Radiological Investigation on Sediments: A Case Study of Wadi Rod Elsayalla the Southeastern Desert of Egypt

The presence of heavy radioactive minerals in the studied granitoids from which the Wadi sediments leads to the study of the exposure to emitted gamma rays from the terrestrial radionuclides, such as 238U, 232Th, and 40K. The geological study revealed that the Wadi sediments derived from the surrounding granitoids, such as syenogranite, alkali feldspar granite, and quartz syenite. The mineral analysis confirmed that the granitoids were enriched with radioactive minerals, such as uranothorite as well as monazite, zircon, yttrocolumbite, and allanite. The mean activity of the 238U, 232Th, and 40K concentrations are 62.2 ± 20.8, 84.2 ± 23.3, and 949.4 ± 172.5 Bq kg−1, respectively, for the investigated Wadi sediments, exceeding the reported limit of 33, 45 and 412 Bq kg−1, respectively. Public exposure to emitted gamma radiation is detected by estimating many radiological hazard indices, such as the radium equivalent content (Raeq), external and internal hazard indices (Hex and Hin), annual effective dose (AED), annual gonadal dose equivalent (AGDE), and excess lifetime cancer (ELCR). The obtained results of the radiological hazards parameters showed that public exposure to emitted gamma radiation can induce various dangerous health effects. Thus, the application of the investigated sediments in different building materials and infrastructures fields is not safe. A multivariate statistical analysis (MSA) was applied to detect radionuclide correlations with the radiological hazard parameters estimated in the granite samples.

Management of a Suspected Case of Gallbladder Cancer with Individualised Homoeopathy: A Case Report

Background India has a highest incidence of gallbladder cancer (GBC) and contributes 10% of global GBC burden. The risk of GBC increases with age. The first peak of GBC occurs at 50 to 60 years and second peak at 70 to 80 years. In this article, the authors have presented a suspected case of GBC in a male patient of 65 years. Radiological reports also show presence of gallstones in this case. Studies show that four out of five persons with GBC have gallstones when they are diagnosed. The patient had pain in right upper abdomen, weight loss for few months, liver function test was highly altered and a space-occupying lesion was found in the gallbladder on radiological investigation. Patient was receiving treatment in a private medical college and hospital where computed tomography (CT) scan and magnetic resonance cholangiopancreatography detected gallbladder mass . Age of the patient, significant weight loss, presence of gallstones, abnormal liver function test and gallbladder mass have raised a suspicion of gallbladder cancer. Patient was advised for CT-guided biopsy by doctors of private hospital, but patient did not go for biopsy because of his belief that biopsy may worsen malignancy. Patient came to National Institute Homoeopathy for homoeopathic treatment to avoid biopsy and surgery. Method After proper case taking and repertorisation, a constitutional medicine Carcinosin was prescribed in Q-potency. Patient was kept under follow-up for more than a year and the patient is still under treatment. During treatment different potency of Carcinosin was prescribed in ascending scale. Results During the course of treatment, significant clinical, radiological and biochemical and pathological improvement has occurred. Conclusion Homoeopathy is among the commonly used alternative approaches in cancer. It is being widely used as palliative and curative care in patients suffering from cancer. Though studies on the use of homoeopathy in cancer after surgery, radiotherapy and chemotherapy have been reported, clinical trials on effects of homoeopathy in cancer are rare. In this case report, a suspected case of GBC was treated by higher homoeopathic dilution with significant improvement.

SPIGELIAN HERNIA VARIOUS PRESENTATION AND MANAGEMENT- A CASE SERIES

BACKGROUND: Spigelian hernia is rare and requires high index of suspicion. Given the case of inconsistent ndings and signs the diagnosis of spigelian hernia presents with great difculties than its treatment. Incidence of spigelian hernia ranges from 0.1% to 2% of all abdominal hernias AIM: Aim of this case series is to analyze epidemiological aspects, clinical presentation, challenges in diagnosis, surgical technique characteristics, morbidities and hospital stay MATERIALS AND METHODS: A total number of 4 patients who had undergone surgery for spigelian hernia for a period of 6 months from the month of Jan to June 2021 in the dept of general surgery in KMCH were studied. All 4 cases have been analyzed in this study period and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. All cases presented with pain. Only 2 among 4 cases presented with swelling. Denitive diagnosis of all cases could be done only by CT. Out of these 1 was taken up as emergency.Intraoperatively 3 cases were interstitial and 1 was subcutaneous type. All 4 cases were treated by open surgical technique and by placing mesh at different planes CONCLUSION: Diagnosis of spigelian hernia presents with great difculties and hence one must be aware of the clinical presentation. Pain is the consistent feature of all hernias and only occasionally swelling is present which may mislead easily. Computed tomography of abdomen and pelvis still prevails as the denitive radiological investigation in the diagnosis of spigelian hernia. There are many planes at which mesh can be placed for repair where the operative techniques vary. Though the outcome was good in all four cases discussed here, the post operative complication and duration of stay was considerably less when the mesh was placed in the intermuscular plane.

Surgical management of primary Ewing’s sarcoma of the petroclival bone extend into the sphenoid sinus: A case report and review of literatures

Background: Ewing’s sarcoma (ES) is a malignancy that arises from bones or soft tissue, characterized by primitive small and round blue cells. Primary ES typically occurs in the long bones, vertebrae, or pelvis, and is extremely rare in the skull base. Case Description: A 14-year-old girl presented with posterior cervical pain and dysfunction of multiple cranial nerves (CNs). Radiological investigation revealed a solid mass of the petroclival bone extending into the sphenoid sinus. The patient underwent endoscopic transsphenoidal surgery for diagnosis of the pathology, and partial resection was safely achieved. Histopathological, genetic, and radiological examinations confirmed the diagnosis of primary ES. Subsequently, the patient underwent adjuvant chemotherapy and radiotherapy following which the clinical symptoms resolved. Complete response was achieved after multimodal treatment. Twenty months after treatment, the patient remains in remission without recurrence or metastatic disease. Primary ES of the petroclival bone has been reported in only three cases in the literature. As seen in the present case, dysfunction of multiple CNs is the most common manifestation of petroclival ES. Diagnosis should be confirmed by histopathological and genetic examinations considering the nonspecific clinical symptoms and radiological features. Conclusion: Multimodal treatment, including surgery, chemotherapy, and radiotherapy, can result in favorable outcomes. Clinicians should consider safe resection during surgical management to prevent complications that can delay postoperative multimodal treatment.

SP8.1.5 Breast cancer follow up; Is routine mammography indicated?

Aim This paper aims to review the outcome from yearly mammography in detecting breast cancer recurrence and new primary tumours in patients with a history of breast cancer. Methods From 2014, following treatment for breast cancer, patients were enrolled in a program of self-directed aftercare (SDA). They were given open access to the Breast service. Regular planned appointments were not offered. All patients underwent annual mammography for 5 years. Retrospective analysis of the SDA database from 2014 to 2016 was undertaken, time to and mechanism of detection of breast cancer recurrence in this population was determined. Results 352 patient records were analysed (1760 mammograms), 29 recurrences were identified. 12 locoregional, 12 systemic, 5 locoregional and systemic. Median time to diagnosis of recurrence was 30 months. Locoregional recurrence was detected by surveillance mammography (4 patients), clinical examination following patient request (7 patients), non-breast radiological investigation (5), by non-breast cancer care Doctors (1). No contralateral cancers were detected in patients who had mastectomy or WLE. Conclusion Despite limited evidence for regular clinical assessment post breast cancer treatment, the practice remains recommended. In this study regular clinical review was replaced by open access. Annual mammography was retained. Mammographic value out-with detection of malignancy (new/recurrent) was not assessed. The number of tumours detected (4 out of 1760 mammograms) would suggest that non-stratified routine mammography is of limited value for most patients. Further study is required to determine the risk or value and the cost/benefit analysis of mammographic follow up of breast cancer.

EP.TU.184A story of a successful hunt for long-lost needles

Introduction There are various case reports of intraluminal foreign body following a clear history of ingestion commonly presenting in paediatrics or in patients with a psychiatric background. Case presentation We present a rare cause of unusual foreign bodies evident within the abdomen, radiologically. There was no history of ingestion nor insertion. 70-year-old male has been suffering from chronic abdominal pain, presented to the emergency department with acute lower abdominal pain. He had previous splenectomy with distal pancreatectomy 23 years ago and laparotomy (adhesiolysis) 5 years back. He sought medical opinion on several occasions whereby, based on his intricate surgical history, adhesions were a possible culprit. This admission with acute pain warranted a thorough review of past history and a closer radiological investigation. These showed historical presence of sewing needles for 3 years. Conclusion Foreign body can manifest as acute reactions with inflammatory response, however if not removed can cause scarring and chronic pain as seen in this case. Although evident in radiological images over period of pain recurrence, this was not identified as a cause. We emphasize the need for direct communication between surgical and radiological teams in an unusual case scenario like these, to prevent incidence of symptoms from foreign bodies.

EP.TU.260Retained appendiceal tip and abdominal wall appendicolith - a rare combination of post appendicectomy complications

Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately. An 29 year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis. On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed. The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief. This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.

SP3.1.7 Performance of ultrasound in the diagnosis of cholecystitis and prediction of the “difficult cholecystectomy”

Aims Ultrasound has long been the radiological investigation of choice for right upper quadrant pain for the detection of gallstones and cholecystitis. However, previously reported sensitivity, specificity and other diagnostic metrics have varied widely and the underlying patient numbers have been small. We present robust and exhaustive diagnostic metrics based on a large series of 793 patients. Methods All laparoscopic cholecystectomies at our university hospital were prospectively logged between 2017 and 2020. The ultrasound findings, Nassar operative difficulty and histopathological findings were all collected in addition to patient biometrics. Results In our large patient series, sensitivity of ultrasound for cholecystitis was lower than previously reported at 75.7% for acute cholecystitis, 34.6% for chronic cholecystitis and 42.7% overall. Moreover, we show that sensitivity degrades with the time between ultrasound and cholecystectomy, falling below 50% at 140 days. Finally, we show that ultrasound strongly predicts Nassar difficulty grade of cholecystectomy and that its ability to do so is greatest where the interval between ultrasound and cholecystectomy is less than 27 days. Conclusions We present robust diagnostic metrics for ultrasound in the diagnosis of cholecystitis. These should caution the clinician that ultrasound may miss a quarter of cases of acute cholecystitis and over half of all cases of cholecystitis. Conversely, the finding of a thickened gallbladder on ultrasound can predict a “difficult cholecystectomy” and highlight the need for appropriate expertise and resources. Both this prediction and the diagnostic sensitivity are best if the ultrasound is done less than 27 days before cholecystectomy.

TP9.2.22A six year retrospective study of appendicular neoplasms and review of literature

Aims The aim of this study was to evaluate the incidence of appendiceal neoplasm, identify possible association of pre and intra-operative factors associated with it, and to determine its clinical significance. Methods Using pathological reports from surgical specimens of appendix from January 2015 to September 2020, a single centre retrospective analysis was performed. Medical records of patients, pre-operative investigations, intra operative findings, histological reports and post operative management were evaluated. Results The incidence of appendiceal neoplasms was 2.33% (65/2791). They consisted of Neuroendocrine tumor (NET) in 35(53.85%), followed by Low grade mucinous neoplasm (LAMN) in 23(35.38%), Goblet cell carcinoid in three (4.62%), mucinous cystadenoma 2(3.08%), one (1.54%) adenocarcinoma and one (1.54%) metastasis. Appendicitis was the most common indication for surgery. 46(70.77%) patients had emergency surgery. 89.13% emergency surgeries was appendicectomy, NET being the most common tumor in 60.87%. 19(29.23%) patients had elective surgery, all had pre operative radiological investigation, LAMN being most common. Only five (7.69%) patients had intra operative suspicion of tumor. Ten patients required second procedure in the form of right hemicolectomy in nine, and cytoreducetive surgery in one. All patients were followed up as per national guidelines. Conclusions The incidence of appendiceal neoplasms though low, has been steadily rising. Its diagnosis is rarely evident on pre operative radiological investigations. Surgeons should be aware of these neoplasms and its frequent association with emergency appendicectomies done for suspected acute appendicitis.