Squamous cell carcinoma metastases to both sides of the heart--a case report.

We report a case, which was taken up for surgery following a diagnosis, of multicentric myxoma in both chambers of the heart, on echocardiography. Postoperative histopathological examination showed it to be squamous cell carcinoma metastases. The mode of presentation, clinical implication and rarity of this pathology are discussed.

Fistulization of hepatic hydatid cyst into duodenum.

Though rupture of hepatic hydatid cyst is not uncommon, fistulization into the gut following rupture is rare. We report a case in whom a hepatic hydatid cyst ruptured into the first part of the duodenum.

Ksharsootra (medicated seton) treatment for fistula-in-ano.

BACKGROUND: Recurrence and incontinence are common after conventional surgery for fistula-in-ano. Medicated seton (ksharsootra) is a time-tested therapy. METHODS: Seton treatment was given to 114 patients with anal fistulae. The initial loose seton was changed weekly to achieve fistulotomy. RESULTS: Application of non-medicated seton did not show any cutting action; hence all patients were treated with ksharsootra after 3 weeks. Anal discharge (n = 114) and burning pain (35) were noted in the first 48-72 hours. The cut-out rate was around 1 cm/week, with mean cut-out time 8.3 weeks (range 3-18). All wounds healed well and patients remained ambulatory. Local induration developed in 18 patients; four had an abscess. There was no incontinence or recurrence over a follow-up of 6 months to 2 1/2 years. CONCLUSIONS: Ksharsootra treatment for anal fistulae is safe and effective, with low complication rates.

Modified Partington's procedure for pancreaticojejunostomy in chronic pancreatitis.

BACKGROUND: Various techniques have been described for pancreaticojejunostomy for chronic pancreatitis. We prospectively evaluated a modification of Partington's procedure with Roux-en-Y anastomosis for chronic calculous pancreatitis. METHODS: From 1980 to 1994, 53 patients with chronic calculous pancreatitis (46 men, 7 women; aged 14-70 years, mean 38) underwent surgery by the modified technique and were followed up for 1-14 years. The inclusion criterion for this procedure was pancreatic duct dilated to greater than 7 mm. End-to-side pancreaticojejunostomy was done by fishmouthing the jejunal end to a required length and anastomosing it to the pancreatic duct which is opened along its whole length. The procedure was evaluated in terms of feasibility of anastomosis, time required for surgery, perioperative complications and postoperative results. RESULTS: There were no anastomotic leaks or obstructive bowel symptoms in the immediate postoperative period. Excellent pain relief was seen in 81% of cases, and substantial relief in 12.8%. Average weight gain in the postoperative period was 4.2 Kg. Endoscopic retrograde pancreatography six months after surgery showed patency of anastomosis with free flow of dye into the jejunal loop across the anastomosis. CONCLUSION: The modified Partington's procedure is easy to perform and functions well without any complications. Pain is relieved successfully in a majority of cases.

Leiomyosarcoma of the duodenum.

Leiomyosarcoma of the duodenum is a rare tumor. These tumors manifest with unexplained melena, anemia and sometimes partial duodenal obstruction. Diagnosis is difficult on account of inaccessibility for biopsy. Treatment involves excision of the duodenum with reconstruction, a difficult task with high morbidity and mortality. However, if the tumor is successfully treated, its prognosis is usually good because of its non-aggressive nature.

Pulmonary complications of upper abdominal surgery.

Pulmonary complications encountered in 67 patients undergoing upper abdominal surgery in our unit in one year period are analysed. Pulmonary function tests and their post-operative reduction, as also the risk factors are discussed. Pathophysiology responsible for pulmonary complications is outlined.

Gastric carcinoma in the young (review of 14 cases).

A retrospective study of 14 cases of gastric carcinoma in the age group of 19 to 35 years is presented. The relevant literature has been reviewed.

Non-specific abdominal pain--a clinical entity.

A total of 48 cases of non-specific abdominal pain admitted in one year period were studied. Routine investigations of blood, urine, stool and X-ray examinations done after admission were negative. The pain was relieved in 48 hours time with analgesics and antispasmodics. During their follow-up in the out-patient department a variety of causes were discovered on investigations.