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

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

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

New Technology in Colorectal Cancer-a Boon or a Bane

Better patient care in today’s world is almost synonymous with newer technology. Newer technology in the form of latest gadgets used for diagnostics, preoperative work up; per-operative care and post operative smooth recovery have become the part and parcel of our standard day to day quality care and any practitioner, nowadays, refusing to incorporate these gadgets in his day to day practice is labeled as orthodox and an outdated clinician.We as service providers need to be technology friendly and at the same time try to use these gadgets for quality care and cure. We have to be the ones guiding the technology rather than being guided by the technology. But probably many a times that may not be true in day to day practice with most of us. With the result we have allowed the technology to be our bad master rather than utilizing its services as a good servant and probably in the name of better care many a times the new technology is used abusively rather than genuinely and the ultimate impact may not only be financial but even the physical; and the sole sufferer is the end user; that is the patient. I will in my article try to weigh the pros and cons of this theme and try to come out with a balanced conclusion for the worthy readers

RISK FACTOR ASSESSMENT OF NON-COMMUNICABLE DISEASES USING COMMUNITY BASED ASSESSMENT CHECKLIST (CBAC) AMONG KASHMIRI ADULT POPULATION.

Background: In India, non-communicable diseases (NCD) are the leading cause of death in India, with mainly cardiovascular diseases (CVD) which account for nearly 1 in 3 deaths. Therefore, prevention of CVD risk factors is an important public health priority. Aim of the study: The aim of the study was to assess the risk factors of NCDs using CBAC form among Kashmiri adults.Materials and Methods: This was a community based cross sectional study conducted in the field practice area of department of community medicine, Government medical college Srinagar over a period of three months.Results: Among the total of 601 , 212 (34.7%) were found to have high risk and 398 (65.2%) were found to have low risk. Majority (38.6%) of the high-risk patients were in the age group of 41 to 50 years. Age, gender and educational level was significantly associated with high-risk participants with a p value of <0.001. Tobacco consumption, physical inactivity and presence of Non communicable diseases were significantly higher among high-risk participants. Conclusion: 34.7% of the study participants were found to have high risk on CBAC assessment. CBAC is a very simple tool that can be used to screen the risk of NCDs in communities by ASHA workers

Minimally invasive procedure for hemorrhoids: Surgical results

Objectives: The purpose of the present study was to determine the surgical results of stapled hemorrhoidectomy and overall satisfaction of the patient and to evaluate its suitability as a routine day care surgery procedure in this part of the world. Materials & Methods: A total of 30 patients were operated from June 2006 to Dec 2008. The median age of the patients was 49.1 years. The main symptom was digital recognition of perianal mass (96%). The procedure was performed under regional (epidural or spinal) or general anesthesia. The average operative time was 31.08 minutes. The procedure was performed with PPH03, a 33 mm diameter hemorrhoidal circular stapler. The patients were prospectively evaluated for postoperative pain and bleeding, satisfaction scores, anorectal function, return to work and cost effectiveness of the procedure. Results: The duration of the PPH procedure ranged from 30-45 minutes (average 31.08 minutes). The suture line was on average 3.5cm (3 - 4.5) above the dentate line. Excision of external skin tags while undergoing PPH was performed in 16.6% cases (n=5). No stapler failure was detected. Seven patients (23.3%) had bleeding after the stapler off and 3 patients (10%) had bleeding in the first post operative day. Patients average pain score was 1.57 (VAS 1-5) at 24 hrs in the 1st postoperative period. Of note, three patients had no pain at all immediately after surgery. No patients had recurrence of hemorrhoidal prolapse, bleeding or anastomotic stricture upon rectal exam or fecal incontinence Ninety percent of patients (n=27) were discharged in a day while as 10% were discharged after 2 days because of their co morbid conditions Return to work was early between 5-7 days postoperatively with high patient satisfaction score. Conclusions: Stapled hemorrhoidectomy (SH) is a safe, effective and well tolerated procedure in the treatment of grade 3 and grade 4 hemorrhoids with less postoperative pain and high patient satisfaction, which seems to have all the requirements for Day Care Surgery

Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir

Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results

“PNR-Bleed” classification and Hemorrhoid Severity Score—a novel attempt at classifying the hemorrhoids

Hemorrhoids are the most common anorectal disorders with a prevalence of 39% in general population. Hemorrhoids are generally classified on the basis of their location and degree of prolapse. Goligher’s classification does not describe the number of hemorrhoidal columns involved and does not give much consideration to the amount of blood loss. To describe the hemorrhoidal disease more vividly, we devised the “PNR-Bleed” (or PNR-Booking) classification system. We tried to classify the hemorrhoids based on the four main characteristics of the hemorrhoidal disease i.e. the degree of hemorrhoidal Prolapse (P), Number (N) of the primary hemorrhoidal columns involved, Relation (R) of the hemorrhoidal tissue to dentate line and the amount of Bleeding (B) from it. All the four components in this classification system are graded into five grades ranging from 1 to 5. The peculiarity of this new classification system is that it allows more detailed documentation of the hemorrhoids in a particular patient and conveys more explicit meaning and information about the hemorrhoids for future references. Based on this ‘PNR-Bleed’ classification, we are introducing another concept of scoring the severity of hemorrhoids and referred it as the Hemorrhoid Severity Score (HSS). Hemorrhoid Severity Score (HSS) is the total score obtained by the sum of the numerical grades of all four characteristics of hemorrhoids in “PNR-Bleed” classification. This new “PNR-Bleed” system of classifying the hemorrhoids and calculation of HSS seems to be more comprehensive, detailed, more objective and easily reproducible. Resumo: As hemorróidas são os distúrbios anorretais mais comuns, com uma prevalência de 39% na população em geral. As hemorróidas são geralmente classificadas com base em sua localização e grau de prolapso. A classificação de Goligher não descreve o número de colunas hemorroidais envolvidas e não dá muita importância à quantidade da perda de sangue. Para descrever a doença hemorroidária de maneira mais precisa, criamos o sistema de classificação “PNR-Bleed” (ou PNR-Booking). Tentamos classificar as hemorróidas com base nas quatro principais características da doença hemorroidária, isto é, o grau de prolapso da hemorroida (P), número (N) das colunas hemorroidais primárias envolvidas, a relação (R) do tecido hemorroidário para a linha denteada e a quantidade de sangramento (B) originando-se dele. Todos os quatro componentes deste sistema de classificação são classificados em cinco graus, variando de 1 a 5. A peculiaridade desse novo sistema de classificação é que ele permite uma documentação mais detalhada das hemorróidas em um paciente em particular e transmite o significado e informações mais explícitos sobre as hemorróidas. para referências futuras. Com base nessa classificação “PNR-Bleed”, estamos introduzindo outro conceito para o escore da gravidade das hemorróidas e denominado HSS, de “Hemorrhoid Severity Score”. O escore de gravidade da hemorroida (HSS) é o escore total obtido pela soma dos graus numéricos de todas as quatro características das hemorróidas na classificação “PNR-Bleed”. Esse novo sistema “PNR-Bleed” de classificação de hemorróidas e cálculo do HSS parece ser mais abrangente, detalhado, mais objetivo e facilmente reproduzível