Embryonal Carcinoma in Cryptorchid Abdominal Testis of an Infant

Cryptorchidism is a known predisposing factor for the development of testicular tumors in adults. Age of patient at the time of treatment of undescended testes has some bearing on the risk of neoplasia. Testicular neoplasia at the time of primary surgery for cryptorchidism has been reported rarely in prepubertal period. We report a case where embryonal carcinoma was detected in a cryptorchid testis of an infant

Cholangitis and Choledocholithiasis After Repair of Duodenal Atresia: A Case Report

Cholelithiasis is a rare but known complication of surgery for duodenal atresia. Occurrence of choledocholithiasis as sequelae of duodenoduodenostomy is still rarer. Biliary stasis resulting from compression of common bile duct due to periductal fibrosis may predispose to gallstone formation. We are reporting a case of choledocholithiasis in a 6 year old child as a late post-operative complication of duodenoduodenostomy (for duodenal atresia in the neonatal period). To the best of our knowledge this is the first case of its kind reported in English literature. Cholecystectomy followed by choledocholithotomy was done and the patient had an uneventful recovery. Upper abdominal pain in any patient with a history of surgery for duodenal atresia in the past warrants a thorough evaluation for any biliary tract anomaly, cholecystitis, cholangitis, cholelithiasis or choledocholithiasis

Splenic hydatidosis with abdominal pain – a rare presentation in a developing nation

Introduction. Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even rarer. Splenic hydatidosis constitutes 2% to 3.5% of all hydatid cysts. Aim. To present a case report of splenic hydatidosis with abdominal pain. Description of the case. We report here a case of isolated splenic hydatid cysts in a 23 year old female, who presented with dull dragging pain in the left hypochondrium. Diagnosis was made on computed tomography imaging of the abdomen and microscopic examination of the laminated hydatid cyst wall and supplemented with positive enzyme linked immunosorbent assay for hydatid antibodies. Conclusion. The incidence of splenic involvement by hydatid cysts is very low. Man is an accidental intermediate host, as entry of the larval forms into humans represents an end stage in its life cycle. Until recently the gold standard treatment for splenic hydatidosis was splenectomy, as medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases, to reduce opportunistic post splenectomy infection

A Prospective Study of Altered Inflammatory Response and Its Clinical Outcome Following Laparoscopic and Open Cholecystectomy

Background: Inflammatory response following surgical trauma has long been a matter of study. Results, however, have been varied. We sought to assess changes in the levels of proinflammatory and anti-inflammatory cytokines in patients undergoing laparoscopic and open cholecystectomy and their impact on the clinical outcome of patients concerning the postoperative pain score. Methods: The study involved 90 cholecystectomies (55 laparoscopic and 35 open) for chronic cholecystitis. Blood samples were collected 2 hours preoperatively and at 4 and 24 hours post surgery. Sera were evaluated for the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha. The independent sample t-test was used to compare the means of a variable between the 2 groups. Statistical analysis was done using SPSS, version 17. Results: The rise in the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha was significantly more in the open cholecystectomy group at 4 hours (P<0.00). At the 24th postoperative hour, the levels of all 3 cytokines were also higher in the open cholecystectomy group (P<0.001 for interleukin-1β, P=0.185 for interleukin-10, and P<0.001 for tumor necrosis factor-alpha). At the 4th postoperative hour, the patients in the laparoscopic cholecystectomy group had a significantly lower pain score (P<0.001) than the open group. Conclusion: Both laparoscopic and open cholecystectomy procedures altered the inflammatory milieu of our patients in the postoperative period. Inflammation caused by the laparoscopic procedure was significantly less. More research is needed to target specific inflammatory and anti-inflammatory cytokines to reduce surgical stress and improve patient outcomes

Peripheral Neutrophil to Lymphocyte Ratio (NLR), a cogent clinical adjunct for Ki-67 in breast cancer

Abstract Background Clinical utility of Ki-67 immunohistochemistry (IHC) in breast cancer (BC) is mainly limited to decide for the use of chemotherapy and estimate prognosis in patients with either Ki-67 index  30%; however, lacunae still exists pertaining to its analytical validity. Neutrophilia is common in cancer with accompanying lymphocytopenia. Neutrophil to lymphocyte ratio (NLR) captures the intricate balance between pro-tumor neutrophilia and anti-tumor lymphocyte immunity. This study aimed to correlate cellular proliferation in breast cancer with NLR. Methods An observational study was carried out including 73 cases of BC; pre-treatment NLR and Ki-67 grading were performed. NLR  0.05) and molecular subtype (p > 0.05); however, NLR was found to be significantly correlated with TNM stage (p < 0.001) and Ki-67 (p < 0.001). Conclusion NLR is fast emerging as a personalized theranostic marker in breast cancer. Instead of determining a generalized cut-off value, individual baseline NLR and its dynamics with disease progression will help manage patients better, obviating some of the drawbacks associated with Ki-67