Tertiary Center In South India Research Articles

Enteric duplication in children: Experience from a tertiary center in South India.

Background:Enteric duplications (EDs) are rare aberrations of the embryonic gut. This study was undertaken to define the clinical characteristics and management challenges of this unusual entity in the Indian population.Materials and Methods:Hospital records of 35 children with 38 ED operated between 2003 and 2014 were analyzed and followed up.Results:The median age at presentation was 285 days (range 1-day to 16 years) with male preponderance (71%). Small bowel duplications were the most common (44%), and thoracoabdominal duplications were seen in 8% children compared to 2% in the literature. The median duration of symptoms was 18 days (interquartile range [IQR] 3-210 days). Associated anomalies were seen in 49% children with vertebral and spinal anomalies being the most common. Ultrasonogram (US) was done in 83% children and had a sensitivity of 55%. In the presence of a gastrointestinal bleed, Technetium99m pertechnetate scintigraphy scan had a positive predictive value of 80%. Thirty-five lesions were completely removed. Mucosectomy was done in two children, and one total colonic duplication was left in situ after providing adequate internal drainage. There was no postoperative mortality. The follow-up was possible in 66% children.Conclusions:EDs are uncommon and have varied, nonspecific symptoms. Thoracoabdominal duplications are more common in the Indian population. The US is a good screening tool but requires a high index of suspicion where complete excision is not possible; the provision of adequate internal drainage is an acceptable alternative. The long-term prognosis of children with ED depends on the extent of physiological disturbance due to associated anomalies.

Clinico-etiological study of 30 erythroderma cases from tertiary center in South India

Background:Erythroderma is a morphological reaction pattern of skin having many underlying causes and finding the etiology helps in the proper management of erythroderma cases.Aim:To evaluate the clinical profile, etiology of erythroderma and to correlate clinical diagnosis with histopathology.Materials and Methods:This study was performed at the department of dermatology, Father Muller Medical College and Hospital, Mangalore, South India. We studied 30 consecutive cases of erythroderma with respect to the epidemiological, clinical and histological data. Clinico-histological correlation was analyzed for etiology of erythroderma.Results:The mean age of onset was 52.3 years with a male to female ratio of 14:1. In addition to erythroderma, other co-existent features included pruritus, fever, lymphadenopathy, and edema. Of the pre-existing dermatoses, psoriasis was the most common (33.3%) disease followed by eczema (20%), atopic dermatitis (6.6%), pityriasis rubra pilaris (3.3%) and drug-induced erythroderma (16.6%). In 16.6% of cases, etiology could not be ascertained. Clinico-histopathological correlation could be established in 73.3% of cases.Conclusion:Clinical features were identical irrespective of etiology. Detailed clinico-histopathological examination helps to establish the etiology of erythroderma.

Comorbid conditions in patients with physician diagnosed COPD: Data from a tertiary centre in South India

Background: COPD represents an increasing burden worldwide. COPD is a leading cause of hospitalizations in adults, particularly older adults. Comorbidities are a common cause, or a contributing cause, to many of these hospitalizations. Aims & Objective: To study the comorbid conditions in patients with physician diagnosed COPD in a tertiary centre in South India. Material and Methods: A random sample of 500 patients after taking verbal consent were selected from all COPD patients who attended Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinnaavutapalli, Vijayawada, over a period of 1year in 2012. Personal interview was held to collect data including age, gender, literacy, occupation, comorbidities. Results: The mean age of 500 COPD patients was 61.2. Out of which 47.2% are below 60 years and 52.8% are above 60 years. Males constituted majority of the study population (80.8%). 77% of the total study population gave a history of smoking. Majority of the patients had 2 comorbid illnesses (30%). Among the co morbidities, depression was the commonest comorbid illness (50.4%), followed by anaemia (44%). Conclusion: Knowledge regarding associated comorbidities with COPD in a tertiary care center helps the physician to take the comprehensive management plan. We recommend screening of patients with COPD for possible comorbidities so that appropriate treatment can be initiated at the earliest so as to decrease the cost burden.

1011 - Borderline Tumors of the Ovary: 19 Years Experience from a Tertiary Center in South India

ABSTRACT Introduction Borderline tumours of the ovary are neoplasms of low malignant potential (LMP) and constitute 10-15% of all epithelial ovarian cancers. This retrospective analysis was done to determine the outcome of patients with LMP tumours treated at our institution. Methods and results Data was collected from the department master records which were updated at every patient visit. Between 1993 and 2008, 68 patients were diagnosed with LMP tumours of ovary. The median age at presentation was 39.8 years. Sixty percent of patients were post menopausal. Eight patients presented with infertility (11.7%). Ascites was present in 50% of patients. Forty nine patients underwent radical surgery (72%) and 19 patients had fertility sparing surgery (FSS) (28%). Mucinous tumours were seen in 39 patients (57.3%), serous in 25 patients (36.7%), Brenner tumour in three (4.4%) and endometroid tumour in one patient (1.4%). Fifty five patients presented in FIGO stage I (80%) and 13 patients in stage III (20%). Micropapillary serous tumours were seen in eight patients (11.7%), invasive peritoneal implants in five patients (7.3%) and microinvasion in four patients (5.8%). Seven patients underwent chemotherapy post operatively. The median overall survival (OS) was 178 months and the median progression free survival (PFS) was 175 months. Micropapillary serous tumours, invasive peritoneal implants, microinvasion, suboptimal surgery and advanced stage were found to be poor prognostic factors for PFS and OS on univariate analysis. Recurrence was seen in seven patients of whom five patients died of progressive disease. Eighteen patients are on follow up and are free from disease. There was no difference in outcome between patients who underwent radical surgery and FSS (p = 0.11). Seven out of eight patients who had infertility at diagnosis were able to conceive and deliver normally after treatment. Conclusion Borderline ovarian tumours have an excellent prognosis. Fertility sparing surgery is a feasible option in these patients and is compatible with a favourable long term outcome. Disclosure All authors have declared no conflicts of interest.

Clinico-pathological correlation of non specific inflammation in bowel histology with joint manifestation in a tertiary center in South India

The aim of our study was to determine whether the pattern of arthropathy in patients with suspected enteropathic arthritis bore any relation to their gut histology and specifically to chronic nonspecific gut inflammation. Records of 39 patients with suspected enteropathic arthritis from rheumatology clinic between January 2006 and December 2008 who had undergone ileocolonoscopic biopsy were analyzed retrospectively. Patients were grouped into 3 categories, namely those with normal bowel histology, those with mild nonspecific chronic changes, and those with histology suggestive of inflammatory bowel disease. Patients with nonspecific chronic gut inflammation had higher occurrence of axial involvement with or without peripheral articular involvement as compared to those with normal gut histology (8/9 vs. 10/21, P = 0.049), and this pattern was similar to that in patients with IBD. Wrist joint involvement was more common in patients with normal bowel histology (12/21) than the other two groups (P = 0.003). All groups had fared well on follow up while taking treatment with sulphasalazine and methotrexate.

Congenital adrenal hyperplasia - experience from a tertiary centre in South India

Congenital adrenal hyperplasia is a group of autosomal recessive disorders caused by enzyme deficiency which leads to defects in biosynthesis of steroid precursors. Most common is 21 hydroxylase deficiency. Clinical spectrum varies from non-classical CAH to classic CAH, and it may be simple virilising form or salt-wastinfg type. 29 patients were included in our study from January 2012 to October 2012. 76% were females. Male babies typically presented with adrenal crisis between 3rd to 6th week of life. Around 20% of females were identified and appropriately treated only after late adolescence. Short stature was seen in 1/3rd of patients. 1/3rd of patients had suppressed 17 OHP levels suggestive of over-replacement therapy which may contribute to final reduction in adult height.

Gastrointestinal lymphomas: Pattern of distribution and histological subtypes: 10 years experience in a tertiary centre in South India

Gastrointestinal tract (GIT) is one of the major sites of extra-nodal lymphomas constituting 10-15% of all non-Hodgkin's lymphoma cases and about 30-40% of extra-nodal lymphomas. Considerable variation exists in the literature with respect to incidence of the various histological subtypes and sites of involvement. This study was undertaken to ascertain the anatomic distribution, histological subtypes and sites of all GIT lymphomas presenting to a tertiary referral hospital in southern India. The histological material of 361 patients over a period of 10 years (2001-2010), with histopathological diagnosis of lymphoma involving the GIT (both primary and secondary), was analyzed retrospectively. All lymphomas were reclassified according to the World Health Organization 2008 classification. These 361 cases include 336 primary and 25 cases of lymphomas, where the involvement was secondary. Primary lymphomas consisted of 267 males (79.64%) and 68 females (20.24%) with a male:female ratio of 3.93:1. The mean age was 45 years (range 3-88). Diffuse large B-cell lymphoma (DLBCL) was the commonest subtype (222 cases; 66.71%), followed by low-grade marginal zone lymphoma of the mucosa associated lymphoid tissue (MALT) type (34 cases; 10.12%) and Burkitt's lymphoma (35 cases; 10.48%). The commonest site was stomach (180 cases; 53.57%), followed by small intestine (79 cases; 23.51%) and large intestine (68 cases; 20.23%), respectively. There were some uncommon types of GIT lymphomas documented during the study. In this largest retrospective single centre study from India, we establish that the pattern of distribution of primary GIT lymphomas (PGLs) in India is similar to the western literature in that the stomach is the commonest site of PGL and DLBCL is the commonest histological subtype. Immunoproliferative small intestinal disease cases were seen in this study, which is uncommon in the west.

P46 TNF-α polymorphism in Takayasu's Arteritis—a preliminary study from tertiary centre in South India

P46 TNF-α polymorphism in Takayasu's Arteritis—a preliminary study from tertiary centre in South India

O15 Efficacy of mycophenolate in medium vessel and ANCA associated vasculitic disorders—experience from a tertiary centre in South India

O15 Efficacy of mycophenolate in medium vessel and ANCA associated vasculitic disorders—experience from a tertiary centre in South India

What Determines Nutritional Recovery in Malnourished Children After Correction of Congenital Heart Defects?

Malnutrition is common in children with congenital heart disease (CHD), especially in developing countries. To examine the impact of corrective intervention on the nutritional status of children with CHD and identify factors associated with suboptimal recovery. Consecutive patients with CHD in a tertiary center in South India were evaluated for nutritional status before and 2 years after corrective intervention. Anthropometry was performed at presentation and every 6 months for 2 years, and z scores were compared. Malnutrition was defined as a weight-for-age, height-for-age, and weight/height z score <-2. Determinants of malnutrition were entered into a multivariate logistic regression analysis model. Of 476 patients undergoing corrective intervention (surgical: 344; catheter-based: 132) z scores of less than -2 for weight for age, height for age, and weight/height were recorded in 59%, 26.3%, and 55.9% of patients, respectively, at presentation. On follow-up (425 patients [92.5% of survivors; 20.63 +/- 13.1 months of age]), z scores for weight for age and weight/height improved significantly from the baseline (weight: -1.42 +/- 1.03 vs -2.19 +/- 1.16; P < .001; weight/height: -1.15 +/- 1.25 vs -2.09 +/- 1.3; P < .001). Height-for-age z scores were not significantly different. Malnutrition persisted in 116 (27.3%) patients on follow-up and was associated with a birth weight of <or=2.5 kg, nutritional status at presentation, and height of parents and not with type of cardiac lesion, dietary intake, or socioeconomic factors. This study from South India demonstrates severe malnutrition in over half of the patients with CHD and is not always reversed by corrective surgery or intervention. Persistent malnutrition after corrective intervention is predicted by nutritional status at presentation, birth weight, and parental anthropometry.

0223 Bilateral breast carcinoma - synchronous and metachronous lesion - a retrospective analysis from a tertiary center in South India

0223 Bilateral breast carcinoma - synchronous and metachronous lesion - a retrospective analysis from a tertiary center in South India

O36 Efficacy and safety of mycophenolate in Takayasu's arteritis—experience from a tertiary centre in South India

O36 Efficacy and safety of mycophenolate in Takayasu's arteritis—experience from a tertiary centre in South India

Bilateral breast carcinoma – synchronous and metachronous lesion – a retrospective analysis from a tertiary center in south India

Bilateral breast carcinoma – synchronous and metachronous lesion – a retrospective analysis from a tertiary center in south India

PALLIATIVE GASTRECTOMY IN ADVANCED GASTRIC CANCER: IS IT WORTHWHILE?

Gastric cancer remains one of the leading causes of cancer-related deaths. Many patients present late, and therefore, resections are often palliative in nature. The aim of this study was to assess the feasibility of resectional operation and the survival advantage of surgical resection in advanced gastric cancer. The effectiveness of palliation and the quality of life following operation for gastric cancer were assessed. One hundred and fifty-one patients who underwent operation for gastric cancer at a tertiary centre in South India during a 5-year period between 1999 and 2003, were included in this study. Four sites of tumour spread were used as indicators of incurability in these patients. These were unresectable primary tumour or macroscopic residual primary tumour (T+), unresectable lymph nodal metastasis (L+), unresectable liver metastasis (H+) and peritoneal metastasis (P+). The resectability rate and survival were assessed in relation to these four factors. The resectability rate decreased as the number of sites of tumour spread increased. The overall survival was significantly better in the subgroup of patients who had a resectional operation (total gastrectomy or subtotal gastrectomy), as opposed to the subgroup who had non-resectional operation (exploratory laparotomy or laparotomy with gastrojejunostomy) (P = 0.0003). This survival advantage of resectional operation disappeared when more than two sites of tumour spread were present. The quality of life was significantly better when a resection operation was carried out. In advanced gastric cancer, palliative resection has a survival advantage if the tumour spread is restricted to two or less sites. Patients who undergo resectional operation have better palliation of symptoms and their postoperative quality of life is significantly better.