Biomedical subjects
Publications and source records attributed to V Seenu.
A case of aneurysm of the inferior thyroid artery is presented. It is usually not possible to diagnose the exact site of origin clinically. Digital subtraction angiography can determine the precise site and type of aneurysm. In view of the high incidence of complications, early surgical treatment is recommended.
Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually). A case of primary pelvic hydatid cyst presenting with obstructive uropathy leading to chronic renal failure is presented. A combination of preoperative albendazole therapy of 1.2 g/day for 8-12 weeks and surgical excision were effective in alleviating the symptoms and improving the renal function.
A case of splenic vein obstruction due to infiltration by Hodgkin's lymphoma of the colon is reported. The patient presented with massive upper gastrointestinal hemorrhage and a lump in the abdomen. Laparotomy revealed a colonic tumor infiltrating the splenic vein, causing left sided portal hypertension.
BACKGROUND: In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS: SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS: We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION: Station II nodes may predict metastatic involvement of additional nodes in the axilla.
BACKGROUND: Cholecystectomy is one of the commonest general surgical operations. Laparoscopic cholecystectomy is currently the most favoured approach. As it is associated with less postoperative pain and ileus, it allows early discharge of patients from the hospital. Studies from the West have reported that 'day case laparoscopic cholecystectomy' is feasible and safe. In India, the current practice is to admit patients for laparoscopic cholecystectomy 24-48 hours prior to surgery and to discharge most patients within one to two days of surgery. There is no report from any Indian centre describing 'day case laparoscopic cholecystectomy'. We conducted a prospective study to assess the feasibility, safety and patients' acceptance of 'day case laparoscopic cholecystectomy' in a tertiary care hospital. METHODS: Eighty-four patients with symptomatic cholelithiasis, aged less than 65 years with ASA grade I and II, were offered day case laparoscopic cholecystectomy. Seventy-four patients consented to be included in the study. The nature of operation and likely postoperative course were explained in detail to the patients. Conventional 4-port laparoscopic cholecystectomy was attempted in all patients. The main outcome measures assessed were successful management of patients on day case basis and its acceptance by the patients. RESULTS: Sixty-eight (92%) patients underwent successful laparoscopic cholecystectomy. Fifty-five of these (81%) were successfully managed as day case procedures. There were no major complications. Three of the 55 patients (5.4%) needed re-admission and could be managed conservatively. Fifty-three (96%) patients described their experience as 'pleasant'. None of them described their experience to be 'unpleasant' or 'bad'. Fifty-four (98%) patients stated that they would recommend day case laparoscopic cholecystectomy to close friends and relatives. CONCLUSION: In selected patients, day case laparoscopic cholecystectomy is safe and feasible in a developing country.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
We report a case of a 45-year-old male presenting with asymptomatic right lower chest mass following a forgotten penetrating trauma. This case highlights a rare; delayed complication of lower chest penetrating injuries by the bull gore, involving the diaphragm. Intercostodiaphragmatic hernia should be kept as a differential diagnosis of slowly growing lower chest wall asymptomatic masses with forgotten injuries in the past.
We report a 31-year-old man with chronic renal failure and ascites who developed severe abdominal pain and a local non-pulsatile mass after therapeutic paracentesis. Doppler study confirmed a pseudoaneurysm of the right inferior epigastric artery. The patient recovered after the artery was ligated and the aneurysm excised.
Although risk factors for wound infection following conventional open cholecystectomy have been extensively studied in the literature, for laparoscopic cholecystectomy (LC) these have not been evaluated thoroughly. We studied factors that influence wound infection following LC. The aim of our study was to evaluate the incidence of wound infection following LC in low-risk patients and the factors that influence its causation. Over a 2-year period, 113 low-risk patients undergoing elective LC for symptomatic gall stone disease were included in this study. Nasal swab and abdominal skin swab cultures were taken one day prior to surgery to detect any aerobic organisms. Intraoperatively, gallbladder bile and a swab from the epigastric port were taken for aerobic and anaerobic culture. Post-operatively, a wound swab was taken from the infected port site (if any) and cultured to detect any aerobic and anaerobic organisms. The duration of preoperative hospital stay, operating time and intraoperative bile spillage were noted for each patient. The patients were evaluated on post-operative days 1, 7, 14 and 30 to look for any evidence of wound infection. Step-wise logistic regression analysis was performed to evaluate the factors influencing the occurrence of wound infection. Wound infection developed in 7/113 patients (6.3%) and was more common in patients who were positive for nasal Staphylococcus aureus (7.3% v. 4.1%, p not statistically significant), bactibilia (12.7% v. 1.5%, p < 0.01) and wound contamination at the time of surgery (13.9% v. 1.3%, p < 0.04). Step-wise logistic regression analysis showed a 13.2 times higher incidence of wound infection in patients who had bactibilia. Bactibilia is the most important predictor of wound infection in low-risk patients undergoing elective LC. As it may not be possible to diagnose which patients have bactibilia by routine investigation, it is advisable to use prophylactic antibiotics to reduce the incidence of wound infection.
Spontaneous Appendicocutaneous fistula (SACF) is a rare complication of acute perforating appendicitis. We describe one such case where the patient presented with a chronic discharging sinus in the right flank. Pathogenesis of this unusual lesion, its clinical presentation and the management are discussed and the literature reviewed. Preoperative diagnosis of this condition needs high index of suspicion. CT fistulogram is a valuable aid in this regard.
Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.
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A 89 year old female patient presented with severe dysphagia and was suspected to have carcinoma of the esophagus. Endoscopy revealed an esophageal phytobezoar which passed down spontaneously after unsuccessful endoscopic extraction attempt. Barium swallow study revealed diffuse spasm of the esophagus. A review of English literature revealed only 17 previous cases of esophageal bezoar. Salient features of esophageal bezoars are discussed based on previous reports and the current case.
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BACKGROUND: Breast cancer accounts for 20% of all female cancers in India and most patients present with advanced disease. Many factors may be responsible for the late presentation including the prehospital diagnostic and therapeutic approach towards breast lumps which may be malignant. To evaluate these factors we carried out a prospective investigation at the Institute Rotary Cancer Hospital of the All India Institute of Medical Sciences. METHODS: We studied 100 new patients with breast cancer seen in a special clinic over a 12-week period, excluding patients who did not have a palpable lump and those who had had an operation in another hospital more than six months previously. RESULTS: Fifty-seven of the patients were from urban and 43 from rural areas. Only 20 patients were aware of breast cancer before the onset of their illness. They were mainly from an urban background, educated and had a family history of breast and other malignancies. The total duration of illness ranged from 1 week to 10 years (mean 11.3 months) and the time to first visit ranged from 1 day to 9.5 years (mean 6.7 months). The delay between the first contact with a doctor to the date seen in the Institute Rotary Cancer Hospital thus amounted to a mean of 4.6 months. The duration of illness as well as time to first visit was also significantly shorter in urban patients, those who were educated and those who were aware of the disease. Fine needle aspiration cytology was used in 50 patients and was diagnostic in 39. Thirty of the 100 patients had no diagnostic investigations. Of the 43 patients treated elsewhere, the operation had been inadequate in 17 and 27 of the 43 patients were found to have had faulty adjuvant therapy. Many patients did not carry their operation notes and histopathology reports and when these were available, they were often of poor quality. The use of staging investigations was incomplete so much so that in 22 patients the disease could not be staged at all because of poor records. CONCLUSION: Breast cancer is seen in our hospital in an advanced stage because most patients are unaware of the disease. However, the treating physician also contributes to delay in the diagnosis, uses the diagnostic and staging investigations improperly, performs inadequate surgery and prescribes inappropriate adjuvant treatment. Record keeping is also of a poor quality. We need to provide more information to both patients and doctors about breast cancer.