May–Thurner syndrome causing deep vein thrombosis in the postoperative patient

May–Thurner syndrome is a rare cause of left iliac deep vein thrombosis due to an anatomical variant in which right common iliac artery overlies and compresses left common iliac vein against lumbar spine. Patients with May–Thurner syndrome usually present in their 2nd to 4th decade of life. Pregnancy and intra-abdominal surgeries are known precipitating factors in acute May–Thurner syndrome. We report the case of a woman in her 3rd decade of life who presented with May–Thurner syndrome following total abdominal hysterectomy. This case report hopes to bring attention to the high variant of patient population with May–Thurner syndrome and the necessity for surgical intervention of stent placement to prevent recurrence

Functional outcomes following various reconstructive methods following various forms of maxillectomies- a tertiary centre experience

Background: The maxilla is the pivotal structure of the midface, separating the oral, antral, and orbital cavities, and providing support to the globes, lower eyelids, cheeks, lips, and nose. In addition, the maxilla play a critical role in speech, swallowing, and mastication. To evaluate the functional outcomes following various reconstructive methods following various forms of maxillectomiesMethods: Retrospective analysis of medical records of patients who underwent various forms of maxillectomies from January 2011 to December 2013. Postmaxillectomy defects were managed by either prosthesis or local flaps.Results: Forty patients had various forms of maxillectomies. Fifteen patients had Browns class 1 maxilectomy and all of these patients underwent reconstruction with Pectoralis major myocutaneous flap. Ten patients underwent class 2a maxillectomy and reconstruction with obturator and Split skin thickness grafting. Nine patients underwent class 3a-b resection and four patients class 4a-b resection and all had reconstruction with temporalis myofascial flap. Two patients underwent orbitomaxillary resection with palate preserved and reconstruction with temporalis myofascial and forehead flap. Mean follow up period was 8 months (Range 6- 24 months). Two patients developed moderate grade of trismus after completion of radiotherapy.  One patient developed recurrence in neck after 6 months of completion of adjuvant radiotherapy. All had moderate to fair speech and eating function which improved over time.Conclusions: There was no difference between flap reconstruction or obturator intervention of maxillary defects in speech and eating function. Small and lateral defects are better reconstructed with obturator and defects involving orbit and total maxilla are better reconstructed with regional flaps. Hence even in the era of microvascular flaps, obturator and regional flaps can still be considered for reconstruction of maxillectomy defects with fairly good outcome

Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies

Background: The laparoscopic approach for colorectal cancers are still a matter of controversy. In the present study, we tried to compare the laparoscopy with open methods of colorectal resections.Methods: Retrospective study where patients diagnosed with colorectal cancer in our hospital from year 2014 January to December 2016 were taken. Total number of cases were 69 of which, the total number of right colon cases were 26. Out of twenty-six, 12 underwent open procedure and 14 underwent laparoscopic resections. Total number of left colon cancers were 09. Of these, 2 underwent open and 7 underwent laparoscopic procedure. Thirty-four (34) rectal cancers were included in the study. Of these, 12 underwent open rectal procedures and 22 underwent laparoscopic resections. Multiple parameters like duration of surgery, post-operative complications, postoperative stay, pathological T staging, lymph node yield, positive nodes, distal resection margins, circumferential radial margins were compared.Results: Operating time was significantly shorter in open procedure than laparoscopic surgery in both rectal resection and right hemicolectomies. The postoperative stay was significantly shorter in laparoscopic right hemicolectomy compared to open procedure. All other parameters like post-operative complications, T stage, lymph node yield, positive nodes, distal resection margins and CRMs were comparable in both groups. The lymph node yield was similar in upfront and post neoadjuvant carcinoma rectum cases.Conclusions: Laparoscopic colorectal resections have similar rates of complication, with shorter hospital stays with no compromise on oncological clearance with respect to lymph node yield, CRMs, distal resection margins compared to open procedures

Limb salvage surgery for giant cell tumours around knee joint: a single institute experience

Background: Giant cell tumours (GCTs) of bone are benign but locally aggressive tumours. The surgical treatment of GCTs in the around knee joint mainly includes curettage and bone grafting, extended curettage and cement filling, segmental resection and modular endo prosthesis reconstruction.Methods: Retrospective analysis of the presentation, the functional outcome following modular endoprosthetic reconstruction, prosthetic survival and the recurrence rate in 17 patients with Campanacci grade 3 GCTs involving distal femur and proximal tibia, who underwent segmental resection and modular endoprosthesis reconstruction in a single centre from 2015 to 2018. The surgery was performed according to the general principles of limb salvage surgery and modular segmental replacement was used. All stems were cemented in place. Isometric exercises and mobilization with crutches were started on 2nd postoperative day. Knee joint bending was started for proximal tibia patients after 2 to 3 weeks. Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Immediate post-operative complication like delayed wound healing, flap necrosis, wound infection, foot drop, leg length discrepancies were evaluated.Results: The average MSTS functional score was 78%.3 year prosthetic survival was 100%. None of the patients had recurrence. One patient had left lower lobe metastasis for which wedge resection was done.Conclusions: Segmental resection and endoprosthetic replacement has good functional outcome in patients with tumours around the knee joint. As GCTs are tumours with less chance of local and distant metastasis after complete excision, endoprosthetic prosthesis is a good treatment option after complete excision

Tumor histoculture captures the dynamic interactions between tumor and immune components in response to anti-PD1 in head and neck cancer

Abstract Dynamic interactions within the tumor micro-environment drive patient response to immune checkpoint inhibitors. Existing preclinical models lack true representation of this complexity. Using a Head and Neck cancer patient derived TruTumor histoculture platform, the response spectrum of 70 patients to anti-PD1 treatment is investigated in this study. With a subset of 55 patient samples, multiple assays to characterize T-cell reinvigoration and tumor cytotoxicity are performed. Based on levels of these two response parameters, patients are stratified into five sub-cohorts, with the best responder and non-responder sub-cohorts falling at extreme ends of the spectrum. The responder sub-cohort exhibits high T-cell reinvigoration, high tumor cytotoxicity with T-cells homing into the tumor upon treatment whereas immune suppression and tumor progression pathways are pre-dominant in the non-responders. Some moderate responders benefit from combination of anti-CTLA4 with anti-PD1, which is evident from better cytotoxic T-cell: T-regulatory cell ratio and enhancement of tumor cytotoxicity. Baseline and on-treatment gene expression signatures from this study stratify responders and non-responders in unrelated clinical datasets