Solid Pseudopapillary Neoplasm of Pancreas – A Case Series from Bangalore, India

BACKGROUND Solid pseudopapillary neoplasm (SPN) of pancreas is a rare epithelial tumour of low malignant potential. SPN accounts for less than 1 to 2 % of exocrine pancreatic tumours. It mainly affects women between the second and third decade of life, and its management is not well defined. The aim of this study was to report clinicopathological characteristics of SPN and its outcome. METHODS A retrospective study was conducted in a tertiary care centre from January 2015 to December 2019. All patients who were diagnosed and treated as SPN of pancreas in our institute were retrospectively reviewed. A data of the characteristics of these patients was developed, including age, gender, size, location of tumour, treatment, histopathological and immunohistochemical features. RESULTS Six patients were diagnosed as having SPN of pancreas, during the 5-year period. All 6 patients were female. Youngest age of occurrence was 15 years. Maximum age was 41 years. Average age was 25 years. All patients were symptomatic and the most common symptom was dull aching upper abdominal pain. Contrast enhanced computed tomography (CECT) was done for all patients. 3 patients had typical features of SPN. Endoscopic ultrasound (EUS) was done for 4 patients and EUS fine needle aspiration cytology (FNAC) was done for 3 patients. Patients were provided with procedure details and informed consent was taken. All patients were subjected to surgical treatment. Out of six patients, two underwent laparoscopic spleen preserving distal pancreatectomy, two patients underwent classical Whipple’s procedure and two patients had undergone median pancreatectomy. CONCLUSIONS SPN are rare neoplasms, typically affecting young females without clear histogenesis and with a malignant potential. Appearance from imaging studies can be adequate to guide surgical resection without pre-operative pathological assessment. But in unclear cases, EUS-FNAC with immunohistochemistry helps in establishing a pre-operative diagnosis. Surgical resection should be offered when feasible. Prognosis of SPN of the pancreas is good due to its favourable biological features, even in the presence of distal metastasis. KEYWORDS Solid Pseudopapillary Neoplasm (SPN)

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An overview of endoscopic stapedotomy in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202207 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1102

Author(s):

Atish B. Gujrathi ◽

Siddharth A. Shroff ◽

Nishikant Gadpayale ◽

Naman Agarwal

Keyword(s):

Hearing Loss ◽

Intraoperative Complications ◽

Adult Population ◽

Tertiary Care ◽

Case Series ◽

Anatomical Variations ◽

Common Symptom ◽

Tertiary Care Centre ◽

Female Ratio ◽

Endoscopic Stapedotomy

Background: Stapedotomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio.Methods: This study consists of 30 patients who underwent stapedotomy for otosclerosis. This study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded, during the period of 2 years (2017-2019). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. Results: Age of patients included in this study ranged from 15 to 50 years. Youngest patient was a 17-year-old male. Age of presentation was most commonly seen in third decade of life. Male to female ratio was 1:2. The most common symptom was hard of hearing followed by tinnitus. In this study, 76.67% of the patient’s had bilateral disease. 66.66% of patients had hearing loss between 41-55 dB with mean pre-operative pure tone average was 51.16 dB. About 80% of patients had successful air bone closure between 0-10 dB after the surgery.Conclusions: Endoscopic stapedotomy seems a feasible and relatively safe surgical technique in limited case series. Cosmetically this procedure was more compliant by the patients however endoscopic stapedotomy requires a significant learning curve and an extreme expertise.

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Peripartum hysterectomy: a five year review at a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173490 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3590

Author(s):

Deepak A. V. ◽

K. J. Jacob ◽

Sumi P. Maria

Keyword(s):

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Tertiary Care Centre ◽

Retrospective Case ◽

College Hospital ◽

Peripartum Hysterectomy ◽

Medical College ◽

Obstetric Haemorrhage ◽

Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally.

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S153 – Radiological Balloon Dilatation of Neo-Pharyngeal Strictures

Otolaryngology ◽

10.1016/j.otohns.2008.05.327 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P127-P128

Author(s):

Robert L Harris ◽

Grundy Alan ◽

Tunde A Odutoye

Keyword(s):

Total Laryngectomy ◽

Balloon Dilatation ◽

Malignant Disease ◽

Outcome Measure ◽

Tertiary Care ◽

Case Series ◽

Stent Insertion ◽

Care Centre ◽

Tertiary Care Centre ◽

Main Outcome Measure

Objectives Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post-total laryngectomy and pharyngolaryngectomy neo-pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy. Methods A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post-total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure. Results 5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation. Conclusions Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.

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Should we care about Plasmodium vivax and HIV co-infection? A systematic review and a cases series from the Brazilian Amazon

Malaria Journal ◽

10.1186/s12936-020-03518-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Paola López Del-Tejo ◽

Nadia Cubas-Vega ◽

Cecilia Caraballo-Guerra ◽

Bernardo Maia da Silva ◽

Jefferson da Silva Valente ◽

...

Keyword(s):

Systematic Review ◽

Plasmodium Vivax ◽

Vivax Malaria ◽

Tertiary Care ◽

Case Series ◽

Brazilian Amazon ◽

Outcome Data ◽

Malaria Episode ◽

Tertiary Care Centre ◽

Cross Sectional

Abstract Background Malaria and HIV are two important public health issues. However, evidence on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available information related to Plasmodium falciparum on the African continent. It is unclear whether HIV can change the clinical course of vivax malaria and increase the risk of complications. In this study, a systematic review of HIV/PvCo studies was performed, and recent cases from the Brazilian Amazon were included. Methods Medical records from a tertiary care centre in the Western Brazilian Amazon (2009–2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics and outcomes are reported. Also, a systematic review of published studies on HIV/PvCo was conducted. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted. Results A total of 1,048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which 9 (42.9%) had AIDS-defining illnesses. This was the first malaria episode in 11 (52.4%) patients. Seven (33.3%) patients were unaware of their HIV status and were diagnosed on hospitalization. Severe malaria was diagnosed in 5 (23.8%) patients. One patient died. The systematic review search provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3 and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. Conclusion Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections is not routinely performed, and therefore the real prevalence of HIV/PvCo is unknown. This study showed a low prevalence of HIV/PvCo despite the high prevalence of malaria and HIV locally. Even though relatively small, this is the largest case series to describe HIV/PvCo.

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Cutting the chorda tympani: not just a matter of taste

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000733 ◽

2010 ◽

Vol 124 (9) ◽

pp. 999-1002 ◽

Cited By ~ 15

Author(s):

N Guinand ◽

T Just ◽

N W Stow ◽

H Cao Van ◽

B N Landis

Keyword(s):

Middle Ear ◽

Tertiary Care ◽

Case Series ◽

Salivary Flow ◽

Middle Ear Surgery ◽

Chorda Tympani ◽

Tertiary Care Centre ◽

Ear Surgery ◽

Salivary Function ◽

History Of

AbstractIntroduction:Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.Setting:Tertiary care centre.Material and methods:We report a case series of three patients with bilateral chorda tympani lesions. Chorda tympani function was assessed using ‘taste strips’ and unstimulated sialometry. A careful history of oral symptoms was taken.Results:All patients showed transient or permanent bilateral ageusia of the anterior two-thirds of the tongue, and a decreased resting salivary flow rate. In addition, all patients suffered from transient or persistent, distressing xerostomia.Conclusion:Taste disorders may occur after middle-ear surgery but they are mostly transient, even when the chorda tympani nerves are sectioned bilaterally. In contrast, bilateral chorda tympani lesions may lead to severe, persistent and distressing xerostomia. Based on this neglected aspect of chorda tympani function, we emphasise the importance of preserving the chorda tympani whenever possible.

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Tubercular mastitis: An institutional experience from a tertiary care centre of northern India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i3.16847 ◽

2017 ◽

Vol 8 (3) ◽

pp. 72-75

Author(s):

Amit Gupta ◽

Lovenish Bains ◽

Deepshikha Yadav ◽

Prashant Durgapal ◽

Manish Kumar Agrawal

Keyword(s):

Tertiary Care ◽

Needle Aspiration ◽

Care Centre ◽

Medical Sciences ◽

Tertiary Care Centre ◽

Aspiration Cytology ◽

Northern India ◽

Institutional Experience ◽

Needle Aspiration Cytology ◽

High Index Of Suspicion

Background: Tuberculous mastitis (TM) is a rare extra pulmonary presentation of tuberculosis. It may be problematic to distinguish from carcinoma breast, a condition with which it may coexist. Fine needle aspiration cytology (FNAC) / biopsy are indispensable for diagnosis and tuberculosis culture when positive may be very valuable to guide antimicrobial therapy.Aims and Objectives: To disseminate the message to the concerned expertise that it can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed.Materials and Methods: 19 cases of tubercular mastitis between January 2012 to March 2014 were identified and included in the present study. Cytology and biopsy alongwith AFB stain was done for confirmation.Results: Age ranged between 23- 55 years (median 33 years). Axillary nodes were palpable in 9 (47.3%) patients. Acid Fast Bacilli stain which was positive in only 3 patients. All the 19 patients were started on antitubercular treatment.Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease.Asian Journal of Medical Sciences Vol.8(3) 2017 72-75

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Accidental tramadol ingestion in children admitted in tertiary care centre

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195200 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2661

Author(s):

Vadlakonda Sruthi ◽

Annaladasu Narendra

Keyword(s):

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Ventilatory Support ◽

Case Series ◽

Pediatric Intensive Care ◽

Hemodynamic Instability ◽

Tertiary Care Centre ◽

Medical College ◽

History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

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Clinical study of multiple myeloma and treatment responses in a tertiary care centre

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214417 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3356

Author(s):

Immanni S. M. Giridhar ◽

C. Deepak Yadlapalli ◽

Muralidhar Gullipalli ◽

Venkatesh Mushini ◽

Yerraguntla S. Sarma ◽

...

Keyword(s):

Multiple Myeloma ◽

Treatment Options ◽

Tertiary Care ◽

Elevated Serum ◽

Staging System ◽

Stage Iiib ◽

Common Symptom ◽

Tertiary Care Centre ◽

Incurable Disease ◽

Unknown Significance

Background: Multiple myeloma (MM) evolves from Monoclonal gammopathy of unknown significance (MGUS), a premalignant clinical condition. Second to non-Hodgkin’s lymphoma, MM is the most common haematological malignancy. The aim of the study was to review the clinical profile and response of individuals treated for MM from this part of country.Methods: We evaluated data of patients with MM managed between 2013 and 2019 at a tertiary care cancer hospital in Rajamahenderi, India. Data regarding demographic variables, clinical features, disease characteristics and treatment details were collected and analysed.Results: Total of 54 patients with MM were managed. Mean age was 59.4 years. Males accounted for 63%. Bone pain (90%) was the most common symptom. Elevated serum creatinine was noted in 16.7% and M band in 42 (77.8%). X-ray of skull showed lytic lesions in 41 (75.9%). Mean haemoglobin value was 8.8±1.9 g/dl and serum calcium was 9.12 mg/dl. Majority of subjects, 44 (81.48%) belong to stage IIIA, 9 (16.67%) to stage IIIB, and 1.85% to stage IIA of Durie Salmon staging system. No response was noted in 17 (31.5%), 4 (7.4%) subjects had a progressive disease even on treatment, and 8 (14.8%) subjects had a very good partial response. Median survival of subjects belonging to DSS stage II was 17 months, IIIA was 11.037 months and stage IIIB was 17.463 months.Conclusions: MM has an early onset in India. Though MM is an incurable disease, many promising treatment options are there which lead to increase in survival. Early treatment helps in improving mortality rates, better quality of life and decreases disease burden.

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CLINICAL PROFILE AND MANAGEMENT OF PATIENTS OF AMOEBIC LIVER ABSCESS IN A TERTIARY CARE CENTRE

10.36106/ijsr/5406508 ◽

2020 ◽

pp. 5-7

Author(s):

Rakesh Mishra ◽

Debabrata Banerjee ◽

Debarshi Jana

Keyword(s):

Drug Treatment ◽

Liver Abscess ◽

Tertiary Care ◽

Clinical Manifestations ◽

Needle Aspiration ◽

Intestinal Disease ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

Tertiary Care Centre ◽

Early Recovery

Introduction: Amoebiasis is caused by the protozoan Entamoeba histolytica. Most infections are asymptomatic; clinical manifestations include amoebic dysentery and extra intestinal disease. Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Amoebae establish hepatic infection by ascending the portal venous system. Aim: To study various aspects of Amoebic Liver Abscess like demographic profiles, clinical presentations, association with intestinal disease, radiological and laboratory findings, treatment modalities and complications. Materials and Methods: A hospital based prospective observational study was performed in the Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, from Jan 2018 to Jun 2019. All confirmed cases of amoebic liver abscess above the age of 18 years admitted in Command Hospital (EC) were included in this study. The patient were then subsequently followed up for 01 year with USG abdomen every 03 monthly. Results: Total 40 patients of Amoebic Liver Abscess with age more than 18 year were enrolled in the study. The age ranged from 26 to 70 years (mean age 46.2 year). Male patients were dominated over female. 80.0 % were from rural background. About 55% patients were addicted to alcohol & 25.0 % were known diabetics at presentation. In all, 07 (17.5%) patients with abscess size of 6 cm to 10 cm (Vol> 300 cc) were treated by needle aspiration and drug therapy. Remaining 17(42.5%) patients with abscess size more than 10 cm were treated with pigtail drainage and drug. Conclusion: There is significant advantage of pigtail drainage with drug treatment over needle aspiration with drug and only with drug treatment in terms of decrease in lesion size and early recovery.

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A Clinicopathological Review of Adnexal Masses in a Tertiary Care Centre of Rural Haryana - A Retrospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/500 ◽

2021 ◽

Vol 8 (30) ◽

pp. 2719-2723

Author(s):

Shivani Khandelwal ◽

Lakra Pinkey ◽

Sangwan Vijayata ◽

Mahendru Rajiv ◽

Siwach Sunita ◽

...

Keyword(s):

Retrospective Study ◽

Tertiary Care ◽

Serous Cystadenoma ◽

Common Symptom ◽

Tertiary Care Centre ◽

Adnexal Masses ◽

Sexually Transmitted ◽

Medical College ◽

Wide Range ◽

Ectopic Pregnancies

BACKGROUND There is a wide range of adnexal masses ranging from functional cyst to infection and even malignancy. Epithelial ovarian tumours are the most common benign ovarian lesion. The purpose of this study was to study the pattern of adnexal masses in rural area and plan the preventive steps according to the pattern. METHODS It was a retrospective study of patients who presented with adnexal masses in Bhagat Phool Singh Medical College (Women), Khanpur, Sonepat, Haryana, India over a period of 5.5 years from September 2012 to August 2018. The file records of the patients who underwent surgery for adnexal masse were evaluated to identify the risk factors, presenting complaints, examination findings, serological markers and radiological findings. The histopathological reports were reviewed. The cases excluded were ectopic pregnancies. Frequency distribution tables were used and data was analyzed using percentages. RESULTS Out of total 180 adnexal masses, 167 (92.77 %) cases were of ovarian origin. Out of these, 150 (83.33 %) cases were benign and 17 (9.44 %) were malignant. Among the benign lesions, serous cystadenoma was the most common lesion counting for 54 cases i.e., 30 %. In our study, most common symptom was vague abdominal pain- 63.88 %. Maximum adnexal masses were in the age group of 41 - 50 years i.e., 53 (29.44 %). Different types of surgeries were done. Maximum were bilateral oophorectomies with transabdominal hysterctomy 88 (48.88 %). CONCLUSIONS By proper education about personal and perineal hygiene, use of contraceptives, we can at least prevent some sexually transmitted diseases causing pelvic inflammatory disease (PID) and adnexal masses. KEYWORDS Adnexal Mass, Benign, Malignant, Serous Cystadenoma

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