Evolution of surgical techniques in the management of vertebral body tumours and the current status.

Primary vertebral body tumours constitute only about 5% of skeletal tumours. Their morbidity is high due to instability and neurological deficits related to the spine. The complex anatomy further highlights the expertise needed in their management. A multidisciplinary management has heralded tremendous improvements in the treatment of primary vertebral body tumours. From incomplete resection with a high recurrence of these tumours in the early 20th century, to the present day complete en-bloc excision of the tumours, guided by the well-established staging and classification systems, have been the significant changes brought about in the long course of treatment of these complex tumours. The overall results are better with radical excision in combination with adjuvant therapies. Complex and previously unimaginable surgical techniques are accomplished easily with a multi-disciplinary approach and with newer spinal instrumentation. Understanding of the evolution of surgical techniques and the prevalent classifications are essential in the surgical management of vertebral body tumours.

Validation of a structured questionnaire for COPD and prevalence of COPD in rural area of Mysore: A pilot study.

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in India and there is a need to study the prevalence of COPD, particularly in the rural areas, which may be most affected due to their lifestyle. MATERIALS AND METHODS: FIRST STAGE: Validation of the questionnaire-105 consecutive patients underwent administration of the structured questionnaire and spirometry was used as a gold standard for the diagnosis of COPD. Second stage: Adults above 40 years (n = 900) in two villages of Mysore district were administered with the validated questionnaire, Knowledge and Attitude questionnaire and Fagerstorm questionnaire, to assess nicotine dependency. RESULTS: The questionnaire was found to have a sensitivity of 62.5% and specificity of 87.6% to diagnose COPD. Of the total 900 adults surveyed (Males: 453, Females: 447), the total prevalence of COPD was 7.1%. Males had a higher prevalence (11.1%) compared to females (4.5%). The prevalence of smoking was very high among men at 71.9% and all the women were nonsmokers. The prevalence of COPD was 14.7% in smokers, 19.3% had mild to moderate nicotine dependency and 12.8% were highly dependent. Of the women exposed to regular biomass fuels, the prevalence of COPD was 3.9%, which increased to 4.8% on addition of regular passive smoking. In smoking, male gender and age were significantly associated with COPD (P < 0.05). CONCLUSION: The structured questionnaire is a useful tool for the screening of COPD in field studies. Smoking and biomass fuel exposure are important risk factors for COPD.

Ultrasound evaluation of pelvic nodes in cervical carcinoma.

This is a retrospective analysis to assess the utility of ultrasound in assessing pelvic nodes in patients with cervical carcinoma. Seventy five patients who underwent radical hysterectomy with lymph node dissection in a three year period were included in the study and the pre-operative ultrasound findings were compared with the final pathological nodal status. Ultrasound examination had a sensitivity of 66.67%, a specificity of 78.33% and an accuracy of 76%. The positive predictive value was 43.5% and the negative predictive value was 90.4%. The sensitivity and positive predictive value are likely to be higher in more advanced stages of the disease where operative staging is rarely performed. Ultrasound can be a fairly accurate non invasive diagnostic test to assess the pelvic nodes besides assessing the local extent of the disease, the kidneys and the retroperitoneum.

Incidentally detected renal cell carcinoma in patients with other cancers.

Widespread imaging of the kidneys as part of an abdominal or abdominopelvic evaluation of other diseases has led to a marked increase in the incidence of serendipitous renal cell carcinoma. These tumors are generally small, of low pathological stage, and carry a better prognosis than symptomatic cancers. This may merely be due to their earlier detection than the usual renal cell carcinoma. The malignant potential of these tumors, however, might still be high. We report 2 cases of incidentally detected renal tumors in patients with other cancers.

Adenocarcinoma of the urachus.

During the past 5 years, three patients with adenocarcinoma of the urachus were treated at our hospital. Abdominal ultrasonography helped clinch the diagnosis in all cases. All patients underwent surgical excision of the neoplasm with partial cystectomy. The clinical, radiological, and histological findings, as well as the pathogenesis of this rare neoplasm are discussed along with the surgical management.