A prospective study on the relevance of crush or squash cytology of central nervous system lesions, in the present-day surgery

Background:Theintra-operative cytology in the evaluation of central nervous system (CNS) lesions isasimpleandrapidtechnique, and a usefultool. There is not much literature available on the value of crush cytology during the operation. The current study was planned to assess the feasibility and efficacy of intra-operative squash cytology as standalone method in the rapid intra-operative diagnosis of intracranial tumor.Methods:A prospective observational study was carried out in the department of neurology in collaboration with department of pathology, Medanta: The Medicity, Gurugram, for a period of six months from January 2019 toJune 2019, on randomly selected 60 patients, aged: 18 years and above. Two to three tissue bits, from different sites of the mass, were taken to prepare squash cytology smear.Results:Out of 60 patients operated, 54 had neoplastic and 6 had non-neoplastic lesions. Neoplastic benign lesions were observed in 41 patients and neoplastic malignant lesions were diagnosed in 13 patients. There was 17.67% offering a wrong diagnosis on crush cytology. Out of the 13 cases of meningioma, there was a discrepancy in 3 (three) cases.Conclusions:Crushcytologyisausefuladjuncttothediagnosisinneurosurgicalpractice.Thisstudysuggests and confirms the reliability of squash cytology, but further multicentre studies with larger number of patients may help to decide its use in clinical practice.

Role of laparoscopy in the diagnosis and management of benign adnexal masses

Background: Adnexal masses are frequent findings in women of all age groups. It consists of the ovaries, fallopian tubes and uterine ligaments. Women can present with various gynaecological complaints and adnexal masses could be detected while examining and investigating for these complaints. The aim was to study the role of laparoscopy in diagnosis and management of benign adnexal masses.Methods: The study was conducted on 48 women of reproductive age group. Per speculum examination was done and PAP smear was taken before bimanual examination was done. A complete per vaginum examination was done and the adnexal mass was assessed for its size, side, consistency, laterality and tenderness. Laparoscopy was done to confirm preoperative diagnosis and appropriate procedure done depending on diagnosis.Results: Pain in the lower abdomen was the commonest chief complaint seen in 87.5% cases. 41.67% cases were suspected to have endometriosis while on laparoscopy it was seen in 47.92%, 33.33% were suspected to have ovarian cyst which decreased to 25% on laparoscopy, ectopic pregnancy in 16.67% cases both pre-operative and on laparoscopic examination and tubo-ovarian mass in 8.33% cases pre-operatively and 2.08% on laparoscopy.Conclusions: This study has shown that if proper preoperative evaluation was done, author can select the appropriate patients for laparoscopic approach.

El dilema de las reintervenciones quirúrgicas / The dilema of surgical reinterventions

RESUMEN Introducción: En la actualidad, la diversidad de criterios relacionados con las reintervenciones quirúrgicas constituyen un verdadero problema científico, por cuanto, resulta de gran importancia profundizar en torno a los principales aspectos cognoscitivos relacionados con este tema a fin de elevar la calidad asistencial y, con esa premisa, el índice de supervivencia, sobre todo en la población envejecida como grupo vulnerable. Objetivos: Identificar los factores que permitan reconocer las condiciones modificables que disminuyan las complicaciones y fallecimientos de los enfermos tributarios de un nuevo tratamiento quirúrgico para salir adelante y sobrevivir. Métodos: Revisión digital de publicaciones actualizadas en español e inglés en bases de datos: Google, Redalyc, PubMed, Medline, Lilacs, Elsevier. Resultados: Las complicaciones posquirúrgicas y las que requieren una reintervención en particular son de origen multifactorial. No existe una definición y una clasificación estandarizada de las complicaciones posquirúrgicas para notificarlas. Las más utilizadas son las objetivas de Clavien Dindo y Accordeon, basadas en la estratificación del tratamiento requerido, el riesgo y gravedad. Conclusiones: A pesar de que el gran avance tecnológico actual en los métodos diagnósticos y terapéuticos ha permitido que los pacientes con complicaciones posquirúrgicas sean reintervenidos con mayor seguridad, la morbilidad y la mortalidad a causa de estas continúan elevadas(AU)

ABSTRACT Introduction: Nowadays, the diverse criteria related to surgical reinterventions are a real scientific problem since it is very important to delve into the main cognitive aspects associated to this topic in order to raise the quality of medical assistance and thus the survival index in the old population as a vulnerable group. Objectives: To identify the factors that allow recognizing the modifiable conditions that lead to less complications and deaths of patients undergoing a new surgical treatment. Methods: Search of updated publications in English and Spanish made in Goggle, Redalyc, PubMed, Medline, Lilacs and Elsevier databases. Results: The postsurgical complications and those requiring surgical reintervention in particular are of multifactoral origin. There is neither one single definition nor one standardized classification of the postsurgical complications to notify them. The most used objective classifications are Claven Dindo and Accordeon, based on the stratification of the required treatment, the risk and the severity. Conclusions: In spite of the fact that the great technological advances in the diagnostic and therapeutic methods have allowed the reoperation of complicated patients with higher margin of safety, morbidity and mortality caused by such complications are still high(AU)

Diagnosis of Infected Total Knee Arthroplasty

Infection of a knee prosthesis leads to specific problems in relation to the function of the knee joint. Making an accurate and early diagnosis is the first step in effectively managing patients with periprosthetic joint infection. At the present time, the diagnosis remains dependant on clinical judgment and reliance on standard clinical tests, including serologic tests, analysis of the aspirated joint fluid and interpretation of the intra-operative tissue and fluid test results. The screening test results that may suggest the possibility of infection include elevation of the erythrocyte sedimentation rate and/or the serum C-reactive protein level at more than three months after an arthroplasty. Cultures of the aspirated joint fluid can be especially helpful for patients who have symptoms suggestive of infection. The joint fluid cell counts may also be helpful, but Gram staining of the joint fluid has poor sensitivity and specificity. Intra-operative culture should not be used as a gold standard for periprosthetic infection owing to the high percentages of false-negative and false-positive cases. The criteria for diagnosing infection on the basis of frozen sections of implant membranes have not yet been standardized, but in many laboratories, more than five neutrophils per high-power field in five or more fields have been found to be suggestive of infection. Combined with clinical judgment, the total white cell count and percentage of neutrophils in the synovial fluid more accurately reflects periprosthetic joint infection. When this is combined with hematologic exams, infection can be safely excluded or confirmed.

A Case with Thyroid Tuberculosis Diagnosed by Non-operative Method / 대한내분비학회지

Tuberculosis of the thyroid gland is extremely rare, with a few surgically removed cases having been reported. The differential diagnosis, from malignancies and other non tuberculous granulomatous lesions, is impossible clinical grounds. We experienced a case of tuberculosis of the thyroid gland with palpable thyroid nodules, in a 23 year-old female patient. She was clinical and biochemically euthyroid. US and CT scans demonstrated a low density mass in the left low lobe of the thyroid gland. An FNAB showed caseous necrosis, and AFB stains demonstrated tuberculosis bacilli. We report a case of tuberculosis of the thyroid gland, diagnosed by a non-operative method.

Mucocele do apêndice / Mucocele of the appendix

A case of benign appendiceal mucocele treated by appendectomy tony is reported. Appendiceal mucocele is a rare lesion of the appendix, characterized by a gross enlargement of the appendix from luminal accumulation of mucoid substance. It is a rare condition, detected in only 0.1-0.4 percent of all appendicectomies, with a female predominance and an average age at the time of diagnosis over 50 years. The possibility of a pre-operative diagnosis is examined. Abdominal ultrasound and CT scan of the abdomen or colonoscopy may suggest the diagnosis. However the diagnosis is often incidental. The pathogenesis and the different surgical strategies are discussed.