Transaxillary endoscopic excision of benign breast lumps: a new technique.

BACKGROUND: Benign breast lumps affect 10% of women in their lifetimes. Despite a favorable natural history enabling surveillance as an option, surgical excision continues to be popular. Avoiding a scar on the breast is an inherent feminine desire. Because the breast is a part with a high charge in the culture, women seek to keep it away from the surgical knife. Numerous minimally invasive approaches have evolved as a result of this psychology. These leave much to be desired. Circumareolar incision at best camouflages the scar, which still is sited on the breast. This scar is subject to the same sequelae as any other breast scar. The axilla, an anatomically contiguous space, provides easy access for endoscopic breast surgery. The authors used this access to excise benign breast lumps endoscopically. This spared the breast from a scar. METHODS: Between January 2002 and March 2005, 14 women with benign breast lumps underwent surgery. Transaxillary endoscopic excision of 18 such lumps was performed. RESULTS: A total of 14 women with 18 benign breast lumps underwent surgery. The mean operative time per patient was 66.78 min (range, 40-110 min). No axillary injury, bleeding, technical difficulty, surgical emphysema, conversion, hematoma, or rehospitalization occurred. All the women expressed their satisfaction and happiness with the operation. CONCLUSION: Endoscopic excision of benign breast lumps is a safe and patient-friendly procedure.

Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique.

BACKGROUND: Over the last two decades, laparoscopic cholecystectomy has become the gold standard for treating cholecystolithiasis and an index operation for evaluation and assessment of laparoscopic surgical skills. Its wider application and continuous refinement have not been accompanied by a commensurate decrease in morbidity due to biliary, vascular, or visceral injuries. Use of an energy source, especially monopolar electrosurgery, has been identified as a culprit for many of these injuries. This study assessed the feasibility of performing laparoscopic cholecystectomy safely without using any energy source by taking advantage of the avascular anatomical planes. METHOD: Patients attending the surgery clinic of our center who were candidates for a laparoscopic cholecystectomy were enrolled. Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of the hospital and was conducted as per GCP guidelines. RESULTS: Between June 2005 and July 2006, 83 patients were enrolled. All patients underwent laparoscopic cholecystectomy without any energy source being used. There was no incidence of biliary, vascular, or visceral injury. All patients remained hemodynamically stable. There was no conversion or mortality. The hospital stay was 8-16 h. Patients were followed up by telephone for the first 48 hours and then by regular outpatient visits until they were well. CONCLUSION: A safe laparoscopic cholecystectomy without using any energy source can be performed by following the proper anatomical footprint.

Medical certification in respect of alleged torture victims.

Torture is a global problem and affects a large number of people worldwide. The opinion of doctors in certifying various types of physical, and psychological injuries being caused accidentally or resulting from attempted suicide or by torture is very significant. A number of times, discrepancies between complaints and physical findings are noted. Meticulous examination is desirable in order to prove guilt or innocence.

Hanging-delayed death (a rare phenomenon).

Hanging is one of the most common methods of suicide in India in which death of the individual occurs instantaneously. However, a few cases have been reported in literature in which death has occurred after a certain period of time or the patient has survived after prolonged resuscitative measures. A case of a 20-year-old female is described who survived for nine days after hanging, remaining unconscious throughout in the hospital. She died due to cerebral damage caused by cerebral anoxia.

Accidental hanging with delayed death in a lift.

While hanging is a common method of committing suicide in India, accidental hanging is uncommon. However, it does occur when people are engaged in auto-erotic practices. An adult male who was helping passengers trapped in the lift of an outpatient department at a teaching hospital was accidentally hanged. He survived for 39 days. This case highlights a rare but serious hazard in the use of lifts.

Sudden death in neurocysticercosis by trauma.

Neurocysticercosis (NCC) is the commonest parasitic infection affecting the central nervous system in the world. However, sudden death is rare in these cases. Increased intracranial pressure, hydrocephalus, acute encephalitis, meningitis and reaction to antilarval drugs are the common causes of death in NCC. The case reported here is a rare case of sudden death, in an apparently healthy asymptomatic young adult male, who met with a vehicular accident and died almost instantaneously due to ruptured cysts of cysticerci produced by trauma. Possible mode of death is also discussed.

Accidental strangulation in a cycle rickshaw.

A 50-year-old female was accidently strangulated when her chunni (a piece of cloth worn around the neck) was caught in the moving wheel of a rickshaw in which she was travelling. She was brought to the nearest hospital and died within 16 hours, remaining unconscious throughout the hospital stay. Cause of death was asphyxia as a result of constriction of the neck by ligature strangulation.

Estimation of age from epiphyseal union at the wrist and ankle joints in the capital city of India.

Various studies conducted in and outside India for estimation of age from long bone joints revealed that unlike other vital parameters no uniform pattern exists for epiphyseal union of long bones in different countries of the world and also in different parts of the same country. A radiological study was conducted in 180 boys and girls of the capital city of India, Delhi, between the age group of 14-20 years to find out the age at which epiphyseal union at wrist and ankle joint takes place. The result of the study showed that the wrist joint epiphyseal union is completed in all cases in the age group of 19-20 years in males and 18-19 years in females. In the ankle joint, 17-18 years was the age group in males and 16-17 years the age group in females which showed complete epiphyseal union in all cases.

Study of head injury victims in fatal road traffic accidents in Delhi.

The study revealed 31% were the victims of Head injury injury in this part of Delhi in vehicular accidents. Although majority of the fatalities were on the spot quite a number of such victims survived for a varied period. A multipronged approach including the preventive and curative measures for this man-made calamity is the need of the hour. Amongst various preventive measure are wearing helmet be made compulsory for both the driver and pillion riders of two-wheelers, development of a safe traffic sense amongst the road users. Traffic Police should be honest, exemplary punishment for the reckless driver, decongestion of Delhi roads etc. The curative measures are facilities of CT scanners and neurosurgeons in all the major hospitals, provision of first-aid in the PCR (Police control room) vans, to institute immediate treatment to the victim without waiting for the medico-legal formalities, opening of more fully equipped Accident and trauma centres. It is high time the concerned authorities gave some serious thought towards this avoidable epidemic on Delhi roads.

Accidental strangulation in a rickshaw.

A 40-year-old female was accidentally strangulated by a 'Chunni' (piece of cloth worn around neck) while travelling in a cycle rickshaw. She was declared dead on arrival in the hospital. This case highlights the hazards of wearing cloth loosely around the neck while travelling in a rickshaw which is a common mode of transport for short distances in India and other South-East Asian countries.