Plexiform neurofibromatosis of vulva

Plexiform Neurofibromatosis of vulva is a rare, benign tumor of genital tract arising from nerve sheath of peripheral nerve. It may present as solitary lesion or as part of Von Recklinghausen’s disease. Genitourinary neurofibroma is rare, however clitoris and labia majus happen to be the most frequent location of neurofibromatosis involving female genital tract. We present a case of plexiform neurofibroma arising from left labia majora in a young patient having features of Von Recklinghausen's disease. She complained of discomfort while walking due to rubbing of pedunculated mass arising from her labia majora. We carried out the surgical excision of the mass followed by primary repair of labia majora. She has been followed up on out-patient basis for about three months without any recurrence so far

Giant plexiform neurofibroma of digital nerves: A case report and review of the literature

Neurofibroma is a benign tumor arising from nerve sheath of peripheral nerves, and may present as an isolated lesion or may present as part of von Recklinghausen′s disease. Although plexiform neurofibromas usually affect the face, neck, back, and inguinal region, however other areas may rarely be affected. Plexiform neurofibroma of the palm is a very rare entity, which may affect the fine motor functions of the hand. Surgery is the only treatment option available, but due to diffuse involvement of the nerves and infiltrating nature of the lesions, complete resection may be impossible in many of the cases. We are reporting a case of giant neurofibroma of the palm affecting digital nerves in a 37-year-old patient presenting with features of Von Recklinghausen′s disease. He presented with pain and swelling over left palm of 8 years duration. We carried out the surgical excision of the mass, and the individual has been followed-up on out-patient basis for about 3 months without showing any evidence of local recurrence

Amelanotic melanoma of the nasal mucosa: A rare case report

Melanomas develop due to malignant transformation of melanocytes, which are derived from the neuroectoderm. Although the majority of melanomas are cutaneous, they occasionally arise from extra-cutaneous tissues as well which contain melanocytes, such as uvea, leptomeninges, or the mucosa. Melanomas can be melanotic or amelanotic. Approximately, 15-20% of all malignant melanomas arise in head and neck region and over 80% of these involve the skin. Mucosal malignant melanomas are very rare and may affect the upper aero-digestive tract (UADT). Their incidence is approximately as low as 0.5-3% of all malignant melanomas. Majority of noncutaneous head and neck malignant melanomas affect the ocular origin and only 6-8% originate in the mucous membranes of the UADT. Nasal mucosal melanomas account for <1% of all melanomas and <5% of all nasal tract neoplasms. The incidence of amelanotic melanomas (AMs) has been estimated to be between 1.8 and 8.1% of all melanomas. We present a case of 62-year-old lady presenting with epistaxis and a mass in left nasal cavity, diagnosed as AM and managed by wide local excision and primary reconstruction in our institution

Evaluation of stone volume and its relationship with surgical outcomes in patients with staghorn calculi

Introduction: Urolithiasis is one of the most common renal diseases with a significant burden on health-care system worldwide. Here, we evaluated the stone volume and its relationship with duration of operation, blood loss, and total stone clearance in patients with staghorn calculi. Materials and Methods: This was a prospective, single-center study conducted from October 2015 to September 2017. Patients of either sex aged more than 18 years of age with a confirmed diagnosis of staghorn calculus were eligible to participate in the study. Eligible patients were divided into three groups based on stone volume (assessed by three-dimensional computed tomography): Group 1 (≤5000 mm3), Group 2 (>5000 to ≤20,000 mm3), and Group 3 (>20,000 mm3). Results: A total of 85 patients were enrolled in the study (Group 1, n = 9; Group 2, n = 66; and Group 3, n = 10). The mean age was 43.68 years, and 62.4% of patients were male. The mean operative time increased significantly from Groups 1–3, (31.67, 60.14, and 92.30 min, respectively). The mean pre- and postoperative hematocrit was highest in Group 3 (2.82%) (P < 0.0001). Overall, the correlation between stone volume and operative time and difference in hematocrit showed a positive relationship. A total of five patients had residual calculus, and only four patients reported complications. Conclusions: The results showed that patients with larger stone volume need more operative time and may have more blood loss

Does urodynamics study help in evaluation and prognosis of treatment in benign prostatic hyperplasia with diabetes mellitus?

Aims: The aim is to study the clinical significance of urodynamics study (UDS) in patients of benign prostatic hyperplasia (BPH), with and without diabetes mellitus (DM) and to predict the outcome of surgical depending on UDS findings. Materials and Methods: A total of 120 BPH patients were studied and divided into two groups, BPH with DM and without DM. Initial evaluation, diagnostic tests, and urodynamic examination were done in all patients, and results were statistically analyzed. Results: There was no significant difference of age and prostate volume in both groups (P > 0.05), but there was a significant increase in symptom score in patients of BPH associated with DM (P < 0.05). Bladder outlet obstruction (BOO) was found in majority of patients in our groups (96.66%) with good detrusor function. Out of 120 patients, 6 patients (2 patient in BPH group and 4 patients in BPH with DM group) had detrusor underactivity (DU). There was a significant difference in the International Prostate Symptom Score, quality of life, peak flow rate, and postvoid residual urine, pre- to post-operatively in each group (P < 0.05). Out of the 6 patients who had DU, 4 patients (1 patient in BPH group and 3 patients in BPH with DM group) showed improvement in their flow rate and symptom score. Conclusion: DM in cases of BPH patients is not the prominent factor in deciding surgical treatment. It is the severity of BOO which determines the treatment and its outcome. UDS is an invasive and costly test and does not appear to be mandatory in clinically significant BPH even if associated with DM

Helicobacter pylori in gastroduodenal perforation

Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori) and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92%) turned out to be positive for H. pylori and only four cases (8%) were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers

Reconstruction of soft tissue defects around the ankle and foot

Introduction: Soft tissue defects over ankle and foot region are encountered quite frequently following road traffic trauma and surgery. Management of such cases is a challenging task for any reconstructive surgeon because of paucity of skin and relative poor vascular status of skin in this region. Hence, invariably such cases require microsurgical free flap coverage, expertise for which may not be available at all the centers, such procedures require long operating hours and suitable recipient vessel may not be available in crush injuries. Materials and Methods: Thirty consecutive patients having soft tissue defects around ankle and foot region who underwent various reconstructive procedures in a medical college hospital during last 2 years form the basis of this study. This study was carried out to enlist various etiological factors and reconstructive surgical procedures employed to manage such cases without microsurgery. Results: The age of these patients ranged from 9 to 72 years. Twenty-five patients were males while 05 were females, with a mean age of 25 years. Road traffic accidents happened to be the primary cause of such defects in as many as 15 patients, cycle spoke trauma in 02 patients, implant exposure following orthopedic surgery in 6 patients, diabetic angiopathy in 4 patients and chronic osteomyelitis in 3 patients. The site of the defect was lower fourth of tibia in 16 patients, dorsum of foot in 2 patients, sole in 5 patients, medial aspect of ankle in 02 cases, lateral aspect in 02 cases and retro calcaneal region in 03 cases. In 10 cases distally based superficial sural artery flap was used to reconstruct the defect. In step rotation flap was used to provide sensory flap cover in the weight bearing heel in 04 cases. Inferiorly based fasciocutanenous flaps in 09 cases and muscle flaps were used in 07 cases. Conclusion: Distally based sural artery based flaps are very handy to provide skin cover around ankle and malleolar regions. Muscle flap can be used when the defect is small but deep to obliterate the cavity and it can be covered with skin graft

A comparative study of open technique and Z-plasty in management of pilonidal sinus

Introduction: Pilonidal sinus is one of the common problems encountered in general surgical practices and the management of this disease is variable, contentious and problematic. Principles of treatment require eradication of the sinus tract; complete healing and prevention of recurrence. Although several surgical techniques have been described over the years, the management remains controversial. Aims and Objectives: The aim of this study was to compare the two techniques of the open method and Z-plasty in the management of pilonidal sinus, in terms of incidence of post-operative pain, total hospital stay, total recovery time, complications and recurrence rate. Materials and Methods: This is a prospective comparative study which was conducted in the surgical department of a teaching hospital. A total of 50 cases were included in this study. Of these, 25 cases were operated by the open technique and 25 by excision and Z-plasty. Observation and Result: The mean age at presentation was 29.44 years. Male genders followed by age between 20 and 30 years were the most common predisposing factors. The mean body mass index, early and late post-operative complications were comparable between the two groups. Mean hospital stay and total recovery time was significantly more in open technique group compared with Z-plasty group. Visual analog score was also significantly more in open technique group when compared with Z-plasty group. Conclusion: Excision with Z-plasty was better technique in terms of lesser hospital stay, lesser recovery time, less post-operative pain

Our experience with Miniperc XS in the management of renal stones

Objective: This study was conducted to evaluate the efficacy and safety of Miniperc (MIP) XS (7.5 Fr) nephroscope in the treatment of renal stones up to 20 mm. Methods: This was a prospective study that enrolled 65 patients with limited stone burden in calyx or pelvis, which were treated with MIP XS. Primary outcomes included stone-free rates (SFRs), operative time, length of postoperative hospital stay, requirement of analgesic postsurgery, decline in hematocrit, stent requirement, and complications and requirement of ancillary procedure. Results: The mean stone size was 17.46 ± 2.9 mm. The patients were treated with MIP XS and had a mean operative time of 38.63 ± 8.4 min, 1.74% drop in hematocrit levels postsurgery and 96.9% SFRs. The length of hospital stay was 55.48 ± 4.6 h. Postoperative fever and nephrostomy leakage occurred in 9 and 1 patients, respectively. Six cases required some drainage procedure (double-J stent/nephrostomy). No patient required blood transfusion. Conclusion: This study showed that MIP XS could be considered as an effective treatment option in the treatment of renal stones up to 20 mm as it scores in all the standard parameters used to measure percutaneous nephrolithotripsy outcomes