Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

Comparative Study between Fine Needle Aspiration Cytology and Histopathologic Examination in Thyroid Enlargements - A Validation Study

Background:Swellings of thyroid are frequently encountered in surgical practice. Clinical evaluation helps in diagnosis but distinguishing early malignant lesions from benign goiters is difficult. Histopathological examination (HPE) is the only means by which precise diagnosis can be made. An alternative approach other than operative is called for since most swellings are benign. Fine needle aspiration cytology (FNAC) is a simple and safe procedure, carried out with minimum equipment and good patient compliance. This study aims at correlating the cytological diagnosis using Bethesda system for reporting thyroid cytopathology with the final histological diagnosis to evaluate the sensitivity, specificity, and positive predictive value of smears. Thereby, its role in the preoperative diagnosis of thyroid swellings is assessed in planning proper management. Materials and Methods: Consenting patients with a thyroid swelling undergoing both FNAC and surgery with HPE of the resected thyroid gland were included in the study and analyzed. Results and Conclusions: A total of 62 patients were included in our study and were graded into categories based on the Bethesda system of thyroid reporting. The histopathological results were compared with respect to the incidence of malignancy in each category classified as per Bethesda System of reporting Thyroid Cytopathology. The predictive values of FNAC in the present study were sensitivity 41.2%, specificity 96.97%, predictive value of a positive result 87.5%, and negative predictive value 74.4%. In the present study, an overall accuracy rate of 77.6% was obtained. We concluded that the Bethesda system of reporting thyroid cytopathology is effective; however, risk of malignancy is significantly high in Bethesda II category and therefore warrants further workup including ultrasound-guided FNAC of suspicious foci.

Gas Gangrene after an Intramuscular Injection: A Case Report.

Gas gangrene is a necrotic infection of soft tissue associated with a high mortality, often necessitating amputation to control the infection. It is mainly caused by Clostridium perfringens which is a Gram-positive, anaerobic, spore-bearing bacillus widely found in nature, particularly in soil and feces. Incubation time for gas gangrene is short, usually <24 h, and the physical finding of crepitus is characteristic in the setting of soft tissue infection. Herein, we present a case of gas gangrene of the gluteal region and thigh following an intramuscular injection where the patient was treated with multiple debridements, antibiotics, and hyperbaric oxygen therapy; a review of the literature is presented here.

Bladder Metastasis: An Unusual Presentation of Stomach Cancer.

Linitus plastica of the stomach is a type of gastric carcinoma usually diagnosed at a late stage due to a lack of early pathognomonic symptoms. A diagnosis is usually by endoscopy and biopsy, however, lack of mucosal involvement leads to false negative reports. Over 50% of patients present with distant metastasis. Metastasis to bladder is rare and synchronous detection of bladder metastasis along with the primary tumor has only been reported in 5 cases in English literature. We present a case where clinical suspicion of a gastric malignancy was made in retrospect after biopsy of bladder tumor confirmed metastasis from a gastrointestinal primary.