Metastases of Renal Cell Carcinoma to the Contralateral Adrenal Gland Managed by Laparoscopic Adrenalectomy.

Renal cell carcinoma (RCC) is the most lethal urological cancer. It is estimated that one thirds of the patients with localized cancer will develop distant metastasis after radical treatment. Adrenal metastasis of RCC are relatively rare and can be either synchronous or metachronous; ipsilateral, contralateral or bilateral; solitary or part of a massive metastatic spread. Contralateral adrenal metastasis are uncommon. It is well-known that some patients with isolated metastasis may benefit from surgical treatment. However, the optimal diagnosis and treatment of the contralateral adrenal metastasis from RCC has not yet been well defined. Since it was first described, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time, and improved patient satisfaction are widely accepted. We report our experience with laparoscopic management of contralateral, metachronous adrenal metastases from RCC. Patients undergoing radical/partial nephrectomy for RCC were prospectively followed and evaluated regularly for general health status, local recurrence of tumor, and distant metastases. Patients identified to have had adrenal lesion/mass during the follow-up period were evaluated in detail both with imaging as well as endocrinal evaluation for assessment of functional status of these lesions. All these patients underwent laparoscopic adrenalectomy under general anesthesia. During the study period Jan 2006-Dec 2015, 8 patients (7 male and 1 female) with a mean age of 57.8 years underwent laparoscopic adrenalectomy. The mean operating time was 111.2 ± 32.5 min, blood loss was 45 ± 8.6 cm3 and postoperative stay was 37.5 ± 9.3 h. None of the patients had any major complications both early and delayed. The overall survival was 44.62 months. Metachronous, solitary, and contralateral adrenal metastasis from RCC is an extremely rare clinical complication that can occur very late after the radical/partial nephrectomy. Increased use of imaging modalities has led to more efficient and early detection of these lesions. Aggressive surgery remains the treatment of choice in these cases. Laparoscopic adrenalectomy remains a good, safe option with minimal morbidity and short hospital stay.

Cytomorphometric analysis and assessment of periodic acid Schiff positivity of exfoliated cells from apparently normal buccal mucosa of type 2 diabetic patients.

BACKGROUND: In recent years, important advances have been made in the diagnosis of diabetes mellitus, and new strategies have been put forward for its treatment. The purpose of this study was to analyze the cytomorphometric changes and glycogen content in exfoliated cells of oral mucosa as an adjunct in the diagnosis of diabetes mellitus. METHOD: The smears were taken from buccal mucosa of 30 type 2 diabetes mellitus patients (study group) and 30 healthy individuals (control group). One smear was stained with rapid Papanicolaou stain and the other with periodic acid Schiff stain (PAS). In Papanicolaou stain smears, the nuclear area, cytoplasmic area and cytoplasmic to nuclear ratio were evaluated from 50 cells in each smear using Image analysis software (Q Win Standard, Leica™) and a research microscope (DM 2500, Leica). PAS-stained smears were analyzed for the presence of glycogen in exfoliated cells. RESULTS: The results showed that the mean nuclear area was significantly higher (p < 0.001) in the study group whereas the mean cytoplasmic area did not exhibit a statistically significant difference (p > 0.001). The mean cytoplasmic to nuclear ratio was significantly lower in the study group (p < 0.001). There was a significant increase in the count of PAS-positive exfoliated cells of the study group as compared with the control group (p < 0.001). CONCLUSION: The results associated with clinical observations suggest that type 2 diabetes mellitus can produce morphologic and functional alterations in oral epithelial cells, detectable by microscopic and cytomorphometric analysis using exfoliative cytology which can be used in the diagnosis of the disease.

Cardiac tamponade secondary to fulminant myocarditis - A case of custodial death.

Cardiac tamponade following rupture of the heart occurs very rapidly, resulting in a fatal fall in the cardiac output and circulatory collapse. Spontaneous cardiac rupture is an uncommon occurrence and that too occurring secondary to myocarditis is a very rare event. Myocarditis is an inflammatory disease of the myocardium and its clinical presentation is highly variable. Due to its highly variable clinical presentation, the diagnosis is frequently made at autopsy. In this article, we report death of a prisoner due to cardiac tamponade following right ventricular rupture secondary to fulminant myocarditis.

Thoracic malignant schwannomma in adults.

A rare case of thoracic malignant schwannomma, in an adult, is presented here. This case shows an aggressive, rapid progression, which is characteristic of the disease. In spite of the best surgical and chemotherapy treatment, the patient died within four months of diagnosis.

Primitive neuro-ectodermal tumor of the lung in an adult.

A rare case of a thoracic primitive neuro-ectodermal tumor in an adult is presented here. In this case, wide excision surgical excision followed by chemotherapy and radiotherapy were delivered. But due to the rapid aggressive progression of the tumor, which is the characteristic of disease, the patient died within four months after the diagnosis.

Promotion of cutaneous wound healing by famotidine in Wistar rats.

BACKGROUND & OBJECTIVE: Drugs like famotidine, omeprazole and sucralfate which have been reported to promote the healing of gastric ulcers, may have the same effect on cutaneous wounds. Due to paucity of information in this regard, the present study was planned to investigate the effect of these drugs on resutured incision, excision and dead space wounds in Wistar rats. METHODS: Resutured incision, excision and dead space wounds were inflicted under light ether anaesthesia aseptically. Control animals received vehicle and other groups received famotidine, omeprazole and sucralfate orally for a period of 10 days in the incision and dead space wounds, whereas in excision wounds till complete closure. On the 11th day after estimating breaking strength of the resutured incision wounds, animals were sacrificed and granulation tissue removed from dead space wounds to estimate the breaking strength and hydroxyproline content. Quantification of granulation tissue and histological studies were also carried out. Wound closure rate, epithelization time and scar features were studied in the excision wound models from the day of famotidine till complete closure of the wound. RESULTS: Only famotidine significantly promoted the healing process in all the three wound models studied. Histopathological studies revealed increased collagen content and granulation tissue in famotidine treated group compared to control. INTERPRETATION & CONCLUSION: In all the three wound models studied famotidine promoted wound healing whereas omeprazole and sucralfate did not do so. The pro healing effect of famotidine needs to be explored clinically.

Prevalence of Campylobacter pylori in non-ulcerative dyspepsia.

Endoscopic biopsies were taken from the gastric antral mucosa, in 150 cases of non-ulcerative dyspepsia at the Gastroscopic Clinic, Dist. Hospital, Belgaum. Spiral or curved bacilli, were demonstrated in specimens from 99 patients. The histologic demonstration of the organism by Warthin Starry stain (66%) was superior to Haematoxylin and Eosin (47.33%), Urease test (42%) and Gram's stain (35.33%). There was a strong association between C pyloridis in the gastric mucosa and histologically defined gastritis (95.55%).