Surgery Outpatient Department Research Articles

Congenital heart defects in children with Gastro-intestinal malformations

Background. Congenital malformations of the gastrointestinal (GI) tract are common birth defects detected in the neonatal period and usually present with signs of GI obstruction which at times can be life threatening. Anorectal malformations are among the more frequent congenital anomalies. The co-occurrence of congenital heart defect (CHD) along with GI malformation can significantly affect the natural history of either defect. Purpose - to study the prevalence of GI malformations in children with CHD and study the risk factors. Materials and methods. A total 100 patients of GI malformations were enrolled out of which 66 (66%) were males and 34 (34%) were females. All patients with any GI malformations (anorectal malformation, tracheoesophageal fistulae, anterior abdominal wall defects) presenting to Neonatal Intensive Care Unit (NICU), Paediatric Cardiac unit, Pediatric and Pediatric surgery outpatient department (OPD) as well as In-patient department (IPD) between October 2019 to October 2021 were included in study. A detailed history and examination was done followed by echocardiography and the prevalence of CHD among GI malformation was observed and risk factors were studied. Results. Most common GI anomaly was anorectal malformation (71%) followed by tracheoesophageal fistula (17%), CHD was seen in 14 children. Most common heart defect was ventricular septal defect (VSD) (43%) followed by patent ductus arteriosus (PDA) (36%) and atrial septal defect (ASD) (14%). Among cases with anorectal malformation, CHDs was seen in 10% and the most common defect was VSD (43%). Forty one percent of cases with tracheoesophageal fistula had CHDs with PDA (57%) being the most common underlying defect. Functional heart defects were present in 28 children of GI malformations. Conclusions. The coexistence and severity of CHD in patients with GI malformation can have prognostic implications. Thus, early cardiac evaluation should be performed in every case of GI malformation, preferably with echocardiography. This is likely to help in the risk stratification as well as management of such children. The study was performed in accordance with the principles of the Declaration of Helsinki. Study is approved by Ethical Committee of the Institution. Informed consent of patients was obtained for the study. No conflict of interests was declared by the authors.

A Decade of Imaging Patients with Traumatic Brachial Plexopathy: What have We Learned?

Aim In this paper, the authors share their experience of imaging patients with traumatic brachial plexopathy by magnetic resonance neurography (MRN) spanning over a period of nearly 10 years. Setting and Design This was a single-institution, prospective, observational study conducted between August 2012 and March 2022. Materials and Methods Children and adults presenting to the plastic surgery outpatient department with features of traumatic brachial plexopathy were included in the study. The MRN study was performed in a 1.5T scanner (Magnetom Essenza, Siemens, Erlangen, Germany). The area scanned extended from C3 level to T3 level. Statistical Analysis Descriptive statistics (percentages, mean, median, and mode). Results A total of 134 patients ( n = 134) were included in the study. The age of our patients ranged from 6 months to 65 years. The mean age was 24.95 ± 12.10 years, with a median of 23 years. All patients had unilateral injury, and the right side was more commonly involved. Road traffic accident was the most common mode of injury, and blunt crush-avulsion was the most common mechanism of injury. Involvement of shoulder, elbow, and hand together (panplexopathy) was the most common clinical presentation. Conclusion This study of patients with traumatic brachial plexopathy imaged by MRN, spanning nearly a decade, has led to several interesting observations. The majority of these injuries occur in young men from urban areas who usually present with panplexopathy. The most common mode of injury is road traffic accident, and blunt crush-avulsion is the most common mechanism of injury.

Lateral Intercostal Artery Perforator Flap for Breast Cancer: A Case Report from Oman

Breast cancer is the commonest cancer in females. Historically, breast cancer surgery (BCS) was not considered a safe option, until 20 years back when those concerns were dismissed by the introduction of several surgical techniques. Today, women living in countries with fairly advanced healthcare systems, have the option of getting surgical treatment that is both safe and aesthetically pleasing. One of the promising surgeries being discussed in literature and is not widely practiced worldwide is the Lateral Intercostal Artery Perforator Flap (LICAP) flap. We present a case of a 52 y/o lady who self-presented to the Breast Surgery Outpatient Department (OPD) after she noticed a mass on her left breast. The patient was willing for BCS as she was particularly concerned about cosmesis. LICAP flap surgery was performed and the results were remarkable. LICAP flap is a surgical technique that, despite it requiring sharp surgical skills, continues to be a promising addition to the BCS options for women with breast cancer. With good planning and using intra-op ultrasound it can be the preferred choice for many patients.

Relation of Cholelithiasis and Body Mass Index among Different Age Groups

INTRODUCTIONCholelithiasis is a common presentation in the department of surgery. One of the potential risk factors of cholelithiasis is obesity, which is a common problem faced by most adult population. The aim of this study is to see the association of cholelithiasis with body mass index among different age groups. MATERIAL AND METHODSThis cross-sectional study was done in the Department of General Surgery of National Medical College, Birgunj. Ethical clearance (Ref. F-NMC/565/078-079) was obtained from the institutional review committee. Total of 75 subjects were included in the study. Subjects presenting with cholelithiasis in the out-patient department of Surgery were included in the study. Height and weight of the subjects were recorded along with age and other parameters. Body mass index (BMI) was calculated using the Quetelet’s formula, weight in kg/ height in m2. The body mass index was than categorized according to World Health Organization. RESULTSThe mean age of the total participants was 43.85±11.82 years. The mean BMI was 25.81±9.95 kg/m2. Among the age group 20 – 35 years 30% were overweight and 15% were obese where as in age group 36 – 50 years 44.4 % were overweight and 11.2 % were obese. Similarly in participants above 50 years 32.1% were overweight and only 3.6% were obese. CONCLUSIONCholelithiasis is one of the common surgical problems. Number of patients with gallstones increases with increasing age. In this study, more number patients are seen with normal BMI. However, higher number of patients are found having overweight or obesity in the age group of 36-50 years.

Study on aetiopathogenesis and management of rectal prolapse in tertiary care centre in Odisha, India

Introduction: Rectal prolapse refers to a circumferential, full-thickness protrusion of the rectum through the anus and also has been called complete prolapse, or procidentia. Internal prolapse occurs when the rectal wall intussuscepts but does not protrude, and is more accurately described as internal intussusception. In adults, rectal prolapse is far more common among women. The diagnosis is obvious on inspection, except in the case of concealed rectal prolapse. At present, the fixation of the rectum to the sacral hollow is considered to be the most rational operation in the surgical management of complete rectal prolapse. The present study is undertaken at S.C.B.Medical college hospital, Cuttack to evaluate the aetio-pathological factors associated with rectal prolapse and the different surgical methods available to repair them. Methods: A hospital-based Cross-sectional study was done among the patients Presenting .with Rectal Prolapse either attending Surgery Out-Patient Department or admitted to the Department through Emergency Department and giving consent for the study. Results: In the study 91.2% were complete and 8.8% were partial prolapse. The maximum age group showing thus prolapse was from 31-50 years age group, with males having more incidence of prolapse than females. Among the females, multi-porous were having increased incidence of prolapse.

A retrospective study on the pathologies in patients with coccydynia-lumbosacralgia and their treatment

BackgroundThe aim of this study was to arrange the treatment according to the etiology following the differential diagnosis in patients who had presented to the Orthopedics and Traumatology and General Surgery outpatient departments, and to emphasize the post-treatment success. MethodThe charts of 156 patients who had presented to the Orthopedics and Traumatology, General Surgery Departments of the Kafkas University Faculty of Medicine between July 2012 and June 2021 were retrospectively reviewed after permission was obtained from the ethics committee in this study. The demographic findings and Visual Analogue Scale (VAS) results for those with a symptom of pain as detected during the physical examination were recorded from the patient charts. ResultsA total of 156 patients who had presented with traumatic and non-traumatic conditions to the Orthopedics Clinic complaining of pain, burning, sensitivity, discharge and hyperemia at the coccyx region were included in the study. The reason for the lumbosacralgia was found to be traumatic as in heavy lifting or working physically difficult jobs in 62 of the 95 patients (65.26%) who presented with lumbosacralgia and pain referred to the coccyx. The mean VAS was 7.37 before treatment and 2.32 following conservative treatment. There was a history of falling on the coccyx region in 8 of the 14 patients with traumatic isolated coccydynia. The pre-treatment mean VAS was 8.64 in the patients with a diagnosis of coccydynia while the post-treatment mean VAS was 0 in 8 patients with full recovery, 4.33 in 3 patients with partial recovery, and 9.66 in 3 patients with no recovery. The pre-treatment mean VAS was 7.58 in the 29 patients with thrombosed hemorrhoids, decreasing to 0 after treatment. The pre-treatment mean VAS was 4.16 in the 18 patients with a pilonidal sinus, again decreasing to 0 after treatment. ConclusionPossible underlying etiological factors should be taken into account when making a diagnosis in patients with coccydynia and the treatment should be determined in a multidisciplinary manner.

Effectiveness of local injection of autologous blood versus corticosteroid in treatment of tennis elbow

Background: Tennis elbow or lateral epicondylitis is characterised by pain and tenderness at the lateral epicondyle of humerus. There are various treatment modalities recommended, but there is no universally accepted therapeutic modality yet. Objectives: To compare the functional outcomes of local injection of corticosteroid versus autologous whole blood for tennis elbow. Methods: This was a non-randomised trial conducted from May 2020 to January 2021 after ethical clearance. Patients attending orthopaedic surgery outpatient department, Kathmandu Medical College with lateral epicondylitis of the humerus were included by convenience sampling into corticosteroid group or autologous blood injection group based on whether they presented on odd or even calendar days respectively. There were 38 patients in corticosteroid group and 36 patients in autologous blood group. The visual analogue scale (VAS) and Nirschl staging system were calculated before injection, and then at one week, six weeks, and six months after injection. Results: Patients in both groups showed statistically significant decrease in pain from preinjection scores on both VAS and Nirschl scale at all follow-ups. There was no statistically significant difference between the two groups up to six weeks. At six months, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group on both scoring systems. Conclusion: Both groups showed comparable improvement up to six-week follow-up. Autologous blood injection group had significantly better improvement at six months. Autologous blood injection was more effective than corticosteroid injection at midterm follow-up, and had lower recurrence rate.

A COMPARATIVE STUDY OF ULCER HEALING WITH SILVER FIX FOAM DRESSING AND REGULAR BETADINE DRESSING

BACKGROUND An ulcer is not a serious health problem for the patient but a major health concern due to discomfort, pain, loss of workdays, and treatment cost. Several treatment modalities are available in treating ulcers based on their aetiology. In most ulcer management, povidone-iodine has been used for a very long duration with good results. On the other hand, silver, an antibacterial and anti-inammatory agent, is a newer treatment modality. In this study, we wanted to evaluate and compareAims and Objectives the healing of an ulcer in patients treated with silver x foam and betadine with regard to the progress of healing and duration, and rate of healing in both methods. This was a comparative study conducted after obtaining approval from the ethical committeeMATERIALS AND METHODS of Rangaraya Medical College and Government General Hospital, Kakinada, in the Department of General Surgery, over two years from June 2018 to May 2020 among patients suffering from non-healing ulcer who attended the general surgery outpatient department of Government General Hospital, Kakinada. The advantage of silver foam dressings is that they can be changed every 4th or 5th day when comparedRESULTS to betadine, which requires daily or alternate day dressings. Silver foam dressings show better control of infection and rate ofCONCLUSION healing when compared to povidone-iodine in the management of all patients with ulcers.

Etiological Spectrum of Diseases Among the Patients Presenting with per Rectal Bleeding Attending at Surgery Outpatient Department in a Tertiary Level Hospital

Background: Per rectal bleeding is a problem that is frequently encountered by doctors. There is marked geographical variation in the frequency of different etiologies. This study was conducted to determine the frequency of various causes of per rectal bleeding in patients attending in a tertiary level hospital in Chittagong, Bangladesh.
 Materials and methods : It was a retrospective study, and non-probability purposive sampling was done. All the patients over ten years of age presenting at the Surgery Outpatient Department with the complain of per rectal bleeding were included. A total of 685 patients were included in this study over a period of 2 years.
 Results: Mean age of the patients was 36 ± 13 (Mean ± SD) with a range of 10-82 years. Male-female ratio was 1.5:1. Haemorrhoids were the most common cause (34.6%) of per rectal bleeding, followed by chronic anal fissure (26.1%), chronic anal fissure with haemorrhoids (14.9%), colorectal polyps (11.4%) colorectal cancer (8.3%) and Inflammatory Bowel Diseases (IBD) (0.9%). No cause of per rectal bleeding was found in 3.8% of patients. Maximum patients with colorectal cancer presented in their fifth and sixth decades of life. 
 Conclusion: Haemorrhoids and fissures in ano are the most common causes of per rectal bleeding in our setting. However, the number of colorectal polyps and colorectal cancers are not negligible.
 JCMCTA 2022 ; 33 (1) : 9-14

Role of local antibiotics in the treatment of acute anal fissure.

Objective: To assess the role of topical antibiotic (mertronidazole) in the treatment of acute anal fissure. Study Design: Randomized Control Trial. Setting: General Surgery Outpatient Department of Aziz Fatima Hospital. Period: January 2020 and March 2021. Material & Method: In this study, patients were divided into two groups randomly. Patients in Group 1 were given only 0.2% GTN ointment and those in Group 2 were given 0.2% GTN ointment and metronidazole cream. All patients’ VAS scores for pain and healing of fissure by examining the peri anal area, as well as any adverse effects of the drugs, were recorded and statistically compared. Patients demographic characteristics, such as age and gender, were recorded. All patients were physically examined at the end of weeks 2, 4, and 6 of treatment. All statistical data analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics were used for comparisons. t test, and chi-square test were used to assess independent samples. A p-value <0.05 was accepted as statistically significant. Results: There were 46 (92%) female and 4 (08%) male patients in Group 1 and 48 (96%) female and 2 (24%) male patients in Group 2. The mean ages of the patients were 35.4±3.7 years in Group 1 and 37.8±4.2 years in Group 2. The mean VAS scores of the patients at the time of presentation to the hospital (pretreatment) were 7.2±1.2 in Group 1 and 7.4±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 2 were 4.6±0.8 in Group 1 and 4.2±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 4 were 3.2±O.7 in Group 1 and 2.4±0.8 in Group 2 (p=0.00004). The mean VAS scores of the patients at the end of week 6 were 2.36+0.65 in Group 1 and 1.86±0.48 in Group 2 (p<0.00054). In Group 1, 6(12%) patients had recovery at week 4 and 26 (32%) patients at week 6 with no recovery seen in 18(36%) patients. In Group 2, 9 (18%) patients had recovery at week 2 and 33(66%) patients at week 4 with no recovery seen in 8(16%) patients. There was a statistically significant difference between these data (p=0.022). Conclusion: We have observed that topical metronidazole along with other traditional management is an fruitful, easy-to-use, safe, rapid and secure option that helps in further reducing pain associated with anal fissure and increasing the healing rate. It is also effective in preventing the anal fissure to become chronic.

Comparison Between Ferguson's Technique and Mitchelle Bank Technique for Inguinal Herniotomy in Children

Objective: To assess the safety of the Mitchelle bank technique for herniotomy in children by comparing its recurrence rate with conventional Ferguson's technique.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Paediatric Surgery Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Sep 2019.
 Methodology: Children below the age of 6 years coming to Paediatric Surgery Outpatient Department with inguinal hernia were included in the study. The patients were divided into two groups. Group-I underwent herniotomy by Mitchelle bank technique (MBT-group) while Group-II by Ferguson's technique (FT-group). The demographic characteristics of the studied population, operative time, and intra-operative and post-operative complications were recorded.
 Results: The mean age of the patients was 25.94 ± 17.06 months in Ferguson's technique-group and 24.76 ± 16.63 months in the Mitchelle bank technique-group. The mean operative time was less in the Mitchelle bank technique-group (13.17 ± 1.47 minutes) as compared to Ferguson's technique-group (16.23 ± 1.51 minutes) (p<0.05). Early complications such as hydrocele, seroma and hematoma were seen in 5 (2.3%), 6 (2.6%) and 3 (1.3%) cases in Ferguson's technique-group, and 15 (6.9%), 8 (3.7%), and 9 (4.1%) cases in the Mitchelle bank technique group, respectively. Late complications such as orchitis, testicular atrophy, and recurrence were seen in 5 (2.3%), 6 (2.6%), 2 (0.9%) in Ferguson's technique group, and 6 (2.6%), 4 (1.8%), and 3 (1.3%) in the Mitchelle bank technique group (p>0.05).
 Conclusion: Mitchelle bank technique is safe for herniotomy in children with less operative time and no increase in...

Abdominal Contusions at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: Abdominal contusion is a closed trauma of the abdomen without continuity between the peritoneal cavity and the outside. The prognosis depends on the severity of the initial injuries but also on the speed and efficiency of their management. In Kayes hospital, there is no data on this traumatic lesion, hence the interest of this study which had as objectives to determine the prevalence of abdominal contusions, the diagnostic and therapeutic aspects. Materials and method: This is a retrospective study that took place from January 1, 2017 to December 31, 2020 or a duration of 4 years, conducted in the Department of General Surgery of the Hospital Fousseyni DAOU of Kayes. All patients admitted to the emergency department for abdominal contusion, whether isolated or not, and who were treated in the general surgery department during the said period were included. Results: During the study period, 1598 patients were hospitalized in the general surgery department, including 42 patients with abdominal contusion, i.e. a prevalence of 2.6%. Our study population consisted of 39 men (92.9%) and 3 women (7.1%), i.e. a sex ratio of 13. The mean age was 21.3 years, with extremes of 8 and 73 years. Thirty-three (78.6%) and nine (21.4%) patients came directly from the emergency department and the general surgery outpatient department, respectively. Road traffic accidents were the primary cause of abdominal contusions, with 24 cases (57%). Consciousness was preserved (GCS 15) in 39 (92.9%) patients. Fever and hemodynamic instability were respectively found in 11 (26.2%) and 4 (9.5%) patients. Emergency abdominal and pelvic ultrasound revealed hemoperitoneum and visceral lesions in 30 (73.1%) and 23 (56.1%) patients respectively. On physical examination, localized abdominal defense was found in 27 (64.3%) patients. Visceral lesions were dominated by hepatic fracture, 7 (30.4%) cases. Non-operative treatment (surgical abstention + medical treatment, strict ................

Comparison of Testicular Volume and Blood Flow in Children Before and After Surgery for Inguinoscrotal Diseases- A Prospective Cohort Study

Introduction: Testicular diseases in children include hernia, hydrocele, undescended testis, epididymal cyst or torsion testis. Some of these like hernia and undescended testis will have affect on the testicular volume and blood flow. These are predictors for the future function of the testis. Manipulations during surgery can also affect blood flow to the testis. Aim: To compare testicular volume and blood flow in children undergoing surgery for inguinoscrotal diseases in both normal and diseased sides, before and after surgery. Materials and Methods: A prospective cohort study was conducted from March 2019 to December 2019 in which 30 children were selected from Surgery Outpatient Department (OPD), Department of Paediatrics, Gian Sagar Medical College, Rajpura, Punjab, India. For patients having inguinoscrotal disease, ultrasonography (US) and colour doppler was done preoperatively on all cases by an experienced radiologist, using the same machine settings on the seventh day and three months postsurgery. Preoperative and postoperative testicular volume and blood flow was recorded in all the patients. The Statistical Package for Social Sciences (SPSS) software was used to statistically analyse the data arising, p<0.05 was accepted as statistically significant. Results: Total of 30 children (10 months to 10 years of age) formed the total sample of the study. Pathology was found in 18 patients on the right side and 12 patients on the left side. When the right and left side pathology were compared, it was found that right testicular volume was less as compared to left side. This difference was statistically significant with the p-value 0.006. There was a significant difference in blood flow between the right and left testis, both before (p-value 0.007) and after surgery (p-value=0.004). Testicular volume increased three months postsurgery in all the patients. This difference was more evident in left side pathology (p<0.05) as compared to right side (p>0.05). The increase in mean blood flow of diseased testis was significant after seven days of surgery (p-value <0.05). But change in mean testicular volume and blood flow after three months of follow-up was found to be non-significant. Conclusion: Inguinal surgery does not affect the testicular volume and blood flow. But long term follow-up for children of inguinal surgery for its effect on fertility should be evaluated.

Assessment of Epithelial to Mesenchymal Transition Markers in Breast Carcinoma and its Association with Histopathological Grading, Size and Metastasis

Introduction: Carcinoma breast is the most common malignancy affecting women worldwide. Early detection is key to its effective management. Epithelial to Mesenchymal Transition (EMT) has implications in progression of breast carcinoma and metastasis. Aim: To assess use of EMT Immunohistochemical (IHC) markers in breast carcinoma. Materials and Methods: This is a hospital-based descriptive study and was carried on patients of breast carcinoma attending the Outpatient Department of Surgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India, from July 2011 to October 2013. Histopathological examination of 67 mastectomy specimen was done and graded using Scarff-Bloom-Richardson (SBR) grading system. Lymph nodes found were screened for metastasis. Subsequently IHC study with cytokeratin 5/6 and vimentin were done to assess EMT. Statistical analysis was done using Chi-square or Fisher’s exact test on Statistical Package for Social Sciences software (SPSS) version 15.0 USA. Results: Using SBR grading system, 11 (16.4%) cases were of grade I, 34 (50.7%) cases of grade II and 22 cases were of grade III (32.8%). Out of total, 27.3% (3/11) of grade I, 67.6% (23/34) of grade II and 90.9% (20/22) of grade III tumor were found to have metastasis. Positivity for cytokeratin 5/6 and vimentin were 27.3%(3/11) and 63.6% (7/11) respectively in grade I tumours. Grade II tumours showed 5.9% (2/34) positivity for cytokeratin 5/6 and 82.4% (28/34) for vimentin. Positivity for cytokeratin 5/6 was 0 and 95.5% (21/22) for vimentin in grade III tumors. Conclusion: Increase in metastasis was seen with progression of grade. Down regulation of cytokeratin5/6 and up-regulation of vimentin was observed as the grade of tumour increased. Cytokeratin 5/6 and vimentin may be used to assess EMT which in turn shows higher chances of metastasis.

Intracholecystic Papillary Neoplasm with Low-grade Intraepithelial Neoplasia: A Rare Entity

Intracholecystic Papillary Neoplasm (ICPN) is a recently described, rare, mass forming, epithelial neoplasm originating in the mucosa of the gall bladder. It usually protrudes in the lumen and is generally noninvasive but may show dysplastic changes which may be low-grade or high-grade or may be associated with invasive carcinoma. Authors hereby describe a case of ICPN in a 57-year-old female patient who reported to Surgery Outpatient Department (OPD) with the chief complaint of pain in abdomen since last five days. On ultrasonography, gall stones were detected for which she underwent cholecystectomy. Histopathological Examination (HPE) revealed a papillary growth in the body of gall bladder measuring 1.0 cm in diameter. Sections from the growth showed back-to-back arranged glands exhibiting a papillary pattern. The glands were lined by columnar epithelium with basally located nuclei. Pyloric metaplasia was noted focally. No foci of invasion were seen. Papillary hyperplasia was noted in adjacent areas along with features consistent with chronic cholecystitis. Thus, a diagnosis of ICPN with low-grade intraepithelial neoplasia was made. The patient recovered well postsurgery and is on regular follow-up.

Triple Assessment for the Diagnosis of Carcinoma Breast in a Tertiary Care Hospital of Tripura: A Cross-sectional Study

Introduction: A combination of invasive and non-invasive procedures, clinical examination, radiological imaging (mammography/ ultrasonography/ Magnetic Resonance Imaging (MRI)) and fine needle aspiration cytology called the triple assessment test is being increasingly used in place of the more invasive core needle biopsy and histopathology. Aim: To evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma and to determine sensitivity and specificity with regards to histopathology in the diagnosis of the disease. Materials and Methods: A cross-sectional study was conducted among 61 women of more than 25 years of age having palpable breast lump, attending the surgery Outpatient Department (OPD) and breast clinic of a tertiary care hospital from January 2017 to February 2019. Data on socio-demographic status, menstrual and obstetric information, clinical examination performed, mammography, Fine Needle Aspiration Cytology (FNAC), High resolution sonography breast and histopathology were recorded into predesigned and pretested proformas and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of total 61 patients participated in the present study, most patients were of 41-50 years of age, with a mean age of 44.23±7.37 years, married, non-vegetarian and without any past history of alcohol consumption. Sensitivity and specificity of triple assessment was 98.3% and 100% respectively. The positive predictive value of Triple Assessment was 100% while the negative predictive value was 66.7%. All values were significantly better than both clinical breast examination and FNAC in detecting malignancies. Conclusion: The triple test was also found to be as accurate in diagnosing breast carcinoma in this geographical region. A patient with a negative triple test report can be safely followed up without the need for biopsy.

Atypical Breast CarcinomaA Series of Six Cases

Breast cancer comprises 10.4% of all cancer among women world and it the second most common type of cancer. Increased public awareness and screening have led to earlier diagnosis at different stages. Surgical resection can be done earlier and complete cure of the disease can be achieved. As a result survival rates for breast cancer in young women have improved significantly. Six unusual type of breast carcinoma, presented to the Surgery Outpatient Department were referred to Pathology Department for further investigations. Patient age and sex, clinical characteristics of the tumour, the duration of the lesion, the size, radiological investigation, Fine Needle Aspiration Cytology (FNAC), trucut biopsy and histopathological examination were noted. Immunohistochemical examination also done in all the cases. Out of the six cases of breast carcinoma, one was the mucinous carcinoma of breast, two invasive papillary breast carcinoma, one apocrine carcinoma, one invasive Pleomorphic Lobular Carcinoma (PLC) of breast and one was fibromatosis like metaplastic carcinoma of breast. All the patients were female except, a 71-year-old male who presented with invasive papillary carcinoma. All the female patients were presented at postmenopausal age group. After careful examination of the cytology and histopathological slides the final diagnosis was made which helped the clinician for further treatment. Rare breast cancers do not differ from other types of breast cancer in their presentation. But they vary by treatment regimens and outcomes. So, proper diagnosis with imaging, FNAC, trucut biopsy and histopathological examination is a combined tool for proper diagnosis and treatment.

English

BACKGROUND Breast diseases have been known to mankind since ancient times. However, earlier it was a matter of taboo and embarrassment that meant detection and diagnosis were rare. But the involvement of more women and actively bringing out the disease into open is a recent phenomenon. Various types of lesions from inflammation to carcinoma can affect the breast. Lump in breast is the commonest complaint which the patient presents to the surgeon. Different aetiologies of breast lump need different lines of management. We wanted to study the clinical profile of patients up to 40 years presenting with a discrete breast lump, diagnose different pathological conditions causing them and also study different investigations used for diagnosis. METHODS The study was done from October 2013 to December 2015 on a total of 305 consenting patients attending surgery outpatient department and those patients admitted in wards at government medical college, Nagpur were up to 40 years of age with a complaint of a breast lump. Clinical profiles of patients up to 40 years of age presenting with breast lumps were studied along with different investigations for diagnosis and different treatment modalities. RESULTS The highest incidence noted was fibroadenoma (178) in 58.36 % of cases and the lowest incidence was of duct ectasia (3) in 0.98 % of cases. The incidence of fibroadenoma in married women was 46.06 % and in unmarried was 53.93 %. The lowest number of breast lump cases was found in the 10-20 yrs (59) age group and a maximum number of breast lump cases was found in the 21-30 yrs age group (140). Total 74 patients diagnosed with malignancy were the most commonly affected patients in the age group of 31 – 40 yrs. Out of 305 patients with a history of self detected lump 87 i.e. 28.52 % had mastalgia and 16 patients presented with nipple discharge. Ultrasound showed only their benign breast disease characteristic and the definitive diagnosis was not possible in them. CONCLUSIONS Rate of benign pathologies is comparatively much higher than malignant ones in young females; however, increasing trends of malignancy in this age group cannot be neglected. With the global trend towards an increase in the incidence of breast malignancy, for every patient with a breast lump, cytological / tissue diagnosis by an expert pathologist must be established, before a further line of treatment can be planned. KEY WORDS Fibroadenoma, Malignancy (CA Breast), OPD (Outpatient Department), Trucut Biopsy.

Small Cell Neuroendocrine Carcinoma in Head and Neck

Introduction: Poorly differentiated neuroendocrine carcinomas (NECs) originating from the eye are rare and very highly malignant diseases with a poor prognosis. Small cell NEC of the head and neck is a rare disease and highly aggressive. Early recognition and treatment are crucial for reducing morbidity and mortality. Case Presentation: A 19-year-old male visited our oncology surgery outpatient department due to the progressive neck mass enlargement originating from the eye. The patient was previously diagnosed with invasive choroid malignant melanoma of the left eye which had metastasized to the lymph nodes of the left neck. He underwent a surgical removal/exenteration of the left eye. The result showed that the patient’s survival with poorly differentiated tumors was about 14% while patients with well-differentiated NEC had a survival rate of 34%. It also indicates that the prognosis of these tumors is very poor with a total of over 90% of patients having distant metastatic disease. Histopathological examination showed the tumor tissue and its immunohistochemistry with positive streaks of CD56, NSE, Synaptophysin, and Ki67 suggested small cell NEC.Conclusions: it is crucial to establish an early diagnosis of these tumors to reduce morbidity and mortality. No optimal treatment for such disease has yet been established.

Evaluating the Effect of Ormeloxifene on Multiple Fibroadenomas and Mastalgia.

Introduction:Most common benign breast conditions presenting in the breast clinics include fibroadenomas and mastalgia, both these conditions cause considerable anxiety in the patients. Among other treatment modalities, the hormonal drug treatments are gaining popularity. Ormeloxifene (centchroman) is an antiestrogenic drug which is shown to have effect in reducing the pain in mastalgia patients and the size of fibroadenoma.Objectives:Ormeloxifene is selective antiestrogen and a nonsteroidal drug. It has a discerning antiestrogen action and hence is useful for the treatment of mastalgia and multiple small fibroadenomas. Hence, the objective of our study was to assess the effect of Ormeloxifene (centchroman) on multiple fibroadenoma and mastalgia.Materials and Methods:Patients with benign breast disease attending our surgery outpatient department from June 2016 to July 2017. Patients were started on Ormeloxifene 30 mg on alternate days for a period of 3 months. Patients were followed up to 6 months after the inception of the study. Parameters recorded include the Visual Analog Scale (VAS) for pain and ultrasonography for breast lump size.Results:Thirty patients were included in the study. We found very good response in the mastalgia; the VAS scores in these patients dropped from 10 to 3 in 90% in the 1st week of introduction of the drug, and at the end of 1 month, almost all of the patients were painless. Overall final response was noted in terms of complete dissolution and change in the size was noted in 34% partial response in 46 %, no changes in 17 % and increase in size of fibroadenoma was noted in only one case.Conclusion:Novex is proved to be safe drug for the treatment of mastalgia and fibroadenoma. Its results were great in mastalgia group. At the end of 6 months, the number of surgeries (if needed) decrease and there is considerable improvement in the patient satisfaction rate.