CRC): A Systematic Review and Meta-Analysis

7/19/2015

Introduction

Metabolic syndrome (MetS) is a commonly associated with cardiovascular disease and diabetes. Interest in the relationship between MetS and cancer has been evolving. The aim of this systematic review and meta-analysis is to evaluate the association between MetS and the risk of colorectal cancer (CRC).

Method

Case-control and prospective cohort studies with CRC incidence or mortality in participants with and without MetS were included in the analysis.

Results

Fifteen studies, which reported an association between MetS and CRC, were included. This comprised 12,019 cases of CRC in a total of 739,731 participants. The results showed that MetS confers a significant increase in the risk of CRC incidence (OR 1•52, 95% CI 1•33 - 1•73). When studies that did not adjust for confounders were excluded, the effect estimate was similar (OR 1.41, 95% CI 1•25 - 1•58). MetS is associated with an increased risk (51%) of CRC in both males and females.

Conclusion

It may be beneficial to identify and optimally treat MetS components as part of the screening or preventive measures for risk factor modification of CRC.

Keywords

colorectal cancer, metabolic syndrome, risk factors, meta-analysis, systematic review, colon cancer, rectal cancer

WJSR Article No. 3: Primary Pure Squamous Cell Carcinoma of Gallbladder: A Rare Entity

7/18/2015

Introduction

Adenocarcinoma is the most common malignant neoplasm of the gallbladder. Although areas of squamous differentiation may be seen in adenocarcinoma, primary pure squamous cell carcinoma is rarely reported and accounts for less than 1% of all gallbladder malignancies.

Case Report

We report a 50-year-old female who presented with right upper quadrant pain. She was operated on based on a presumptive diagnosis of acute cholecystitis with Empyema of gallbladder according to clinical and ultrasonographic findings. Histopathological examination revealed well differentiated keratinized squamous cell carcinoma infiltrating into the muscle layer up to the serosa. Thorough evaluations by CT scan of abdomen post operatively revealed no other primary site for the tumor.

Conclusions

Primary squamous cell carcinoma of the gallbladder is a rare histological finding. There is no consensus on its treatment due to its rarity.

Key words

Gallbladder, Squamous Cell Carcinoma, acute cholecystitis, Cholecystectomy;

WJP Article No. 6: Giant cells in giant cell reparative granuloma: physiognomic or pathognomic relevance?

7/7/2015

Giant cell reparative granuloma is a tumor-like lesion, which is characterized by the typical appearance of dotted granulation tissue. Such dotting is attained by the giant cell populations. Histogenesis and pathogenesis of such multinucleated giant cells are, hitherto, controversial. Some attributed the origin of multinucleated giant cells to an osteoclastic lineage from differentiated mononuclear cells. This paper, however, suggests another origin with a newly introduced mechanism of action.

WJSR Article No. 2: Role of Extended Lymphadenectomy for Gastric Cancer

7/7/2015

Significant variability exists throughout the world in the extent of lymphadenectomy that is performed for gastric adenocarcinoma. D2 lymphadenectomy is the standard lymphadenectomy performed in high incidence countries such as Japan and South Korea, and less extensive lymphadenectomies are often performed in lower incidence countries such as the Unites States. This article reviews the evidence on the extent of lymphadenectomy that should be performed for gastric adenocarcinoma.

Keywords

gastric adenocarcinoma, lymphadenectomy, surgery, stage, survival

WJECP Article No. 3: Determinants of Unhealthy Behaviors among Adult Cancer Survivors

7/7/2015

Objective

To evaluate the impact of time since cancer diagnosis, access to health care, and demographics in the prevalence of cancer six unhealthy behaviors (lack of exercise, overweight, inadequate sleep, less life satisfaction, current smoking and alcohol use) among cancer survivors.

Methods

Maryland Behavioral Risk Factor Surveillance System (BRFSS) participants, who reported in 2009 a previous history of cancer were included in this study. With the exception of non-melanoma skin cancers all cancer sites were included. Logistic regression assessed time since cancer diagnosis, access to health care and demographics as predictors of unhealthy behaviors.

Results

Unhealthy behaviors were differentially predicted. Time since cancer diagnosis was not significant for any unhealthy behaviors after multivariate adjustment. Access to health care has significant impact on sleep and life satisfaction. Female gender was significant for weight gain. Current smoking, alcohol use, and lack of exercise were affected by place of residence. Most striking were large and statistically significant high ORs for current smoking in all local Maryland jurisdictions compared to Montgomery County.

Conclusions

Contrary to our hypothesis, cancer survivors did not participate more in healthy behaviors with increasing time since cancer diagnosis. We expected health care access to play a critical role in advising cancer survivors to adopt healthy behaviors. However, this was true for only two of the six unhealthy behaviors. This study increases awareness about Maryland adult cancer survivors, and may motivate a renewed prevention mindset for physicians towards their cancer survivor patients as well as patients with cancer.

WJMSCR Article No. 8: A Small- and Medium-Vessel Vasculitis Causing Colo-Colonic Intussusception: A Case Report and Review of the Literature

6/29/2015

Introduction

Intussusception is the invagination of one segment of the gastrointestinal tract into an adjacent segment. In the adult population, intussusceptions confined to the colon which present as a single, initial manifestation of vasculitis are less common.

Case Presentation

We report a rare case of vasculitis of uncertain etiology serving as the lead point for a colo-colonic intussusception in an adult male patient.

Conclusions

Whereas in some casesmanagement of adult intussusception is straightforward, the management of other cases can be controversial. Awareness of the advantages and disadvantages of different management recommendations is important for surgeons. Surgical resection was considered mandatory in our case because of the possibility of occult malignancy serving as the lead point of the intussusception.

Keywords

Intussusception; Colo-colonic; Vasculitis; Florid Vascular Proliferation

WJP Article No. 5: Prognostic Validity of Agnor in a Diaspora of Maxillofacial Fibro-Osseous Lesions

6/2/2015

Fibro-osseous lesions of the jaws comprise a diverse, interesting, and challenging group of conditions that pose difficulties in classification and treatment. Common to all is the replacement of normal bone by a tissue composed of collagen fibers and fibroblasts that contain varying amounts of mineralized substance, which may be bony or cementum-like in appearance. All were stained with H&E to confirm the diagnosis in addition to the argyrophilic nucleolar organizer region staining stain (AgNOR) to conduct the morphometric study. This study investigates 20 cases of fibrous dysplasia (FD), 35 cases of peripheral ossifying fibroma (POF), 20 cases of central ossifying fibroma (COF), 5 cases of ossifying fibromyxoid tumor, as well as 10 cases of normal mucosa as a control group. One-way ANOVA (ANalysis Of VAriance) with post-hoc Tukey HSD (Honest Significant Differences) tests were calculated to compare between the mean AgNOR score of area fraction of the studied lesion. Pearson’s correlation (r) test and its P-Value were calculated between the mean AgNOR score of area fraction and duration of every lesion.

Key-words

Fibro-osseous lesions, AgNOR stain, fibrous dysplasia, ossifying fibroma, morphometric analysis.

WJECP Article No. 2: Factors Associated with Residents' Place of Death in the Chongwen District of Beijing from 2007 to 2012

5/25/2015

Introduction

Developed countries pay more attention to the place at which residents die, but little is known about this topic with respect to China. Given its recent economic development, the distribution and factors associated with place of death in a developed area of China may display unique characteristics. The aim of this study was to determine the current distribution and characteristics of residents’ place of death in the Chongwen district of Beijing and to analyze the factors associated with the place of death.

Methods

Data on residents’ place of death from 2007 to 2012 in the Chongwen district of Beijing were collected from the Death Cases Reporting System of China. We determined the distributions and trends of place of death and analyzed the factors associated with place of death via univariate and logistic regression analyses.

Results

The average proportion of residents who died at an inpatient hospital ward was 49.2% in the Chongwen district of Beijing and displayed an increased trend from 2006 to 2012 (χ2=4.240, P=0.039). Gender, age, marital status, education level, occupation and cause of death were associated with place of death (P<0.001). Being widowed (odds ratio (OR)=1.193), divorced (OR=1.415), having a low education level (middle school: OR=1.381; primary school: OR=1.705; or illiterate: OR=1.923), being unemployed (OR=1.690) and suffering from cardiac disease (OR=2.063) were risk factors for dying outside a hospital ward. Male gender (OR=0.082), being in the 75-84 year age group (OR=0.721) and suffering from cancer (OR=0.374) or respiratory system disease (OR=0.608) were associated with a reduced risk for dying outside a hospital ward.

Conclusions

The proportion of residents who died at a hospital ward in the Chongwen district of Beijing was higher than that of the overall country of China and was similar to that of developed countries. Residents with low education levels, who were unemployed, and who were not married were more likely to die outside the hospital. Policy-makers should focus on effectively assisting low-income residents in obtaining resources for end-of-life medical care. These results emphasize the difficulties with medical and mental care for elderly individuals who live alone.

Keywords

China; place of death; factors; end-of-life care.

WJSMRO Article No. 6: Nasopharyngeal Carcinoma with Atypical Ophthalmic Presentation- A Rare Case Report

5/17/2015

Introduction

Nasopharyngeal carcinoma (NPC), a rare malignancy with unique and complex etiology, is most confused and commonly misdiagnosed disease and can present as painless enlargement of upper neck nodes, followed by nasal, aural, ophthalmic, neurological manifestations.

Case presentation

We present a case of NPC in a 24 year old unmarried female, who initially presented with painless bilateral loss of vision, initially treated empirically for optic neuritis and Tuberculosis for four years.

Conclusion

Isolated painless and bilateral loss of vision though unusual and rare manifestation of NPC should be considered as a possible differential.

Key words

nasopharyngeal carcinoma, bilateral loss of vision, optic neuritis, paraneoplastic effect, ophthalmic presentation.

WJMSCR Article No. 7: Intraduodenal Migration of a Retained Surgical Gauze as a Cause of Gastric Outlet Obstruction

WJMSCR Article No. 6: Foreign Body Mimicking an Oral Pathology

4/3/2015

Foreign bodies’ adherence to the hard palate is unusual and can mimic an oral pathology. The diagnosis of this foreign body is challenging: it is based on an amnestic history, unspecific or absent symptoms and oral examination. The oral examination could be difficult when dealing with paediatric patients. Imaging techniques may mislead and so an exam under anaesthesia is often necessary to make the proper diagnosis. We report a case of 2 years-old male child referred to our attention for a strange lesion on the hard palate. After poorly significant MRI, we were unable to perform an oral examination and a general anaesthesia procedure was performed. A small translucent mass that turned out to be a piece of plastic adherent to the hard palate, was removed.

WJP Article No. 4: Mitotic Kinase Aurora B is Frequently Overexpressed in Aggressive B-Cell Lymphoma

3/30/2015

Introduction

Aurora B is a mitotic kinase responsible for the proper organization of chromosomes and scheduling during cell division. This study aimed to examine the alterations in Aurora B expression in relation with major up- and downstream cell kinetic proteins (survivin, phospho-histone H3, Ki-67) in aggressive B-cell lymphoma. The potential cytogenetic background of kinase overexpression was also studied.

Study design

Fifty patients with aggressive B-cell lymphoma were recruited to the study. Reactive lymph node samples were used as non-neoplastic control. Protein expression was studied by immunohistochemistry, AURKB gene locus at 17p13.1 and chromosome 17 copy numbers were determined by fluorescence in situ hybridization.

Results

We observed that Aurora B expression is strongly influenced by overall cell proliferation capacity. Cell cycle related Aurora B overexpression was determined by the Aurora B/MIB-1 index (AMI) and was stated in 13 cases (26.0%). Kinase overexpression (AMI>0.5) in aggressive lymphoma was associated with induced mitotic activity determined by phospho-histone H3 labelling. Copy number changes of AURKB locus (17p13.1) did not influence kinase expression. High AMI was not associated with significant chromosome 17 copy number alterations in this setting.

Conclusions

Aurora B is overexpressed in a significant portion of aggressive B-cell lymphoma. Since Aurora B expression is strongly dependent on the cell proliferation rate, total proliferative capacity should be considered in a quantitative assay. As a consequence of kinase upregulation the mitotic process is potentially accelerated disabling proper repair function at the G2/M checkpoint and enabling incomplete chromosomal segregation and movements leading to a more aggressive phenotype in diffuse B-cell lymphoma.

Keywords

aggressive B-cell lymphoma, Aurora B, kinase deregulation, genetic instability

WJMSO Article No. 2: The Effect of Induced Anisometropia nn Binocular Visual Function

3/28/2015

Background

To determine the effect of experimentally induced anisometropia on binocular function in healthy adults as a means of assessing the likely effects of uncorrected anisometropia on binocular visual development in childhood.

Design

This prospective study was conducted in Department of Ophthalmology, JLN Medical College, Aligarh Muslim University, Aligarh, U.P., India

Patients and Methods

A total of 30 healthy adults aged between 18-35 years and free of ocular disease participated in the study. One to five diopter (D) of unilateral hypermetropia and myopia was induced in each eye in ID increments. Fusion was assessed with the Worth-Four Dot test for distance (WFDT) and near and Bagolini’s lenses (BL); stereopsis with the TNO test, bifoveal fusion with the four-prism diopter base-out test (4PDBOT) and aniseikoniawith charts.

Results

All subjects showed a decline in binocular function with increasing levels of anisometropia. Significantly increasing foveal suppression as evident on the WFDT and BL, with all subjects definitely suppressing at +3 Danisometropia. Aniseikonia was altered by 2% per 1 D anisometropic Induction. Proportion of cases with monofixation significantly increased upto 3D (p<0.05). Stereopsis decreased in proportion to the degree of anisometropia. Three diopters of anisometropia, regardless of type, produced a marked reduction of stereoacuity in all patients.

Conclusions

Relatively low degrees of spherical anisometropia (as small as 1D) causes significant abnormalities in high-grade binocular function in adults. The potential amblyogenic effects of even small uncorrected anisometropia on binocularity in children require further investigation, and should be considered in developing guidelines for the empiric correction of refractive errors.

KeyWords

Amblyopia, Aniseikonia Anisometropia, Binocular visual function, Worth-Four Dot test

WJSMRO Article No. 4: Matrix Metalloproteinases in Head and Neck Cancer

3/26/2015

Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases, which degrade all kinds of extracellular matrix proteins. MMPs play an important role in cell behaviors such as proliferation, migration, differentiation, apoptosis, and host defense. Polymorphisms in the promoter regions of multiple MMPs and overexpression of MMPs and tissue inhibitors of metalloproteinases (TIMPs) are associated with head and neck cancer risk, higher T and N stage, and a worse prognosis. Serum and plasma levels of MMP and TIMP might be useful in diagnostics and follow-up. However, their use as therapeutic target should be further investigated, since the antitumor activity of matrix metalloproteinase inhibitors has been disappointing thus far.

WJMAS Article No. 2: Epiphrenic Esophageal Diverticulum Diagnosis Treatment

3/24/2015

Introduction

Epiphrenic esophageal diverticulum is a rare entity of the esophagus. The symptoms closely mimic those of cardiac disease. Endoscopy, barium study and mannometric evaluation are necessary for a complete diagnosis.

Case Report

A case of an epiphrenic diverticulum diagnosed and treated conservatively is presented. The symptoms, diagnostic work up and therapeutic options are discussed.

Conclusions

All patients diagnosed as having an epiphrenic esophageal diverticulum should undergo a trial of conservative treatment. If the response is poor then laparoscopic intervention is the treatment of choice for treating this lesion.

Key Words

Epiphrenic Esophageal Diverticulum, Diagnosis, Treatment

WJSR Article No. 1: Surgical ‘Hot Clinics’: What Do the Patients Think?

3/22/2015

Background

Surgical ‘hot clinics’ have been introduced recently in the UK and offer an alternate surgical care pathway with significant benefits to the NHS. The aim of this study was to explore the views of patients seen in surgical hot clinics.

Methods

All patients attending the surgical ‘hot clinic’ over a six-week period at a busy teaching Hospital in London, from Feb 2013 to March 2013 were included. The study was registered as an audit as it aimed to evaluate a new service. A questionnaire was specifically designed to explore patients’ experiences. No patient identifiable data was collected and patients were asked to complete the questionnaire after their consultation.

Results

115 patients attended the surgical ‘hot clinic’ over the study period. 58% of the patients were attending the clinic for the first time and the rest were follow-ups. 86% of the patients saw a nurse within 30 min of arrival. 79% saw a doctor within 60 minutes of arrival in clinic. Majority of the patients felt the clinical area was clean (98%). Majority of the patients felt that they were provided privacy (99%), involved in the decision-making (91%) and adequate information was provided (91%). Doctors and nurses were rated high (85%). 95% of patient rated their experience as 8 or above (scale of 10). Majority would prefer to be seen in the ‘Hot Clinics’ (83%) and would recommend it to family and friends (87%).

Conclusions

Surgical ‘Hot Clinic’ is an effective alternative surgical pathway, which are well received by patients.

WJMSCR Article No. 5: Paget’s disease of the Breast: Report of a Case and Review of Literature

3/17/2015

Background

Paget’s disease of the breast continues to pose both a diagnostic and therapeutic dilemma to the surgeon. Understanding the pathology of the lesion is pivotal in planning the surgical option for the lesion.

Introduction

Paget’s disease is one of the differential diagnosis of eczematous lesions of the nipple areola complex. It is invariably associated with an underlying cancer.

Case Report

A case of Paget’s disease of the breast treated by breast conserving surgery is presented.

Conclusion

Unilateral eczema of the nipple areola complex warrants immediate biopsy. MRI is a useful adjunct in the diagnosis of this disease. The outcome of biopsy dictates the best choice of surgical option.

Key Words

Paget’s disease nipple breast diagnosis treatment

WJSMRO Article No. 3: Glioblastoma Multiforme (GBM) with Cervical Lymph Node and Skeletal Metastases: A Case Report and Review of Literature

3/6/2015

Glioblastoma Multiforme (GBM) is the most aggressive intracranial tumor and diffusely infiltrates the surrounding brain tissue. Despite their malignant nature, they do not typically invade blood vessels and rarely spreads outside the central nervous system (CNS). Median survival of GBM patients after completing standard treatments is about 14 months and few have long term survival. Extra neural metastases usually occur after surgery in which the tumor cells may find an access to extra-cranial vessels, the most common sites being pleura and the lungs. Although the exact mechanism of extra-neural metastasis has been poorly understood, the lymphatic drainage, the venous system and the adjacent dura and bone invasion have been suggested as the three possible routes of extra-neural spread. Interestingly, we treated a rare case of extra-neural metastases of the GBM having left neck nodal mass and osseous metastases first time at our center. She was 21 year old female who had biopsy proven cervical lymph node metastases and radiologic evidence of skeletal metastases from Glioblastoma Multiforme and reviewed the literature.

Key words

GBM, Metastases, Skeletal metastases

WJMSCR Article No. 4: Polypoidal Ampullary Gangliocytic Paraganglioma: A Rare Case of Biliary Obstruction

3/6/2015

Gangliocytic paraganglioma is a distinctively rare tumor that is mainly found in the second part of duodenum. It is a benign tumor which rarely recur or metastasize to regional lymph nodes. It can be sessile or pedunculated. It is usually in close proximity with the ampulla of vater, invasion of which may present with obstructive jaundice. Most of the gangliocytic paragangliomas are found incidentally during endoscopy or during investigation for gastrointestinal bleeding. Our patient is a 46 year old female and a hepatitis B carrier. Noted to have raised alkaline phosphatase on routine blood test. MRCP revealed dilated CBD with no ductal stone, pancreatic head mass or liver mass. ERCP showed a 4cm ampullary polyp with elongated mucosal stalk. Transduodenal ampullectomy with sphinteroplasty was performed. Histology and immunohistochemical staining confirmed tumor consistent with gangliocytic paraganglioma arises from the wall of ampulla, the tumor was excised completely with clear margin.

WJP Article No. 3: Age as a Predictive Tool of Aortic Valve Dimensions-An Autopsy Based Observational Study

3/5/2015

Introduction

Diseases of the aortic valve cause considerable morbidity and mortality. Modern cardiothoracic surgery procedures including valve replacement procedures give tremendous relief to the suffering. In certain transcutaneous procedures used in aortic stenosis, unlike in open heart surgery, there is no way of direct valve sizing. A non-invasive method of estimating valve size would be helpful. The aims of the study were to estimate the average aortic valve dimensions for each age group for male and female and also to compare the valve dimensions with the external and internal parameters of the body and heart.

Study Design

It was a prospective observational type of study. Data collected from consecutive cases over a period of one year was analysed. 585 cases with age ranging from 13 days to 90 years were examined. Mean age was 42.26 years

Material and Methods

Aortic valves from hearts dissected at autopsy were formalin fixed. Measurement of aortic valve circumference was taken at the supra aortic ridge (commissure) level. The valve diameter, circularised orifice area, effective indexed orifice area were calculated from it. The correlations of aortic valve dimensions with the external and internal parameters were assessed. Linear regression between aortic valve diameter and age was done.

Results

The mean aortic valve diameter of adult was 2.1cm (S.D 0.296). The regression equation to derive aortic valve diameter from age in adults aged 21 years or above was 1.718 + 0.009 x age (in years).

Conclusions

From the above study we were able to conclude that the age and aortic valve measurements correlate positively in adults. The results can be of use to the anatomist, pathologist doing autopsy as well as the cardiothoracic surgeons.

Key words

Aortic valve, aortic stenosis, valve replacement, supra aortic ridge, age, valve measurement

WJMSO Article No. 1: Intravitreal Bevacizumab as a Treatment of Diabetic Macular Edema in Patients Refractory to Laser Photocoagulation Therapy

3/1/2015

Aim

To evaluate the effectiveness of intravitreal Bevacizumab injection as treatment of Diabetic macular edema in patients who are not responding to previous photocoagulation.

Material and Methods

40 eyes of 40 diabetic patients were treated with 1.25 mg of intravitreal bevacizumab injection as the primary therapy for diabetic macular oedema. The main outcome measures included best-corrected visual acuity, fundus fluorescein angiography, and macular oedema map values of optical coherence tomography before and after intravitreal injections.

Results

All the eyes had received some form of laser photocoagulation before (not less than six months ago), but all of these patients had persistent diffuse macular edema with no improvement in visual acuity. The visual acuity increased in 30 of 40 eyes (75%) during a mean follow-up time of 5.6 months. The mean baseline best-corrected Log MAR value for visual acuities of the patients before intravitreal bevacizumab injection was 1.09 ± 0.23. After treatment, it was 0.90 ± 0.17 at the 1-month, 0.81 ±0.24, at 3-month, and 0.77 ± 0.26 at the last visit examination and the differences were significant when compared with baseline values (for each, P<0.001). The mean edema map values significantly decreased by 33.3% at the last visit examination when compared with preinjection values (P<0.001). No adverse events were observed, including endophthalmitis, inflammation and increased intraocular pressure or thromboembolic events in any patient. Mild anterior chamber inflammation was observed in four eyes (10%), which resolved in a week with topical corticosteroid. No other injection- or drug-related complications were observed.

Conclusions

Initial treatment results of patients with diffuse diabetic macular edema not responding to previous photocoagulation did not reveal any short-term safety concern. Intravitreal bevacizumab application provides significant improvement in visual acuity of diabetic patients and clinical course of macular oedema, and may therefore be a promising approach in the primary treatment of diabetic macular oedema.

WJSMRO Article No. 2: Taenia Saginata Anchored to the Duodenum Presenting with Haematemsis in a Healthy Adult Male

2/22/2015

Introduction

Taenia saginata is found all over the world, for example; Sudan, Great Britain, China, Iran and Indonesia. It infects people with poor hygiene.

Finding

This case report is about the finding of a tape worm (Taenia saginata) anchored to the mucosa of the second part of the duodenum in a healthy adult male. It presented with haematemsis for which oseophago-gastro-duodenscopy was done. No part of the worm was seen by the patient in the stools.

Conclusion

The worm was removed by the scope and treatment was given to the patient who remained well on follow up.

Keywords

Tape worm in duodenum; Tape worm in stomach; Haematemsis; Gastroduodenoscopy

WJP Article No. 2: Multinodular Pulmonary Amyloidosis: A Rare and Challenging Diagnosis

2/22/2015

Background

Pulmonary amyloidosis is a very rare form of localized amyloidosis. Microscopic examination plays a key role in the diagnosis because of the non specificity of clinical and radiological findings. Even PET scan isn’t helpful to make the diagnosis.

Observation

We present the case of a 66-year-old man with a smoking history and an occupational exposure to dust. He presented with asymptomatic multiple pulmonary masses evoking the diagnosis of pulmonary metastasis. Surgical resection was performed and microscopic examination confirmed the diagnosis of multinodular amyloidosis.

Conclusion

This case highlights the fact that pulmonary amyloidosis may cause multiple nodules.

WJMAS Article No. 1: Predictive Validity of the ProMIS Hybrid Simulator in a Urology Residency Training Program

2/22/2015

Objectives

We assessed the predictive validity of ProMIS hybrid laparoscopic simulator in a urology residency program.

Methods

Between June 2008 and December 2011, we trained 14 urology residents on ProMIS, measuring 5 basic laparoscopic tasks (peg transfer, pattern cutting, EndoLoop placement, extracorporeal suturing, and intracorporeal suturing). Then, we compared their last performance on ProMIS to their first performance on a porcine laparoscopic nephrectomy model. Two independent urologic surgeons with laparoscopic experience rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Non-parametric spearman correlation test was used to compare each rater’s cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the ProMIS simulator.

Results

The kappa results showed acceptable agreement between the two observers amongst all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the ProMIS simulator was demonstrated.

Conclusions

We could not demonstrate the predictive validity for the ProMIS hybrid simulator in our urology residency program.

Key words

ProMIS, MISTELS, Laparoscopic simulator, MIS training

WJMSCR Article No. 3: A Rare Complication after Laparoscopic Appendectomy: Septic Thrombosis of Superior Mesenteric Vein

2/2/2015

Introduction

Septic pylephlebitis and thrombosis of superior mesenteric vein is a rare but life threatening complication of acute appendicitis. The aim of this presentation is to share our experience in diagnosis and management of a patient with septic thrombosis of superior mesenteric vein (SMV) encountered after laparoscopic appendectomy and to call attention to this rare but fatal entity.

Case Presentation

A 28 years old male presented to the emergency room with complaints of fever and severe abdominal pain. He had a history of laparoscopic appendectomy 1 week ago in another hospital. His body temperature was 39.5degree C, White Blood Cell was 10.7 103/mm3, C Reactive Protein was 118 mg/dl. The patient underwent contrast enhanced computed abdominal tomography examination for etiological work up. There were endoluminal trombus and increase in the diamater of superior mesenteric vein in its 8 centimeters segment. The patient was hospitalised, parenteral systemic antibiotherapy was started with third generation cephalosporin and metranidazole. Also antiocoagulant medication was started, with subcutaneous low molecular weighted heparin, 1mg/kg, twice a day. Control computed abdominal tomography performed 1 week later showed partial decline in the size of trombus and diamater of superior mesenteric vein. Heparine was switched to warfarine, and the patient was discharged. In his third week control, he was symptom free and laboratory findings were in normal ranges.

Conclusion

Septic pylephlebitis and thrombosis of superior mesenteric vein is a rare but life threatening complication of acute appendicitis. Parenteral anticoagulants and antibiotics are the first choice in the treatment and should be started immediately, interventional radiology or surgical treatment may be used in selected cases. Contrast enhanced computed abdominal tomography is the first choice among radiological modalities in diagnosis.

Key words

appendectomy, septic thrombosis, superior mesenteric vein

WJP Article No. 1: Mesectodermal Leiomyoma: A Unique Morphology, Revisiting the Embryogenesis

2/2/2015

Mesectodermal leiomyoma connotes a tumor originating from the smooth muscle of the ciliary body, a mesodermal tissue derived embryologically from the neural crest (ectoderm). The tumor recapitulates its ancestral embrogenic pathway, bearing the histomorphology quite different from the usual fascicular architecture comprising of myogenic spindle cells of a leiomyoma originating from the smooth muscles at other locations. We present a case of 19 year-old female presenting with a history of progressive loss of vision in the left eye for last 8-10 months. Histopathologic features were those of leiomyoma of the ciliary body with strong immunohistochemical expression of smooth muscle actin. Thus, leiomyomas arising from the ciliary body are rare specialized tumors, recapitulating the mesectodermal ancestry. Early diagnosis and timely surgical intervention is necessary to prevent complications.

WJMSCR Article No. 2: Congenital Malformations of the Aortic Arch with Associated Intra-Abdominal Issues: When to Intervene?

1/31/2015

Congenital malformations of the aorta are rare congenital vascular defects. Severe Aortic Coartation (AoCo) and Aortic Arch Interruption (AAI) are aortic anomalies associated with left ventricular outflow tract obstruction and ductal-dependent distal systemic perfusion, requiring early surgical repair. Two neonates, one with severe AoCo and the other with AAI, presented with signs of heart failure and ductal-dependent distal systemic perfusion, and prompt surgery was required. However, other intra-abdominal issues required urgent abdominal surgery. Aortic surgery had to be deferred until the patients were recovered and optimized after the abdominal surgery. Both of the patients had successfully undergone surgical aortic surgery with good results. Timing of surgery for congenital aortic arch anomalies should be weighed according to the patient conditions to ensure a good clinical outcome and to minimize the post-operative morbidity and mortality.

Keywords

Aortic Arch Interruption, Aortic Coarctation, Congenital Heart Defects, associated intra-abdominal disease, timing of surgery.

WJSMRO Article No. 1: How Common Are Benign Retroperitoneal Tumors? A Case Series with Review of Literature.

1/24/2015

Introduction

Benign retroperitoneal tumors are usually rare and form 4%-25% of all retroperitoneal tumors in the past. Due to advanced imaging modalities the number of incidental tumors has increased and now forms up to 60% of all retroperitoneal tumors. Based on imaging techniques, various diagnostic criteria have been developed to ascertain origin and to determine the benign or malignant nature of these tumors. Large sizes, symptoms, heterogenous lesions on imaging, are considered as signs of malignancy. But surprises do occur.

Case Presentation

We present two cases of benign retroperitoneal tumors, first a case of massive retroperitoneal tumor in a 30 year old male with vague abdominal pain. Preoperative computed tomography revealed heterogeneously enhancing mass 20×15×12 cm with cystic areas and calcifications, suspected to be malignant and of pancreatic origin. Peroperatively it was of retroperitoneal origin and pancreas was compressed &pushed superiorly. Patient underwent total excision of tumor. Second case, a 24 year male with incidentally diagnosed presacral lesion, 7×7cm size, with extension into S1 sacral foramina. Heterointensity on T2 W magnetic resonance imaging gave a suspicion of malignant nerve sheath tumor and the tumor was excised in toto. Both the patients postoperative histopathology showed a benign schwannoma and immunohistochemistry was positive for S 100. Both patients are tumor free 12 months and 7 months respectively after surgery.

Conclusion

Benign retroperitoneal tumors can grow to a large size before they become symptomatic. Massive size is often misleading regarding both site of origin of tumor and the benign or malignant nature of it. Preoperative imaging will not always give a clue to the nature of it making preoperative diagnosis of benign tumors very difficult. But complete excision of tumor gives excellent results.

Key words

Schwannoma, Retroperitoneum, Computed tomography, Magnetic resonance imaging, Immunohistochemistry

WJECP Article No. 1: Knowledge, Attitudes and Perceptions of Head and Neck Radiotherapy in Ghana

1/18/2015

Background

Throughout the course of therapy, including radiotherapy, surgery and chemotherapy, side effects and complications can arise and have the potential to be severe and sometimes fatal. Due to the anatomic location of the vital organs of speech, swallowing and respiration, the side effects and complications of the treatment of head and neck cancers are more common than similar treatment for cancers at other anatomic sites. It is therefore important that patients’ perception about these side effects and complications of radiotherapy be established to enable the cancer management team to help patients better understand these conditions as well as the management strategies available.

Aim

The aim of the study was to investigate the knowledge, attitudes and the perceptions of patients on the side effects of head and neck radiotherapy.

Methodology

A descriptive survey with structured questionnaire as data collection tool was used. The data collected was analysed with Microsoft Excel Software and SPSS version 18. The results were presented on tables, bar charts and pie chart as well using regression analyses.

Results

The results obtained suggested that 60% of the participants had positive perception about the side effects and complications of radiotherapy, since most of them agreed that these conditions were as a result of the radiation therapy, even though, some still saw it as progression of their disease condition.

Conclusion

Head and neck cancer patients have positive perception about the side effects and complications of radiotherapy as a result of the treatment.

Key words

Perception, Side effects, Complications, Head and Neck cancers, Radiotherapy.

WJMSCR Article No. 1: Intrahepatic Pancreatic Pseudocysts Complicating Chronic Calcific Pancreatitis - A Rare Differential for Multiple Cystic Liver Lesions

1/8/2015

Pseudocyst is a common complication of acute and chronic pancreatitis.Though relatively common complication of pancreatitis an intra hepatic location is rare.More over multiple pseudocysts of liver are even rare to occur. We present a case report of pseudocysts in a 24year old female patient with chronic calcific pancreatitis communicating with pancreatic duct and extending into left lobe of liver.

Key words

Pseudocyst, pancreas, left lobe of liver, falciform ligamentum, ligamentum teres

WJECP Article No. 7: Reliability and validity of the Questionnaire on Annual Physical Activity Pattern: A validation study using combined heart rate and accelerometry data as an objective measurement

12/31/2014

Introduction

Physical activity (PA) is a modifiable lifestyle factor with great public health potential. However, it is still unclear which type, intensity, and temporal pattern of PAis most beneficial. Therefore, a Questionnaire on Annual Physical Activity Pattern (QUAP) for healthy adults was developed; focusing on a detailed assessment of past year PA.The aim was to investigate its test-retest reliability and validity.

Materials and Methods

The self-administered 22-item questionnaire was evaluated in a study embedded into the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Participants included men and women aged 47-82. Reliability was examined in 119 participants by comparing two measurements taken 6-8 weeks apart. Criterion validity was examined in 1109 participants by comparing the physical activity level (PAL) derived from an accelerometry device (Actiheart) to those from the questionnaire.

Results

Reliability was acceptable overall with intraclass correlationcoefficients ranging from 0.64 to 0.87, with the exception of the domain sedentary behaviour (r=0.43).Regarding validity, the Spearman correlation coefficient was 0.33. Slightly higher correlations were found for men (rs=0.34), and participants with a lower BMI (rs=0.36). Bland-Altman plots showed a mean difference of -0.00 (SD=0.22) for total PA.

Conclusions

Our findings suggest that the questionnaire has acceptable reliability and validity comparable to other questionnaires. It enables the identification of domain-specific activity patterns and a differentiation between participants with similar energy expenditure but different behaviour. This additional information about distinct activity patterns may finally enable researchers to analyse PA more specifically in terms of health benefits and to provide more detailed public health recommendations

Keywords

Questionnaire, accelerometer, epidemiology, reliability, validity, physical activity

WJMSCR Article No. 17: Cardiogenic Shock with Acute Myocardial Ischemia after Successful Conservative Treatment for Infective Endocarditis: Case Report

12/22/2014

A febrile 81-year-old patient admitted for back pain was diagnosed with Streptococcus viridans infection. Thoracic echocardiography revealed infective endocarditis (IE), aortic valve vegetation, and mild aortic regurgitation, despite an ejection fraction of 60% and normal left ventricular wall motion. Antibiotic therapy was initiated with penicillin G (2,400,000 IU/day) and gentamycin (120 mg/day). On day 14, white blood cell counts had decreased from 10,700 to 5200/L and C-reactive protein from 10.2 to 1.3 mg/dL, without embolization. On day 20, she developed acute myocardial infarction corroborated by elevated CK-MB (102.4 IU/L). Coronary arterial angiography revealed triple vessel disease, including left main trunk stenosis. The non-coronary cusp of the aortic valve was perforated and herniated toward the left ventricle. Concomitant aortic valve replacement and coronary artery bypass grafting at the three sites were successful. Postoperative course was uneventful, and the patient did not require antibiotics or warfarin at a 6-month follow-up visit.

Key words

Acute aortic regurgitation, Infective endocarditis, Acute myocardial infarction

WJSMRO Article No. 17: Matrix Metallopeptidase 9 (MMP-9) Expression in Oral Cancer Andand Adjacent Normal Tissue

12/15/2014

Background

Despite advances the oral cancer in India is continued to be diagnosed in late stages and have poor prognosis. The disease has preponderance for local recurrence and development of second primaries. To explain this theory of field cancerization has been proposed. In this study we looked at the expression of MMP-9 in tumor tissue and in the adjacent microscopically normal tissue, to explain higher failures in oral cancer after successful treatment.

Patients and Methods

MMP-9 expression was looked at by immunohistochemistry in 100 patients with oral cancer in the tumor and adjoining normal tissue. Data on stage of the disease, treatment and other demographic and pathological features was collected in presetproforma.

Results

Frequent expression of MMP-9 was observed in Oral Squamous Cell Carcinoma (OSCC), with 85% and 80% of tumor and adjacent tissue samples expressing the protein. The expression in patients with neck node metastasis was significantly higher compared to those with no nodal metastasis.

Conclusions

The results of the present study show that MMP-9 overexpression is a good indicator of aggressive nature of the disease and is associated with increased nodal metastasis.

WJMSCR Article No. 16: Isolated Abdominal Aortic Dissection Presenting with Rectal Bleeding.

12/8/2014

Isolated Abdominal Aortic Dissection (IAAD) may present in a variety of ways resulting in misdiagnosis. It is a rare clinical entity having been reported infrequently in the literature. Presentation of an IAAD with rectal bleeding to our knowledge has not been documented previously and may be directly attributed to occlusion of the internal mesenteric artery by a dissecting aneurysm resulting in ischemic colitis. Description of the mechanism and management is discussed as well as alternative access to the abdominal aorta in cases of “hostile” abdomen

WJMR Article No. 7: Transcranial Magnetic Stimulation and Psychological Therapies: A beneficial Combination?

12/8/2014

Background

Repetitive TMS (rTMS) has been found to be an effective treatment for major depression. A number of psychological therapies have also been shown to be effective. We hypothesised that the efficacy of rTMS could be increased by combining this treatment with psychological therapies in an Enhanced rTMS program.

Study design

Within a clinical rTMS service, we designed a pilot study to evaluate the effects of combining rTMS and psychological therapies, having already delivered rTMS alone for previous patients.

Materials and methods

In an Enhanced rTMS program, patientsattended a half day program, which included both psychological therapies and a session of rTMS, three days a week, for six weeks. The program included mindfulness based cognitive therapy, problem-solving therapy, computerized Cognitive Behavioural Therapy, exercise, and relaxation. The outcomes of the combined program were compared with patients who previously received only rTMS.

Results

A total of 18 people commenced the Enhanced rTMS program, with 14 completing the program. Patients who completed the full program showed a similar improvement in depressive symptoms to those treated with rTMS alone (59 patients), suggesting that there may be limited advantage in adding psychological therapies.

Conclusions

The addition of psychological therapies to rTMS did significantly not improve the rate of beneficial outcomesin comparison to rTMS alone; however the sample size was relatively small. There was low adherence to the full program in some patients, with some preferring to attend only certain program components.

Key Words

neurostimulation, CBT, exercise, mood disorders, problem solving therapy

WJP Article No. 17: Tumorlets, an Incidental Finding in a dual Pulmonary Lesion; A Pathologist’s Curiosity.

12/8/2014

Tumorlets are collections of neuroendocrine cells seen in the lungs.They may be incidentally detected and are usually seen associated with chronic lung diseases like bronchiectasis,bronchial asthma and sequestration.It is important to identify tumorlets especially in patients with prior history of carcinoma breast,since theymimic metastatic disease.

Our patient was a 49 year lady who presented with cough and dyspnea of 6 months duration. Radiology revealed a large cavitatary lesion occupying the entire lower lobe of right lung. A lobectomy was done and gross examination revealed a large cavity with thickened wall, bronchioles were also thickened and reached up to the pleural surface. Histology confirmed the diagnosis of bronchiectasis with cavity formation. Adjacent lung showed granulomatous reaction but there was no caseation necrosis. One of the sections had a minute (1mm) focus showing a group of cells with neuroendocrine features. Further bits were taken and sections studied revealed a tumorlet of 4mm size. So a final diagnosis of bronchiectactic cavity with granulomatous reaction and tumorlet formation was made. We report this case because of its rarity.

Key words

bronchiectasis, granulomatous reaction, tumorlets

WJSR Article No. 11: Aspirated Ginger with Fungal Growth in Trachea of an Adult

Metastatic ovarian tumors are thought to account for approximately 10–30% of malignant ovarian tumors. Krukenberg tumor refers to amalignancyin the ovary that metastasizedfrom a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast (approx. 04%). Krukenberg tumor during pregnancy arising from breast is even rarer (0.1 - 0.2%).The presence of adnexal masses during pregnancy ranges from 1:81 to 1:2,500 pregnancies, but only 3% of these masses are malignant. Management of such cases can present as diagnostic & treatment dilemma. We report a case of 25 year primiparous female with Krukenberg tumor of breast origin.

Keywords

Krukenberg tumor, Pregnancy, Breast, Invasive Lobular carcinoma, IHC.

WJSR Article No. 8: Subserous Uterine Fibroid Presenting as Hemoperotoneum: A Case Report

11/9/2014

Uterine fibroids are the most common of all the benign neoplasms affecting females in reproductive age groups. The subserous types of fibroids are rare in incidence but sometimes they present with rare complications as torsion of its pedicle or detachment from uterus resulting in a wandering variety of fibroid. Hemoperitoneum because of rupture of surface veins over these subserosal fibroids is very rarely encountered and reported. These patients usually present to emergency department with features of acute abdomen with hemorrhagic shock and need an urgent surgical intervention to take care of the problem.

Key words

Uterus, Fibroid, Subserous, Hemorrhage

WJSR Article No. 9: Gangrenous Meckel’s Diverticulum in an Adult: a Case Report

11/9/2014

Introduction

Meckel’s diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract, although complications from a Meckel’s diverticulum are rarely seen in the adult population.

Case Report

We are reporting the rare occurrence of a huge gangrenous Meckel’s diverticulum in an adult, which was managed successfully by emergency laparotomy and resection. A 25-year man presented with four days history of pain abdomen, recurrent vomiting, abdomen distention, low grade fever and non-passage of flatus and stool. X ray of abdomen in erect posture show dilated bowel loop. The patient underwent emergency laparotomy. A huge gangrenous Meckel’s diverticulum was found for which resection and anastomosis of the ileum was done.

Conclusion

This case serves to highlight the surgical emergency of Meckel’s diverticulum in an adult.

Key Words

gangrenous meckel’s diverticulum, emergency surgery, acute abdomen.

WJMR Article No. 6: RETRACTED: Effectiveness of Multicultural Communication between Radiographers and Patients and Its Impact on Outcome of Examinations

11/8/2014

Retraction notice

This article has been retracted as per the policy of Narain Publication Pvt. Ltd. (NPPL): This article (Antwi WK, Kyei KA, Quarcoopome LNA. Effectiveness of Multicultural Communication between Radiographers and Patients and Its Impact on Outcome of Examinations. World J Med Res 2014, 3:6) has been retracted as this is an unintentional duplication of the earlier article in the same journal [1]. The editors would like to confirm the retraction of this paper for an unintentional duplicate publication.

WJSMRO Article No. 16: Histopathologic & Immunohistochemical Diagnosis of Primary Epithelioid Angiosarcoma of the Liver Mimicking a Metastatic Adenocarcinoma– Case report & Review of Literature

Key words

ectopic thyroid; lingual thyroid; CT angiography

WJP Article No. 15: Necrotic Pseudoxanthomatous Nodule: An Unusual and Less Known Manifestation of Endometriosis

10/22/2014

Necrotic pseudoxanthomatous nodule (NPN) is an uncommon manifestation of endometriosis. It grossly presents as nodules over peritoneal surfaces. Histopathologically, it is marked by presence of a central area of necrosis surrounded by hyalinization and histiocytes arranged in a palisaded fashion along the periphery of the necrotic area. These histiocytes have abundant granular or foamy cytoplasm. It represents the end stage endometriosis. Here we are reporting two such cases. It is important to know about this entity as it can be confused with necrotic tumor or infectious pathology, to avoid misdiagnosis in the absence of more classical features of endometriosis and from management point of view.

Keywords

necrotic pseudoxanthomatous nodule, endometriosis, necrosis, histiocytes

WJSMRO Article No. 13: Advanced Sebaceous Gland Carcinoma of the Eyelid in a Pthisical Eyeball Managed by Exenteration with Skin Grafting

10/13/2014

Sebaceous gland carcinoma is rare malignant neoplasm involving eyelids having aggressive local behaviour and metastasis to regional lymph nodes and distant organs.A 59 year old male presented with growth involving left upper and lower eyelid since two years. His vision in right eye was 20/40 and left eye was no PL. There were multiple nodular swellings involving whole upper lid, lateral canthus and lateral half of lower eye lid. Eye ball structures were not visible. MRI orbit was suggestive of heterogeneously enhancing lesion seen on anterolateral aspect of left globe involving orbicularis oculi, lacrimal gland, lateral, superior and inferior recti and inferior oblique along with orbital fat. The eyeball was pthisical. CT brain showed no intracranial extension. Biopsy was suggestive of sebaceous gland carcinoma. Left orbital exenteration was done with skin grafting. Exenteration is currently performed less often but it is still indicated for advanced and diffuse sebaceous gland carcinoma with orbital invasion.

Keywords

Eye lid, Sebaceous gland carcinoma, exenteration, skin grafting

WJMSCR Article No. 14: Post Therapy Lymphocytic Thyroiditis in a case of Primary Thyroid Tuberculosis - A case report

10/10/2014

Abstract

Lymphocytic thyroiditis following anti- tubercular therapy for thyroid tuberculosis is extremely uncommon. Primary tuberculosis of thyroid gland itself is a very rare clinical entity even in countries where tuberculosis is endemic. Thyroid tuberculosis can rarely be associated with features of hyperthyroidism or hypothyroidism. The aim of presenting this case report is to emphasize that this clinical entity should be kept in mind while treating thyroid diseases especially in a country where the prevalence of tuberculosis is high as well as to gain a better understanding of the clinical characteristics, diagnosis and treatment of this rare condition.

Key Words

Thyroid tuberculosis, Thyroiditis

WJMR Article No. 5: Outbreak of Egyptian ophthalmia at the Royal Military Asylum, Chelsea, in 1804

10/10/2014

This article traces the source, and follows the course, of the outbreak of trachoma that struck the Royal Military Asylum, Chelsea, in April 1804. The scourge lasted until June 1810 when Staff Surgeon Patrick MacGregor persuaded the Institution’s Board of Commissioners to accept his recommendation as a possible cure for this disease. As a result, the epidemic came to an abrupt end and was not again experienced in the life of the Institution. During the six years it raged unabated the Surgeon registered over 1,500 cases of ‘Egyptian ophthalmia.’

WJP Article No. 14: Giant Cystic Lymphangioma of Pancreas –A Rarity

9/14/2014

Lymphangiomas are rare benign neoplasms common in head and neck region. Intraabdominal lymphangiomas are rare and pancreatic cystic lymphangiomas (PCLs) account for only 1%of such neoplasms. To the best of our knowledge only about 75 cases have been reported including this case and the average size was 20cms.Though benign, PCLs can cause severe abdominal discomfort and may even rupture. Here we report a case of PCL in a 21 yr old male who presented with abdominal pain and epigastric mass .Clinicoradiological evaluation revealed a multicystic septate mass in association with the pancreas about 40x30cms.With the preoperative differential diagnosis of pseudocyst pancreas/cystic neoplasm we proceeded with exploratory laparotomy. A distal pancreatectomy and splenectomy was done since the lesion was arising from the body of the pancreas. Histological examination revealed a multicystic lesion lined by endothelial cells with lymphocytes in the wall and the diagnosis of PCL was made.

Key words

Cystic, Distal pancreatectomy, Lymphangioma, Pancreas

WJSMRO Article No. 12: Acellular Collagen Matrix versus Autologous Breast Reconstruction: What do the Patients Prefer!

9/7/2014

Background

Acellular collagenl matrix (ACM) is getting more popular and well established in recent years in breast reconstruction where it is used to achieve implant cover and produce a better outcome. There are different types of tissue matrix which are made from different materials such as porcine dermis (Strattice tm ), foetal bovine dermis (Surgimend tm), etc. Another well-known method of breast reconstruction is using autologous tissue such as Lattisimus Dorsi flap or Transverse Rectus Abdominis Myocutaneous flap.

Aims: We are looking into the outcome of breast reconstruction using ACM versus breast reconstruction with autologous tissue. The outcomes include patient satisfaction, post-operative psychosocial, sexual and physical well-being, complications after breast reconstruction, information given and evaluation from patients on surgeons and medical team’s care towards patients.

Methods

This study is carried out as a retrospective study on a single institution. Patients who have had breast reconstruction using ACM and autologous tissue were randomly identified from the electronic patient records from year 2009 to 2013. Questionnaires were posted to patients and data were analysed. Breast Q questionnaire was used for this study. Breast Q™ is a validated and copyrighted questionnaire designed for researchers to assess a patient’s perspective before and after their breast reconstruction. The Breast Q™ scoring system was used to analyse our data. Each cohort received 18 responses, therefore the total sample size is 36 patients.

Results

On average, patients have scored more than 60 out of 100 on all the aspects except on sexual well-being where the mean score for patients who has had ACM was 49 and for the patients who had autologous reconstruction was 59. Patients with ACM scored slightly higher score as compared to patients with autologous reconstruction in terms of physical well-being, satisfaction with surgeons and overall care whereas patients with autologous reconstruction scored slightly higher scores as compared to patients with ACM in terms of satisfaction with breasts, outcomes, psychosocial well-being, social well-being and satisfaction with information. In the result analysis, we also looked into median for each categories and used Mann Whitney U test as our statistical analysis. The value for U statistic was 21. For 5% two-tailed level, critical value of U is 13. As calculated U> U critical, and the p value is 0.247996, we accept the null hypothesis that the two groups of data are not different.

Conclusions

There was no significant difference in terms of outcomes in between the 2 groups of patients. Through this study, it is suggested that breast reconstructions using ACM and autologous tissue are safe to be used and patients satisfaction s are good.

WJECP Article No. 6: The spectrum of solid childhood malignant tumours in a tertiary health care institution.

9/5/2014

Background

Experts on malignant disease in childhood in the late thirties once stated that cancer is rare in childhood. Now, over seventy years later, childhood cancer is reported to be the leading cause of death in children between 1 and 15 years worldwide. Malignant tumors in infancy and childhood constitute about 2% of all malignant tumors. The objective of this study is to present the spectrum of childhood malignant tumors and compare our findings with similar reports from reliable institutions in other parts of the world.

Patients and method

This is a retrospective study of all cases of malignant tumors seen in children in our department over the last 5 years (from Jan 2008 to Dec 2012). Studies elsewhere had always included hematological malignancies such as lymphoma and leukemia which are relatively more common in pediatric age group. We therefore, decided to exclude hematological malignancies and focus on mesenchymal and other malignancies. The age in months, sex and histological diagnosis were recorded a pre-designed data form. All these were analyzed using the statistical package for social science (SPSS) Software version 20.

Results

Altogether 56 out of 2,610 cases representing 2.2% of all malignant tumors were seen in this study with females and males constituting 52% and 48% respectively. The male to female ratio (M: F) was approximately 1:1. Tumors were more common in children above 42 months of age and least common below 6 months. Wilms’ tumor accounted for 44%, while retinoblastoma accounted for 20%. Others included rhabdomyosarcoma (9%), malignant teratoma (8%) and Yolk sac tumor (5%).

Conclusion

Wilms’ tumor is the most common childhood malignant tumor at our centre. This is in agreement with almost all the studies done elsewhere. However, some variations exist in other centers.

Keywords

infancy, childhood, malignant tumor.

WJSMRO Article No. 11: Primary Histopathologic and Immunohistochemical Diagnosis of Malignant Pheochromocytoma of Adrenal gland-Case report and Review of Literature

9/4/2014

Malignant pheochromocytomas (PCC) are rare tumours. In the absence of distant metastasis, diagnosis of malignancy on histological grounds has always been challenging and controversial. We report a case of a 32 Yrs. female who presented with abdominal pain and was incidentally diagnosed as having right adrenal mass. Based on histology (using Pheochromocytoma Adrenal Gland Scaled Score – PASS) and IHC a diagnosis of Pheochromocytoma with features of malignancy was given. Patient underwent excision preceded by NACT and is doing fine till date.

Key words

Malignant pheochromocytoma, PASS score.

WJP Article No. 13: Metastatic Clear Cell Renal Cell Carcinoma: A Mimicker of Primary Clear Cell Carcinoma Ovary: How to Differentiate?

9/4/2014

Introduction

Renal cell carcinomas account for about 3/ 4th of the renal tumors. About 1 /3rd of these have metastatic disease. However, metastasis to ovaries is rare. Only few cases have been reported in literature. We are reporting a case of 45 year old lady presenting with simultaneous clear cell renal cell carcinoma along with ovarian metastasis.

Case presentation

A 45 year old lady presented with complaints of hematuria for 7 months. A diffuse lump was noticed in the right lumbar region and iliac fossa measuring 10 X 8 cm in size. CECT of abdomen showed a heterogeneously enhancing lesion measuring 9.9 X 8.4 X 8.2 cm in upper and midpole of right kidney suggestive of oncocytoma or renal cell carcinoma (RCC) and a heterogeneously enhancing right adnexal lesion likely to be of malignant etiology. However, serum CA-125 level was within normal limits. The right sided radical nephrectomy was performed along with total abdominal hysterectomy with bilateral salpingoophrectomy. A diagnosis of right sided renal cell carcinoma with metastasis to right ovary was established on histopathological and immunohistochemical examination.

Conclusion

The metastatic clear cell RCC should be considered as a differential diagnosis of clear cell tumors in ovary. The distinction is important for their therapeutic and prognostic implications. This is possible on the basis of their histomorphological and immunohistochemical characteristics.

Keywords

renal cell carcinoma, clear cell carcinoma, ovarian metastasis

WJMSCR Article No. 13: Leiomyoma of Jejunum as a Cause of Intestinal Obstruction and Acute Abdomen: Case Report and Review of the English Literature

9/3/2014

Leiomyomas are uncommon tumors originated from either circular or longitudinal muscular layer, or muscularis mucosae. They occupy the fourth place of all small intestinal tumors, being the most common benign tumors of the small intestine. The jejunum is the most frequent location, followed by ileum and duodenum. They are the most frequent of all small intestinal tumors producing symptoms. Diagnosis is performed by CT, endoscopy or barium swallow. The behavior of these tumors is defined by the number of mitosis and clinical behavior. Leiomyomas must be treated with surgery. Wide resection is required in order to avoid recurrence. We report a case of leiomyoma which presented as intestinal obstruction, requiring urgent surgery. Leiomyoma is an extremely rare cause of intestinal obstruction and few cases have been described with this presentation in the English literature.

Key Words

Leiomyoma, intestine, obstruction, tumor.

WJP Article No. 12: Infantile (Desmoid Type) Anterior Mediastinal Fibromatosis-A Case Report

9/3/2014

Introduction

Desmoid-type fibromatosis is fibroblastic proliferation occurring in the deep soft tissues and is characterized by infiltrative growth and tendency towards local recurrence but does not metastasize. It represents 3.5% of fibrous tumors and 0.03% of all neoplasms. Desmoid fibromatosis are rare in children, may occur in head and neck region but are extremely rare in the mediastinum with only five cases being reported in the literature till date. This case is being presented for its rarity

Case presentation

Three year old male child presented with a gradually progressive, firm 17x10cm swelling, fixed to the chest wall with dilated veins. Radiological imaging revealed possibility of soft tissue sarcoma/Ewing’s sarcoma. Cytological diagnosis of spindle cell tumor of intermediate grade, possibly of neuronal origin was made. Thoracotomy and excision of tumor was performed. Grossly there was a single, partially skin covered, grey white mass measuring 17x10x5cm, C/s showing grey white areas of whorling and cartilage projections. Microscopically interlacing fascicles of bland spindle cells in a collagenous background were seen with fusiform nuclei, uniform chromatin and inconspicuous nucleoli. No pleomorphism, mitoses were seen. Surrounding adipose tissue and bone was infiltrated by tumor. On Immunohistochemistry the tumor showed diffuse positivity for vimentin, focal positivity for S-100 and was negative for desmin. A diagnosis of mediastinal fibromatosis was made. However, the Patient succumbed to intraoperative cardiac arrest.

Conclusions

Fibromatosis should be considered in differential diagnosis of any spindle cell tumor of anterior mediastinum. It is impossible to give a preoperative definite diagnosis of fibromatosis on FNAC but with a core needle biopsy and IHC, the differential diagnoses can be narrowed.

Key words

Fibromatosis, Infantile, Mediastinum, Desmoid Tumor

WJSMRO Article No. 10: Clinical Outcome of Vulvar Carcinoma: 10-Years’ Experience from A Tertiary Care Center of Pakistan

8/15/2014

Purpose

Retrospective analysis was aimed to analyze patient’s characteristics and outcome with vulvar carcinoma treated at our center.

Material and Methods

All patients with histopathological proven carcinoma vulva, treated at our hospital during the year 2002-2011, were retrieved and analyzed retrospectively. Clinical presentation, treatment given, survival and complications were recorded. Overall survival was determined with respect to stage of disease, histology, grade and lymph node status.

Results

29 patients with histologically proven squamous cell carcinoma were eligible for this analysis. The median age was 58 years (range 32 to 75 years) and median follow up was 29 months (range, 9 to 131 months). The patients with squamous cell carcinoma had Grade-I in 16 cases, Grade-II in 9 and Grade-III in 4 patients. Five patients presented with FIGO stage I, 7 in stage II, 10 in stage III and 7 with stage IV-A. 12 patients underwent surgery (simple vulvectomy 2, radical vulvectomy and inguinal lymph node dissection 10. Ten patients received post-operative chemoradiation and 5 of them were received post-operative radiotherapy alone. 17 patients treated with definitive chemoradiation and 3 of them have received radiotherapy alone. All failures occurred during first 2 years after completion of treatment. The 5 years overall survival was 44.8% for all stages. Stage and nodal positivity were found to have significant impact on overall survival.

Conclusion

Overall survival is quite comparable to the reported series. Majority of patients presents in locally advanced stages so multidisciplinary approaches should be used to have better outcome.

WJMR Article No. 4: Effectiveness of Multicultural Communication between Radiographers and Patients and Its Impact on Outcome of Examinations

8/3/2014

Background

Communication plays an important role in the practice of radiography. It is important that radiographers are aware of patients’ physical and emotional needs which could be achieved through effective communication. The diversity of the patient population creates challenges to quality healthcare provision to all segments of the population, without effective communication.

Aim

A 55-year-old male presented with loin pain of one month duration. Imaging studies revealed non functioning right kidney with ipsilateral megaureter. The patient underwent right nephroureterectomy and on histopathology, the diagnosis of MCDK with pyelonephritis was made.

Conclusion

MCDK associated with ipsilateral obstructed megaureter is an extremely unusual presentation in adult patients. Association of pyelonephritis with MCDK is even rarer.

Keywords

Multicystic dysplastic kidney, pyelonephritis, megaureter, adult.

WJMSCR Article No. 11: Mesenchymal Tumours of the Liver in Children: Report of Four Cases

Results

Cancer cases are increasing in younger women and since their breasts are dense mammography which is a standard screening test is not of much relevance in this age group. Role of ultrasonography in screening dense breasts has been studied in a few settings and found to be promising.

Conclusions

In a low resource country like India if efficacy of ultrasound for screening of young women can be studied it may be a viable option forscreening themin the future.

Key words

ultrasonography, breast, young women,India, dense breasts

WJP Article No. 9: An Unusual Case of Neuroenteric Cyst (Type B) with Fetal Type Glands, Peyer’s Patches and Associated Dermal Sinus

7/25/2014

Neuroenteric cyst is a rare congenital developmental anomaly of the central nervous system. These are found in the spinal column, brain , mediastinum, abdomen, pelvis and are associated with various congenital spinal anamolies.Spinal neurenteric cysts commonly manifest during the second and third decades of life. Although these cyst are benign recurrences may occur and they may cause various neurological symptoms if the treatment is delayed.

We hereby present a case of a seven year old child who presented with a globular swelling in the back since birth.

Key word

Neuroenteric cyst, Fetal type glands, Dermal sinus, Peyer’s patches

WJMSCR Article No. 10: Cutaneous Tuberculosis – An Increasingly Rare Entity in Surgical Practice

7/8/2014

Cutaneous tuberculosis, although rare, can cause significant diagnostic confusion to physicians, surgeons and dermatologists alike. This case series covers three distinct cases of cutaneous tuberculosis and reviews the literature regarding common presentation, evaluation and treatment.

WJMSCR Article No. 9: Giant Cutaneous Horn Arising From a Burn Scar: A Case Report and Literature Review

6/20/2014

Cutaneous horn (cornu cutaneum) is a descriptive term for a conical, dense surface projection of adherent keratin that resembles an animal’s horn. The underlying process may be benign, premalignant or malignant.

Historically, cutaneous horns have evoked interest and superstition, at times, resulting in the bearer being socially isolated or outcast. Classically, cutaneous horns occur in sun-damaged skin of elderly (greater than 5th decade), fair-skinned patients, often on the face, ears, penis, extremities and occasionally the trunk.

We present an unusual case of a relatively young (44 year old) black male, who developed an impressive cutaneous horn from a burn scar – a site, rarely described to yield such a lesion.

Key words

Giant cutaneous horn; burn scar carcinoma; cutaneous horn; marjolin’s ulcer

WJMSCR Article No. 8: Adjustable Pulmonary Artery Banding: A New Strategy now Available in Asia

Background

To examine V5 as the dosimetric predictor of radiation pneumonitis in patients received thoracic radiation therapy beside V20, V30 and MLD.

Methods

One-hundred patients receiving thoracic irradiation from 2011 to 2012 at Subei People’s Hospital were retrospectively reviewed, from which esophageal and lung cancer patients were eighty-six and fourteen, respectively. Pneumonitis was graded by using the Common Terminology Criteria for Adverse Events version 4.0. Dosimetric parameters (V5, V10, V15, V20, V25, and V30) were entered as continuous variables. A cross tabulation, an independent t-test and a receiver observer curve (ROC) were used to analyze the data.

Results

In the final, 50(50%) of total 100 patients had grade 0-1 RP, 44(44%) had grade 2 RP, 4(4%) had grade 3 RP and 2(2%) had grade 4 RP. No significant discrepancy was found between grade 0-1 and grade 2-4 in the following clinical parameters, such as age, gender, ECOG performance status and history of chemotherapy. No significant difference of RP incidence was found between Non-CT and Concurrent-CT arms (χ2 = 0.026, P > 0.1). The ROC indicated the AUC value was 0.627 for V5 (P = 0.034).

Conclusions

Those patients whose DVH parameters such as MLD, V20 and V30 were constrainted still occur RP. V5 was a statistically significant parameter associated with grade 2-4. We recommend V5 should be kept as low as possible, in addition to the conventional dosimetric factors. 50% of V5 is considered to be a threshold, the incidence of grade≥2 RP in the group with V5< 50% and ≥ 50% were 59.36% and 33.3 %( P < 0.05).

WJP Article No. 8: Meckel-Gruber Syndrome

4/29/2014

Meckel Gruber Syndrome (MKS) is a rare autosomal recessive malformation syndrome characterized by multiple congenital anomalies ultimately leading to the death of fetus in utero or shortly after birth. It is characterized by classical triad of occipital encephalocele, infantile polycystic kidneys and postaxial polydactyly.Diagnosis of MKS is made on the basis of ultrasonographic, clinical and morphological findings. Herein we describe two cases of MKS presenting as classical triad.

WJP Article No. 7: Anti CCP Antibody Assay: A Diagnostic Dilemma in Diagnosis of Tubercular Synovitis

4/27/2014

Objective

Anti-CCP antibodies assays have been reported to be a specific diagnostic marker than rheumatoid factor in the diagnosis of rheumatoid synovitis. There may be diagnostic dilemma if anti CCP antibody assays are also positive in cases of tubercular synovitis. In this study we look for prevalence of anti CCP in cases of active tubercular synovitis of knee and compare it with controls.

Methods

Serum levels of anti CCP antibodies were measured in 31patients of tubercular arthritis of knee and were compared with equal number of age matched controls.

Results

A total of 38.7% of tubercular arthritis patients showed positive results on serum anti CCP antibody assay and the mean of anti CCP levels in patients of tubercular arthritis was more than that in the control group

Discussion

Anti CCP assay for diagnosis of rheumatoid synovitis may give false positive results in patients of tubercular arthritis

Conclusion

Test for anti CCP antibody is positive in many patients of tuberculous synovitis.

Keywords

Tuberculosis, rheumatoid arthritis, false positive

WJSR Article No. 6: Amyand’s Hernia Presenting as Irreducible Hernia in an Inafnt

4/19/2014

Amyand’s hernia is the presence of a normal or inflamed appendix in an inguinal hernia sac. It is commonly mistaken for an incarcerated or strangulated hernia or torsion of testis. The preoperative diagnosis of this condition is very difficult. Treatment of this condition involves surgical exploration of the involved side with or without appendicectomy. We present a case of a three month old infant presenting with features of irreducible hernia who was found to have inflamed appendix in hernial sac.

Key words

Hernia; appendix; torsion; appendicectomy

WJSR Article No. 5: High Fat Diet is not Associated with Stimulation of Colorectal Cancer Liver Metastases

4/16/2014

Background

A high fat diet induces fatty infiltration of visceral organs and has been associated with the development of some cancers and may influence the progression and spread of cancer. The impact of high fat diet on the growth and development colorectal liver metastases is uncertain.

Methodology

Liver metastases were induced in CBA mice using a murine derived colon cancer cell line by intrasplenic injection. Mice were fed either a high fat (60% fat content) (n = 20) or low fat diet (5% fat content) (n = 20) for 6 weeks prior tumor induction and maintained on the same diet thereafter. Tumor volume and patterns of spread were assessed at day 21 post induction. Tumor necrosis, apoptosis and proliferation were assessed using immunohistochemistry.

Results

No difference in liver metastases, tumor necrosis or apoptosis was observed between the two groups. There was a trend towards increased tumor proliferation in the high fat diet group.

Use of conscious sedation and analgesia in the treatment of the skin wounds or subcutaneous abscesses in children in order to minimize the “procedural” pain.

Methods

Were performed 37 consecutive procedures of conscious sedation and analgesia in urgency and in selected pediatric patients, mostly for the suture of superficial wounds and grazes and/or cutting and for the drainage of subcutaneous abscesses. The extemporaneous sedoanalgesia was performed with a mixture of 50% nitrous oxide and 50% oxygen inhaled through a face mask and with the patient breathing spontaneously. The following dedicated treatment was performed at least three minutes after the administration of the medicinal gas.

Results

All patients completed the treatment, the analgesic and anxiolytic effects were effective. No major complications occurred and the dimission was early in all cases, except one case of sudden pronounced postprocedural sedative effect regressed after five minutes of observation and oxygen at 100%.

Considerations

The pain is often influenced by both subjective threshold of the patient to the sensation of pain, but also from emotional responses based on individual experiences. The conscious sedoanalgesia is indicated for the treatment of short duration pain, when is requesting a rapid analgesic and anxiolytic action or limited in duration to perform minor pediatric procedures. The medicament has a short on- and offset-time and a fast recovery after a slight alteration of the perception of space and time, with modest side effects.

3/17/2014

Background

Breast cancer; the leading malignancy in Ghana accounts for 15.4 % of all cancer cases and appears to be on the increase. The cause of breast cancer is not known to date but several factors are known to increase the risks of developing this malignancy. All the known and proven risk factors are generally categorised into two main forms: preventable and non-preventable risk factors.

Aim

The study aimed at determining the major preventable risk factors among breast cancer patients in Ghana.

Method

The medical records of thirty breast cancer patients admitted at the Korle-Bu Teaching Hospital were conveniently sampled each year over a 5 year period, from 2006-2010. Self-reported risk factors by patients were recorded. Risk factors considered were smoking, alcohol drinking, family history of cancer, Obesity, overweight, age at having first child, the use of oral contraceptive pills, and null parity. Data were then analysed using descriptive statistical method under SPSS software: bar charts, line graph and pie chart.

Results

Obesity was consistently the highest risk most patients were exposed to for each of the year under review with an average number of 34.9%. Smoking was the least represented (4.6%).

Conclusions

Obesity was consistently the predominant preventable risk factor for the past five years and is likely to dominate for the next 5-10 years if lifestyles are not adjusted.

Keywords

Malignancy, risk factors, lifestyle, breast cancer, predominant.

WJSR Article No. 2: Prevalence of Postcholecystectomy Symptoms: Long Term Outcome after Open versus Laparoscopic Cholecystectomy

3/17/2014

Objectives

After cholecystectomy, a certain number of patients continue to suffer from abdominal symptoms or develop such symptoms postoperatively. The aim of this study was to compare the prevalence of postcholecystectomy symptoms (PCSs) between open and laparoscopic cholecystectomy and to find out and investigate the cause of PCSs.

Material and Methods

This study was conducted in MB Government Hospital, Udaipur on 100 patients undergoing open or laparoscopic cholecystectomy for symptomatic cholelithiasis. Preoperative and postoperative symptoms of 50 Patients (37 females), aged 20 to 79 years, who underwent open cholecystectomy, were prospectively compared questionnaire with those of 50 patients (39 females) aged 16 to 75 years, who underwent laparoscopic cholecystectomy. Patients were followed up for an average of 11 to 12 months.

Results

There was no statistically significant difference in prevalence of postcholecystectomy symptoms after open cholecystectomy compared with laparoscopic cholecystectomy (26% v/s 14%, P = 0.134).

Conclusions

There is no significant difference in prevalence of post-cholecystectomy symptoms after open cholecystectomy compared with laparoscopic cholecystectomy.

WJP Article No. 5: Squamous Cell Carcinoma Arising In a Dentigerous Cyst- A Case Report

3/17/2014

Squamous Cell Carcinoma (SCC) arising from epithelial lining of dentigerous cyst is rare and these are distinct pathologic entity with only few cases in the literature. Primary intraosseous squamous cell carcinoma constitutes 1-2.5% of all odontogenic tumors and 1-2% of all intraoral cancers. Differential diagnosis of dentigerous cyst and the malignant tumor arising in the cyst is difficult due to nonspecific clinical and radiological examination. It is on histopathological examination that diagnosis is often made. We present a case of SCC arising from dentigerous cyst highlighting the importance of careful histopathological examination so as to prevent misdiagnosis of apparently innocuous cystic lesions.

WJMSCR Article No. 5: A Giant Primary Supraumbilical Hernia Coexisting with a Giant Lipoma: A Case Report

3/16/2014

Background

A ventral hernia is a hernia involving the anterior abdominal wall. It is further divided into primary abdominal wall hernias (those hernias that occur spontaneously in the anterior abdominal wall with no previous history of abdominal wall surgery or trauma) from incisional hernias (occurring from a weak scar in the anterior abdominal wall). Giant ventral hernias are considered in cases where the hernia orifice is greater than 10 cm. Giant lipoma are considered when weight is <5kg.

Case Presentation

A 30year-old female was admitted in the surgical ward with a three year history of progressive, painless abdominal swelling above the umbilicus. The swelling does not disappear, especially, when lying supine. Examination revealed an obese woman, with a BMI of 40.1, well hydrated and pink. Her temperature was 36.8ºC. The cardiopulmonary status was normal with a pulse rate of 89/min, blood pressure of 110/78mmHg and the lung fields were clear. There was a swelling around the umbilicus with no visible peristalsis; no visible and palpable cough impulse. The swelling was soft with no area of tenderness; however, it was difficult to reduce. Digital rectal examination was normal. Haemogram was 10.1g/dl. Abdomino-pelvic ultrasound scan of the abdomen reported loculated fluid and some gas levels suggestive of a huge mass of various loops of bowel adjourning fatty tissue in lobules in the anterior abdominal wall. Intra-operatively, the abnormalities found were an invagination of loops of jejunum through a defect and fatty tissue (lipoma) in the anterior abdominal wall. Following excision of the lipoma and successful manual reduction, a wall defect of about 11.8cm was found. The defect was primarily repaired with a non absorbable Nylon suture. Patient did well postoperatively and was discharged after 10 days. The patient has been entirely free of symptoms since six months of operation.

Conclusion

Careful preoperative preparation, operative technique, and postoperative care are required for successful management of giant primary supra-umbilical hernias coexisting with a lipoma

Key words

Giant, Hernia, Lipoma, Ventral

WJP Article No. 4: Extraskeletal Ewings Sarcoma Presenting as Nasopharyngeal Mass- Rare Tumour & Rarest Presentation

3/16/2014

Extraskeletal Ewing’s sarcoma (EES) is a rare, rapidly growing, round-cell, malignant tumor of uncharacterized mesenchymal cell origin that can develop in the soft tissues at any location and is morphologically similar to the commoner Ewing’s sarcoma arising from bone. EES can develop in soft tissues of any location but its occurrence in head and neck as a primary tumor is very unusual. It occurs predominantly in adolescents and young adults between 10-30 years of age and it follows an aggressive course with a high rate of recurrence.

WJMSCR Article No. 4: Cervical Chordoma Mimicking a Pottic Abscess

Key words

Risk factor, voice quality, glottis carcinoma, radiotherapy

WJMSCR Article No. 3: Sphenomaxilloethmoidal Aneurysmal Bone Cyst: Case Report and Review of Literature

2/8/2014

Aneurysmal bone cysts are non-neoplastic benign lesions, with obscure pathogenesis. the cyst consists of many vascular spaces that grossly resemble a blood-filled cavity and characterized by "blow out distention" of the skeletal contour. These bone cysts generally occur in long bones and vertebrae but rarely in the skull This 22- year- old woman, previously healthy, had a swelling on the left side of the face that had been gradually increasing for the last 3 months. There was no history of trauma. a left Clinical and neuroradiological presentation of the skull and face ABC was not specific. Histopathology confirmed the diagnosis. Total excision was the treatment of choice

Keywords

Aneurysmal bone cyst. Benign skull tumor

WJP Article No. 2: Squamous Cell Carcinoma of The Cervix Metastasis to the Jejunum – A Rare Case Report

2/8/2014

Introduction

Intestinal metastases usually represent a late stage of disease in which other haematogenous metastases are also frequently found. It is exceedingly rare for squamous cell carcinoma of the cervix to metastases to the jejunum.

Case report

This case report describes about a case of 50 years old female presented to the surgical out patient department with vomiting and pain per abdomen. Resection and primary anastomosis of involved jejunal wall was performed. Diagnosis of peritoneal and jejunal metastases of squamous cell carcinoma associated with mesenteric cyst, adhesion and perforation of jejunum was made.

Conclusion

To conclude, any patient presenting with signs and symptoms of intestinal obstruction it is necessary to keep in mind the possibility of jejunal metastatic tumor and to appropriately diagnose and treat.

Key Words

Perforation, intestinal, resection

WJSR Article No. 1: A Rare Presentation of Insulinoma as Postpartum Hypoglycaemia

2/8/2014

Insulinomas are rare neuroendocrine tumors, being even rarer during pregnancy. Postpartum hypoglycemia is an uncommon presentation due to insulinoma. We present a case of 25 year old female who presented with complaints of sweating and drowsiness relieved by taking oral glucose. Patient had history of loss of consciousness five days after delivery. She was evaluated with necessary investigations but the cause could not be identified and hence treated symptomatically. She is suffering from similar complaints since 10 months whenever she skips a meal which were relieved by taking glucose. Patient was evaluated with supervised 72 hour fast during the present admission during which she developed neuroglycopenic symptoms after four hours of fasting, with low plasma glucose of 27mg/dl and inappropriately elevated levels of serum insulin 13.5 µU /ml. Failure of endogenous insulin secretion to be suppressed by hypoglycemia is the hallmark of an insulinoma .Magnetic resonance imaging of abdomen revealed a 1.5*1.9 cm mass in body of pancreas which was treated by enucleation with histopathology confirming insulinoma. Our case illustrates the importance of considering insulinoma as a cause of postpartum hypoglycemia.

WJP Article No. 1: Pancreatic metastasis of Merkel cell carcinoma diagnosed by EUS-FNA: a case report and review literature.

1/26/2014

Introduction

Merkel cell carcinoma (MCC) is a rare primary skin tumor with aggressive behavior. We report a case of metastatic Merkel cell carcinoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in an Asian male and review of the literature.

Case presentation

A 65-year-old filipino man with history of primary cutaneous mcc of the left forearm presented with intractable nausea and vomiting. The patient was found to have a 3.5 x 4 cm pancreatic mass by abdominal computerized tomography. Eus-fna was subsequently performed. The cytological and pathological examination revealed atypical cells with hyperchromatic nuclei. The immunohistochemical stains were consistent with mcc. To our knowledge, only seven such cases have been reported in the english literature.

Discussion

EUS-FNA of the pancreas can effectively obtain tissue adequate for establishing the diagnosis of metastatic mcc. thorough knowledge of clinical history and accurate interpretation of cytology and cell block preparation obtained by EUS-FNA are essential to establish the definite diagnosis of MCC. Patients with metastatic MCC to the pancreas have a grave prognosis even with an appropriate treatment.

Keywords

Merkel cell carcinoma; pancreas; pancreatic mass; pancreatic tumor; neuroendocrine carcinoma

WJSMRO Article No. 1: Hereditary gastric cancer – diagnosis and clinical implications

1/26/2014

Gastric cancer is still one of the world's leading causes of cancer mortality. Approximately 10% of gastric cancers appear to have a familial predisposition. In this this group, 1-3% are considered as hereditary syndromes, with a clear genetic pathway, associated with the most important mechanisms of the CDH1 germline mutations. This mutation lead to the hereditary diffuse gastric cancer syndrome (HDGC). Other syndromes of familial prevalence of the gastric cancer, correlated with genetic mutations, are the hereditary nonpolyposis colorectal cancer, Li-Fraumeni syndrome, Peutz-Jeghers syndrome, Familial Adenomatous Polyposis, Cowden disease. Families HDGC can be identified and tested for causative mutations in CDH1, in other syndromes screening gastroduodenoscopy is indicated.

WJMSCR Article No. 2: Poorly Cohesive Cells of the Colon Cancer: A New Pathological Entity?: A Case Report and Literature Review.

1/24/2014

Poorly differentiated adenocarcinoma a rare form of colorectal carcinoma associated with poor prognosis. In addition, the appearance of poorly cohesive cells is very rare in this type of cancer. In this case report, a 25-years-old man presented with abdominal pain and vomiting. A 5x2x2 cm infiltrative and constricting tumor in the sigmoid colon was observed and the patient underwent a sigmoidectomy. A review of the literature on poorly differentiated carcinoma Ã¢â‚¬â€œwithin areas of poorly cohesive cellsÃ¢â‚¬â€œ of the colon yielded no previously described cases. Clinically, colorectal carcinomas occur most frequently in patients after age of 40 year and incidence in men is slightly higher than among women. The etiology of malignant large bowel tumors is usually multifactorial. Colonic lesions in young adults must be distinguished from malignant tumors. We presented this case as an example of atypical clinical, radiological and histopathological findings.

Keywords

Poorly, cohesive cell, colon, carcinoma

WJMSCR Article No. 1: Neglected Antero- Inferior Dislocation of Hip Treated with Primary Reverse Hybrid THR- A Rare Case Report

1/5/2014

Introduction

Antero-inferior dislocation of hip is a rare disease with not much literature regarding the reporting and management modalities of this type of dislocation. We here present a case of neglected antero-inferior dislocation of hip.

Case report

We present a case of 25 year old male patient who presented with history of trauma 1 year back fixed flexion deformity of 40 degrees and abduction deformity of 20 degrees of the hip with apparent lengthening of affected limb. Patient did not take any medical treatment but has a history of massage and prolonged immobilization. Patient reported to us one year later with deformities of lower limb. Patient was walking with support of a stick and was unable to squat, sit cross legged and his activities of daily living hampered. X-ray and MRI confirmed antero-inferior dislocation of hip with indentation of femoral head and features suggestive of signs of avascular necrosis of femoral head. Weight bearing dome of acetabulum was flattened. Primary hybrid THR with cementless femoral component and cemented acetabular component was done.

Conclusions

The patient is walking independently with full range of motion at the hip at 1 year of follow up and able to perform all activities of daily living independently.

Keywords

neglected, antero-inferior, hybrid THR, hip dislocation

WJP Article No. 17: Isolated Intra Fourth Ventricular Neurocysticercosis

12/15/2013

Introduction

Neurocysticercosis is one of the most frequently observed central nervous system parasitic infection caused by the larvae of the pork tapeworm, Taenia solium. The fourth ventricle is the most frequent location of intraventricular neurocysticercosis that carries a higher risk for CSF blockage and resulting in hydrocephalus.

Methods

We report a series of cases of 13 patients with symptomatic obstructive hydrocephalus due to cysticercus in the fourth ventricle presenting to us over a period of 7 years.

Conclusion

The excision of fourth ventricular cysts typically requires a microsurgical approach via suboccipital craniotomy.

Key Words

neurocysticercosis, fourth ventricle, hydrocephalus, Neurosurgical procedure

WJSR Article No. 14: Evaluation of S-100B Protein as Prognostic Marker in Head Injury Patients

12/4/2013

Objective

The aim of study is to estimate S-100B protein level as a serum marker of brain cell damage after traumatic brain injury and to predict the clinical outcome and course of patients.

Methods

Total twenty-six patients of head injury and ten healthy controls were included into study. All subjects were examined in detail and investigated by noncontrast-computed tomography. Head injury associated with other organ involvement was excluded from study. The venous blood was collected on day 0 (within 24 hours), day 3 and day 7. Their serum was stored at -70°C and S100 B were estimated using ELISA S-100B immunoassay kit.

Result

Patients, who survived, showed initially high level of S-100 B, which progressively decreased on day 3 and 7 while patients expired, showed progressively increased levels of S-100 B level with clinical deterioration.

Conclusion

S-100 B represents the new generation of biochemical markers of head injury. There was a significant association between S-100 B protein level and outcome and course of head injured patients.

Key Words

S-100 B, Head injury, Traumatic brain injury, Prognosis

WJP Article No. 16: Masson’s Trichrome and AgNOR Study of Fibrous Dysplasia and Ossifying Fibroma in Lagos University Teaching Hospital Patients

12/4/2013

Introduction

Fibrous dysplasia (FD) and ossifying fibroma(OF) pose diagnostic challenges.This study attempts to differentiate between the two lesions, using AgNOR and Masson’s Trichrome staining techniques.

Study design

A retrospective study on FD and OF.

Materials and methods

Forty cases each of fibrous dysplasia and ossifying fibroma were randomly selected from the oral biopsy archives of Lagos University Teaching Hospital. Three 5 microns paraffin sections per case were stained with Hematoxylin and Eosin, Masson’s Trichrome and AgNOR respectively. Proportions of bone trabeculae type and mean AgNOR scores for both lesions were analyzed for χ² and t statistics respectively using the Epi-info statistical package.

Results

Proportions of Lamella bone trabeculae type in ossifying fibroma(52.5%) was significantly higher than in fibrous dysplasia (30.0%); proportions of mixed bone trabeculae type in fibrous dysplasia (70.0%) was significantly higher than in ossifying fibroma (50.0%) (p< 0.05). Proportions of woven bone trabeculae type in fibrous dysplasia (60.0%) was not significantly higher than in ossifying fibroma (55.0%) (p> 0.05). Mean AgNOR score for ossifying fibroma (130.4 ± 32.3/ 100 cells) was significantly higher than for fibrous dysplasia (92.3 ± 27.4/ 100 cells) (p < 0.05).

Conclusion

Proportions of Lamella and mixed bone trabeculae types and mean AgNOR scores are important features to distinguish between fibrous dysplasia and ossifying fibroma, while proportions of woven bone trabeculae type is a poor distinguishing feature. This is the first demonstration of employing mixed bone trabeculae proportions to distinguish between fibrous dysplasia and ossifying fibroma.

WJSMRO Article No. 13: Unusual Variants of Diffuse Large B - Cell Lymphoma at Extranodal Sites. - Are These Distinct Diagnostic Entities

11/27/2013

Context

Diffuse Large B - Cell Lymphoma (DLBCL) is a heterogenous category of Mature B- Cell Neoplasms in the updated 2008 WHO Classification. We Present here the more uncommon variants in unusual locations that have unique Clinicopathologic features and which the author believes are possibly distinct biologic entities in our experience.

Objective

We highlight here the Clinicopathologic and Immunohistochemical features of a few of the more uncommon variants and also discuss actual scenarios and practical difficulties encountered in cases presenting to our institution

Data sources

Material from the author's institution, CAP Protocol for the examination of specimens from patients with Non – Hodgkin's Lymphoma / Lymphoid neoplasms, literature from Pub Med and the WHO Classification of tumours of hematopoietic and lymphoid tissues 2008.

Conclusions

While WHO recognizes several morphologic and clinical subtypes of DLBCL, their distinction and categorization and site specific features remain difficult to reproduce, lack of consensus among reporting pathologists further hampering accurate delineation. Many variants moreover, clubbed under the rubric of DLBCL NOS probably are distinct biologic entities, which need to be recognized as such.

WJMR Article No. 7: Microbiological Profile of Brain Abscess

11/27/2013

Objective

The objective of the study was to review the microorganisms found in the brain abscess.

Methods

We evaluated 104 patients of brain abscess admitted at our university hospital. Apart from routine hematological investigations and chest X-ray, all patients were subjected to CT scan or MRI study. Skiagram Skull, CSF study, Ultrasonography of head through open fontanelle in infants and in patients with cranial defects and special tests for Tuberculosis, HIV were done accordingly. Microbiological evaluation of the isolate was done in all cases. Preoperative and postoperative neurological function was assessed.

Observations

Pus culture was positive in 54.56 percent of cases. Anaerobic organism was found in 5.77 percent while mycobacterium in 3.85 percent, fungi in 1.92 percent. Streptococcus was the commonest offending organism followed by Staphylococcus and Pseudomonas. Pseudomonas was most resistant organism.

Conclusion

Chronic suppurative otitis media is still a major cause of brain abscess in developing country like India, which is a benign and curable disease and should not be neglected. Streptococcus was the commonest offending organism see. Unless anaerobic cultures are done, anaerobic organisms as causative agents can be easily missed. With the advent of newer and exotic diseases the culture spectrum of brain abscess is bound to change.

Key words

Brain abscess, subdural abscess, cerebral abscess, cerebellar abscess, chronic suppurative otitis media, bacteria, fungal culture

WJP Article No. 15: Gaint Cell Tumor of Tendon Sheath Involving Second Metacarpal Bone: –A Rare Case Report

11/27/2013

Introduction

Giant cell tumor of tendon sheath (GCTTS) is a benign slow growing tumor with a high incidence of recurrence. Intraosseous metacarpal involvement of GCTTS is an uncommon manifestation of this tumor, but it is well known because of its potentially aggressive local growth. Only few cases are reported in the literature.

Case Report

A 22 years old female presented with pain and swelling over the left hand since 3 months. X-ray findings revealed soft tissue lesion over left second metacarpal. On the radial aspect there was a bony erosion of the second metacarpal involving the cortex of the metacarpal. Tumor along with partial excision of left second metacarpal was removed and sent for histopathological examination. Microscopically an admixture of polygonal and spindle shaped mononuclear cells, xanthoma cells, multinucleated gaint cells in a collagenous, variably hyalinised stroma was seen. The histopathological diagnosis of gaint cell tumor of tendon sheath was made.

Conclusion

To conclude this entity has to be kept in mind when there is a swelling in the metacarpal area.

Key Words

intraosseous, synovial, fibrous histiocytoma

WJMR Article No. 6: Conventional Versus Neuro-Navigation Guided Shunt Surgery

11/21/2013

Objective

The aim of study is to evaluate the efficacy of ventricular catheter placement through neuro-navigation versus conventional technique.

Methods

All patients undergone ventriculo-peritoneal shunt from August 2011 to September 2013 were included in this study. Total sixty cases were included and divided into two groups. The first group comprised of shunt surgery using conventional method of shunt placement as per anatomical landmarks. The second group had proximal end placement with help of Frameless Neuronavigation System. The relationship between proximal ventricular catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale: 1) Grade I; Position of tip is anterior to foramina of monro , free-floating in cerebrospinal fluid, 2) Grade II; touching choroid plexus or ventricular wall, tip is posterior to foramina of monro 3) Grade III; tip within parenchyma, crossing to opposite side.

Results

Sixty patients were considered, and divided into two groups: 1.Ventricular end insertion through conventional technique, 2. Neuronavigation assisted ventricular end insertion. There were 30 patients in each group. In conventionally treated study group, 20 patients (66.66%) revealed grade 1 placement of ventricular end,8patients (26.66%) had grade 2, and 2 patients(6.66%) showed grade 3 in post operative CT scan. Neuronavigation study group had 28 patients (93.33%) in grade 1 placement and 2 patients (6.66%) in grade 2 while none was in grade 3 on post operative CT scan. Infection rate was same in both groups.

Conclusion

Despite technological improvements, ventriculoperitoneal shunts are still often complicated by malfunction, predominantly with proximal catheter obstruction.Significant proportion of shunt fail¬ures were due to obstruction of the ventricular catheter, and accurate placement of the shunt catheter is highly important to reduce the incidence of shunt malfunction. Frameless navigation is a valuable tool to optimize the trajectory and final position of shunt catheter. The use of navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates thus the incidence of revision will go down.

Key Words

Neuronavigation, Hydrocephalus, Ventriculoperitoneal shunt.

WJSMRO Article No. 12: Subpial Spinal Lipoma without Dysraphism

11/20/2013

Introduction

Subpial spinal lipoma without dysraphism is rare lesion and the management remains challanging. In our study we present the extensive clinico-radiological findings and optimum management protocol.

Methods

Fifteen patients who reported with nondysraphic spinal cord lipomas between March 2000 and April 2012 were retrospectively reviewed. All had varying degrees of neurological symptoms at the time of surgery with characteristic features on magnetic resonance imaging. All patients underwent decompression with a laminectomy/laminoplasty and duroplasty.

Results

The age at presentation ranged from 14 to 45 years (mean 28.8Yrs). Patients were followed-up for minimum of 6 months and maximum of 5 years. The most common location was dorsal spine while 4 vertebral segments involvement was found in 66.6% of cases. There was neurological improvement following surgery in all cases. Four patients had recurrence of symptoms.

Conclusion

Surgical excision of subpial lipomas is best treatment offered to the patients presenting with neurological deﬁcits. The amount of surgical resection has not any influence on recovery from symptoms. Hence aggressive debulking should not be attempted as it may aggrevate neurological deficit. Thus adequate decompression with preservation of neural structures should be the aim of surgery.

Keywords

Intraspinal subdural lipomas, Intradural lipoma, Non-dysraphic lipoma, Spinal lipoma,

WJMR Article No. 5: Intraoperative Ultrasound Guided Spinal Tumor Resection

11/20/2013

Objective

The objective was to assess the efficacy of intraoperative ultrasound in spinal intradural space occupying lesion.

Methods

We prospectively performed intraoperative ultrasound in 87 patients of spinal intradural space occupying lesion admitted at our university hospital. Intraoperative ultrasound with SonoSite, 180 plus hand carried ultrasound system with c11/7-4 Mhz curved array transducer probe was done in all cases . Extradural tumors, abcess,metastasis have been excluded from this study. A preoperative Magnetic resonance imaging was preformed in all patients. Preoperative and postoperative neurological function was assessed.

Observations

Intraoperative ultrasound examination is excellent in localizing intradural space occupying lesions. Intraoperative ultrasound helps in planning the durotomy. In cases of small spinal tumors especially intramedullary tumors intraoperative ultrasound helps in pinpointing the location of tumor beneath the dura. Laminectomy or laminotomy can be extended if necessary according to size and location identified with repeated peroperative ultrasonic examination. Intraoperative ultrasound helps in delineating the completeness of resection. Residual tumor left if any was excised.

Conclusion

Intraopeative ultrasound is portable, does not require any specialized setup, provides real time images, cost effective, can be repeated as and when required during the procedure with minimum scanning time, and ensures patient and operator safety.

Keywords

Intraoperative ultrasound, intradural tumors, intramedullary tumors, intradural extramedullary space occupying lesions.

WJPSO Article No. 3: Stressors, Coping and Coping Strategies Among Young Adults with Cancer

11/20/2013

Introduction:

Research shows that young adults with cancer experience physical and mental changes that affect both their body image and their ability to cope with the situation. The purpose of this study was therefore to describe stressors, coping and coping strategies among young adults with cancer.

Study design

A qualitative interview study.

Material and methods

Setting: Swedish university hospital. Data was collected through semi-structured interviews until saturation (12 informants). The interviews were transcribed verbatim and analysed using a phenomenographic approach.

Results

Four categories of stressors where identified: ’feeling physically ill’, ‘side-effects of the cancer treatment that caused negative wellbeing’, ’how can I have cancer when I have none or few symptoms from my body?’ and ‘feelings of psychological distress’. Identified coping styles were ‘physical exercise’, ‘seeking professional help’, ‘trying to regain control’, ‘finding new ways of thinking / acting’ and ‘seeking help from family and friends’. Coping strategies used were problem-focused, emotion-focused, meaning-based and social coping. The informants also used various forms of psychological defense mechanisms.

Conclusion

Young adults with cancer experienced stressors similar to older cancer patients but also specific stressors related to their youth based on a lack of previous experience of severe illness which is an important implication for health care personal. Physical exercise was identified as a coping strategy and further studies are needed to investigate if supervised physical exercise may increase internal locus of control and help young adults with cancer to cope better with their disease and cancer treatment.

Keywords

Neoplasms, stress psychological, adaptation psychological, rehabilitation, qualitative research.

WJMSCR Article No. 24: Ileocolic Intususception due to Non Hodgkin’s Lymphoma –A Rare Presentation in Adults

11/14/2013

Introduction

The first report of intussusception was made in 1674 by Barbette of Amsterdam. In1871 Sir Jonathan Hutchinson was the first to successfully operate on a child with intussusception. Overall the male-to-female ratio is approximately 3:1.The pathogenesis of idiopathic intussusception is not well established. It is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. In enteroenteral intussusception this imbalance can be caused by a mass acting as a lead point or by a disorganized pattern of peristalsis (eg, an ileus in the postoperative period). In approximately 2-12% of children with intussusception a surgical lead point is found. Occurrence of surgical lead points increases with age and indicates that the probability of non operative reduction is highly unlikely. Adult intussusception represents 5% of all intussusceptions and 1% to 5% of all cases of intestinal obstruction in adults. In the adult population approximately 40% of them are caused by primary or secondary malignant neoplasms.

Case Presentation

A 30 years female patient brought to the hospital with pain abdomen since one week. Ultrasound abdomen suggestive of ileo-caecal intussusception. CECT abdomen done which shows ileo-caecal intussusception Laparoscopic assisted reduction of intussueption and resection of ileum-end to end anastomosis done along with appendicectomy . Tumor shows features of Non-hodgkins lymphoma-follicular variant.

Conclusions

Adult intussusception remains a rare cause of persistent or intermittent chronic abdominal pain. In contrast to its paediatric counterpart the treatment almost always is surgical.

Key Words

Intussusception, Lymphoma, Laparoscopy.

WJSMRO Article No. 11: Intraoperative Ultrasound in Intracranial Space Occupying Lesions

11/14/2013

Objective

The aim was to assess the role of intraoperative ultrasound in intracranial space occupying lesion.

Methods

We have performed intraoperative ultrasound in 192 patients of cranial space occupying lesions admitted at our university hospital. Intraoperative ultrasound was performed by SonoSite, 180 plus hand carried ultrasound system with c11/7-4 Mhz curved array transducer probe. A preoperative Computed tomography or Magnetic resonance was performed in all patients. Preoperative and postoperative neurological function was assessed.

Observations

Intraoperative ultrasound examination is an excellent device in localizing the small intracranial space occupying lesion. It also helps in planning the durotomy and extending the craniotomy size if required. It helps in identifying the shortest and safest site to approach the lesion, and helps in preventing the damage to eloquent areas. In cases of cystic tumor with small solid component, it helps in guiding the cyst puncture and exact localization of the solid component. In cases of large intracranial space occupying lesions, post excision intraoperative ultrasound helps in delineating the completeness of resection. Residual tumor if seen in ultrasound was excised.

Conclusion:

Intraoperative ultrasound is portable and does not require any specialized setup. It is cost effective and provides real time images. It can be repeated as and when required during operation with minimum scanning time, and ensures patient and operator safety.

Keywords

Intraoperative ultrasound,glioma, meningioma,intracranial tumour, brain neoplasm

WJSR Article No. 13: Cerebral Candiasis

11/4/2013

Introduction

Cerebral candiasis is not commonly seen in live patients but it is observed in autopsy. It has more preponderance in immunocompromised patients either suffering from AIDS or on steroid therapy.It is very rare in healthy individual.There is strong suspicion of brain lesion as fungal if adjoining paranasal sinus is involved. Treatment includes decompressive surgery followed by Amphotericin.

Methods

All cases with proven diagnosis in last 20 years were taken into consideration. They were analysed in respect of age, sex, clinical feature, radiological feature, surgery and final outcome.

Results

There were 10 histologically proven cases of Cerebral Candiasis with male predominance. The most commonly affected age group is 40 to 50 years. AIDS was present in 3 cases while three patients were immunocompromised. The Frontal lobe was involved in 90% as it was near to ethmoid sinus, which was initial site of affection. The seizure was manifesting symptom. Decompression was done 6 cases while diagnostic biopsy in 4 cases. Long term outcome was unsatisfactory because of underlying cause.

Key Words

Candiasis, cebebral candiasis, Fungal granuloma, AIDS

WJSR Article No. 12: Epidemiological Evaluation of Intracranial Epidermoid Tumor

11/1/2013

Introduction

Epidermoid tumor are benign slow growing lesions of ectodermal origin that present aproximately 1% of all primary intracranial neoplasm.

Material and Method

This observatioal study was conducted at Department of Neurosurgery,Institute of medical sciences,Banaras Hindu University,Varanasi.The design of study was both prospective and retrospective.In Prospective study newly diagnosed histologically proved patients who attended the out patient department between August 2009 to August 2011 were included.Patients who had radiologically proved but refused to give consent for operation were not included in the study.For retrospective study registered cases between august 2004 to august 2009 from medical records with confirmed radiological diagnosis and histopathological result were included.

Results

Epidermoid constituted 1.7% of total intracranial tumors.The mean age of all patient's were 38.26+_12.87(range24-64 years).The most common location was cerebellopontine angle present in 23(67.64)patients.Headache was most common symptom at the time of presentation.The duration of symptoms range from three months to 14 years with mean of 35 months.Patients who presented with only Trigeminal neuralgia had a mean duration of symptoms of 29.4 months as copmpared to 38.4 months for those who did not have trigeminal neuralgia.

Conclusion

Epidermoid are uncommmon benign intracranial lesions.They have characteristic presentations and specific radiological findings.While gross total resection of epidermoid (radical removal of cyst content and lining wall)is the definative treatment to prevent recurrance and aseptic meningitis but sometimes subtotal resection may be necessary to preserve neurological function.It should be strongly suspected in young patients presenting with features of trigeminal neuralgia not responding to medical therapy, these patients should be investigated radiologically for early detection and better management.

This study confirms that patients are more likely to refuse adjuvant drug treatment than surgery or radiation, and that refusal of treatment is associated with an increased risk of disease recurrence.

WJMSCR Article No. 22: Bilateral Angiosarcoma of Breast

10/18/2013

Introduction

Sarcoma of the breast is a rare tumor with poor prognosis. Majority of the cases described in literature are secondary to radiotherapy. Fine needle aspiration cytology is a good tool for diagnosis. Optimal treatment for breast sarcoma is still unclear.

Case Report

A 25 years female presented with a recurrent 10x8 cm lump in her left breast. Systematic examination of the contralateral breast revealed a 4 x3 cm lump in her right breast also. FNAC suggested the possibility of a malignant mesenchymal lesion. Bilateral simple mastectomy was performed. Histopathology revealed bilateral angiosarcoma of the breast with extensive haemorrhage and necrosis. Immunohistochemistry was positive for Vimentin and CD 31 but negative for S 100. Adjuvant chemotherapy (MAID regime) was given to the patient.

Discussion

Primary sarcoma of the breast usually presents as a lump with variegated consistency in the breast in a young female often secondary to radiotherapy. FNAC is diagnostic. Angiosarcoma is the most common variant. 5 year survival ranges from 40%-91 %. Margins of surgical resection are an important prognostic indicator. Axillary dissection is generally thought to be unnecessary for soft tissue sarcomas.

Conclusion

Adequate surgical excision, grade and tumor diameter seem to be the most important prognostic factors.

Key Words

Sarcoma, Breast, Mastectomy, chemotherapy

WJSMRO Article No. 10: Helical Tomotherapy for Treating Supraclavicular and Internal Mammary Nodal Chain in Breast Cancer

10/18/2013

Objective

To describe one of the first clinical experiences of treating the Internal mammary chain (IMC) and supraclavicular fossa (SCF) using helical tomotherapy (HT), with brachial plexus sparing where necessary.

Methods

Three breast cancer cases in whom both SCF and IMC irradiation was required were planned and treated using HT to a dose of 50Gy in 25 fractions or equivalent. In one case dose escalation to the SCF was required to treat clinically palpable node. Inverse planning dose constraints were applied to PTVs and OARs.

Results

HT plans achieved adequate target coverage for all three PTVs in the three cases; mean HI of 1.09, 1.08 and 1.11 and mean CI of 0.6, 0.5 and 0.6 for chest wall, SCF and IMC were obtained respectively. The mean heart dose achieved was 11.8Gy, 18.0Gy and 6.2 Gy for the three cases respectively. The mean heart dose of the second case was higher as it involved bilateral chest wall and IMC irradiation. Mean V20Gy for ipsilateral and contralateral lung was 25.9% and 2.5% respectively. Mean dose of contralateral breast (in two cases) was 5.1Gy. Skin acute toxicity was Grade I in all three cases. At a median follow up of 1 year, all three patients are locoregionally controlled.

Conclusion

Helical tomotherapy is a technique where complex volume treatment in breast cancers could be delivered with adequate homogeneity and conformity indices and high capabilities of critical organ sparing. Further long term studies are required to assess local control and late toxicity.

WJP Article No. 14: Retroperitoneal Paraganglioma: Clinical Presentation and Treatment Outcomes in Two Patients

10/18/2013

Introduction

Paragangliomas are rare neuroendocrine tumors that arise from extra-adrenal autonomic ganglia. The aim of this paper is to analyze the presentation, diagnosis and treatment outcomes of two patients with retroperitoneal paraganglioma treated in our hospital.

Case Presentation

The first case is a 34 year old female, ASA status 1, who underwent elective surgery for removal of retroperitoneal tumor. Laparoscopic surgical resection was decided. Minimal tumor manipulation was followed with severe hypertension. Due to high suspicion of the presence of a catecholamine-secreting tumor, intravenous antihypertensive drugs were given. The patient coursed with hypotension and acute pulmonary edema after the surgery. Transthoracic echocardiogram showed apical ballooning with impaired ejection fraction of the left ventricle. After 3 days in Cardiac Care Unit the patient was discharged. The second case is a 25 years old male, with large history of refractory hypertension who was admitted in our hospital with sweating, palpitations, dizziness and hypertension. Catecholamine dosage was performed in plasma and urine and the results were inconclusive. The CT scan showed a right hypoplastic kidney and a 2.5 x 1.9 cm nodular mass located between his left renal artery and vein. Because of the high suspicion of paraganglioma we decided the tumor excision. The patient recovered without complications, and was discharged 4 days after surgery. Final surgical pathology demonstrated in both cases a paraganglioma.

Conclusions

The paraganglioma is a rare tumor associated with high morbidity and mortality when the diagnosis is made intraoperatively.

Key words

Extra-adrenal pheochromocytoma, Retroperitoneal mass, diagnosis.

WJPSO Article No. 2: Clinical Implications of Delay in the Diagnosis and Treatment of Early Stage Breast Cancer

10/18/2013

Introduction

We reviewed the incidence and clinical implication of primary treatment delay in a population of newly diagnosed breast cancer patients.

Methods

The original medical record of 591 patients referred to Cancer Treatment Centers of America at Midwestern Regional Medical Center (CTCA/MRMC) with recurrent breast cancer was reviewed and data stored electronically to be analyzed. Approval from our Institutional Review Board (IRB) was not required as this was a retrospective record review with no direct patient contact and no specific patient information or identification was published.

Results

In 95 patients there was a delay of at least six months between the first symptoms of breast cancer and the start of treatment. All but one of the 95 patients presented with a palpable mass. Median delay for the entire group was 18 months. The cause of the delay in starting treatment was; physician error (27/591), patient refusal (65/591) and patient inability to obtain medical care (2/591). Length of delay due to physician error was shorter, and delay due to patients declining medical treatment was significantly longer. Those 23 patients who had attempted to control their disease with alternative treatments before coming to Cancer Treatment Centers of America at Midwestern Regional Medical Center (CTCA/MRMC) were more likely to decline our treatment recommendations.

Conclusions

Delay in diagnosis and treatment of patients with early stage breast cancer is still a common event due to physician error, or more commonly patient reluctance to seek treatment. Delay is associated with higher probability of advanced disease.

WJP Article No. 13: Cutaneous Adnexal Tumours: A Clinicopathological descriptive study of 70 cases

10/17/2013

Background

Cutaneous adnexal neoplasms are large and diverse group of skin tumours that are classified according to embryologic and histologic features into eccrine, apocrine, follicular and sebaceous. The aim of study is to assess the clinicopathological characteristic of these tumours.

Material and methods

A total of 70 cases were studied during a period of 6 year, who were diagnosed to have cutaneous adnexal neoplasm and confirmed by histopathology. All the specimens were formalin fixed, processed and stained with H&E and special stains wherever necessary. Clinical data were gathered and tumours were classified as eccrine, follicular, apocrine and sebaceous after examination

Results

Among 70 cases, 67 cases were benign and 3 cases were malignant. Male (64.33%) outnumbered the female (35.67%) at our centre. Tumour with eccrine differentiation constituted the maximum number , 38 cases( 54.3%) followed by follicular differentiation 24 cases( 34.3%);tumours of sebaceous and apocrine differentiation 4 cases each( 5.7% )

Conclusion

Cutaneous adnexal neoplasms are relatively uncommon neoplasm with distinct histological features , commonly distributed in head and neck region with a male dominance in our study.

Key words

Cutaneous adnexal neoplasm, skin tumours, histopathology

WJMR Article No. 4: Interim FDG-PET in Diffuse Large B-Cell Non-Hodgkin’s Lymphoma: A Meta-Analysis

10/17/2013

Background

FDG-PET is increasingly being used in non-Hodgkin’s lymphoma (NHL), however, the value of interim FDG-PET (IFDG-PET) performed during induction chemotherapy is not established. A meta-analysis was designed to define the clinical utility of IFDG-PET.

Methods

According to predefined selection criteria, literature search identified 22 studies included in the analyses.

Results

There were 1,957 patients (median age of 55 years, 58% males, 95% diffuse large B-cell, 36% stage I/II, and 64% stage III/IV). Patients with negative IFDG-PET had 62% reduction in the risk of disease progression (hazard ratio [HR] = 0.38; 95% CI, 0.30–0.47; P <0.0001) and 72% mortality reduction (HR = 0.28; 95% CI, 0.21–0.38; P <0.0001) as compared with those with positive IFDG-PET. IFDG-PET predicted survival regardless of the number of chemotherapy (CTX) cycles prior to interim assessment. Meta-regression analysis demonstrated that higher study quality score, increasing median age, increasing number of prior CTX cycles, and longer follow-up were associated with more favorable progression-free survival (PFS). Moreover, visual methods were more related to lower HRs as compared with quantitative/semi-quantitative (Q/SQ) interpretation techniques. IFDG-PET demonstrated moderate sensitivity and specificity for predicting PFS (61.8% and 66.0 %, respectively), and overall survival (62.0% and 63.0%, respectively), with visual image interpretations outperforming Q/SQ methods. The meta-analysis showed several limitations attributed to studies quality and to interpretation methods.

Conclusion

The current meta-analysis demonstrated the predicting utility of IFDG-PET. Future studies should use standardized imaging parameters and examine the effect of using IFDG-PET results on adaptive induction therapy.

Key Words

Non-Hodgkin’s lymphoma; FDG-PET; Interim; Prediction; Prognosis.

WJSR Article No. 10: Neutrophil-Elastase Inhibitor- Sivelestat Assists in Reducing Ischemia Reperfusion Injury in a Muscle Flap Model: An Experimental Study

10/17/2013

Aim

To examine the effectiveness of a neutrophil elastase inhibitor, Sivelestat on ameliorating ischemia reperfusion injury in a muscle flap model.

Materials and Method

Eighteen male, 8-week old, specific pathogen-free Sprague Dawley rats were examined in 3 groups; Saline-treated control group(CG)(n=6), Ischemia group (IG)(n=6), Sivelestat-treated group(SG)(n=6). Gastrocnemius muscle flap was approached as previously described in studies. The sural artery branching from the politeal artery was clamped with 2v microvascular clamps. In the control group, the clamps were left in place for 5 hours of ischemia, prosecuted by 3 hours of reperfusion and saline was given during the reperfusion period.In the ischemia group, the gastrocnemius muscle flap was raised and islanded and the vascular pedicle was tied to mimic total ischemia. In Sivelestat group, the gastrocnemius muscle flap was raised as an islanded flap, the pedicle was clamped with 2v microvascular clapms for 5 hours, prosecuted by 3 hours of reperfusion. During the reperfusion period, a 16 gauge cannula was placed from the tail veins of the rats and Sivelestat was infused at a 10 mg/kg/hour dosage for 3 hours creating a pharmacological postconditioning procedure.After a total of 8 hours, the incisions were sutured and the rats in all groups were examined for 7 days in terms of wound healing, allergic reactions and general conditions. On the seventh day of reperfusion, gastrocnemius muscles were harvested for histological analysis with hematoxylene eozine and for myeloperoxidase activity and formeasuring the amount ofbicinchoninic acid which are both predictors of neutrophil elastase accumulation in the tissues.

Results

Inflammatory reaction in groups 1 and 2 were predominated by lymphocytes, followed by eosinophil leukocytes and plasmocytes resulting in edema collection. In group 3, the sivelestat-treated rats, the number of neutrophil leukocytes are much less, the inflammatory reaction is attenuated with less edema collection in between the tissues.Median tissue myeloperoxidase levels were significantly elevated in control muscle(group1) 2.45 (1.32-4.28) units /g wet weight) compared with that harvested from ischemic 1.12 (1.08-2.02) (p<0.001).

Conclusion

Use of Sivelestat will aid in decreasing the degree of myozite damage in upper limb replantations, crush syndromes and compartment syndromes and will help obtain more functional results in hand surgery where warm ischemia time is of utmost importance.

Keywords

Neutrophil elastase inhibition, ischemia reperfusion injury, Sivelestat, limb replantation

WJMSCR Article No. 20: Acute Atrazine Food Poisoning in Shaibupe: A Farming Community in Northern Ghana

10/17/2013

Objective

Atrazine is a restricted selective herbicide in most developed countries, but still finds its way into Ghana. Oral ingestion of large doses is associated with death. Published autopsy data on atrazine related food poisoning is scanty. We present seven cases of acute atrazine poisoning involving two girls (aged 2 and7 years), 3 boys (aged 2, 5 and 6 years), and two adults, man and woman(aged 34 and 45 years respectively), in a farming community in northern Ghana.

Case report

Seven of the 8 members of one family were reported to have died following consumption of cooked beans. Autopsy was performed on all seven bodies. At autopsy the liver, stomach contents and blood from the seven victims, together with cooked and uncooked beans from the scene were sent for toxicological analysis at the Forensic Science Department of the Ghana Standards Authority. Atrazine was detected in significant quantities in the uncooked and cooked beans, the stomach contents, blood and liver samples from each of the victims.

Conclusion

Our findings may be the tip of an” iceberg” of deaths following contamination of food with chemicals in farming communities in Ghana. There is the need to raise awareness of this danger for the appropriate institution to enforce laws regulation the importation and use of agrochemicals in Ghana. There is also the need for continuous education of farmers about the safe handling, hazards and effects of agrochemicals.

Key Words

Autopsy, Herbicides, Atrazine, Food-poisoning.

WJMSCR Article No. 19: Isolated CNS Nocardiosis in an Immunocompetent Patient

9/7/2013

Introduction

Nocardiosis is typically regarded as an opportunistic infection; risk factors For developing Nocardiosis include Diabetes, HIV infection (especially if CD4 count is <100), glucocorticoid therapy, transplantation, and malignancy (most often after recent hemotherapy). However; about one third of patients are immunocompetent; here, we present a case of Nocardiosis in an immunocompetent patient.

Case presentation

A 69 year old female with past medical history of COPD, Invasive ductal carcinoma of breast presented with progressive left sided weakness and headaches of one week duration. Initial evaluation was significant for left sided weakness in the upper and lower extremities along with left sided facial droop. CT brain without IV contrast revealed a ring enhancing mass measuring 2.4 mm * 2.8 mm in the right basal ganglia with significant adjacent edema, effacing the right lateral and third ventricles, and 2 mm leftward midline shift. Stereotactic biopsy of the brain mass identified it as an abscess and histology revealed acute and chronic inflammatory cells with no viable tissue. Gram stain and culture showed aerobic branching gram-positive organisms, which were later identified as Nocardia Farcinica.

Discussion

Although Nocardial brain abscess generally occurs in immunosupressed hosts, they were also reported in immunocompetent individuals. In immunosuppressed patients, involvement of the CNS should be ruled out even without neurologic symptoms.

Key Words

Nocardia Farcinica, Abscess, brain,

WJP Article No. 12: Adenosquamous cancer of the oesophagus arising from Barrett’s metaplasia: a review of the pathophysiology and treatment options

8/15/2013

In this article we report a case of adenosquamous carcinoma arising from Barrett’s metaplasia, only the 6th clinical report of this entity in the literature, and we review the pathophysiology that may underlie its development. Given the rarity of this tumour the optimal treatment is largely unknown but the prognosis appears relatively poor. Given that the most recent data suggests a significant survival benefit from neo-adjuvant chemotherapy in adenosquamous carcinoma and, with phase III trials supporting the use of trimodality therapy, conventional neoadjuvant cisplatin-based chemoradiotherapy followed by surgical resection remains the recommended treatment of choice until further data is available.

Key words

Adenosquamous, Barrett’s, Carcinoma, Oesophagectomy, and Treatment

WJMSCR Article No. 18: Bile Duct Injury during Laparoscopic Cholecystectomy in a Polycystic Liver

8/14/2013

Introduction

Cystic lesions of the liver consist of a heterogeneous group of disorders and might present a diagnostic and therapeutic challenge. Large hepatic cysts are symptomatic and cause complications more often than smaller cysts. In addition, the anatomical localization might present an additional risk factor in the incidence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC).

Study design

Currently, there are no randomized trials concerning the increased incidence of BDI in patients with multicystic livers. To assess the specific diagnostic and management problems of this case the clinical benefits of early diagnosis, adequate surgical technique, and multidisciplinary management are discussed.

Material and methods

We described a case of bile duct injury following LC in a patient with a preoperative diagnosis of multicystic liver and cholelithiasis, analyzing the disease treatment profile through findings on physical examination, laboratory, radiological and pathological investigations.

Results

The intraoperative detection of bile leakage facilitated the immediate repair of the biliary tree with a good surgical and clinical outcome at 18 months follow-up.

Conclusions

The manifestation of bile duct injuries during the postoperative period might be reduced through early detection and timely management. Improved results can be achieved through the judicious selection of a combination of interventions in the majority of patients. These diagnostic and therapeutic topics might offer a new classification system with economic and functional value to improve the performance and surgical outcome of the patient.

Key Words

multicystic liver, bile duct injury, BDI, cholelithiasis, laparoscopic cholecystectomy

WJMSCR Article No. 17: Traumatic vulvar hematoma at term pregnancy: How trivial?

8/13/2013

Background

The overall incidence of trauma during pregnancy is about 5 to 7%. Among the different injuries sustained, trauma to the vulva has not been reported. Even outside obstetrics, traumatic vulvar hematomas are rare. The incidence is not known and literature is limited to the reported cases. The present case addresses the issues related to the management of non obstetric traumatic vulvar hematoma in an obstetric patient at term gestation.

Case Presentation

A gravida 5 woman presented at term gestation with a traumatic vulvar hematoma which was successfully managed by emergency incision and drainage. An uneventful vaginal delivery ensued thereafter.

Keywords

hematoma, pregnancy, term, trauma, vulvar

WJP Article No. 11: Fine needle aspiration versus core needle biopsy in the diagnosis of the intraductal breast papillary lesions

8/13/2013

Background

Diagnosing breast intraductal papillary lesions by fine needle aspiration (FNA) is often difficult and provides indeterminate results. The aim of this study was to determine an effective diagnostic method for intraductal papillary lesions, when the initial FNA cytology was insufficient.

Patients and Methods

The cytopathology records of 79 women diagnosed with intraductal papillary lesions were retrospectively evaluated

Results

Of the initial FNAs, 26 specimens were classified as benign, 51 were indeterminate, and 2 were suspicious for malignancy. Repeat FNAs or core needle biopsies (CNBs) were performed on 20 and 23 cases, respectively. Thirteen of 20 cases (65%) of the second FNA specimens and 6 of 23 cases (26%) of the CNBs were indeterminate. The probability of indeterminate diagnosis was significantly lower in the CNBs than the second FNAs (p<0.05). However, some cases failed to be diagnosed by CNB, partly because the samples were insufficient for diagnosis, and partly because the lesions seemed to be beyond the diagnostic capability of CNB even with an aide of immunohistochemistry using multiple primary antibodies. Overall, 13 of 79 cases were malignant. /p>

Conclusions

For intraductal papillary lesions initially diagnosed using FNA, a CNB may be recommended instead of FNA, if additional evaluation is required. An adequate CNB may facilitate accurate diagnosis, although some cases will remain indeterminate.

Key words

Intraductal papillary lesion, Fine needle aspiration, Core needle biopsy

WJMSCR Article No. 16: Colovesical fish bone perforation in a 94 year old lady

8/5/2013

Introduction

Perforation of the alimentary tract and surrounding organs is a recognised complication of the ingestion of foreign bodies, particularly fish bones. Such perforations are more common at the proximal end of the alimentary tract and in countries where ingestion of fish bones is more prevalent, such as Japan.

Case Presentation

We report a case of a 94 year old lady who presented to A&E in the UK with an inflammatory mass in her lower abdomen caused by a fish bone perforating her colon and urinary bladder. A left hemi-colectomy and partial cystectomy was performed and the patient recovered well.

Discussion

The ingestion of foreign bodies, particularly fish bones is well documented. However, this is the first reported case in the UK of a fish bone causing trauma to the urinary bladder. In such cases where involvement of the urinary bladder is suspected, cystoscopy may be of benefit.

Key words

fish bone, perforation, urinary bladder, diverticular disease, colon

WJSMRO Article No. 9: Use of Natural Orifice for Specimen Extraction in Laparoscopic Solid Organ Surgery

8/1/2013

Background

One of the limitations of laparoscopic solid organ surgeries is making a relatively big incision for specimen extraction. This is often encountered with large tumors and in cases where morcellation of the specimen would distort the tissue architecture hindering pathological examination. This report highlights the use of a natural orifice for specimen extraction to avoid the above mentioned difficulty.

Case Report

A 34 year old female with Hodgkin’s Lymphoma underwent concomitant laparoscopic splenectomy for massive splenomegaly and laparoscopic assisted vaginal hysterectomy and bilateral salpingo-oophorectomy for menometrorrhagia. Given the significant size of the specimen, 17 x 10 x 3.5 cm, there was concern preoperatively about the need to make a significant incision in the abdomen for specimen extraction. After the initial laparoscopic splenectomy through the transabdominal approach, the specimen was placed in an endocatch bag and left in the upper abdomen. Laparoscopic vaginal hysterectomy was then done. Prior to the closing of the vaginal cuff, with persistent gentle manipulation, the spleen was extracted through the vagina without any architectural distortion. The vaginal cuff was then repaired in a routine manner. This avoided a large incision in the abdomen. Estimated blood loss was 150 ml. The spleen weighed 425 grams. Patient recovered well from the surgery.

Conclusions

Use of natural orifice for solid tumor extractions may be feasible in selected patients without oncological compromise. Laparoscopic resections for massive splenomegaly, although challenging, can be safely accomplished even in a community setting. Concomitant laparoscopic gynecologic and general surgery procedures can be done with good functional outcomes.

Keywords

Laparoscopy; Natural Orifice; Splenectomy; Vaginal Hysterectomy

WJMSCR Article No. 15: Lipoma Tongue - A Rare Site for Common Tumor

8/1/2013

Although lipomas are among the most common mesenchymal neoplasms, only 1-4% affects the oral cavity. Lipoma of the tongue represents about 0.3% of all benign lesions of the oral cavity [1, 2]. These soft tissue tumors of adipose tissue origin may not derive our attention as such but the site of its presence paves way for driving our attention. Lipoma of tongue is a rare site for a common tumor. Herewith, such a case is presented for its rarity of site.

WJECP Article No. 5: Assessing the occupational history of breast cancer patients undergoing radiation therapy and chemotherapy: retrospective-study

8/1/2013

Background

Breast cancer, a disease of both the developing and the developed world’s is the leading type of cancer in women. Its incidence in a year is approximately 20-25 per 100,000 women, varying from region to region, and this rate is continuously increasing over the past decade. There is contradictory evidence on whether occupation is a risk factor for breast cancer. It has been reported that clerical workers, teachers, medical and health care personnel, agricultural workers, and some industrial workers are at greater risk of developing breast cancer. Our study aims at assessing the occupational history of breast cancer patients undergoing radiation therapy and chemotherapy

Materials and Methods

A self-administered questionnaire on socio-demographic, known risk factors and occupational history was given to eighty-one breast cancer patients undergoing radiation therapy at the Korle-Bu Teaching Hospital. SPSS software version 14 was used to analyse the data.

Results

Eighty-one eligible breast cancer patients undergoing radiotherapy and chemotherapy participated in the study. The age range was 31-76 years and the mean age was 51.7 years (standard deviation of 10.9 years). 70.3 of the participants at the time of study were married and 22.2% indicated that they had basic education. Most (75.3%) of the patients were employed. Majority of the participants were traders (50.8%) with a minimum working duration of 8 years and a maximum of 49 years. 87.7% of the participants had never worked with equipment and 18.5% of the participants had been working with chemicals.

Conclusions

The study identified trading to be the major occupation among the participants. There was however increased alcohol consumption among the participants

Keywords

Occupation, Breast cancer, Risk factor

WJMSCR Article No. 14: Recurrent Penile Fracture

7/27/2013

The fracture of the penis occurs when an erect penis is subjected to a blunt trauma that bends it abnormally. The tear in the tunica albuginea is usually transverse. Urethral injury occurs in 20% of these patients. Surgical treatment consists of exposure of the fracture site by a local incision or by degloving the penile skin from a distal circumcoronal incision1 and suturing the tear in the tunica albuginea with absorbable1, 2 or non-absorbable sutures. Collagen deposition is complete 6 weeks after the injury but there is a continuous gain in the tensile strength of the scar for 2 years, caused by remodeling of collagen.

WJECP Article No. 4: Study on high risk factors of breast cancer amongst working women from Delhi, India.

7/26/2013

Introduction

Breast cancer is on the rise in urban population of India. It is imperative to identify the high risk factors of this disease and screening practices of the women.

Study design

Descriptive, cross- sectional

Materials and methods

The community based study was conducted in all the women more than 20 years of age working at 10 different offices at Delhi, India. All those women who attended the breast cancer early detection programme conducted at their offices during 2012-13 were included in this study. Self administered questionnaire were used to collect the necessary data. Data was entered in Microsoft Excel and SPSS version 21 was used to analyse the results

Results

The present study was conducted in a total of 721 women from 10 offices of Delhi where only 12.2% had reached menarche before 12 years of age. From amongst the married women 24(4.3%) delivered their first child after 30 years of age. 96.7% of the married women with children had breast fed their new-born. History of oral contraceptive use was present in 301(41.7%) of the women. Only 48(6.6%) of the women had ever taken HRT. Red meat was not consumed by 452(62.6%) of the women and only 28/721(3.9%) consumed red meat 3 times or more in a week .Physical exercise of 30 minutes 5times or more per week was undertaken by only 49(6.8%).321(44.5%) of the women were overweight and 274(38%) obese. 19(2.6%) of the women had themselves undergone treatment for breast cancer. Main perceived reason for cancer of the breast cited by women was diet (adulteration/pesticides) 487(67.5%) followed by family history of breast cancer by 459(63.7%). Only 32(4.4%) had ever examined their breasts. None had gone for a clinical breast examination as a screening method and only five (0.7%) had gone for a screening mammogram from their side.

Conclusion

Overweight and lack of physical activity are widely prevalent in women. Also perceptions about the causes of breast cancer and practice of screening are poor. This calls for efforts to make them aware about the disease and the screening modalities.

Key words

Breast cancer, high risk factors, working women, screening.

WJSR Article No. 9: Unilateral Primary Ovarian Leiomyoma With Degeneration Masquerading As Ovarian Malignancy

Method

retrospective study of 317 consecutive breast cancer patients cT1-T2 (<3cm), treated from January 2001 to December 2005 and followed at least for 7 years till 31st December 2012. Events recorded were: axillary lymph node relapse, ipsilateral breast tumor recurrence (BTR), contralateral breast cancer, and distant metastasis (DM). /p>

Results

axillary recurrence occurred in 1 out of 190 SLN negative patients (0.5%). BTR occurred in 16 patients (5.0%), with a median of 20 months from RT. In multivariate analysis HER2+++ status was the only risk factor related to BTR. A BTR related to poor prognosis, as 38% developed metastasis. DM occurred in 7.9% with a median of 2.5 years from surgery. 6 years cancer related survival was 93.4% (297/317) and disease free survival was 88.6% (281/317).

Conclusion

adjuvant radiotherapy, in combination with standard systemic therapy, in early staged breast cancer patients provides excellent long term cure rates with low locoregional relapses. Risk factors identification and surgical stagement with SLN biopsy constitute an optimal approach in breast cancer management.

WJP Article No. 10: Dermatofibrosarcoma Protberans of Breast

6/15/2013

Dermatofibrosarcoma protuberans is a rare soft tissue tumour of the skin with the potential for intermediate malignancy [1]. It is a rare, locally aggressive but rarely metastasizing tumor of the deep dermis and subcutaneous tissue. It may occur at almost any site but is more common in the trunk and extremities [2, 3]. Breast is the rare site of occurrence of this entity. It is characterized by local invasion and recurrence. We report a rare case of DFSP of breast in a 14 year old girl.

AbbreviationsDFSP-dematofibrosacoma protuberance, FNAC-fine needle aspiration cytology, MRI-magenetic resonance imaging, IHC-immunohistochemistry

WJMSCR Article No. 11: Mega colon Secondary to Chronic Constipation

Results

Ependymomas constitutes 5.6% of total intracranial tumours. 81 patients were diagnosed as ependymoma based on CT scan or MRI but only 63 patients were histologically proved to be cases of ependymoma. CT scan showed low density tumours in fifty one cases; only one tumour was somewhat of high density. Tumour was hypo intense in T1 and hyper intense in T2 in all the 11 cases. Eighty one percent of tumours were homogenously enhancing and only 19% showed heterogeneous enhancement. Hydrocephalus was present in 63.5% patients. Calcification was seen in 25.4% patients.

Conclusion

Intracranial ependymoma constitute a significant proportion among brain tumours. CT scan and/or MRI are required for early detection and better management.

Introduction

WJMSCR Article No. 10: Hair Dye Imitating Multiple Basal Cell Carcinoma of the Scalp

5/21/2013

Basal cell carcinoma is the most common malignant skin tumor. Multiple basal cell carcinomas are frequently developed in patients receiving ionizing radiation at a younger age. We present a case of multiple pigmented lesions on the scalp of a 65-years-old female with a history of radiotherapy for the treatment of tinea capitis at her childhood and a histologically confirmed basal cell carcinoma 2 years ago. The use of dermatoscopy prevented us from a misdiagnosis. This case of hair dye imitating pigmented BCC in a patient specifically prone to this type of tumor should be in mind of any plastic surgeon or dermatologist before scheduling a patient for surgery so one can avoid the stress and unpleasantness of unnecessary surgery.

Key words

Basal cell carcinoma, Skin Cancer, Tinea capitis, Radiation therapy, Dermoscopy.

WJMSCR Article No. 9: A case of Multiple Bilateral Trigger Digits: Injection or Surgery?

5/18/2013

Trigger finger is one of the most common problems presenting to hand clinics in the UK [1]. Characterised by catching or locking on extension of the flexed digit it can affect all the digits in the hand [3] with the ring, thumb and middle finger most frequently affected [1, 5] . The incidence of multiple digits being affected is between 20% [5] and 24% [6], with a higher Incidence in Diabetes Mellitus sufferers [5]. The most successful methods used to treat trigger finger are corticosteroid injection and surgical release [1, 11]. We report an extreme case of a patient with eight trigger digits in whom corticosteroid injection had previously failed, review the literature and advocate the use of surgical release as an earlier treatment option in those patients with multiply involved digits.

WJSMRO Article No. 5: Hyperinsulinemic Hypoglycemia due to Diffuse Nesidioblastosis in Adults

5/18/2013

Background

Nesidioblastosis is a rare cause of adult-onset hyperinsulinemic hypoglycemia. We describe a 28-year-old lady who presented with sudden loss of consciousness. Hyperinsulinemic hypoglycemia was found.

Material and Methods

Preoperative imaging’s and intraoperative ultrasound failed to identifiy any pancreatic insulinoma. Selective intra-arterial calcium stimulation with venous sampling showed an elevated insulin level within the distal splenic vein. Open distal pancreatectomy was performed.

Results

Histopathology confirmed nesidioblastosis.

Conclusions

Her recovery was uneventful.

Keywords

Hyperinsulinemic hypoglycemia; Adult nesidioblastosis; Distal pancreatectomy, insulinoma.

WJSMRO Article No. 4: Time for Change in Particle Therapy of Intraocular Tumors

5/9/2013

This article has no abstract

WJSMRO Article No. 3: Neoadjuvant Radiochemotherapy in the Multidisciplinary Treatment of Rectal Cancer

5/8/2013

Introduction

Rectal cancer is one of the most common malignancies in the Western world. More than 50% of tumours are diagnosed at a locally advanced stage. The multidisciplinary approach is the gold standard in the treatment of rectal cancer. With total mesorectal excision (TME), introduced by Heald R. J, and the development of specific neoadjuvant radiochemotherapy treatments (NRCT), a significant impact in local recurrence rates, downsizing, down staging, clinical complete response (cCR) and pathological complete response (pCR) has been reached. NRCT and surgery are the most important determinants in reaching pCR and local control of disease.

Materials and Methods

A total of 11 patients (with stage II and III rectal cancer treated in our Institute between 2004 and 2011 were included in our study: 5 males and 6 females, average age 67,82 (range 54-77 years). In all patients, the diagnosis was performed with colonoscopy and histology. The staging in all patients was carried out with a total body CT scan and a trans-rectal ultrasound examination. All patients underwent long-course neoadjuvant radio-chemotherapy (details in table).

Results

All but one of the patients is still alive. No patient had local recurrence at follow up; pCR was observed in 4 patients; downstaging was seen in 5 patients; no response was observed in 2 patients. The results of the multidisciplinary treatment of our cases are shown in table 1. In 4 cases, it was necessary to briefly discontinue the NRCT treatment due to toxicity. We had no complications in the peri-operative period. One male patient is suffering “impotentia erigendi”, and 2 patients report impaired defecation.

Discussion

Treatment of rectal cancer has dramatically improved over the last twenty years. Before the introduction of TME, the local recurrence rates were between 20 and 40%. In recent decades, NRCT has emerged in the treatment of stage II-III rectal cancer. In particular, the EORTC study showed that the association of NRCT treatment combined with surgery has a considerable impact about reduction of local recurrence rates: they are at 7.6%. NRCT is well tolerated by patients. We can state the efficacy of NRCT in the absence of correlated peri-operative morbidity.

WJMSCR Article No. 8: Rhabdomyolysis Induced by a Mild Case of Salmonella Gastroenteritis

5/7/2013

Rhabdomyolysis is a rare complication of Salmonella infection. We report a case of a 19-year-old male who presented with gastroenteritis, and was found to have rhabdomyolysis without other severe complications. It is important to recognize that a mild case of gastroenteritis may have accompanying severe clinical complications, such as rhabdomyolysis.

WJMSCR Article No. 7: Contact Angioedema of Male Genitalia after use of Emla Cream Towards Routine Neonatal Circumcision

4/29/2013

Introduction

Routine neonatal circumcision is commonly performed under topical anesthesia with a eutectic mixture of lidocaine and prilocaine (EMLA). We report that such anesthesia runs the risk of complications that may actually impede the performance of this procedure in the event of a hypersensitivity reaction. We report to our knowledge the first case of contact angioedema in a neonate towards routine circumcision.

Case report

After 30 weeks of gestation, a first born male premature infant weighing 1,230 grams was born with esophageal atresia and duodenal obstruction. At the age of two days a gastrostomy feeding tube was inserted and he was transferred from a local to a major medical center for correction of a tracheo- esophageal fistula and a right inguinal hernia. Following thoracotomy and herniorhaphy, eventually the feeding tube was removed. He gradually improved and at 6 months old the baby was recommended to perform circumcision. Emla cream was applied with polyethylene sheet closure one hour before the procedure. At the ceremony hall, upon exposure the genitalia was revealed an open prepuce with swelling extending towards the proximal shaft precluding any possibility of inserting the guard traditionally used in guillotine circumcision. Subsequently some of the swelling subsided and patiently waiting allowed guard insertion and successful routine circumcision despite the ensuing swelling.

Conclusions

This case stresses the importance of adherence to instructions and appropriate follow up when prescribing medication even for topical use. EMLA cream should be used judiciously due to its possible risk of immediate allergic reaction.

Keywords

Prepuce excision, topical anesthesia, penile hypersensitivity, allergic reaction.

WJMR Article No. 2: Association of E-selectin A561C (S128R) and G98T gene polymorphism with essential hypertension in a Chinese population: a meta-analysis

4/14/2013

Background

Gene polymorphism is considered to contribute in the etiology of essential hypertension (EH). In particular, E-selectin (SELE) gene is one of the candidate genes susceptible to EH. Moreover, SELE A561C (S128R) and G98T gene polymorphisms have been suggested to be associated with the increased risk of EH, but the results are still inconsistent.

Material and methods

The present study aims to evaluate the association of SELE A561C and G98T gene polymorphisms with EH. Nine separate studies on the relationship of SELE A561C and G98T gene polymorphisms with EH were analyzed through meta-analysis. Among these studies, five were for A561C with 1662 subjects, and four studies were for G98T with 1356 subjects. Pooled odds ratio (OR) and its corresponding 95% confidence interval (95% CI) were calculated using the fixed effect model.

Results

SELE A561C and G98T gene polymorphisms were found to be significantly associated with EH under a dominant genetic model and an allelic genetic model. The pooled ORs for AC+CC/AA genotype, frequency of C allele, GT+TT/GG genotype, and frequency of T allele were 2.39 (95% CI: 1.68–3.39, P < 0.00001), 2.07 (95% CI: 1.50–2.86, P < 0.00001), 1.63 (95% CI: 1.07–2.47, P = 0.02), and 1.51 (95% CI: 1.01–2.26, P = 0.04), respectively.

Conclusions

The current meta-analysis suggests that the SELE gene polymorphisms of the C allele and CC genotype of A561C as well as the T allele and TT genotype of G98T might be related to EH susceptibility in the Chinese population.

Keywords

E-selectin, A561C, G98T, gene polymorphism, hypertension, meta-analysis.

WJSR Article No. 8: The Effect of Lagenaria Siceraria (Molina) on Acute Lung Injury Induced by Oleic Acid in Rats

4/8/2013

Aim

Oleic acid has been used to induce acute lung injury in experimental studies. Lagenaria siceraria (Molina) has been reported to have cardiotonic, hepatoprotective, immunomodulatory, antihyperglycemic, antihyperlipidemic, analgesic and anti-inflammatory properties. In this study, we investigated the effects of Lagenaria siceraria (LS) fruit juice on acute lung injury induced by oleic acid in rats.

Material and Method

Thirty five adult female Sprague Dawley rats divided into 5 groups, 7 in each. Group I and group II received normal saline for 30 days, group III, IV and group V received LS at a dose of 200 mg/kg, 200 mg/kg and 400 mg/kg for 30 days by gavage respectively. 100mg/kg oleic acid was administered i.v in group II, group IV and group V. Histopathological examination of the lung was performed with light and electron microscopy. Levels of protein carbonyl, malondialdehyde, superoxide dismutase, catalase and glutathione peroxidase levels were measured in tissue samples. Levels of TNF alpha, IL10, IL6 and total tissue oxidant status and total tissue antioxidant status were measured in serum samples.

Results

Light microscopy showed that LS at both doses decreased the total lung injury score compared to group II. In electron microscopy, LS at both doses decreased the thickness of the fused basal lamina when compared to group II. TNFα, IL6 in serum and MDA in tissue were higher in group II when compared to group me and attenuated in group V significantly.

Conclusion

Lagenaria siceraria attenuated the extent of acute lung injury induced by oleic acid in rats.

Key Words

Lagenaria Siceraria, lung injury, oleic acid, pneumocyte.

WJMSCR Article No. 6: A Unusual Case of Dislocation of The Foot

Cerebral malaria is uncommonly diagnosed amongst adult in endemic areas in Africa and South-East Asia. It is the most common neurological complication of plasmodium falciparum malaria. It has few specific clinical symptoms with differences in presentation between children and adults. Sequestration of infected red blood cells within cerebral vessels is the main pathological basis of this disease.

We present a case of a- 45 year old Nigerian who died of cerebral malaria despite living all his life in Nigeria (A malaria endemic area for years). Investigation also did not reveal any form of immune suppression.

In this case, autopsy findings show enlarged salty-grey liver and brain with global punctuate hemorrhages in the grey and white matter. Cut surfaces of the slightly enlarged spleen revealed dark red diffluent.

Histopathological examination revealed the presence of parasitized red blood cells with malaria pigment (haemozoin) in blood capillaries within the brain and the lungs.

This case presents a paradox that contradicts the epidemiological impression that the development of immunity during childhood offers protection against severe infection in adult life. It is also presented for pathologists, most importantly forensic pathologist to bear in mind the possibility of an elderly person having cerebral malaria as a cause of sudden death in malaria endemic regions.

Key words

Cerebral malaria, P. Falciparum, parasitized red blood cells.

WJMSCR Article No. 5: Collision tumor of the thyroid: follicular carcinoma plus papillary carcinoma plus adenomatous goiter

4/2/2013

Introduction

The combination of three different types of collision tumors in a single thyroid gland is an unusual event. The term “collision tumor” represents the coexistence of two or more histologically distinct tumors in close proximity to each other.

Case report

We report the case of a 78-year-old female who presented with a cervical swelling. Histopathological findings revealed a true “collision tumor” with components of both follicular and papillary carcinomas.

Discussion

Whether the etiology of neoplastic transformation istumorgenic stimuli or the collision phenomenon remains controversial.

Key words

Collision tumor, Thyroid carcinoma, Histopathology.

WJMSCR Article No. 4: Insular Thyroid Microcarcinoma with Precedent Adenopathy – Peculiar Subset of Malignant Tumor

4/1/2013

Background

A case report of a patient with insular thyroid carcinoma, a poorly differentiated subtype of thyroid tumor with intermediate aggressiveness and prognosis between well-differentiated and anaplastic thyroid malignant lesions is presented.

Case Report

A 59 year old man with an apparent isolated huge lateral cervical adenopathy was directed to our clinic. The thyroid and other cervical structures were clinically inapparent and also could not be identified by imaging methods. Fine-needle aspiration biopsy showed aggregates of small, monomorphic cells with scant cytoplasm, round nuclei with granular chromatin and rare mitosis oriented the diagnosis towards a follicular thyroid carcinoma metastasis.

While intraoperatively completing the selective cervical dissection, a solitary centrolobar micronodule (5 mm) was identified and a total thyroidectomy was done. Microscopy showed neoplastic cells arranged in nests (insulae) separated by hyaline stroma, with grooved nuclei, rare mitosis and necrotic areas diagnostic for insular carcinoma. Complementary radioiodine therapy allowed a stable cure at 36 months follow-up.

Discussion

Appearance of these tumors with rapid evolution in which only precocious diagnosis (although not always possible) orienting the patient towards radical surgery completed by 131 I therapy, both assuring in 1/3 of cases a real chance of cure, to the poorly differentiated thyroid carcinomas is underlined.

Conclusion

Together with the rarity of this subtype of thyroid neoplasia, must be mentioned the precedency of the cervical adenopathy to the primary subclinical microcarcinoma and also the efficacy of the association between radical surgery with 131 I radiation.

Key Words

Insular thyroid microcarcinoma, fine needle-biopsy, prognosis, total thyroidectomy.

WJSR Article No. 6: Epidemiological evaluation of Intracranial Ependymoma

3/25/2013

Introduction

Ependymomas are infrequently seen tumours that have been defined as neoplasms arising from ependymal cells lining the ventricles and the central canal of the spinal cord.

Material and method

Results

Ependymomas constitutes 5.6% of total intracranial tumours. Mean age of all patients was 17.63 years, Fifty eight patients had headache at presentation. Nausea, vomiting, papilloedema and cognitive impairment were present in majority of patients. This can occupy supratentorial or infratentorial compartment of brain.

Conclusion

Intracranial ependymoma constitute a significant proportion among brain tumours so high index of suspicion is required for early detection and better management.

WJP Article No. 7: Maternal Anemia and its Correlation with the Oxidative Stress in Cord Blood

3/25/2013

Background

To find out the effect of maternal anemia on oxidative stress in neonate and to correlate oxidative stress with severity of maternal anemia and birth weight.

Methods

WJMSCR Article No. 2: A case report of Hibernoma focusing on ultrasonographic analysis

Case report

The authors reported 2 cases of appendicular carcinoid on 320 consecutive appendicectomy in the last two years and described clinical features and therapeutic approach for this art of tumors. Appendicectomy in little tumors (< 1 cm) is a gold standard for the treatment and the radical resection is often healing, if the tumor size is mean (between 1 and 2 cm) the resection (appendicectomy vs hemicolectomy) is subject to the valuation of individual case, while the right hemicolectomy is considered according to tumor size (> 2 cm), incomplete tumor resection and/or histological features (medium and high grade, mixed histological).

Conclusions

The size of the tumor is a standard that influences both surgical strategy, both prognosis.The carcinoid of the appendix presents favorable prognosis as regards carcinoid tumors of the gastro enteric tract.

Key words

Appendicular carcinoid well differentiated neuroendocrine tumor, appendicectomy.

WJSR Article No. 2: Rare Presentation of Inguinal Hernia in Female: A Case Report

1/17/2013

Inguinal hernia with uncommon contents in the hernia sac has been reported in the literature. Preoperative ultrasound can be helpful to diagnose the presence an uncommon content in the hernia sac. Here we report a rare case of adult female having inguinal hernia with sac containing atrophied uterus.

Keywords

Hernia, uncommon contents, atrophied uterus.

WJSMRO Article No. 1: Multimodal Treatment of Mediastinal Follicular Dendritic Cell Sarcoma: a case report successfully treated

1/16/2013

Follicular Dendritic Cell Sarcoma (FDCS) is an extremely rare malignant tumour of unknown etiology which, just to its heterogeneity, is not always easily recognized, diagnosed and accurately treated. To date only 49 cases of FDCS are reported in Literature. There could be a difficult differential diagnosis with metastatic carcinoma, ectopic thymoma or primary – metastatic malignant fibrous histiocytoma. Superficial and deep lymph nodes in axilla and more rarely in inguinal sites, are usually involved with aspecific symptoms, very rarely intra-abdominal structures are interested. A mediastinal localization of this tumour is even more rare. An accurate diagnosis is very difficult and is often obtained on surgical specimen and only with immunohistochemical studies. The treatment of first choice for this pathology is surgical excision, whatever is the site of the lesion; radio - chemotherapy could be considered as adiuvant treatment, in case of incomplete excisions, or principal treatment of local recurrences or distant metastases, whose rates vary between 24 and 43% of cases. This combinated therapy seems to be the key of good survival rates. We present a case of a 42 years old young man affected by mediastinal FDCS, successfully treated with surgical complete excision of the mass and radiotherapy.

Keywords

Follicular dendritic cell sarcoma, spindle cell sarcoma, lymph node involvement, mediastinal site, surgical therapy.

WJSR Article No. 1: Laparoscopic Excision of Mesenteric Cyst

1/12/2013

Mesenteric cyst is a rather uncommon disease. It is classified into four types namely chylolymphatic, enterogenous, urogenital remnant and dermoid (teratomatous). They may be asymptomatic or may present with recurrent abdominal pain or even as an acute abdomen. Laparoscopic management of this condition is feasible and rewarding.

Key words

Mesenteric cyst, chylolymphatic, excision, laparoscopic.

WJP Article No. 1: Giant Right Renal Cyst Mimicking Intra-abdominal Malignancy: A Unique Fnding.

1/12/2013

Introduction

Simple cysts are the most common cystic abnormality encountered in the kidney and are caused by large family of hereditary, sporadic, developmental and acquired disorders. Most increase with age and appear to grow more rapidly in younger patients. Association with renal cell carcinoma and hypertension has been reported. Giant renal cyst measuring more than 15.0cm in diameter and containing more than 1500mls of serous fluid are rarely seen.

Case report

We report a case of giant right renal cyst in a 22- year old female of the Yoruba ethnic group in Western part of Nigeria. The cyst measured 60.0 x 42.0 x 25.0cm, with 20,600mls of serous fluid and weighing 12,145gm. She underwent radiological and other routine investigations and subsequently had laparotomy with total excision. Histology confirmed the diagnosis of simple multi-locular renal cyst. The patient had uneventful recovery period and subsequently discharged home after a week in the hospital.

Conclusions

Renal cyst can reach enormous size. This to the best of our knowledge is the largest renal cyst in the medical literature. Studies are needed with particular attention to the factors associated with and if possible the etiology of rapid renal cyst enlargement, the association with hypertension and renal cell carcinoma.

Key words

Giant, cyst, intra-abdominal, renal.

WJMSCR Article No. 1: Anesthetic management of a child with type І homocystinuria

1/6/2013

Homocystinuria is a rare autosomal recessive disease with multiple systemic manifestations, which is classified into three types (type's Ι-III). Here we report an 8-year-old boy who required anesthetic care during an ocular surgery including lensectomy under general anesthesia. Proper precautions should be taken during anesthetic management of such a patient since some particular Anesthetic complications like preoperative thromboembolism and hypoglycemia may worsen the course of Anesthesia. We provided successful anesthetic management for our patient and he was discharged without subsequent complications.

WJMAS Article No. 1: Gasless single-incision laparoscopic cholecystectomy: Preliminary results

1/6/2013

Introduction

Laparoscopic cholecystectomy has usually been performed using three or four ports. As expertise with the technique has improved, however, we have begun to use only one or two ports. Here we report differences between the previous and present methods of gasless single-incision laparoscopic cholecystectomy (SILC).

Patients and methods

Twelve patients (7 males and 5 females aged between 30 and 75 years, mean 56.5 years) were enrolled in this study. The mean BMI was 25.8 (range: 22.5-37.1) kg/m². They were divided into two groups depending on the procedural period (Group1, November 1997-June 1998, and Group 2, December 2009-March 2010). Under general anesthesia, a 2.5 cm vertical incision was made at the umbilicus, and the operating field was created using the original abdominal wall-lift method with a rigid bar. Two 5-mm ports were placed through the same umbilical incision but through separate fascial incisions. After exposing the Calot triangle, the hilum of the gallbladder was dissected laterally and medially to expose the cystic duct and artery, which were then ligated with clips and divided with scissors or coagulating shears. The gallbladder was retrieved using a retrieval bag.

Results

We performed SILC successfully in 10 cases, and the other 2 in Group 2 required conversion to SILC with pneumoperitoneum due to difficulty with the surgical procedure. However, none of the procedures required conversion to open cholecystectomy or addition of other ports. The mean operation time and postoperative hospital stay was 202 min and 7.0 days, and 115 and 3.2 in Group 1 and 2, respectively. There were no intra- or postoperative complications.

Conclusion

Although evaluation of our operative outcomes is still premature due to lack of sufficient experience, our present series shows that gasless SILC is technically feasible and safe for any surgeon sufficiently experienced in the standard technique of laparoscopic cholecystectomy and has additional aesthetic and cost advantages.

WJSMRO Article No. 23: A rare case of Adrenocortical oncocytic neoplasm presenting with Abdominal lump: a case report

12/21/2012

Oncocytic neoplasms are composed of oncocytic tumor cells, which are characterized by having large, eosinophilic, granular cytoplasm owing to the aberrant accumulation of mitochondria [ 1]. The most commonly reported sites for oncocytic neoplasms are the Thyroid, kidney and Salivary gland. Oncocytic neoplasms of the adrenal cortex are extremely rare. We report here a case of oncocytic neoplasm of the adrenal.

WJSMRO Article No. 22: Impact of Body Mass Index on Treatment Outcomes of Adjuvant Radiation Therapy in Saudi Females with Endometrial Carcinoma

12/18/2012

Background

Aim was to evaluate the impact of body mass index (BMI) on locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) in patients with endometrial carcinoma (EC) treated with adjuvant radiotherapy.

Materials and methods

Between June 2006 and July 2011, 66 patients with EC received adjuvant radiotherapy. Median age was 58.02 years (40-88). Mean BMI was 35.9 kg/m² (23-72); BMI < 24 kg/m² (normal weight) in 3 (4.5%), BMI 25-30 kg/m² (overweight) in 19 (28.8%), BMI 31-40 kg/m² (obese) in 20 (30.3%) and BMI > 40 kg/m² (morbid obese) in 24 (36.4%).

Results

Median follow-up was 55 months (6-60). The Kaplan-Meier estimates of LRC, DMC, DFS and OS were 83.3%, 74%, 78.6% and 66.3% respectively. Patients with BMI > 30 kg/m² showed inferior LRC (74.5%-80%) with p 0.003 and inferior OS (55%-61.4%) with p value 0.001. No inﬂuence of BMI on DMC and DFS was seen { hazard ratios of 0.97 (0.78-1.24) and 0.99 (0.81-1.26) respectively}. There was positive correlation of daily treatment setup errors with BMI > 30 kg/m² (p 0.001). No correlation with found between BMI and radiation toxicity.

Conclusion

Patients with EC and high BMI had inferior LRC and OS. Emphasis shall be given on adjustment of setup errors during radiotherapy and on implementation of a national obesity prevention program.

WJSR Article No. 8: What is new in Diagnosis of Tuberculosis

12/8/2012

Tuberculosis is an infectious disease caused by acid-fast bacillus Mycobacterium tuberculosis. It most commonly affects the pulmonary and less commonly the extra-pulmonary sites. It is one of the leading causes of global mortality and morbidity. Despite being such a common disease, the accurate, reliable and rapid diagnosis of tuberculosis has always been challenging even after years of research. Recently, the diagnosis of tuberculosis has reached a new horizon with the advent of molecular diagnostic methods. Still today, mycobacterial culture remains the reference standard test and majority of the newer approaches serve as a compliment to sputum smear microscopy and culture. Rapid diagnosis of drug resistance has opened new channels in the management of tuberculosis demanding the need for the development of effective treatment against MDR and XDR tuberculosis.

WJSMRO Article No. 21: Multilocular radiolucency of anterior mandible

11/30/2012

A multilocular radiolucency in the anterior mandible in a 54 year old patient is presented and discussed as a clinic-pathologic conference. The differential diagnoses considered and algorithm used to arrive at the diagnosis with a review of literature is presented.

WJSR Article No. 7: Port Site Hernia after Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis

11/30/2012

Background

In the era of laparoscopic surgery,the gall stones in the patient of situs inversus totalis being treated by laparoscopic method invites lot of challenges in carrying out the procedure as the port placement,position of the surgeon and camera person changes.

Case Report

Herein,we report a case on a patient of situs inversus who successfully underwent laparoscopic cholecystectomy and later presented with port site hernia.

Discussion

Port site hernia is a well known complication but the port site hernia in a patient of situs inversus totalis is not described.

WJP Article No. 17: Expression of vascular endothelial growth factors (VEGF) in head and neck squamous cell carcinoma and adjacent normal tissue

11/23/2012

The prognosis in the head and neck squamous cell carcinoma depends upon the lymphnode status, margin and distant metastasis. Tumor recurrence has been seen inspite of negative margin reported by the pathologist. This has led to the hypothesis that cells have transformed themselves genetically at the molecular level and escape the recognition of the microscopic eye and later phenotypically express as cancer during follow-up.

Angiogenesis is essential for tumor growth and metastasis. Therefore, vascular endothelial growth factor (VEGF) expression increases chances for local relapse, lymph node recurrence and distant metastasis. In this study we have investigated the expression of vascular endothelial growth factor (VEGF) in tumor tissue and adjacent normal tissue and correlated their expression with lymph node metastasis.

Out of 101 patients, 86 (85.1%) patients showed positive expression of VEGF in the tumour tissue. Of these 86, 67 patients showed positive expression for VEGF in the adjacent normal tissue (chi-square = 8.730, p value = 0.0003 with contingency coefficient 0.204). Of the 101 patients, 77 (76.2%) patients were found positive for the cervical lymphnodes. The Pearson correlation coefficient (r) was 0.203 with p value = 0.004 with confidence interval of r = 0.0086-0.3839.

Thus increased expression of VEGF in adjacent normal tissue in the head and squamous cell carcinoma might be the cause of the tumor recurrence or a second primary disease during follow-up and can used as target for the adjuvant therapy in such patients.

Key words

vascular endothelial growth factor (VEGF), surgical margin, local recurrence, head and neck cancer.

WJP Article No. 16: Immunology of lung cancer

11/11/2012

Lung cancer is the most common malignant disease. This cancer is basically derived from epithelial cells. Increased knowledge of immunology and current therapies has opened perspectives for the use of immunotherapy in the management of lung cancer patients.

In the present communication lung cancer immunotherapy is studied in detail. Both active and passive immunotherapy is used for diagnosis and treatment. Active immunotherapy includes tumor antigens. Tumor antigens are antigenic substances produced in tumor cells and are potential candidates for use in cancer therapy.

Passive immunotherapy includes both humoral and cell mediated immune response. Humoral immune response study was carried out by using monoclonal antibodies. Recent advancement in monoclonal antibody technology provides new approaches for lung cancer treatment and diagnosis. Cellular immune response against tumor mediated cells included natural killer (NK) cells; lymphokine-activated killer (LAK) cells; cytolytic T lymphocytes (CTL); and activated macrophages. These cells alone or with cytokines or interferon’s provide new efficient therapeutic approaches. Studies have also shown additional anti-tumoral effects using these cells and molecular bioengineering. Recently adhesion molecules have also documented their role in immune response. This communication also includes immunocompetence of lung cancer patients.

The advancement in studies has revived the dream of designing tumor vaccines and active specific immunotherapy.

WJPSO Article No. 5: Rehabilitation of the Cancer Patient

Case Report

We present here a case of 25 year old male who presented with persistent vomiting and was diagnosed as having tuberculosis on endoscopic biopsy examination. The patient was successfully treated with four drug anti tubercular treatment without any surgical intervention.

Conclusion

High degree of suspicion is needed as the tuberculosis may mimic numerous other benign and malignant diseases.

WJP Article No. 14: Search for cancer treatment continues: Procathepsin D

10/18/2012

Cathepsin D (CD) has been identified as an aspartic protease involved in protein degradation in the acidic environment of the lysosome, but studies done over the years showed its involvement in other processes like apoptosis, antigen processing, tissue homeostasis suggesting that the enzymatic activity of CD is confined not only to lysosome. Moreover, the enzymatically inactive form of CD, procathepsin D (pCD), has also been shown to be involved in processes like apoptosis and neoplastic growth. Numerous studies done over the past two decades have shown that cancerous cells secrete pCD which acts as a mitogen for both cancerous cells as well as stomal cells by contributing to the processes like angiogenesis, invasion, metastasis and proliferation. In this review, we will discuss the about various forms of CD and their role in different physiological and pathological conditions of cells.

WJSR Article No. 6: Pneumo-cholecystitis in a jaundiced patient presenting with pneumoperitoneum

10/18/2012

Background

Pneumo-cholecystitis is a rare disorder comprising approximately 1% of cases of acute cholecystits. Impaired vascularity with superimposed gas forming bacterial infections leads to pneumo-cholecystitis. Advanced age, diabetes mellitus, impaired immunity, atherosclerosis are predisposing factors.

Case Presentation

We managed a case of pneumo-cholecystitis in a jaundiced patient with hepatitis B infection, who presented with pneumoperitoneum. A thirty five year female had pain abdomen localized to right upper quadrant of abdomen for four days. Vague and tender lump (4cm x 7cm) below right subcostal margin and just lateral to rectus muscle was found on examination. Lab investigations revealed hepatitis B infection with deranged liver functions. Plain X-ray abdomen in revealed free gas shadow under diaphragm. USG revealed distended gallbladder but CT scan showed free gas in peritoneal cavity with distended gallbladder and gas in gallbladder lumen, wall and pericholecystic region settling the final diagnosis of pneumo-cholecystitis. She was clinically stable and no signs of peritonitis were present. Although treatment of choice for pneumo-cholecystitis is splenectomy we postponed surgery due to deranged liver function tests and hepatitis B infection and conservative treatment was used. Patient was discharged after one week and doing well during a follow up of 11 months.

Conclusion

Spontaneous pneumoperitoneum is an extremely rare finding in pneumo-cholecystitis. It should be ascertained that no visceral perforation is present, before proceeding for conservative management.

WJSMRO Article No. 20: Presence of Human papilloma virus and EGFR expression does not predict response to Neoadjuvant chemotherapy in oral cancer

10/18/2012

Introduction

Approximately 25% of head and neck squamous cell cancer, especially oropharangeal cancers are associated with high risk HPV-16, 18, 31, 33, and 35. Patient with HPV-16 related tumors tend to be younger, have smaller primary lesions and experience improved survival compared with patient with HPV-16 negative tumor. Studies have shown a 60 to 80% reduction in the risk of cancer death in HPV positive tumors. Similarly, both high EGFR expression and low HPV titer are associated with poor outcome. This study was carried out to correlate the response of neoadjuvant chemotherapy with presence of HPV and EGFR expression in oral cancer.

Patients and Method

HPV status by PCR and the EGFR expression by IHC was studied in 20 patients of locally advanced squamous cell oral cancer receiving neoadjuvant chemotherapy with docetaxel and carboplatin. Response was evaluated with RECIST criteria. Mean, median and standard deviation were calculated for continuous variables. Responses were correlated with positivity of HPV asserted by PCR and EGFR status.

Results

Majority of the cases had primary tumor of buccal mucosa (25%), lower alveolus (25%) and tongue (25%). HPV 16 was positive in 5 patients (25%), while none of the patient had HPV 18. Level of EGFR expression was 1+ in 6 (30%) 2+ in 5 (25%) and 3+ in 9 patients (45%). 14 patients (70%) were given 3 cycles, 2 patients (10%) 4 cycles, 3 patients (15%) 5 cycles of chemotherapy. complete response was seen in 5%, partial response in 45%, 30% had stable disease and 20% progressive disease. There was significant relation of response with bleeding at the time of presentation (x2 = 8.235, p = 0.041) and site of tumor (x2 = 27.037, p = 0.008) with patients with buccal mucosa, lip and alveolus having a better response than retromolar trigone and tongue lesions. No significant relation was seen with growth type, pretreatment T stage, grade, HPV status and EGFR status.

Conclusion

Human papilloma virus and EGFR expression does not predict response to neoadjuvant chemotherapy in oral cancer.

WJMR Article No. 1: Proteomics at a glance

10/18/2012

In 1995 Mark Wilkins coined the term “proteome” to describe the total set of proteins concealed in the genome and two years later the term “proteomics” was used to describe the study of the proteome with the notion that the availability of a complete genome map would allow proteome construction. The suffix –“ome”/”omics” has been extended to describe not only mapping genes and proteins but also the study of large-scale biological phenomena in general. Accordingly, exploring metabolites is termed metabolomics and so on. Upon completion of the Human Genome Project in which the entire human genome was mapped, an optimistic scientific community imagined being able to understand and treat genetically-based diseases and deliver tailored drug therapy based on individual gene profiling. However, having mapped the complete genome is just one of many steps down this road. Acquiring genetic information does not necessarily translate into knowledge about the gene product itself. Which genes are turned on and off? What are the temporal and spatial perspectives of the gene products, e.g. proteins? How do they interact and affect each other? In the understanding of these questions proteomics has proven to be an indispensable tool.

WJMSCR Article No. 2: Duodenal leiomyoma presenting with chronic melena

10/17/2012

Introduction

Duodenal leiomyomas are rare neoplasms, and when present, are usually asymptomatic.

Case Report

We present a patient with leiomyoma arising from the first part of the duodenum who presented with melena for last 15 years and underwent local tumor excision with pyloroplasty.

Discussion

Most cases are detected incidentally either on radiological investigation or laparotomy or autopsy. It is extremely rare to detect by only presentation chronic melena.

Key Words

Duodenum, Leiomyoma, Pyroloplasty, Gastroduodenotomy, Bleeding, Benign, Neoplasms.

WJP Article No. 13: Scrotal Fibroangioma: A case report

10/15/2012

Introduction

Fibroangioma is a rare benign tumor and is located most commonly in nasopharynx but it has been reported to occur in different parts of the body. No case of fibroangioma scrotum has been reported in the literature.

Case report

We present a patient of scrotal fibroangioma and our experience in managing it. A 48 year male presented with recurrent discharge of blood from scrotum for last three months. We did partial scrotectomy to excise the involved skin and scrotoplasty to close the wound. Post-operative recovery was uneventful with patient becoming symptom free in follow-up period.

Conclusions

Scrotal fibroangioma should be managed on the same principle of its management elsewhere in the body. Painless bleeding from scrotum without fever or itching has high chances of being fibroangioma.

Keywords

Partial scrotectomy, Scrotoplasty, Scrotum, Fibroangioma, Tumor, Benign.

WJSMRO Article No. 19: A case of young breast cancer in which delivery was successfully achieved after postoperative chemotherapy under ovarian function protection using GnRH agonist

10/15/2012

Introduction

Breast cancer occasionally occurs in reproductive period. These patients tend to treat with intensive adjuvant or neoadjuvant chemotherapy because of their younger age if cytotoxic chemotherapy is indicated. However, cytotoxic chemotherapy may cause loss of fertility. There are several reports suggesting possibility of ovarian function preservation by administration of GnRH agonist concomitant with cytotoxic chemotherapy.

Case report

Herein we report a case of spontaneous delivery after adjuvant chemotherapy using FEC*100 followed by weekly paclitaxel under ovarian protection by GnRH agonist. A 28-year-old woman received a mastectomy due to a right breast cancer. Adjuvant chemotherapy was recommended because of high nuclear grade, younger age and negative hormonal receptor status. However, the patient had the strong hope of pregnancy. GnRH agonist was started prior to chemotherapy due to preventing loss of ovarian function by cytotoxic agents. Four cycles of FEC*100 every 3 weeks followed by 12 cycles of paclitaxel every week with GnRH agonist every 4 weeks was administered. Menstruation was recovered 4 months after ending of chemotherapy. She got pregnant spontaneously 15 months after ending of chemotherapy. And she delivered a 2,825g healthy baby in 40weeks 3days.

Conclusions

Fertility may be preserved by ovarian suppression with GnRH agonist during cytotoxic chemotherapy.

Key words

young breast cancer, protection of ovarian function, GnRH agonist.

WJSMRO Article No. 18: Multimodal Treatment for Undiferentiated Carcinoma of the Lacrimal Sac

10/8/2012

Introduction

Primary undifferentiated carcinomas of the lacrimal sac are extremely rare with only a few documented cases and with no cases of Japanese patients to best of our knowledge.

Case report

A 49-year-old female with lacrimation and an orbital mass was referred to our hospital. FDG-PET did not reveal any evidence of metastatic diseases. The patient was treated with a wide resection of right orbital tumor. The pathological examination led to a diagnosis of undifferentiated carcinoma. The postoperative site received 60 Gy in 30 fractions as adjuvant radiotherapy. Neck dissection was performed later. Two cycles of systemic chemotherapy, consisting of docetaxel, cisplatin, and 5-fluorouracil, were delivered sequentially. However, multiple metastatic lesions occurred in the lung, skin and lymph nodes. The patient died 7 months after the initial operation.

Conclusion

The undifferentiated carcinoma of the lacrimal sac exhibited an aggressive behavior with a poor prognosis. Therefore, a careful follow-up is required, because recurrence and metastasis may occur within a very short period of time after the initial treatment.

keywords

Lacrimal sac tumor, Orbital tumor, Undifferentiated carcinoma, Radiotherapy, Head and neck cancer

WJECP Article No. 2: A paired group study to evaluate the perinatal transmission of Human papilloma virus in high prevalence area

9/23/2012

Introduction

In areas of high prevalence of HPV in the population, it may be transmitted to the oral cavity of the child from the mother.

Patients and methods

We collected endocervical swabs from 84 mother and oral swabs from the neonate. DNA was extracted, amplified and checked for HPV-16 and HPV-18 DNA.

Results

Of the 84 women child pair analysed, 60% of the women were found to have HPV DNA in endocervical smear, while buccal smears from 2% of the neonates were positive.

Conclusions

The results suggest a low frequency of the perinatal transmission of HPV in this part of the world.

WJP Article No. 12: p53 is not expressed in Indian salivary gland neoplasm: A light microscopic and immunohistiochemical retrospective review of 140 salivary gland neoplasms

9/10/2012

Introduction

Salivary gland neoplasms are a heterogeneous group of tumours with different biological behaviour.

Patients and Methods

A retrospective analysis of gross and light microscopic features of 140 salivary gland neoplasms treated at Government Medical College, Trivandrum was carried out. Immunohistiochemistry for p53 was performed for 15 benign and 15 malignant salivary neoplasms.

Results

A total of 140 cases were studied during this period. Mean age of the patient was 43 year (SD +16.5) year; ranging from 7 to 87 years. There were 66 (47.1%) females and 74 (52.9%) males. Pleomorphic adenoma was commonest in 54.3%, followed by Warthin’s tumour in 15%, pleomorphic adenoma with myoepithelial predominance in 7.9% of the cases. Among the malignant neoplasm mucopidermoid carcinoma was commonest in 7.9%. p53 immunostaining was not observed in any of the cases.

Conclusions

p53 expression is not seen in Indian salivary cancers, this could be due to selection bias or a true negativity.

WJSMRO Article No. 17: Jaw Tumours in Ghanaian Children and Adolescents – A Retrospective Study

9/8/2012

Introduction

There are few reports on the incidence of jaw tumors in the child. Those from Africa mostly originate from Nigeria and tend to dwell on odontogenic tumors only. In the present literature, there are no records describing the incidence of jaw tumors in Ghanaian children. The aim here is to determine the incidence of jaw tumors in children less than 19 years old attending a teaching hospital in Ghana.

Design:

A retrospective study.

Materials and Method:

Histopathological charts at the department of Pathology of a main tertiary healthcare setup between 1989 and 2008 were reviewed and 118 cases belonging to children less than 19 years were studied further. The pathologies were classified and the incidence in each group recorded. All records were analysed using Microsoft Excel spread sheet.

Findings:

92(77.97%) were benign and 26(22.03%) malignant tumors. Male to female ratio for benign was 0.8:1, for malignant was 1.89:1 and for all tumors 0.97:1. 27(29.35%) benign tumors occurred in the maxilla and 65(70.65%) in the mandible. There were 48(40.68%) odontogenic, and 70(59.32%) non-odontogenic tumors. Ameloblastoma was the commonest odontogenic tumour, (30/48) 62.5%. Fibro-osseous lesions (N=31) were the commonest of all the tumors, constituting 26.27% of jaw tumors, and 44.29% of non-odontogenic tumors. Burkitt’s lymphoma was the commonest malignant neoplasm, (17/26)65.38%.

Conclusion:

Most jaw tumors are benign. 19.67%(118/600) affect children and adolescents, Burkitt’s lymphoma is the most prevalent malignancy and together with other non-Hodgkin’s lymphoma form about 20% of all tumors and 88% of all malignancies affecting the jaws in childhood.

WJSMRO Article No. 16: Expression of p53 Protein in Leukoplakia and Oral Squamous Cell Carcinoma

8/31/2012

Aim:

To evaluate p53 protein expression by immunohistochemistry in oral leukoplakia and squamous cell carcinoma biopsies.

Patients and Methods:

Thirty-two histologically proven oral squamous cell carcinoma, 38 leukoplakia and 20 normal healthy oral mucosal biopsies were included. Half the biopsy specimen underwent conventional histopathological examination and the remaining half was subjected to p53 protein specific immunohistochemistry.

Results:

Out of 32 oral cancer biopsies, 11 (34%) showed evidence of p53 protein staining. Of these 8 had grade 2 or unequivocal staining and 3 had grade I or weak staining. Among leukoplakia specimens, 6 out of 38 (16%) demonstrated p53 stain on IHC. Of these, 1 had grade 2 and 5 had grade 1 p53 stain. On histological correlation all 6 leukoplakia specimens positive for p53 had evidence of dysplasia. Out of 32 p53 negative leukoplakia biopsies, only 5 (16%) had dysplasia. Significantly none of 20 normal oral mucosal biopsies took up p53 stain.

Discussion:

Mutation of p53 gene is one of the most common events in oral carcinogenesis. Accumulation of p53 protein has also been detected in premalignant lesions especially oral leukoplakia with dysplasia as was evident in 16% of our leukoplakia biopsies. This suggests that p53 gene mutation may be an early step in the malignant conversion of oral dysplastic lesions. Such patients can be identified by p53 protein specific IHC and subjected to strict follow-up protocol or undergo wide local excision of their dysplastic lesions.

WJSMRO Article No. 15: Maxillectomy for Carcinoma in Young Adults- A Retrospective Analysis

8/11/2012

Introduction:

Maxillectomy is required for the tumours arising in maxillary sinus, hard palate, upper alveolus or lateral aspect of the nasal cavity. The purpose of this paper is to present the experience in young adults undergoing maxillectomy for malignancy .

Aims & Objectives:

To study the histopathological profile and primary site distribution of the malignant tumors in young adults undergoing maxillectomy and also to study the factors influencing the survival after primary and salvage maxillectomy for malignancy

Materials & Methods:

A retrospective analysis of young adults (18- 45 years) who underwent maxillectomy for carcinoma of the upper alveolus , maxillary sinus, hard palate or nasal cavity treated at a Cancer Center between 2002-2006.

Results:

Hard palate & upper alveolus were found to be the commonest site of tumor in the young patients. Squamous cell carcinoma was the major histological diagnosis. On multivariate analysis male patients and patients in 35- 45 year age group had a significantly better survival compared to females and patients < 35 years . The node positive cases had a significant poor survival compared to node negative cases and those treated with total maxillectomy showed a significantly better survival rate.

Conclusion:

The patients in whom maxillectomy was done as a primary modality of treatment had better survival compared to salvage surgery patients although it was not significant statistically. The nodal status of these patients was a statistically significant factor adversely influencing the disease free survival.

WJP Article No. 11: A Study of Conjunctival Impression Cytology in Patients with Various Types of Psoriasis

8/4/2012

Objective:

To evaluate the changes in specimens of conjunctival impression cytology specimens in patients suffering from various types of psoriasis.

Settings:

Departments of Ophthalmology, Pathology and Dermatology & Venerology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) INDIA.

Materials and Methods:

In this case control study, conjunctival impression cytology specimens were obtained from 29 psoriatic patients and 12 healthy controls without having any ocular abnormalities between November 2006 and May 2008. Specimens were graded on a scale of zero to three according to Nelson’s grading systems.

Results:

Out of 29 psoriatic patients, 82.3% had chronic plaque type, 10.3% had Erythrodermoid and 3.9% had pustular type of psoriasis. Conjunctival epithelial changes were observed in 23 (79.31%) patients (grade I changes in 41.4%, grade II in 27.6% and grade III changes in 20.7%). In the control group only 2(16.7%) cases had grade I changes while rest showed no epithelial changes. All cases of psoriatic erythroderma revealed worse cytological changes (grade III in 66% and grade II in 33.3% cases) while 29.2% of chronic plaque psoriasis and 50% of pustular psoriasis showed worse cytological changes. There was no significant correlation between duration of the disease and severity with cytological grading.

Conclusion:

Conjunctival impression cytology being a simple and non-invasive technique can be an important guideline in early diagnosis and treatment of ocular changes in psoriasis patients. As in our study, psoriatic erythroderma cases showed worse cytological changes (grade II & III) than other types of psoriasis. Hence early intervention and referral of these types of psoriasis patients to ophthalmologists is essential.

WJSR Article No. 5: Transformation of recurrent fibroadenoma to phyllodes tumour: a case report and review of literature

8/2/2012

Introduction:

Fibroadenoma, though considered a common benign breast lesion, can undergo malignant changes, majority of which are in situ carcinomatous lesions..

Case report:

Results: The average duration of MIS was 216 minutes, varying from 150 to 399 minutes which was more than that of OS (180 minutes; range 120 – 300). The average blood loss was 190ml (120-310ml) in MIS compared to 270.45 ml (100-350ml) in open group. Average duration of hospitalization was 11.35 (7-35) days in MIS group compared to 12.5 (5-24) days in open group. Six (35.29%) patients in MIS group had developed morbidity. Similarly four (40%) patients in open group had morbidity. In the MIS average of 12.06 nodes (4 to 17 nodes) were excised during surgery. Average numbers of involved nodes were 2.82 (0-5). In Open Group, an average of 11.20 nodes (8 to 13 nodes) was excised during surgery. Average numbers of involved nodes were 20 (0 and 2).

Discussion: MIS is oncologically safe compared to open surgery. It has almost similar postoperative course, morbidity pattern and duration of hospital stay as open surgery. Increased duration of procedure compared to open surgery is a disadvantage of minimally invasive surgery, especially in the early part of learning curve

WJSMRO Article No. 13: Doppler Ultrasound Evaluation of the Axilla in Clinically Node Negative Breast Cancer

6/28/2012

Aim and Objective: The study was conducted to evaluate the use of Doppler ultrasound in preoperative evaluation of clinically node negative axilla in patients with breast cancer and to correlate the findings with the tissue diagnosis obtained on subsequent sentinel lymph node biopsy or axillary dissection specimen.

Patients and Methods: 86 biopsy proven cases of breast cancer with clinically negative axilla were evaluated using 7.5 MHz high frequency ultrasound with Doppler. The L/S ratio, H/L ratio, flow pattern of lymph node, Resistivity Index (RI) and Pulsatility Index (PI) were recorded.

Results: On the basis of the Doppler ultrasound findings it is possible to identify the subset of patients at high-risk of harboring nodal metastasis and these patients can be offered axillary nodal dissection upfront.

Conclusions: Patients who have an equivocal or indeterminate or negative axilla on Doppler ultrasound should be advised to undergo sentinel lymph node biopsy prior to decisions regarding further management of the axilla.

WJSMRO Article No. 12: Vertebral metastases from oral squamous cell carcinoma of the buccal mucosa – report of a case and review of literature.

6/11/2012

Introduction: Oral squamous cell carcinoma (OSCC) is the most common head neck malignancy having a propensity for loco-regional spread. Hematogenous spread is rare with only a few existing reports in the literature.

Case report and Methods: Here we present a case of 55 year old mail with squamous cell carcinoma of the buccal mucosa with metastasis to vertebrae with a review of the literature on osseous metastases from OSCC.

Conclusions: With improved loco-regional control of the primary disease now possible with newer treatment modalities, more and more cases of distant metastasis from OSCC are being detected. Most frequently reported sites of metastasis from OSCC include lung, bone, liver, adrenals, heart, and kidney.

WJSR Article No. 4: Safety and Efficacy of oral and parenteral glutamine supplementation in reducing chemotherapy induced toxicities in patients with breast cancer receiving chemotherapy: Results of interim analysis of a prospective, randomized, three arm, placebo-controlled study (NCT00772824).

6/6/2012

Background: Side effects associated with use of chemotherapeutic agents in patients with cancer are well known. The role of glutamine supplementation in reducing or preventing chemotherapy induced adverse effects especially gastro-intestinal toxicity in cancer patients is controversial. This randomized controlled trial was carried out to evaluate the effect of glutamine supplementation on chemotherapeutic toxicity in breast cancer.

Patients and methods: 23 patients with breast cancer receiving 72 cycles of adjuvant or neoadjuvant CEF chemotherapy were assessed. These patients were randomized in three groups at the beginning of each cycle to receive either placebo (n=23), or enteral glutamine (n=25) 2g/Kg body weight in divided doses for 5 days or 20% parenteral glutamine (n=24) 50 ml injection (10 g) before the beginning of chemotherapy. Primary end-point was reduction in overall non-fatal side effects and reduction in multiorgan toxicity as assessed by the WHO criteria of grading toxicity associated with use of anticancer drugs.

Results: Glutamine supplementation was associated with significantly lower grades of gastro-intestinal side effects specially nausea, vomiting, diarrhea and mucositis as compared to placebo group (p<0.05). When oral and parenteral glutamine groups were compared both were found to be equally effective (p>0.05) although oral supplementation was more effective in reducing mucositis (p<0.05).

Conclusions: Results of the present study show that glutamine supplementation significantly reduces the GI toxicity and have a favorable safety profile. It is further suggested that a combination of oral and parenteral glutamine may be given together for enhancement of effect.

WJSMRO Article No. 11: Negative pressure wound therapy as an aid to coverage of irradiated chest wounds

6/5/2012

Introduction: Wounds over the irradiated chest present as a tough challenge for coverage to the reconstructive surgeon. This is due to the adverse effects of radiation on local tissue. The best option in such patients is flap coverage. Split thickness skin graft, though a simpler alternative, does not take well or breaks down easily.

Case report: A patient is presented in whom flap coverage was not sought and wound bed was prepared by negative pressure wound therapy to effectively take a skin graft.

Conclusions: This simple technique may be of immense value in aiding closure of problematic wounds over the irradiated chest.

WJP Article No. 10: Actinomycosis of the mandible

6/3/2012

Introduction: Actinomycosis is a rare, slow, progressive disease that mimics neoplasia. Actinomycosis infections of the bone are even rarer and are seen mostly in immunocompromised patients.

Case presentation: A 50 year old male underwent total glossectomy with vein preserving neck dissection and pectoralis major myocutaneous flap reconstruction through a lateral mandibulotomy approach followed by external beam radiotherapy for T3N0M0 carcinoma of the anterior tongue. Two years later he developed an orocutaneous fistula with exposure of dead mandibular bone. The dead bone was excised and histopathology revealed it to be actinomycosis, patient was started on oral penicillin and is disease free at present.

Conclusion: Osteonecrosis of the mandible is a rare complication of radiotherapy and bisphosphonate therapy. Super infection with actinomycosis is rare. Removal of the dead bone and treatment with oral penicillin is the treatment of choice.

WJP Article No. 9: Atypical Carcinoid Tumor of the Lungs: An Enigma

5/24/2012

Introduction: Atypical carcinoid tumor is a rare pulmonary neoplasm, diagnosis of which is commonly missed. Recognition of this disease entity as a possible differential diagnosis of tuberculosis is important in managing patient with this disease.

Case report: Here we report case of a 53 years old patient who was treated in Lagos, Nigeria as a case of pulmonary tuberculosis and died subsequently of atypical bronchial carcinoid tumor that was never diagnosed antemortem.

Conclusions: Early detection and high index of suspicion is crucial in the treatment of atypical carcinoid due to poor prognosis, if not treated early.

WJSMRO Article No. 10: Solid Pseudopapillary Tumour of Pancreas with a Metachronous Papillary Microcarcinoma of Thyroid

5/10/2012

Introduction: Solid pseudo-papillary tumours of the pancreas are uncommon neoplasms of low grade malignant potential usually arising in young females. Association of these tumours with secondary malignancies is exceptionally rare.

Case presentation: A 14 year old girl detected to have a metachronous papillary microcarcinoma of thyroid, following spleen preserving pancreatectomy for a rare solid pseudo-papillary tumour of the pancreas.

Discussion: Solid pseudo-papillary tumours of the pancreas are uncommon neoplasms which have a significant female preponderance. Treatment should be mainly surgical since the tumour has a good outcome even in advance stages. Its occurrence with other malignancies is extremely rare.

WJSR Article No. 2: A Rare Case of Servelle Martorelle Syndrome- Extensive Angio-osteohypotrophic Lesion of Upper Limb

4/16/2012

Background: Servelle Martorelle Syndrome (SMS) is a congenital vascular malformation associated with soft tissue hypertrophy and bony hypoplasia. This rarely involves whole of an extremity, with involvement of part of limbs reported in literature.

Case Report: We present a case of a twelve year boy with history of circumferential soft tissue hypertrophy involving whole of left upper limb, scapular region and axilla since birth. The entire left upper limb length was lesser than the right upper limb.

Conclusions: This is a very rare case of Servelle Martorelle Syndrome having extensive limb involvement at a very young age. Highlighted is the role of conservative treatment and close follow-up to understand the natural history of the diseases, with prompt treatment of complications.

WJP Article No. 8: Congenital Orbital Teratoma with Bilateral Anopthalmia: A Rare Presentation

4/16/2012

Background: Teratomas are rare embryonal tumors that comprise approximately 1% of orbital tumors in childhood.

Case report: This article is to describe a rare congenital orbital tumor arising in an eight and a half month old male child having bilateral anophthalmos. Complete excision of the mass was done. Histopathological examination revealed true teratoma. Follow-up after one year showed no recurrence.

Conclusions: The pathogenesis, clinical features, histopathological findings and treatment of orbital teratoma are discussed.

WJSMRO Article No. 9: Anterior compartment resections of the thigh and postoperative bleeding

4/12/2012

Introduction: In a compartment resection of the anterior thigh which includes the vastus lateralis, as the posterior attachment of the muscle to linea aspera is divided the perforator branches of the profunda may be divided and occasionally retract into in accessible locations behind the femur where they may stop temporarily bleeding through contraction giving the false impression of hemostasis.

Case report: A 28-year old man had a history of a peripheral neuroectodermal tumor in the left anterolateral thigh located in the substance of vastus lateralis and vastus intermedius and two nodules in the left lung. After the neoadjuvant chemotherapy resection of the tumor was carried out. At the end of the procedure the left lateral thigh was noted to be swollen and blood was oozing between the skin staples. The incision was opened, and a large hematoma evacuated. Small bleeding points were coagulated. Bleeders on the muscle surface were suture-ligated. There was also arterial bleeding, with no visible vessel, behind the linea aspera.

Discussion: The techniques to avoid this type of bleeding or to control it at reoperation, if it occurs postoperatively, are described.

WJSR Article No. 3: Primary Duodenal tuberculosis presenting as gastric-outlet obstruction - is pathological diagnosis is always possible

4/10/2012

Background: Gastrointestinal tuberculosis often involves the ileocecal region. The stomach as well as the duodenum are rare sites for tuberculosis and occur as a result of secondary spread from the pulmonary disease. Involvement of stomach and duodenum occurs as a seen in only 1% of cases of pulmonary tuberculosis especially in the patients associated with HIV infection.

Patients and Methods: This report describes two cases of abdominal tuberculosis in children

Results: The diagnosis in both the cases was made after the laparotomy and fine needle aspiration cytology, entric bypass was done in both the cases.

Conclusions: The diagnosis of duodenal tuberculosis is usually made after surgical intervention (exploratory laparotomy) and very rarely it is made preoperatively.

WJSMRO Article No. 8: Recurrent Solitary Orbital Neurofibroma: A rare presentation

3/28/2012

Final Article is Under Production.

WJP Article No. 7: Molecular alterations in gallbladder cancer

3/27/2012

Gallbladder carcinoma, (GBC) first described by M deStoll in 1777 is the fifth commonest cancer of the digestive tract. In Eastern part of Uttar Pradesh, GBC is the third most common cancer of the digestive tract. Carcinoma of gallbladder is mostly found in females with a male to female ratio of 4-5:1. Mortality rate is also higher in females than males.

WJP Article No. 6: Survivin Expression and Correlation with Clinico-pathological Parameters in Breast Cancer

3/10/2012

Introduction: Survivin is an intracellular, multifunctional protein which controls cell proliferation, inhibition of apoptosis and the promotion of angiogenesis. Present study deals with expression of survivin in fibroadenoma and breast cancer and correlation of its expression with other clinico-pathological parameters.

Materials and Methods: Survivin expression was measured by Immunohistochemistry, Western Blotting and RT PCR in 29 cases of fibroadenoma and 91 breast cancer .

Results: Survivin mRNA was present in 44.8% of fibroadenoma and 72.5% of breast cancer cases while survivin protein was expressed in 41.3% of fibroadenoma and 63.7% of breast cancer. Survivin expression showed significant correlation with tumor Stage, histological Grade, estrogen receptor (ER), and HER2 status .

Conclusion: Increased survivin expression at gene level might serve as a diagnostic and prognostic marker in breast cancer and can be used as a therapeutic target.

WJSMRO Article No. 7: Prevention and Management of SIIP Complications with Caution and Safety

3/10/2012

The subcutaneous intravenous infusion port (SIIP) or totally implantable venous port (TIVAD) have been an enormous development in the field of oncology and consequently in many fields of medicine. From their first clinical use, these devices have had an enormous and incommensurable impact on the quality of life, especially in cancer patients. These devices offer them the opportunity of a continuous venous access that permits more reliable and effective treatments. These devices also changed in some way the approach to the patients suffering from cancer, as new and more active therapies have been developed. After many years these devices are not only used for cancer patients, but they spread for many diseases in which continuous intravenous therapies are required.

WJSMRO Article No. 6: Clinico-pathological response of neoadjuvant chemotherapy in advance ocular carcinoma

3/5/2012

Objective: To determine the feasibility, toxicity and clinico-pathological response of anterior chemotherapy in patients of advanced ocular malignancies.

Settings: Departments of Ophthalmology, Surgical Oncology and Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India.

Materials and Methods: Twenty six patients of ocular malignancies between 20 to 65 years of age were treated with chemotherapy (CT) (I.V. cis-platinum, methotrexate, bleomycin) in 16 cases and only injection methotrexate in 10 cases prior to radiotherapy and/or surgery. Before starting chemotherapy all patients were evaluated by history, clinical examination, complete hematological, radiological and pathological investigations. Drug toxicity, clinical and histological changes were observed after completion of treatment.

Results: Out of 26 cases, 21 were primary malignant tumors arising from eye and its adnexa and 5 were secondary malignant tumors arising from paranasal sinuses. Majority of cases had squamous cell carcinoma 16/26 (61.54%) followed by basal cell carcinoma 5/26 (19.23%) and Meibomian gland carcinoma 5/26 (19.23%). Overall response of CT was seen in 19/26 (73.08%) cases, while in 5/26 (19.23%) cases there was no response and rest 2/26 (7.69%) had progressive disease. The maximum response 12/26 (46.15%) was observed in patients treated by combination chemotherapy containing cis-platinum. There was mild to moderate drug toxicity, commonest were gastrointestinal (69.23%) and hematological (69.23%).

Conclusion: Chemotherapy is better adjuvant to surgery and radiotherapy in advanced ocular malignancies.

WJSR Article No. 1: Hepatic portal cholangiocarcinoma: a clinical analysis of 70 cases

3/5/2012

Introduction: Hepatic portal cholangiocarcinoma is associated with poor survival, and this article analyzes an effective therapeutic method.

Patients and Methods: A retrospective analysis was performed in 70 cases of hepatic portal cholangiocarcinoma admitted between January 2004 and February 2007 in Air Force General Hospital, Beijing, China.

Results: Forty-seven cases we performed hepaticodocho-jejunostomy after resection of hepatic portal cholangiocarcinoma. Internal or external biliary drainage and channels for internal radiation were performed for those who were unfit for resection. Of the 70 cases, 5 died within 15 months, 27 survived more than 24 months, and the other cases had survived for 4-18 months.

Conclusions: Surgery is the primary therapeutic method for hepatic portal cholangiocarcinoma. Internal or external biliary drainage can prolong the life span.

WJSMRO Article No. 5: Primitive neuroectodermal tumor of chest wall in a young adult: comprehensive work-up, nine months post surgery follow-up and adjuvant chemotherapy

2/26/2012

Introduction: Primitive neuroectodermal tumor is a malignant small round cell tumor affecting the thoraco-pulmonary region, also known as Askin tumor.

Case report: A seventeen year old male presented with recent onset breathlessness of one and half month duration which was progressive and increased on exertion. After physical and systemic examination he was subjected to chest skiagram, contrast enhanced computed tomography (CECT) scan and magnetic resonance imaging (MRI). Skiagram of chest showed a well circumscribed mass in upper zone of right lung. Fine needle aspiration cytology (FNAC) showed malignant small round cell tumor. Clinical, radiological and cytological findings led to the diagnosis of round cell tumor-primitive neuroectodermal tumor of chest wall. The patient underwent radical surgery with adjuvant chemotherapy. The patient was followed up for nine months. During this period he was clinically and radiologically disease free.

Conclusions: Primitive neuroectodermal tumor is malignant small round cell tumor affecting thoraco-pulmonary region. A standardized multimodality treatment is more beneficial. Long term survival can be achieved with both aggressive local and adjuvant multidrug chemotherapy

WJPSO Article No. 4: Reliability of the Malayalam FACT-Colorectal and predictors of QOL in patients with colorectal carcinoma

2/21/2012

Introduction: Colorectal cancer and its treatment have a profound impact of one’s quality of life. With the increasing prevalence of colorectal cancer in Kerala and given its significant psychosocial morbidity, there is a need for understanding the disease’s impact on the patients’ quality of life.

Patients and Methods: The Functional Assessment of Cancer Therapy for Colorectal cancer (FACT-C) was translated to local language (Malayalam) followed by a prospective study in 102 colorectal cancer patients. Internal consistency of the FACT-C was tested using Chronbach’s alpha. .

Results: Of the four primary QOL domains the alpha values ranged from 0.82 to 0.92 indicating satisfactory internal consistency within each domain. Nearly 50% of the patients had ostomy appliances. Of these 75% were embarrassed because of it and found it difficult to care for the appliance. Physical well-being was poorer in the patients with prior treatment (t=-3, p=0.009), number of children (t=-2, p=0.05), and being on active treatment (t=-2, p=0.03). Physical well-being was significantly better in patients whose spouse’s were highly educated and permanently employed (t=2, p=0.07; t=-2, p=0.04, respectively). Patient’s in the high income group had significantly better social well-being (t=2, p=0.03).

Conclusions: FACT-C Malayalam was found to have a high internal consistency suggesting that the tool is good for use in colorectal cancer patients. Prior treatment, poor income, more children, and active treatment contributes to poor quality of life in colorectal cancer patients.

WJP Article No. 5: Maxillary Ameloblastoma – Management in an oncology centre

2/20/2012

Introduction: Ameloblastoma is a rare benign tumor that arises from the odantogenic epithelium. The tumor causes local destruction.

Case report: A case of maxillary ameloblastoma in a 50 year old male who presented with nasal blockade is presented and its management is discussed.

Conclusions: This case report is being presented to stress the importance of distinguishing maxillary ameloblastoma from malignancy and its treatment by radical resection . Hence it is best managed in an oncology centre where the expertise in surgery, imageology and pathology are present.

WJPSO Article No. 3: Results of an open labeled prospective single group study of quality of life in patients with head neck cancer treated with paclitaxel based chemotherapy

2/13/2012

Objective : The present study was carried out to evaluate the role and response to neoadjuvant chemotherapy in patients with locally advanced head neck cancers and to evaluate its effect on quality of life.

Study Design : Open labeled single group prospective study.

Patients and methods: A total of 34 patients receiving paclitaxel and platinum based neoadjuvant chemotherapy were recruited in this prospective study. Chemotherapy response was evaluated by RESIST criteria and toxicity was measured by WHO toxicity criteria. Quality of life was measured by FACT-HN questionnaire. Statistical analysis was done by using paired t test.

Results : Of the 34 patients, 16 had stage III disease while rest had IVA disease. Complete response was seen in 2 patients, while rest had a partial response. Both the patients showing complete response have received paclitaxel with cisplatin. Most of the patients’ had grade I or II gastrointestinal toxicity, no hematological or bone marrow toxicity was seen in any case. A statistically significant improvement in quality of life was seen at the end of three cycles, this improvement was more in patients receiving paclitaxel with cisplatin compared to carboplatin. Trial outcome index also showed significant improvement.

Conclusions: The results of the present study show good response to neoadjuvant chemotherapy with acceptable toxicity and improvements in quality of life. Its long term effect on survival and pattern of failure needs further studies.

WJP Article No. 4: Idiopathic Orbital Inflammation with rare Parotid Extension

2/13/2012

Objective: Idiopathic orbital inflammation (IOI) is a benign inflammatory process usually confined to the orbit, with preponderance for extraorbital extension (EOE). We describe a case of IOI with possible extension to the parotid gland, a presentation yet to be reported in the literature

Case report: A 38-year-old man was referred from a psychiatric unit with a 9 year history of swelling of the right parotid region, with periorbital swelling and proptosis of the right eye. Eleven years earlier, the orbital swelling was treated with steroid and surgery. At our center, the parotid swelling was treated with steroid therapy and adjunct chemo-radiotherapy. Patient was eventually lost to follow up.

Discussion: Diagnosis of IOI is based on clinical, imaging and histological examination. EOE of IOI, though rare has been reported with 41 cases reported to date. But an EOE to the parotid gland is yet to be reported. The significance of which is the possible addition of parotid gland scanning to all other previously known extraorbital sites, during an EOE survey; being part of IOI management.

WJECP Article No. 1: Human Papilloma virus in oral carcinogenesis and Its routes of transmission

2/6/2012

Introduction: Head and neck cancer include lesions at several subsites within the oral cavity, oropharynx, larynx, hypopharynx. The major known risk factors for the oral squamous cell carcinoma (OSCC) are smoking and alcohol. Recent reports have indicated Human Papilloma Virus (HPV) as a possible causal organism. HPV appears to be an independent risk factor for OSCC irrespective of tobacco or alcohol consumption.

Material and methods: A detailed search of the Medline and Cochrane data base was made. Title and abstract of each article was reviewed by two authors independently. Relevant articles were identified and reviewed systematically for route of transmission of HPV to the oral cavity, and its relationship with tobacco, alcohol and other risk factors.

Results: The most common site observed for the oral HPV infection is tonsil. The association is found in upto 50% of the cases and in most HPV-16 is identified. The chief oncoprotein of HPV-16 encoded by E6 and E7 genes have been reported to play a major role in HPV carcinogenesis by targeting tumor suppressor gene p53 and pRB respectively. Reports suggest oro-genital contact as one of the suspected mode of transmission, beside autoinfection from unwashed infected hands and deep mouth kissing. The perinatal vertical transmission is also reported.

Conclusions: There is not enough evidence to suggest s to what could be the mode of transmission of HPV to oral cavity and its relationship with other risk factors. Further researches on oral sexual behaviors in oral HPV transmission are required.

WJPSO Article No. 2: Impact of Sexual Dysfunction on Breast & Prostate Cancer Patients and their Spouses

2/4/2012

Effects of the cancer treatment last even after the completion of definitive treatment. These impairments are often visible in social, occupational, personal and sexual life. Over the last decade, clinicians have accepted that while survival and disease-free survival are critical factors for evaluation of treatment cancer patients, overall quality-of-life is fundamental [1]. Normal (or close to normal) sex life is vital since an absence may hinder or delay the emotional recovery of the patients. The conventional treatment methods however, lay lesser emphasis on the psychosexual recovery and rehabilitation when it comes to post treatment counseling of a cancer patient.

WJP Article No. 3: Evaluation of Estradiol Levels, Lipid Profile, Estrogen Receptor Status and its Correlation with Histological Variants in Benign Breast Diseases

1/23/2012

Background: Benign breast diseases encompass a heterogeneous group of lesions which are thought to have an endocrine basis. They occur at a younger age in comparison to breast cancer and their etiopathogenesis has not been studied in as much detail as breast cancer.

Aim: To estimate the serum estradiol levels, serum lipid profile and tissue estrogen receptor status in patients of benign breast disease.

Material & Methods: Serum estradiol and lipid levels were measured biochemically while tissue estrogen receptors were assessed by immunohistochemistry in 60 patients of benign breast disease and 20 normal age matched controls.

Results: Serum estradiol and triglyceride levels were significantly higher in benign breast disease patients compared to controls (149 pg/ml vs 115 pg/ml and 164 mg/dL vs 105 mg/dL). The highest estrogen receptor status positivity was observed in fibroadenoma and lesser in fibroadenosis and fibrocystic disease.

Discussion: Higher levels of serum triglycerides and estradiol observed in benign breast disease compared to control suggest their possible etiopathological role. It is possible that higher lipid level leads to increased peripheral production of estrogen. Estrogen receptor positivity was higher in fibroadenomas compared to fibroadenosis and fibrocystic breast disease. Endocrine treatment of these conditions needs to be considered in light of findings of our study.

WJSMRO Article No. 4: Squamous cell carcinoma of lip in a patient of polymyositis

1/18/2012

Introduction: Polymyositis is an inflammatory myopathy that is associated with development of carcinoma as part of paraneoplastic syndromes.

Case presentation: A 38 year old known case of polymyositis presented with small ulcer on lower lip. Patient underwent a wide excision with primary closure and the biopsy revealed squamous cell carcinoma.

Discussion: Development of carcinoma in patients with polymyositis is rare. The disease is treated as the stage of the tumor.

WJSMRO Article No. 3: Importance of the Surgical Approach for TIVAD implant in 2012

1/15/2012

Final Article is Under Production.

WJP Article No. 2: Metastatic follicular carcinoma of thyroid mimicking primary bone tumor

1/10/2012

Introduction: Follicular carcinoma of the thyroid metastasize to bones very commonly, however, its presentation as a long standing soft tissue mass is rare.

Case presentation: A 74 year old lady presented with slowly progressive swelling in the gluteal region for 10 years with sudden increase in size for last two months. Biopsy showed it to be a metastasis from follicular thyroid carcinoma. Search for the primary revealed two occult nodule in thyroid. Patient was treated with total thyroidectomy followed by radio iodine ablation.

Conclusion: Presentation of thyroid carcinoma as primary bone and soft tissue tumor is rare and mimic primary bone tumor or soft tissue sarcoma. Treatment is by Total thyroidectomy followed by radio iodine ablation.

WJPSO Article No. 1: Psychosexual problems of cancer patients and their spouses Results of an open ended survey

1/4/2012

Introduction: Diagnosis and can treatment of cancer is associated with disruption of physical, physiological, psychological and sexual functions. We carried out an open ended survey to know the sexual morbidity and what does the patients and spouses think cause these dysfunctions.

Patients and methods: A total of 100 patients and their spouses were interviewed using an open ended questionnaire. The questionnaire had questions related to 7 construct areas that were identified using a literature search and expert opinion. These 7 construct areas namely cosmesis, physical barriers, psychological factors, activities of daily living, social aspects, physiological-sexual factors and religion were included in the open ended questionnaire

Results: The survey population consisted of 56 women and 44 men with cancer and their spouses. Of these 47 were sexually active at the time of interview. A total of 57 patients had completed the treatment and 36 were on treatment while 7 were waiting for the initiation of treatment. Nearly equal number of patients had primary in head neck region, breast, genitourinary and lymphoproliferative disorders. The physiological reasons, spouse related factors and erectile dysfunction were found to be the most common problems faced by the patients. Besides, these fatigue, pain, lack of arousal, problems of early ejaculations were also identified. Only 9 patients reported that there were no sexual issues that they faced, six of these reported to be sexually inactive.

Conclusions: The results of the present survey show a high psychosexual morbidity in patients with cancer. The reason for sexual problems ranged from physical barrier to reasons like financial problems. Loss of cosmesis and pain was also found to be affecting sexual function. A need is seen to improve the patient spouse; patient physician communication which may in turn might improve the patients’ sexual function.

WJSMRO Article No. 2: Primary Lymphoma of Thyroid

1/2/2012

Introduction: Primary lymphoma of the thyroid accounts for 5% of all thyroid malignancies [1]. It differs greatly from other thyroid neoplasms with regards to the diagnostic and therapeutic approach.

Patients and Methods: We treated 12 patients with thyroid lymphoma over a 10 years period. The commonest presentation was thyroid mass with associated cervical lymph nodes or subcutaneous nodules. More than half the patients had hypothyroidism which was subclinical and detected on hormonal assay. The commonest histological variant was non Hodgkin’s lymphoma of B-cell origin followed by Mucosa Associated Lymphoid Tissue (MALT) cell lymphoma. The main stay of treatment was surgery with adjuvant chemotherapy. At 3 years follow-up 9 patients (75%) were recurrence free.

Discussion: Lymphoma of the thyroid develops in a background of Hashimoto’s disease or chronic lymphocytic thyroiditis. Most patients have associated subclinical hypothyroidism. Fine Needle Aspiration Cytology (FNAC) is of limited help in diagnosis as it may not distinguish thyroid lymphoma from chronic lymphocytic thyroiditis or a follicular neoplasm. Histologically it is usually non Hodgkin’s lymphoma of B cell variety although 10% cases may be of MALT cell origin. Chemotherapy is the sheet anchor of treatment with surgery and/or radiotherapy playing an adjuvant role. Prognosis is usually excellent and 100% survival at 5 years have been reported.

WJP Article No. 1: Chest wall swelling masquerading as breast mass

1/2/2012

A 26 year old female presented with complaints of a hard breast lump for last 2 months. There was no history of fever, pain in the breast or nipple discharge. On clinical examination a 4-5 cm hard lump with smooth surface and well defined margin was found over the right chest wall underlying the right pectoralis major muscle and right breast. The breast parenchyma was unremarkable. There were no axillary, supraclavicular or internal mammary lymphadenopathy.

WJSMRO Article No. 1: Sentinel Lymph Node Biopsy using blue dye technique in Carcinoma of the Buccal Mucosa

12/26/2011

Aim: This study was carried out to evaluate the feasibility and role of sentinel lymph node biopsy by using blue dye in identifying occult metastasis in neck in N0 neck patients with carcinoma buccal mucosa.

Material and Methods: A prospective study was carried out between 2006 to 2008, a total of 28 patients of carcinoma buccal mucosa with clinically negative neck were recruited. Sentinel lymph node biopsy was carried out by peritumoral injection of 1-2 ml of 2.5% isosulphan blue dye. Any blue lymph node visualized during neck dissection was dissected out and sent for histological examination and immunohistochemistry for cytokeratin was performed using PAP peroxidase and anti-peroxidase method.

Results: Sentinel nodes were identified In 27 patients. A total of 37 sentinel nodes were harvested with average of 1.3 lymph nodes per neck, the harvest in our cases was lower than that reported in literature. Of the 37 harvested nodes, 14 were positive and 23 were negative for metastases. One of the 14 positive sentinel nodes (3.7%) patient showed micro metastases that were identified by cytokeratin immunostaining though this node was negative on histology. Out of 14 positive necks level Ib was positive in 6, Level IIa in 6 and Level Ia in 2 cases. Six patients had only sentinel nodes positive for metastases while others also had other positive nodes beside sentinel.

Conclusion: Results of the present study show that sentinel node biopsy using the blue dye alone is feasible, it further demonstrates an orderly spread in cancers of the buccal mucosa, none of the patients with negative sentinel nodes had node positivity in other nodes, suggesting a definite role of sentinel node biopsy in N0 cancers of the buccal mucosa.

World J Surg Med Radiat Oncol 2012; 1:1-8