Octreotide and postoperative pancreatic fistula after pancreaticoduodenectomy: What we know so far? A narrative review

Postoperative pancreatic fistula (POPF) is the most feared complication following pancreatic resection. Octreotide, a synthetic somatostatin analog, has been widely used by pancreatic surgeons worldwide after pancreatic resections, often as per surgeon抯 discretion, to prevent POPF especially in cases at high risk of developing POPF. We herein analyze the data available till date of the subject. A PubMed search with keywords 搒omatostatin OR octreotide OR somatostatin analogues AND postoperative pancreatic fistula� was made. Further filters were applied in the search 揅linical Trial, Meta?Analysis, Randomized Controlled Trial, Systematic Review, from 1990 � 2021,� and the 68 results thus obtained were analyzed and included in this narrative review. There is considerable heterogeneity among the studies assessing the role of octreotide in the prevention of POPF making data comparison difficult, and hence results remain inconclusive. Most of the earlier studies used different definitions of POPF and other complications; included patients with varied pancreatic pathologies such as cancer, chronic pancreatitis, and benign lesions; surgical techniques such as pancreaticoduodenectomy, distal pancreatectomy, and other procedures; use of somatostatin and its analogs such as octreotide, lanreotide, pasireotide, and vapreotide; varied surgeon and institutional volume; and so on. Besides, pancreatic surgery is per se a complex surgical procedure and has its own inherent biases related to patient and the pancreas itself affecting the overall outcome. Data indicate favorable role of newer somatostatin analogs, and further studies are urgently needed. The question about the efficacy of prophylactic octreotide to reduce POPF after pancreaticoduodenectomy remains open to debate

Breast tuberculosis: diagnosis, clinical features & management.

The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. Breast tuberculosis was scarcely reported even from endemic areas until lately when several reports have come up from South Africa and India. The incidence of tubercular mastitis although decreasing in the West, could show a resurgence with the global pandemic of AIDS. Breast tuberculosis has no defined clinical features. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. Antitubercular therapy for 6 months with or without minimal surgical intervention forms the mainstay of treatment today. Over the years since the first description of tubercular mastitis in 1829, the incidence, clinical presentation, diagnostic and treatment methodology of breast tuberculosis has gradually changed. This review discusses the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.

Residual breast tissue in the skin flaps after Patey mastectomy.

BACKGROUND & OBJECTIVES: Patey mastectomy implies complete removal of breast tissue. Likely area where residual breast tissue may be left is under the skin flaps. There is no study examining left over breast tissue under the Patey mastectomy skin flap. The present study was undertaken to study the presence of residual breast tissue in skin flaps after Patey mastectomy in patients with breast cancer. METHODS: In 37 patients of breast cancer undergoing Patey mastectomy, biopsy from under the skin flap at central point of 4 quadrants (upper outer, upper inner, lower inner and lower outer), 3 cm from cut margin of skin was taken to examine for residual breast tissue. RESULTS: In 8 of 37 (21.6%) cases residual breast tissue and in 3 of these (37.5%) tumour tissue was found under the skin flap. INTERPRETATION & CONCLUSION: Overall in 21.6 per cent biopsies from under the skin flap revealed information of probable therapeutic importance. This information may in future serve as an additional prognostic factor to consider irradiation to reduce the incidence of local recurrence in flap positive patients.

Multiple cutaneous horns of the penis: a case report.

Cutaneous horns of the penis are rare. Frequently they are unusual presentations of squamous cell carcinomas of the penis; therefore prompt surgical intervention is warranted. This is a report on a 70-year-old man with multiple cutaneous horns of the penis. The possible causes of cutaneous horns are reviewed.