scholarly journals Results Following Surgical Resection of Recurrent Chordoma Of the Spine: Experience in a Single Institution

2020 ◽  
Author(s):  
Pongsthorn Chanplakorn ◽  
Thamrong Lertudomphonwanit ◽  
Wittawat Homcharoen ◽  
Prakrit Suwanpramote ◽  
Wichien Laohacharoensombat
Keyword(s):  
Surgical Resection ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Oncologic Outcome ◽  
Small Mass ◽  
Low Grade ◽  
En Bloc ◽  
Large Tumor ◽  
Free Margin

Abstract Background: Chordoma of the spine is a low-grade malignant tumor with vague and indolentsymptoms thus large tumor mass is encountered at the time of diagnosis in almost cases and makes a difficult for En-bloc free-margin resection. Salvage therapyfor recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine.Materials and Methods:Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018atone tertiary-care center was conducted.Results: There were 10 patients, 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue and remaining bony structure. Distant metastaseswere found in 2 patients. The average time of recurrence was 28 months after first surgery. Conclusion:En-bloc free margin resection is mandatory toprevent recurrent. The clinical vigilance and investigation to identify tumor recurrent should be obtained periodically,in the first 28 months. Detection of recurrent in early stage with a small mass may be the best chance to perform an En-Bloc margin free resection to prevent further recurrent.

scholarly journals Results Following Surgical Resection of Recurrent Chordoma of the Spine: Experience in a single institution

2020 ◽  
Author(s):  
Pongsthorn Chanplakorn ◽  
Thamrong Lertudomphonwanit ◽  
Wittawat Homcharoen ◽  
Prakrit Suwanpramote ◽  
Wichien Laohacharoensombat
Keyword(s):  
Surgical Resection ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Oncologic Outcome ◽  
Distant Metastases ◽  
Low Grade ◽  
En Bloc ◽  
Large Tumor ◽  
Free Margin

Abstract Background: Chordoma of the spine is a low-grade malignant tumor with vague and indolent symptoms thus large tumor mass is encountered at the time of diagnosis in almost cases and makes a difficult for En-bloc free-margin resection. Salvage therapy for recurrent chordoma is very challenging due to its relentless nature and refractory to adjuvant therapies. The aim of this present study was to report the oncologic outcome following surgical resection of chordoma of the spine. Materials and Methods: Retrospective review of 10 consecutive cases of recurrent chordoma patients who underwent surgical treatment between 2003 and 2018 at one tertiary-care center was conducted. Results: There were 10 patients, 4 females and 6 males were included in this study. Eight patients had local recurrence. The recurrence was encountered at the muscle, surrounding soft tissue and remaining bony structure. Distant metastases were found in 2 patients. The median time to recurrent or metastasis was 30 months after first surgery. Conclusion: En-bloc free margin resection is mandatory to prevent recurrent. The clinical vigilance and investigation to identify tumor recurrent should be performed every 3 to 6 months, especially, in the first 30 months and annually thereafter. Detection of recurrent in early stage with a small mass may be the best chance to perform an En-Bloc margin free resection to prevent further recurrent.

scholarly journals Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems – a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 575-581
Author(s):  
Martina Kreft ◽  
Roland Zimmermann ◽  
Nina Kimmich
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Low Grade ◽  
Singleton Pregnancy ◽  
Perineal Tear ◽  
Vertex Presentation

AbstractObjectivesBirth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.MethodsIn a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.ResultsA total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.ConclusionsThere were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

scholarly journals Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh

2017 ◽  
Vol 31 (2) ◽  
pp. 86-89
Author(s):  
Farzana Deeba ◽  
Parveen Fatima ◽  
Jesmine Banu ◽  
Shakeela Ishrat ◽  
Nurjahan Begum ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Target Population ◽  
Fertility Treatment ◽  
Tertiary Care Centre ◽  
Infertile Women ◽  
The Mean ◽  
Tsh Levels

Objective(s): Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.Materials and methods: This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT4. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.Results: Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.Conclusion: The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89

scholarly journals Spectrum of cytological patterns in cervical PAP smears in a tertiary care center of Western region of Nepal

2019 ◽  
Vol 4 (1) ◽  
pp. 2-8
Author(s):  
Pragya Gautam Ghimire ◽  
Durga BC Rawat ◽  
Kavita Sinha ◽  
Kamar Jahan ◽  
Richa Shrestha
Keyword(s):  
Cervical Cancer ◽  
Epithelial Cell ◽  
Pap Smear ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pap Smears ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Introduction: Cervical cancer is a common health problem in Nepal. There is paucity of data regarding the spectrum of findings in cervical Pap in western Nepal. This study was aimed to study the cytological patterns in cervical Pap smears in patients in a tertiary hospital of Nepal. Methods: This is a prospective, cross sectional, hospital based study. Clinical features of patients who had presented with Pap smear was noted in a structured proforma. Pap smears were studied by a senior pathologist and reported based on revised Bethesda system (2014). Results: Most of the cases belonged to 31-40 years 399 (42.8%). Unsatisfactory/ inadequate sample was present in 133(14.05%) with obscuration due to inflammatory exudate being most common cause. Negative for intraepithelial lesion or malignancy rate was noted in 798 (85.54%) with 477(51.2%) being normal findings. Epithelial cell abnormalities were noted in 116 (14.5 %) smears. Low-grade squamous intraepithelial lesion constituted 321(34.5%), High grade squamous intraepithelial lesion 273(29.3 %) and Atypical squamous cells of undetermined significance 153(16.4%) of epithelial cell abnormalities. Squamous cell carcinoma was present in 9(1%) of all reviewed smears. There was no statistical significance between the age and abnormalities of Pap smear (p=0.9). Conclusions: Pap smear is pivotal in cervical cancer screening in developing countries. It also identifies various inflammatory, infective, benign and malignant pathologies at the earliest thereby decreasing the morbidity and mortality.

Incidence of Involvement of Nipple Areola Complex in Breast Cancer

2015 ◽  
Vol 24 (Number 1) ◽  
pp. 33-38
Author(s):  
Md. R Hoq ◽  
A Sayeed ◽  
B Khan ◽  
R Parvin ◽  
S I Khan
Keyword(s):  
Breast Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
Age Distribution ◽  
Oncologic Outcome ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Areola Complex ◽  
Areolar Complex ◽  
Study Population

In this prospective study, fifty cases of breast cancer were studied in a tertiary care center & different hospitals of Dhaka city for one year, aimed to determine the incidence of malignant involvement of NAC in breast cancer patients of our country with clinically uninvolved nipples from history and postoperative histopathological reports of mastectomy specimens. The age distribution of Breast cancer varied from 25 to 75 years. Highest incidence was in 5th and 6th decades numbering 30 (60%) cases. Incidence of 3rd decades was 8 (16%) cases and in 7th decades was 12 (24%) casesin relation to menstrual cycle Breast Ca incidence is more in post-menopausal women numbering 28 (56%).Lump size of most of the study population found within 2-Scm (T2 stage). Incidence of axillaty lymph node metastasis found positive in 28 patients (56%) and no metastasis in 22 patients (44%). Of 50 patients maximum no 22 (44%) found with moderately differentiated tumour, 16 (32%) patients found poorly differentiated, differentiation could not be assessed in 12 (24%) patient and well differentiated tumour found in only 2 (4%) patients. The most common histological type found in the study population is IDCC 44 (88%). Skin involvement was 0% and only 2% patients have malignant involvement of NAC from underling breast cancer. The conclusion in respect to this study is, Nipple areolar complex can be preserved with breast reconstruction in carefully selected patients going for breast cancer surgery with safe oncologic outcome.

scholarly journals Transformation of Follicular Lymphoma to Double Hit B-Cell Lymphoma Causing Hypercalcemia in a 69-Year-Old Female: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sakshi Kapur ◽  
Miles B. Levin
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
De Novo ◽  
Cell Lymphoma ◽  
Care Center ◽  
Tertiary Care ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Severe Hypercalcemia ◽  
Double Hit

Double hit B-cell lymphomas are rare tumors that are defined by a chromosomal breakpoint affecting the MYC/8q24 locus in combination with another recurrent breakpoint, mainly a t(14;18)(q32;q21) involving BCL2. These tumors mostly occur in adults and carry a very poor prognosis. Double hit lymphomas can occur de novo, or arise from transformation of follicular lymphoma. We report a case of a 69-year-old female with abdominal distention and progressively worsening weakness over six months. Patient presented with severe hypercalcemia and multiple intra-abdominal/pelvic masses. Histopathology results of the abdominal mass were compatible with a double hit B-cell lymphoma. However, bone marrow biopsy results showed a low grade follicular lymphoma, thus suggesting peripheral transformation of follicular lymphoma to double hit B-cell lymphoma. Patient was transferred to a tertiary care center and was started on combination chemotherapy (EPOCH: doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisone). Our paper highlights not only transformation of follicular lymphoma to double hit B-cell lymphoma and the challenges encountered in diagnosing and treating these aggressive tumors, but also the association of new onset/worsening hypercalcemia in such patients.

scholarly journals Emergency obstretic hysterectomy: a retrospective study in a tertiary care center

2019 ◽  
Vol 8 (6) ◽  
pp. 2368
Author(s):  
Vaishnavi Sanjay Shivade ◽  
Vaishali S. Vhawal ◽  
Manisha M. Laddad
Keyword(s):  
Maternal Mortality ◽  
Postpartum Hemorrhage ◽  
Early Stage ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Successful Operation ◽  
Management Options ◽  
Primary Indication ◽  
Skilled Operator

Background: Obstetric hysterectomy remains a necessity in preventing maternal mortality in catastrophic rupture of the uterus or intractable postpartum hemorrhage when all the conservative management options fail. Uterine atony followed by abnormal placentation remains the primary indication of emergency obstratic hysterectomy worldwide. In majority of cases, anticipation, prompt resuscitation and earlier surgical intervention by skilled operator will reduce patient’s morbidity and mortality. The first successful operation was performed in 1876. The main objective of the study was to study frequency, indications and fetomaternal outcome of emergency obstetric hysterectomy in tertiary care center.Methods: Observational, retrospective and analytical study was done over 2 years from January 2017 to January 2019. A total of 11 cases of emergency obstretic hysterectomy (EOH) were recorded.Results: The overall incidence was 1.47 per 1000 deliveries. Atonic postpartum hemorrhage (54%) was the most common indication followed by placenta previa (18%) and placenta accreta (9%). Second gravida were mostly involved (45%) with previous LSCS (45%) as a common risk factor in commonest age group of 20-25 years (46%) amongst them. The most frequent squeal was disseminated intravascular coagulation (45%). Maternal mortality was nil while neonatal mortality being 9%. The decision of performing total or subtotal hysterectomy along with bilateral internal iliac ligation was influenced by patient’s condition.Conclusions: Emergency obstretic hysterectomy is the most demanding obstretic surgery performed in circumstances of life threatening hemorrhages where conservative surgical modalities fail and interventional radiology is not immediately available. Antenatal anticipation of the risk factors, involvement of experienced obstetrician at the early stage of management and prompt hystrectomy after adequate rescuitation will reduce fetomaternal mortality and morbidity.

Primary Colonic Lymphoma

2008 ◽  
Vol 74 (3) ◽  
pp. 214-216 ◽  
Author(s):  
QuintÍN H. Gonzalez ◽  
Martin J. Heslin ◽  
Andrea DÁVila-Cervantes ◽  
Javier Alvarez-Tostado ◽  
Antonio Espinosa De Los Monteros ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Recurrence Rate ◽  
Surgical Resection ◽  
Tertiary Care ◽  
Colorectal Disease ◽  
Common Disease ◽  
Low Grade ◽  
Sigmoid Colectomy ◽  
Presenting Symptoms ◽  
Ldh Value

Surgical resection of primary colonic lymphoma can be an important therapeutic tool. We performed a nonrandomized retrospective descriptive study at the University hospital tertiary care center. From January 1990 to June 2002, a total of 15 patients with primary colonic lymphoma were identified from the tumor registry at University of Alabama at Birmingham and retrospectively reviewed under Institutional Review Board approved protocol. Demographic data, clinical features, treatment method (surgery and/or chemotherapy), recurrence rate, and survival were analyzed. The results are presented as mean ± standard deviation or median and range. Differences in survival were evaluated by the log-rank test and the interval of disease-free survival was calculated using the Kaplan-Meier method. A P value of <0.05 was considered statistically significant. Main outcome measures included surgical results, morbidity, mortality, and recurrence rate. Mean age was 51.5 years (standard deviation 16.4), 33 per cent were male and 67 per cent were female. Presenting symptoms were diarrhea (53.5%), lower gastrointestinal bleeding (13.3%), and nausea and vomiting (46.7%) secondary to low-grade obstruction. Concomitant colorectal disease was present in one patient with ulcerative colitis. Preoperative diagnosis of lymphoma was made in 13 patients (87%) with colonoscopy and biopsy. CT scan was performed in all patients; and none had radiographic evidence of systemic extension. Only one patient had a history of lymphoproliferative disease and exposure to radiation. The most common disease location was the cecum (60%), followed by the right colon (27%), and the sigmoid colon (13%). The mean lactic dehydrogenase (LDH) value was 214.9 u/L (range 129–309). Thirty-three per cent of the patients had an LDH value that was above the upper normal limit. LDH returned to normal after treatment in all patients. Operations performed consisted of right hemicolectomy (13), total proctocolectomy with ileal J J-pouch (1), and sigmoid colectomy (1). Eighty-seven per cent had negative margins at the time of operation. Twelve patients received postoperative chemotherapy (80%). According to the clinical classification of primary non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (Lugano, 1993) all patients corresponded to stage IE. Mean hospital stay was 6.4 days (range 3–26). There was no surgical mortality and the morbidity rate was 20 per cent (3 patients). One patient had a systemic recurrence (7%) approximately 4 months after surgical resection. Mean follow-up was 31 months (median 2–73). Surgical resection of localized, primary colonic lymphoma provides excellent local disease control and should be considered a primary treatment option. The role of chemotherapy remains controversial depending on the grade, stage, and extension of residual disease.

A retrospective analysis of epidemiology and treatment patterns for gastric cancer at a tertiary health care center in India

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4086-4086
Author(s):  
R. Digumarti ◽  
S. J. Rajappa ◽  
S. Uppalapati ◽  
A. Surath
Keyword(s):  
Gastric Cancer ◽  
Retrospective Analysis ◽  
Palliative Chemotherapy ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Treatment Patterns ◽  
The Body ◽  
Early Stage Disease

4086 Background: Gastric cancer is the second most common gastrointestinal cancer in our hospital based cancer registry. This retrospective analysis aims at studying the epidemiology and treatment patterns for gastric cancer at our hospital, which is a tertiary care cancer center for the state of Andhra Pradesh in south India. Methods: A retrospective analysis of the case records of 125 consecutive patients with gastric cancer who presented to our department between Jan 2004 and Dec 2005 were analysed. Data regarding epidemiology, stages at diagnosis and treatment plans were collected. Patients with early gastric cancer received 5FU based chemoradiation or chemotherapy only. Palliative chemotherapy included 5FU/cisplatin based regimens. Results: A total of 125 patients were analysed. The median age was 61years (range 18–82 years). 71% were males and 29% females. Being a tertiary care center, 92% were referred with a confirmed diagnosis on endoscopic biopsy. 30% were smokers, 11% consumed alcohol, 40% had both habits while 29% had neither. The most common part of the stomach involved was the antro-pyloric region (44%) followed by the body (30%), GE junction/cardia (20%) while 6% had diffuse involvement including linitis plastica. At diagnosis, 35% were early stage, 56% metastatic and 8% locally advanced tumors. 90% patients who had surgery for early stage disease had T2,3 tumors. One third had inadequate nodal staging.70% of patients who had curative resections underwent adjuvant chemoradiation and 30% had chemotherapy only. Of all patients with metastatic disease, 65% palliative chemotherapy while 45% opted for best supportive care. Conclusions: The distribution of tumors within the stomach is similar to Japanese data, which may reflect the common etiological factors like high salt diet. The fact that one third of patients had inadequate nodal dissection stresses the relevance of adjuvant chamoradiotherapy protocols. The high incidence of smoking as a contributory factor in the etiology reflects the need for aggressive anti tobacco legislation. The study reiterates the need for inexpensive and novel therapies for palliation of symptoms in patients with advanced disease and widens the scope for collaborative clinical trials. No significant financial relationships to disclose.

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