Successful Surgical Management of Unusual Gallbladder Anatomy Through Laparoscopic Cholecystectomy of Ectopic Gallbladder.

Abnormalities in the position of the gallbladder are not encountered commonly such as the ectopic location. We present a case of laparoscopic cholecystectomy for gallbladder that was found in an ectopic position. The surgical procedure can be difficult in some cases of acute cholecystitis and ectopic position of the gallbladder may add to complexities of the procedure due to abnormal location or anatomical variants of the biliary tree. Preoperative identification of ectopic gallbladder may aid in planning and performing a safe surgical procedure.

Combination of Common Problem in a Rare Disease: Right Iliac Fossa Pain in a Chronic Myeloid Leukemia Patient.

Abdominal symptoms in patients with hematological malignancies can occur due to an array of pathologies. Two diagnoses with similar presentation albeit, generally opposite treatment modalities, are typhlitis (inflammation of cecum) and acute appendicitis. Both diagnoses have to be kept in mind in such a patient presenting with right lower quadrant (RLQ) pain. Sagacious clinical judgment along with the aid of radiological imaging may help in differentiating between the two conditions. We present a case of a young male with chronic myeloid leukemia (CML) on imatinib, diagnosed and started on therapy four years earlier, who presented with symptoms of RLQ pain not typical of acute appendicitis. The accurate diagnosis was made with the assistance of ultrasound (US) imaging and prompt surgical therapy was instituted followed by a smooth postoperative recovery.

Incidental low grade mucinous neoplasm of appendix in pregnancy: A case report & literature review.

INTRODUCTION: Mucinous neoplasms of appendix account for 0.2-0.4% of all the appendix specimens. The occurrence of this neoplasm in pregnancy is extremely rare. We describe a case of a pregnant lady who was diagnosed as acute appendicitis and found to have Low-Grade Mucinous neoplasm on histopathology. In the existent literature, there are only a few such cases reported and none from our Middle East region. CASE PRESENTATION: 42-year-old pregnant lady at 24 weeks of gestation presented with classical symptoms of acute appendicitis. She had leukocytosis but the Ultrasound was equivocal. She underwent laparoscopic appendectomy and found to have an inflamed appendix. Postoperative recovery was satisfactory and was discharged home. The histopathology report showed low-grade mucinous neoplasm of the appendix and she was detailed about it on follow up. DISCUSSION: The incidence of appendiceal neoplasm is rare in routine appendectomy and carcinoid is the most common tumor of the appendix. Low-Grade mucinous neoplasm is a rare entity and its presence in pregnancy is further rarer. CONCLUSION: Since this neoplasm does not manifest with a characteristic clinical profile it is difficult to diagnose, even with extensive preoperative evaluation. Although surgical treatment is straight forward, the management of the appendiceal neoplasm during pregnancy necessitates full knowledge of the natural history of the disease to attain equilibrium of concern for maternal survival and fetal health.

Design and ex vivo kidney evaluation of a high-intensity focused ultrasound transducer and 3D positioner.

This article describes the design, construction, and evaluation of a three-dimensional (3D) ultrasound system to be used for the treatment of kidney tumors using high-intensity focused ultrasound (HIFU). The system consists of a therapeutic ultrasound delivery module (driver, power amplifier, matching circuit, and transducer (1 MHz)) and a 3D positioning module (stepper motors and microcontroller). The system includes software that designs a treatment planning according to the tumor coordinates. In order to verify the capability of the system for moving the transducer, the positioning module was successfully driven to cover cylinders of dimensions as large as 20 cm (diameter) x 10 cm (height) with step sizes as low as 0.05 mm. Several exposimetry experiments were done which showed close match between experimental and theoretical results. Ex vivo experiments were performed and indicated the capability of the system to generate a single lesion of 0.27 cm diameter and 0.45 cm length, as well as five lesions (each with a diameter of 0.3 cm) at prespecified locations. During the ex vivo experiments, temperature monitoring indicated an increase in temperature from 37 degrees C to about 60 degrees C inside the lesion, while outside it the temperature remained below 39 degrees C.

Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours.

We analysed 17 patients with primary malignant bone tumour of the femur who underwent limb salvage surgery with the total femoral custom mega prosthesis during the period 1994-2008. The patients were in the age group of 12-73 years, with a mean age of 30.94 years. There were 14 males. The most common diagnosis was osteosarcoma. The average follow-up period was 54.05 months with the longest being 168 months. The average Musculoskeletal Tumour Society (MSTS) functional score was 66.6%. The two- to 14-year overall survival was 82.4%. Three patients died of disease and one patient required amputation. Complications encountered were deep infection and dislocation of the prosthesis.