Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract

The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy [HCD], a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy [CDJ] in this prospective, randomized study. Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD [10 patients] and group II to CDJ [10 patients]. Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared into the two groups. Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 [10.3] min vs 133.6 [8.9] min; P=<.0001], operative blood loss 137.8 [37.2] mL vs 201.6 [23.4] mL; P=/001], postoperative enteral feeding 3.3 [0.5] days vs 5.0 [0.7] days; P=<.0001] and length of hospital stay 7.5 [0.7] days vs 9.7 [1.2] days; P=<.0001]. During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant. Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ

Clinicopathological study of male breast carcinoma: 24 years of experience

Because breast cancer in men is rare, few patients are available for prospective studies. To learn more about its epidemiology, risk factors, clinical features, genetics and pathology in our country, we conducted a retrospective study of all cases seen in recent decades at our institution. We identified each case of male breast cancer in the database at the Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India, between the years 1983 to 2007. We identified only 32 cases of male breast cancer over the 24-year period. Male breast cancer accounted for 32 [2.8%] of 1141 resected breast specimens, which included all breast lesions and 32 [4.1%] of 780 breast cancer cases. Of the 32 cases, 20 [62.5%] had various associated risk factors. Invasive ductal carcinoma was seen in 30 cases [93.7%]. Of 20 cases that underwent molecular studies, 16 [80%] patients had estrogen receptor positivity whereas 14 [70%] had progesterone receptor positivity. Six cases [30%] overexpressed HER2 and p53. The BRCA2 mutation was observed in 4 cases [40%] while no patient presented with the BRCA1 mutation. An incidence of 4.1% for male breast cancer indicates that this disease is not as uncommon as presumed in this part of the world. Breast cancer in men seems more frequently to be hormone receptor positive and the BRCA2 mutation confers a significant risk to men