Carcinoma Gall Bladder with Bouveret’s Syndrome: A Rare Cause of Gastric Outlet Obstruction

We describe a case of bouveret’s syndrome associated with carcinoma gall bladder. This is probably the second reported case of such an association. Computed tomography detected the calculus in the duodenum but endoscopy could not retrieve it. Open gastrojejunostomy and stone retrieval was done.     

Basal Cell Adenoma of the Parotid Gland—A Rare Entity

Salivary gland tumors are uncommon and constitute about 2.0 to 6.5 % of all head and neck tumors. Incidence of basal cell adenoma is about 1 to 3 % of salivary gland tumors. We present a rare case of basal cell adenoma of the parotid and a review of literature.     

Primary Low-Grade Fibromyxoid Sarcoma of Kidney—an Extremely Rare Entity

Renal LGFMS is an extremely rare tumor. So far, only four cases have been reported in literature. LGFMS are indolent tumor with distinctive histopathological features with potential for late recurrences and metastasis. The diagnosis is made on histopathological examination and supported by immunohistochemical analysis. A 35-year-old young male was presented with flank pain and lump and diagnosed as low-grade fibromyxoid sarcoma after surgery on immunohistochemical analysis. This is the fifth case of renal LGFMS and we presented the review of literature. Radical surgery remains the primary treatment modality. Long follow-up is mandatory.     

Unilocular Cystic Lymphangioma of Thigh—An Extremely Rare Clinical Entity

Majority of cystic lymphangiomas are multilocular and occur in neck and axilla. The cystic lymphangioma is also known as cystic hygroma. Unilocular cystic hygroma of neck and breast have been reported in literature and have been termed hydrocele of neck and breast respectively. However unilocular cystic hygroma of thigh is probably being reported for the first time.     

Anterior Mediastinal Mass in a Child—Known but Rare Entity

Thymomas are exceedingly rare tumours of the anterior mediastinum in children. An early awareness helps timely surgical intervention. Thymomas can occasionally be extremely aggressive. The loss of contour on chest X-Ray, to be confirmed as a large anterior mediastinal mass at computerised tomography, serves identification of a typical bilobed thymic tumour.     

Bladder paraganglioma — A report of two cases

Introduction

Bladder paragangliomas (BP) are rare tumors, with clinical manifestations ranging from hypertension to hematuria to being asymptomatic. Histologically, they can mimic urothelial carcinomas. Around 200 cases of paragangliomas arising in the urinary bladder have been described in the world literature.

Epidermoid Cyst—A Rare Mediastinal Mass

Gallstone disease is a common gastrointestinal problem in day-to-day practice. The Old concept that a typical gallstone sufferer is fat, fertile, flatulent female of 50. This is partially true as the disease has been found in women soon after their first delivery who are thin and underweight and in males also. Conditions that favor the formation of cholesterol gallstones are super saturation of bile with cholesterol, kinetically favorable nucleation and presence of cholesterol crystals in the gall bladder long enough to agglomerate into a stone. Recent studies have defined the role of trace elements (Fe, Ca, Zn and Cu) and defective pH in the formation of gallstones. The aim of the study was to correlate iron-deficiency anemia with gallstone disease. To estimate the serum ferritin level as a diagnostic tool of iron deficiency anemia in patients with gallstone disease, this prospective study of 100 patients was conducted over a period of 24 months in the Department of General Surgery, Jaipur Golden Hospital, New Delhi, India. Serum cholesterol, iron and ferritin levels were compared in patients having gallstones and healthy individuals. A low serum iron level is a factor in bile super saturation with respect to cholesterol, leading to gallstone formation.     

Idiopathic Colonic Perforation in Adult—A Rare Case

Idiopathic perforation of normal colon in adults is rare. The cause for idiopathic perforation is not known. We report a case of idiopathic colonic perforation in adult who presented with sign and symptoms of perforative peritonitis. On laparotomy patient was diagnosed to have a colonic perforation. There was no causative factor for perforation in the patient. This case is reported because of rarity of this disease     

Double aortic arch with aneurysm—A surgical case report

An unusual case of double aortic arch with aneurysm is described. A 61-year-old, hypertensive and syphilitic male patient complained of increasing difficulty in swallowing of approximately five months duration. Barium swallow and subsequent aortography showed the presence of an aneurysm of the ascending aorta involving the left (anterior) arch of the double aortic arch. The tightening of the vascular ring by aneurysmal dilatation of the left aortic arch appeared to be responsible for the delayed onset of the symptom. Surgical correction was made by removing the aneurysmal ascending aorta and left aortic arch and a Dacron graft was inserted between the ascending aorta and the right (posterior) aortic arch. The patient died of cerebral complication about forty hours postoperatively. Surgical problems associated with this unusual condition were discussed retrospectively from the operative and autopsy findings. In reviewing the pertinent literatures this case appeared to be the first operated case of double aortic arch associated with aneurysm.     

Sigmoido-Gluteal Fistula—A Rare Complication in Clinically Asymptomatic Chronic Diverticulitis

Chronic colonic diverticulitis may be associated with typical complications such as local abscesses, stenosis, bleeding, intraperitoneal bowel perforations or fistulas to other organs. Most commonly, fistulas exist between the colon and the bladder; nevertheless, they may also extend to the small intestine, other areas of the colon, ureter, uterus, salpinx, vagina, abdominal wall, portal-and mesenterial venous system, pleura, urachus, biliary system and the hip. We report on a patient with chronic colonic diverticulitis having an unusual sigmoido-gluteal fistula along the sacrum, the piriformis muscle and sciatic nerve. The patient presented with sciatic nerve symptoms and recurrent gluteal abscess formation, but no other clinical symptoms leading to an abdominal pathology. Initially, that fact caused an unsuccessful local treatment under the differential diagnosis of a local gluteal abscess for about a year. Finally, a sigmoid colon resection with end-to-end anastomosis and a proximal diverting stoma was performed. The colostomy was closed electively five months later without any complication.     

Retrorectal Epidermoid Cyst – a Rare Entity: the Effectiveness of a Transperineal Posterior Approach

Background: Presacral cysts are rare presacral tumours. The ideal treatment is a matter of debate.

Methods: We report the case of a 39-year-old woman referred to our institution for a presacral mass, casually diagnosed during a pelvic ultrasound examination. Ano-rectal examination and MRI revealed the presence of a mass (53 χ 52 χ 54 mm) in the retrorectal space, located between the right pyriform muscle and the lateral rectal wall, without signs of invasion of the surrounding structures. We performed the intervention with a transperineal approach in the jack-knife position.

Results: Operating time was 20 minutes. During the postoperative period no complication was observed. The patient was discharged in good general condition. No complication occurred during 48 months follow-up. Conclusion: We chose this approach, because, although alternative approaches are described in the literature, they are based on a small number of patients, even if showing encouraging results. We found the posterior procedure safe, feasible and effective.     

Doctor Patient Communication—A Vital Yet Neglected Entity in Indian Medical Education System

Doctor patient communication is the most important and an integral part of any treatment regimen. Properly carried out it has been shown to have a therapeutic effect equivalent to drugs. Despite being so important part of treatment it is more than often taken and carried out casually. Apart from apathy towards this practice, its omission in the medical study curriculum is an important factor. This study was carried in amongst the surgical residents of surgical departments of various medical colleges to assess the attitude of surgical residents towards patient doctor communication. A questionnaire was forwarded by mail and email and the response was assessed: The responses of the surgical residents from various residents from different medical colleges were similar. Most of the residents prefer inclusion of communication skill in medical education curriculum     

Inflammatory Myofibroblastic Tumor After Lung Transplant—A Rare and Aggressive Complication: A Case Report

IntroductionMalignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior.Material and MethodsWe hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT.ResultsA 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function.ConclusionsAlthough IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.     

Transitional Cell Carcinoma of Ureter Simulating Left Colonic Malignancy—A Rare Case

We reported a case of ureteric tumor, an uncommon disease presenting with colonic obstruction. This 52-year-old lady presented with history of colicky pain left lower abdomen for 5 months. Colonoscopy revealed circumferential nonnegotiable stricture at 25 cm from anal verge, and colonoscopic biopsy was inconclusive. Contrast-enhanced computed tomography (CECT) showed a growth involving sigmoid colon and left ureter with proximal left hydroureteronephrosis with nonfunctioning left kidney. Guided fine needle aspiration cytology (FNAC) showed features of an adenocarcinoma. The patient was operated with a diagnosis of carcinoma colon and underwent low anterior resection with left nephroureterectomy. Histopathology of resected specimen revealed ureteric transitional cell carcinoma with colon infiltration. She had smooth postoperative recovery.     

Simultaneous Medullary and Papillary Thyroid Cancer: A Novel Entity?

Background  

The causes underlying the phenomenon of simultaneous medullary (MTC) and papillary thyroid cancer (PTC) are unclear.     

Diet and Bladder Cancer: A Case–Control Study

To investigate possible relationships between diet and risk for bladder cancer in Serbia, the hospital-based case–control study was carried out. This study included 130 newly diagnosed bladder cancer patients and the same number of controls matched by sex, age (%±%2 years) and type of residence (rural or urban). Dietary information was obtained by using a food frequency questionnaire. Initial case–control comparisons were based on tertiles of average daily intake of control group. The odds ratios (ORs) were computed for each tertile, with the lowest tertile defined as the referent category. All variables (food items) significantly related to bladder cancer were included in multivariable logistic regression analysis. According to this analysis, risk factors for bladder cancer appeared to be consumption of liver (OR=6.60, 95%CI=1.89–23.03), eggs (OR=3.12, 95%CI=1.10–8.80), pork (OR=2.99, 95%CI=1.16–7.72), and pickled vegetable (OR=3.25, 95%CI=1.36–7.71). A protective effect was found for dietary intake of kale (OR=0.21, 95%CI=0.06–0.73), cereals (OR=0.19, 95%CI=0.06–0.62), tangerines (OR=0.21, 95%CI=0.07–0.68), cabbage (OR=0.27, 95% CI=0.11–0.68), and carrots (OR=0.15, 95%CI=0.05–0.41). The study indicated a potentially important role for dietary fat and pickled vegetables in bladder carcinogenesis. An inverse association was recorded between consumption of fruits, vegetables and cereals, and the development of bladder cancer.