Prospective Study of Benign Breast Disease in a Rural Tertiary Care Hospital

Objective of the present study was to evaluate different patterns of benign breast diseases and theirmode of presentation and also to correlate between clinical and pathological findings in cases ofpalpable lesion of breast. A total of 130 patients who attended the Surgery Department in MMIMSRMedical College, Mullana, Ambala with various forms of BBDs, during the period from January 2014to April 2016, were studied. Early diagnoses by doing a triple assessment such as a clinical examination,fine-needle aspiration cytology or a core needle biopsy, and imaging methods such as ultrasonographyor mammography. The clinical diagnoses were compared with the cytological or histological findingswherever possible, and their accuracies were evaluated. Out of the 130 patients who were studied,majority of patients who presented with breast lumps, were in the reproductive age group. Fibroadenoma(41.5%) and fibrocystic (14.6) diseases were the most common BBD's. Most patients presented aspainless lump which is need to be differentiated from carcinoma. BBD's most commonly affectedupper and outer quadrant. Most of the patient (61%) presented within 6 months of development ofbreast lesion showing increasing awareness in females of rural India. BBDs are common in femalepatients. The triple assessment provided a quick diagnosis, and it alleviated unnecessary anxiety fromthe patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytologyand histology, was accurate in most of the cases.

Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters.

Background: Cholecystectomy is the procedure of choice for symptomatic gall stones. Laparoscopic Cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult LC. Preoperative prediction of a difficult LC can help the patient as well as the surgeon prepare better for the intraoperative risk and the risk of conversion to open cholecystectomy. The present study was undertaken to evaluate role of various factors responsible for conversion from laparoscopic to open cholecystectomy and also to study the intraoperative problems faced by the surgeon responsible for conversion in order to make the procedure safer for the patient as well as the surgeon. Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC. Results: Of 50 patients 3 (06%) required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot’s due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm. Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy.

An Adult Male Presenting with a Left Gluteal Region Hemangioma – An Unusual Site.

The word “hemangioma” comes from the Greek haema- (αιμα), “blood”; angeio (αγγειο), “vessel”; -oma (-ωμα), “tumor”. A Hemangioma is a benign and usually selfinvoluting tumor of the endothelial cells that lines blood vessels, and is characterized by increased number of normal or abnormal vessels filled with blood. It usually appears in the initial weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas have completed involution by age five, 70% by age seven, and most of the remainder by age twelve years1. In more severe cases hemangiomas may leave residual tissue damage. In infancy, it is the most common tumor 2.

Three Port Versus Standard Four Port Laparoscopic Cholecystectomy- A Prospective Study.

The current study was undertaken to compare the safety, efficacy, cosmesis, cost effectiveness, complication rates and incidence of conversions. In a period of one year 200 patients with symptomatic GB stone disease were randomly divided into group A (100 patients) for three port technique and group B (100 patients) for standard four port technique. The outcomes were assessed based on duration of surgery, complication rates, postoperative pain, cosmesis, hospital stay and conversion rates.The mean operative time was compared and found to be less in group A. Intraoperative and postoperative complications was similar in both groups. The postoperative pain was less in group A. The mean hospital stay was less in group A (1.27 days) than group B (1.95 days).Better cosmetic results and patient satisfaction was observed in group A. 5 patients of group A required fourth port and 3 patients of group B required conversion to open cholecystectomy. The three port technique is a safe and feasible method in hands of an experienced laparoscopic surgeon. Thus it can be recommended as a safe alternative to conventional four ports laparoscopic Cholecystectomy.

Persistent Vitellointestinal Duct Causing Small Bowel Obstruction - A Rare Entity.

Vitellointestinal {omphalo-mesenteric (OMD)} duct connects the developing mid-gut to the primitive yolk sac, provides nutrition to the embryo and remains patent and connected to the intestines until the fifth to ninth week of gestational period. Varied remnants of the vitellointestinal duct have been reported. The present case report describes a completely obliterated fibrous remnant of the duct. The remnant presented as a thick cord extending from the umbilicus towards the terminal part of ileum with a Meckel’s diverticulum. Herein, we report a case of 20 yr old male who presented with the features of small bowel obstruction due to completely obliterated fibrous remnant of the duct which is a rare entity. Although persistent omphalomesentric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.