Pregnancy-associated mucinous cystic neoplasms of the pancreas - A systematic review.

INTRODUCTION: Mucinous cystic neoplasms (MCN) are mucin-producing epithelial cell tumors of pancreas. They consist of an ovarian-type stroma expressing estrogen and progesterone receptors. Pregnancy-associated MCNs are presumed to be larger in size and more aggressive without any concrete evidence. OBJECTIVE: and Data Sources: Systematic review of published literature using PubMed and Google Scholar databases. Original articles including case reports and series published between 1970&2021 were included wherein MCN was diagnosed during pregnancy/within one-year post-partum. Thirty-three publications having 36 cases, adding one of our own patient were analyzed in this review. RESULT: Median age at presentation was 32 years. Only three (9%) patients were asymptomatic. Mean size of MCN was 135 mm. Ten patients (27%) reported an increase in size during pregnancy. Most tumors involved body and tail of pancreas (60%). Distal pancreatectomy with splenectomy was the most common resection performed (57%). No foetal mortality was reported to date. CONCLUSION: Pregnancy may cause a rapid increase in size of MCN. Decision-making is more complex and needs a fine balance between optimal oncological and obstetric outcomes.

Breaking bad news: Awareness and practice of the SPIKES protocol among general surgery residents at a tertiary care institute in northern India.

Background In general surgery, a clinician is commonly required to break bad news. However, training in communication is not a part of the formal curriculum either in medical school or in surgical residency and there is a paucity of data on awareness of the SPIKES (Setting up the interview, Perception, Invitation, Knowledge sharing, Emotion, Strategy and Summary) protocol among practising surgeons and residents in India. Methods We did a cross-sectional study in the Department of General Surgery at our institution. Junior residents were invited to take part in a one-on-one interview. Descriptive statistics were used to describe the findings of the study. Comparison for categorical data was done using Fisher exact test or chi-square test (whichever was applicable). Results A total of 82 residents with mean (SD) age of 27 (2.5) years (range 23-37 years) participated in the study. Only 31 (37.8%) had ever received training for breaking bad news, though 80 (97.6%) had broken bad news at least once. Twenty-one (26.3%) participants had a bad experience while breaking bad news. Seventy-seven (93.9%) participants felt the need for training in breaking bad news and 76 of them were willing to attend the same. Although the complete SPIKES protocol was followed only by 25 (31.3%) residents, 46 (56.1%) felt that it was practically possible to follow the SPIKES protocol. Conclusion Resident doctors in general surgery face situations of breaking bad news and adherence to the SPIKES protocol is poor. Formal training at every level may enhance their communication skills and enable better healthcare delivery.