Liposarcoma of the Spermatic Cord: A Rare Entity

Primary malignant tumours of spermatic cord are rare. The liposarcoma of spermatic cord is a rare entity and only a few cases have been reported in the literature. We report a case of forty five-year-old male with huge left inguinoscrotal swelling. Fine needle aspiration cytology (FNAC) of swelling revealed the diagnosis of a liposarcoma. The patient was subjected to radical orchidectomy and wide excision. Histopathological examination (HPE) of the resected specimen reported a well-differentiated liposarcoma of the spermatic cord and confirmed the diagnosis

Emergency Pancreaticoduodenectomy in Duodenal Paraganglioma: Case Report

Duodenal gangliocytic paraganglioma (DGP) is a rare tumor that characteristically occurs in the second part of duodenum. These appear as submucosal masses that protrude into the lumen of a duodenum. Gastrointestinal bleeding is the commonest manifestation of DGP. Metastatic spread to regional lymph nodes occurs rarely. Surgical resection is the treatment of choice for DGP. A case of a DGP is reported in young female who presented with a recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy (UGIE) documented a mass in the ampullary region with ulceration in its middle which was bleeding. Recurrent gastrointestinal bleeding necessitated an emergency pancreaticoduodenectomy. Histopathology of specimen documented gangliocytic paraganglioma

Diagnostic Relevance of Primary Investigations in Early Referral and Management of Colorectal Cancer Patients

Aim: Colorectal cancers are largely considered as curable yet the high mortality rates associated with it points out at deficiency in early management of the disease. The aim of this study was to analyze the diagnostic potential of routine primary investigations with an attempt to categorize symptoms for early referral of colorectal cancers patients.Methods: This study involved retrospective analysis of a cohort of 85 patients diagnosed with colorectal cancer that underwent surgery in a period of one year. The patients were arranged into different age-groups to analyze the relative incidence and prognosis of the disease with respect to generalized symptoms and clinicopathological details. Multinomial Logistic Regression analysis was employed to predict the most effective set of parameter combinations for primary prognosis of the diseased state.Results: Abdominal pain, rectal bleeding and change in bowel habits were predominantly reported symptoms; however, these were imprecise with age, sex or stage of cancer. Interestingly, almost 85% of the patients were reported anemic, with a majority of them (41.7%) having Hb 10. Anaemic patients showed significantly higher frequency of symptoms viz. change in bowel habits (p 0.023), rectal bleeding (p 0.035) and/or abdominal pain (p 0.039) compared to non-anaemic ones. The co-occurrence of any two of the symptoms further increased the likelihood of the disease in anaemic patients.Conclusion: A substantial decrease in hemoglobin count with concomitant change in bowel habits, rectal bleeding, and/or abdominal pain could be considered as potential referral markers for early management of suspected colorectal cancers patients

Extensive, Non-Healing Scalp Ulcer Associated with Trauma-Induced Chronic Osteomyelitis

A 77-year-old woman presented with a trauma to the scalp caused from the blade of a windmill. The condition was persistent from the past 50 years. At the initial examination, a deep, foul-smelling and well-circumscribed ulcer was apparent on the head region, involving the majority of the cranium. Skin biopsy specimens of the lesion were nonspecific. The bone biopsy showed extensive necrotic areas of bone and soft tissues, with lymphocytic exudate foci. A computed tomography scan of the head revealed bone destruction principally involving both the parietal bones, and parts of the frontal and occipital bones. Streptococcus parasanguis was isolated from the skin culture, and Proteus mirabilis and Peptostreptococcus sp. were identified in the cultures from the bone. A long-term treatment with amoxicillin-clavulanic acid (1 g/12 h) and levofloxacin (500 mg/day) was prescribed, but even after 6 months, the lesion remained unchanged. The frequency of occurrence of scalp ulcers in dermatological patients is less, principally because of the rich blood supply to this area. We have not found any similar case report of a scalp ulcer secondary to chronic osteomyelitis discovered more than 50 years after the causal trauma. We want to highlight the importance of complete cutaneous evaluation including skin and bone biopsies, when scalp osteomyelitis is suspected

Association of Reduced Folate Carrier (RFC) Gene Polymorphism with Colorectal Cancer Susceptibility In Kashmir.

Folate, important cofactorin one carbon moiety transfer, has been a factor that may modulate the development of colorectal cancer through aberrant DNA methylation and altered nucleotide synthesis and repair. Major folate transport across cell membrane is mediated by reduced folate carrier-1 (RFC1) that also preferably transports chemotherapeutic agents. Variants within the RFC 1 by influencing folate uptake may lead to colorectal cancer susceptibility. Our study is the first to investigate prospectively the RFC gene polymorphism in colorectal cancer in Kashmiri population. A total of 620 subjects (300 colorectal cancer patients and 320 normal subjects) were analyzed by PCR-RFLP technique for RFC gene polymorphism in exon 2 at position 80. We observed 1.27 fold increased risk for AA homozygous variant (OR= 1.27; 95% CI, 0.8678 - 1.875) and 1.19 fold increased risk for GA heterozygous genotypes (OR= 1.19; 95% CI, 0.8080 - 1.760) respectively to CRC susceptibility. However the statistically significant results for smoking and tumor location characteristics were stratified with RFC1 polymorphism, which suggests a possible effect of smoking and cancer location in the etiology of CRC in Kashmir

Transanal Total Mesorectal Excision for Rectal Cancer: Short and Midterm Results

Background: Colorectal cancer is the third most common cancer affecting men and women in most Western countries and is the leading cause of cancer-related deaths. The primary goal of surgery is complete removal of rectal cancer. Total mesorectal excision (TME) is the cornerstone of curative therapy for rectal adenocarcinoma. Transanal total mesorectal excision (TaTME) was introduced for mid and lower rectal cancer and is proposed to allow a precise mesorectal dissection through better visualization in the anatomically limited pelvis. We aimed to check the feasibility of TaTME in terms of the quality of TME, circumferential resection margin positivity, lymph node yield, operation time, mean blood loss, postoperative complications, conversion rate, and hospital stay.Methods: This was a cohort study from July 2018 to June 2020 to validate the efficacy of TaTME in our setup. It included biopsy-proven low and mid-rectal cancers (4-8 cm from the anal verge), T1 with node-positive disease or T2 and T3 with or without nodal disease. Statistical analysis was done by using SPSS software v24.Results: Out of the total patients studied (n=35), 30 (85.7%) were men, and the rest were women. 14 patients received neoadjuvant therapy (40%). Overall, 30 (85.7%) had complete mesorectal excision, 4 (11.5%) patients had near complete mesorectal excision, and one had poor excision. 25 (71.4%) had moderately differentiated adenocarcinoma, 7 (20%) had poorly differentiated adenocarcinoma, and 3 (8.6%) had well-differentiated adenocarcinoma. 34 patients (97.2%) had normal distal resection margins, and only one (2.8%) had positive distal resection margins. Only 2 (5.8%) patients had positive circumferential resection margins (CRM). The mean tumor distance from the anal verge was 4.97 cm. The mean lymph node yield was 7.86±1.73. The mean operation time was 2.095 ±0.461 hours. The mean blood loss was 48.57±11.92 ml. Most patients (71.4%) had no postoperative complications at one month. However, urinary tract infection (8.6%), surgical site infection (5.7%), acute kidney injury (2.9%), anastomotic leak (2.9%), incontinence (2.9%), stromal retraction (2.9%), and rectovaginal fistula (2.9%) were noted. After three months, most patients had no complications (88.6%), though subacute intestinal obstruction occurred in 2 (5.7%) and sexual dysfunction occurred in 2 patients (5.7%). The mean hospital stay was 11.09±2.08 days.Conclusion: The present study suggests TaTME might be a feasible method for oncologic resection of locally advanced mid- and distal-rectal cancer with curative intent. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications were very satisfactory. Short-term morbidity and oncologic outcomes were as good as in other laparoscopic TME series

Effect of Botulinum Toxin Type A on a Rat Surgical Wound Model

ObjectivesThe tension on a wound is one of the important factors that determine the degree of fibrosis and scar formation. We hypothesized that local botulinum toxin type A (Botox) induced paralysis of the musculature subjacent to a surgical wound with a skin defect would minimize the repetitive tensile forces on the surgical wound's edges, and this will result in a decreased fibroplastic response and fibrosis of the wound.MethodsThis is a prospective randomized experimental study. Two distinct surgical wounds were made to the dorsum of 15 adult rats, respectively. One of the 2 wounds was injected with Botox, and the other wound was used as a control, and this was done for all the rats' wounds. We evaluated the wound size, the degree of fibrosis and inflammation, the blood vessel proliferation, the thickness of the wound and the expression of transforming growth factor (TGF)-β1 in the wounds.ResultsThere were significant differences of wound size at the 3rd and 4th week between the Botox and control groups (P<0.05). The Botox group showed less infiltration of inflammatory cells than the control group at the 2nd week (P<0.05). The Botox group showed a smaller number of fibroblasts and less fibrosis than the control group at the 4th week (P<0.05). The Botox group showed much strong collagen density than the control group at the 8th week (P<0.05). For the immunohistochemical staining, there was a lower transforming growth factor (TGF)-β1 expression in the Botox group than that of the control group at the 4th week (P<0.05).ConclusionThe wounds of the Botox-treated group showed a larger wound size, less infiltration of inflammatory cells and less fibrosis, a much greater amount of collagen and a lower expression of TGF-β1 than did the control group. Botox might be used to decrease the fibrosis of a surgical wound without damaging the epithelial growth in situations for which decreased fibrosis is necessary, such as for treating laryngeal, tracheal and nasal stenosis

Cross-cultural adaptation of the locally recurrent rectal cancer – Quality of life questionnaire

Aim: The Locally Recurrent Rectal Cancer - Quality of Life (LRRC-QoL) questionnaire was developed as a disease specific measure of health-related quality of life (HrQoL) in locally recurrent rectal cancer (LRRC), it has previously been validated for use in the UK and Australia. The aim of this study was to translate and cross-culturally adapt the LRRC-QoL to enable its use on an international platform. Materials and methods: Cross-cultural adaptation of the LRRC-QoL was undertaken through a process of 1) Translatability Assessment (TA), 2) forward-backward translation, and 3) pre-testing interviews to establish content validity and conceptual equivalence across all versions. The QQ-10 measure was used to assess face validity and acceptability. The LRRC-QoL was translated into 13 languages: Danish, Dutch, French, Hindi, Italian, Mandarin, Marathi, Portuguese, Russian, Spanish, Swedish, Telugu, and Urdu. Results: In total, 67 patients and 6 clinicians were recruited to pre-testing interviews across 12 countries: Brazil, Canada, Denmark, France, India, Italy, the Netherlands, New Zealand, Pakistan, Singapore, Spain, and Sweden. TA was also undertaken in the USA and Ireland, and translations were prepared in Russian, Marathi, and Telugu. The LRRC-QoL was found to demonstrate conceptual equivalence and content validity across all versions. Mean QQ-10 Value score 76.80 (SD 13.88) and mean Burden score 20.22 (SD 23.03), confirming face validity and acceptability in this international cohort. Conclusion: The LRRC-QoL has now undergone cross-cultural adaptation to enable its use in 10 languages and 16 countries. Its psychometric properties will be further examined through external validation in an international cohort