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Shahin M, Patra S, Purkait S, Kar M, Das Majumdar SK, Mishra TS, Samal SC, Nayak HK. PD-L1 Expression in Colorectal Carcinoma Correlates with the Immune Microenvironment. J Gastrointest Cancer 2024:10.1007/s12029-024-01049-z. [PMID: 38530597 DOI: 10.1007/s12029-024-01049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION/BACKGROUND Colorectal carcinoma (CRC) is a common malignancy, with its diverse clinical, pathological, and molecular features. The immune microenvironment of a tumor comprises of interplay between various cells and molecules, and has a significant role in deciding the tumor behavior and overall prognosis. PD-L1 (programmed cell death ligand-1) has been implicated in the regulation of the tumor immune microenvironment (TIME). There is limited data regarding the correlation of PD-L1 expression with immune cell profile in CRCs, especially in the Indian setting. The study aimed to assess the PD-L1 expression in CRC tumor cells and its association with TIME, mismatch repair (MMR), and various other clinicopathological parameters. METHODS This is a hospital-based, cross-sectional observational study. PD-L1 expression was assessed at the protein level by immunohistochemistry and mRNA level by qRT-PCR. Immune cell markers (CD4, CD8, CD20, FOXP3, and CD163) were interpreted using the ImageJ Fiji platform. RESULTS Of the 104 cases, 21% were PD-L1 positive and were more common in right-sided CRCs. PD-L1 positive cases showed significantly higher concentrations of all T-cell subsets (CD4+ , CD8+ , and FOXP3+), CD20+ B-cells, and CD163+ macrophages were noted. No statistical significance was seen between PD-L1 expression with clinical profile, pathological subtype, grade or stage, mismatch repair status (proficient vs deficient), and survival. CONCLUSIONS The present study showed a relatively lower frequency of PD-L1 in CRC from the Eastern Indian cohort. The immune cell concentration in the present study was calculated using image analysis-based objectivised methods. Significant correlation of PD-L1 expression in tumor cells with the tumor-infiltrating immune cells indicated its crucial role in the pathobiology of CRC especially by regulating the TIME. Considering the therapeutic implication of PD-L1 in various malignancies, it may be one of the crucial therapeutic targets in a proportion of cases.
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Affiliation(s)
- Mohammed Shahin
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susama Patra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Suvendu Purkait
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Saroj Kumar Das Majumdar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Subash Chandra Samal
- Department of Medical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Hemanta Kumar Nayak
- Department of Medical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Singh PK, Sethi MK, Mishra TS, Kumar P, Ali SM, Sasmal PK, Mishra SS. Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial. Langenbecks Arch Surg 2023; 409:19. [PMID: 38150073 DOI: 10.1007/s00423-023-03202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE NPWT has been tried in many surgical fields, including colorectal, thoracic, vascular, and non-healing wounds, for the prevention of SSI. However, its efficacy in the prevention of SSI-grade IV closed abdominal wounds is yet to be explored. METHODS All patients with grade IV abdominal wounds were included in the study. They were randomized into the conventional arm and the VAC arm after confirming the diagnosis intra-operatively. The sheath was closed, and the skin was laid open in the postoperative period. In the VAC arm, the NPWT dressing was applied on postoperative day (POD)-1 and removed on POD-5. In the conventional arm, only regular dressing was done postoperatively. The skin was closed with a delayed primary intention on POD-5 in both arms. The sutures were removed after 7 to 10 days of skin closure. RESULTS The rate of SSI (10% in the VAC arm vs. 37.5% in the conventional arm, p-value = 0.004) was significantly lower in the VAC arm, as were the rates of seroma formation (2.4% in the VAC arm vs. 20% in the conventional arm, p = 0.014) and wound dehiscence (7.3% vs. 30%, p = 0.011). The conventional arm had a significant delay in skin closure beyond POD5 due to an increased rate of SSI, which also led to a prolonged hospital stay (5 days in the VAC arm vs. 6.5 days in the conventional arm, p-value = 0.005). CONCLUSION The VAC dressing can be used routinely in grade IV closed abdominal wounds to reduce the risk of SSI and wound dehiscence.
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Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Mahesh Kumar Sethi
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - S Manwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Sasmal PK, Sahoo A, Mishra TS, Das Poddar KK, Ali SM, Singh PK, Kumar P. Feasibility and outcomes of Desarda vs Lichtenstein hernioplasty by local anesthesia for inguinal hernia: a noninferiority randomized clinical trial. Hernia 2023; 27:1155-1163. [PMID: 37452974 DOI: 10.1007/s10029-023-02837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The Desarda autologous tissue repair is comparable to the Lichtenstein hernioplasty for inguinal hernia regarding recurrence, chronic groin pain, and return to work activities. This study was designed to establish the outcomes of Desarda's repair versus Lichtenstein's hernioplasty concerning post-operative recovery to normal gait and its feasibility under local anesthesia (LA). MATERIALS AND METHODS This study was a single-center, prospective, double-blinded, non-inferiority, randomized trial. Patients undergoing open hernia repair for primary inguinal hernia were included. Patients were randomly assigned and followed up for 2 years. The primary endpoint was the time to return to normal gait post-surgery with comfort (non-inferiority margin fixed as 0.5 days). The secondary outcomes studied were post-operative pain score, the time required to return to work (all previously performed activities), and surgical-site occurrences (SSO). RESULTS One hundred ten eligible patients were randomly assigned [56 patients (50.9%) in the Desarda group and 54 patients (49.1%) in the Lichtenstein group]. All the procedures were safely performed under LA. The median (interquartile range) time for resuming gait post-surgery with comfort was 5 days in the Desarda vs 4 days in Lichtenstein's arm (P = 0.16), thereby failing to demonstrate non-inferiority of Desarda against Lichtenstein hernioplasty. However, there were no significant differences in days to return to work, SSO, chronic groin pain, and recurrence within two years of surgery. CONCLUSIONS AND RELEVANCE This study could not demonstrate the non-inferiority of the Desarda repair versus Lichtenstein hernioplasty regarding the time taken to return to normal gait. Comparing the days to return to work, pain score, SSO, and chronic groin pain, including recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility and efficacy under LA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03512366.
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Affiliation(s)
- P K Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India.
| | - A Sahoo
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - T S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - K K Das Poddar
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - S M Ali
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - P K Singh
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - P Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
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Poddar KKD, Kumar P, Hansda U, Sethi MK, Mishra TS, Sasmal PK, Medhavi, Singh PK, Kumar R. On-demand (SOS) analgesia through Transversus Abdominis Plane (TAP) catheter route for post-operative pain relief in Emergency Laparotomies-a non-randomised interventional study (STAPLE trial). Langenbecks Arch Surg 2023; 408:325. [PMID: 37605091 DOI: 10.1007/s00423-023-03065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION This study aimed to compare the efficacy and safety of on-demand bupivacaine infusion via transversus abdominis plane (TAP) catheter in emergency laparotomy patients. METHODS A non-randomised interventional study was conducted on patients undergoing emergency midline laparotomy. The intervention group received an on-demand infusion of 10 ml 0.5% bupivacaine through TAP catheters, whilst the control group received standard analgesic care. The primary outcome was the amount of rescue analgesic consumption. Secondary outcomes included the post-operative, measured by visual analogue scores (VAS), side effects, time to first flatus, post-operative nausea and vomiting, and pulmonary complications. RESULTS One-hundred-twenty patients (58 in the TAP-SOS group, 62 in the control group) were included in the final analysis. The TAP-SOS group showed significantly reduced rescue analgesic requirement by 91% (p < 0.001) and lower VAS scores at 3, 6, 12, and 24 h (adjusted p < 0.00). Time to out-of-bed mobilisation was significantly shorter in the TAP-SOS group by 12.47 h (p < 0.001), and post-operative pulmonary complications were lower by 75% (p < 0.05). There were no significant differences in bowel recovery, catheter-related complications, or post-operative morbidity. No incidences of catheter-site infection were reported on follow-up; however, the catheter tip-culture was positive in 3 (5.17%) patients. CONCLUSION On-demand bupivacaine infusion through a TAP catheter effectively reduced post-operative pain and opioid requirements in emergency laparotomy patients without complications. If an epidural is not an option, the TAP-SOS approach can be a helpful adjunct in implementing the ERAS protocol in an emergency since it allows for early ambulation and better pain management.
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Affiliation(s)
| | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India.
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | | | | | | | - Medhavi
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India
| | | | - Rahul Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India
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Singh PK, Das Poddar KK, Sasmal PK, Kumar P, Ali SM, Mishra TS. Comparison of laparoscopic port site skin closure techniques (CLOSA): transcutaneous suturing versus subcuticular sutures versus adhesive strips: a prospective single-blinded randomized control trial. Langenbecks Arch Surg 2023; 408:228. [PMID: 37286881 DOI: 10.1007/s00423-023-02950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cosmesis is an essential aspect of laparoscopic surgery. Various methods of skin closure techniques have been described. We conducted a study to evaluate the cosmesis and patient satisfaction with the scars three months after laparoscopic surgery using transcutaneous suture (TS) vs. adhesive strips (AS) and subcuticular suturing (SS). METHODS A randomized, controlled, prospective study was conducted at AIIMS, Bhubaneswar. The included patients were randomly assigned among the three arms. The time for skin closure was measured. Wounds were assessed till discharge, at 14 days, one month, and three months. Cosmesis was measured by the Hollander Wound evaluation scale (HWES) for each incision separately, and patient satisfaction by a 10- point Visual analog scale (VAS). RESULTS One hundred six patients were assessed for eligibility, and 90 patients were randomized. Three-month follow-up data was obtained from 83 patients (92.22%). Baseline characteristics were similar among the groups. Cosmetic outcome was assessed in 312 incisions across 83 patients, and 206 (66.03%) incisions had an HWE Score of 0, but there was no significant difference (p = 0.86). Patient satisfaction was highest in the TS group (TS = 1.29, SS = 1.79, AS = 2.04, p = 0.03). Time for skin closure was the least in the AS arm (41.4 secs, p = 0.00). Skin dehiscence was significantly more in the AS arm. Four (4.44%) patients had port site infections. CONCLUSION This study demonstrates that skin closure by transcutaneous, subcuticular, or adhesive strip methods had comparable cosmetic outcomes at three months. However, the transcutaneous closure method showed better patient satisfaction and minimal post-operative complications.
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Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India.
| | - Kallol Kumar Das Poddar
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India
| | - Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India
| | - S Manwar Ali
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India
| | - Tushar Subhadarshan Mishra
- Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India
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Mohanty CR, Varghese JJ, Panda R, Sahoo S, Mishra TS, Radhakrishnan RV, Topno N, Hansda U, Shaji IM, Behera SHP. Ultrasound-guided selective peripheral nerve block compared with the sub-dissociative dose of ketamine for analgesia in patients with extremity injuries. Am J Emerg Med 2023; 63:94-101. [PMID: 36332503 DOI: 10.1016/j.ajem.2022.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
STUDY OBJECTIVE To compare the analgesic efficacy of ultrasound-guided selective peripheral nerve block (PNB) and sub-dissociative dose ketamine (SDK) for management of acute pain in patients with extremity injuries presenting to the emergency department (ED). METHODS This prospective, open-label randomized clinical trial was conducted in the ED of a tertiary care Institute. The patients were provided with either ultrasound-guided selective PNB or SDK. The primary outcome was a reduction in pain in numerical rating scale (NRS) by at least 3 points without rescue analgesia. The secondary outcomes were the need for rescue analgesia, adverse events, and patient satisfaction on either arm. RESULTS A total of 111 patients with isolated traumatic extremity injuries were included in the final analysis. The NRS score was significantly lower in the PNB group compared to the SDK group at 30, 60,120, 180-, and 240-min post-intervention [group ∼ time interaction, F (5, 647) = 21.53, p ≤ 0.001]. All the patients in the PNB group exhibited primary outcome (NRS ≥3 reductions) at 30 min post-intervention compared with 36 (65%) in the SDK group [-1.02(-1.422,0.622)]. Rescue analgesia was required in 10 (18%) patients in the SDK group compared to none in the PNB group [0.663(0.277,1.050)]. The decrease in NRS score from baseline at 30 min was significantly higher in PNB groups compared to the SDK group [-2.166(-2.640, -1.692)]. The most common side effect reported in the SDK group was dizziness 35(64%), followed by nausea 15(27%). None of the patients in the PNB group reported any complications. Patient satisfaction was higher in the PNB group than SDK group. CONCLUSION The study provides evidence that ultrasound-guided PNB is superior to SDK in terms of its analgesic efficacy in the management of acute pain due to extremity injuries and is associated with higher patient satisfaction. The need for rescue analgesia was significantly less in the PNB group. SDK was associated with a high incidence of dizziness and nausea.
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Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Jithin Jacob Varghese
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ritesh Panda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | | | - Nitish Topno
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shri Hari Priya Behera
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India; Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Purkait S, Mitra S, Adhya AK, Sethy M, Mishra TS. Cytology of angiofibroma of soft tissue of the inguinal region. Cytopathology 2021; 33:276-280. [PMID: 34273199 DOI: 10.1111/cyt.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
Angiofibroma of the soft tissue is a recently described benign fibroblastic/myofibroblastic tumour. We report the cytology of an angiofibroma of soft tissue occurring in a 30-year-old lady which showed bland spindle cells, occasional polygonal cells with nuclear grooving, prominent vessels, frayed stroma around the blood vessels, and scattered lymphocyte-rich inflammatory cells in the background.
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Affiliation(s)
- Suvendu Purkait
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Suvradeep Mitra
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Amit Kumar Adhya
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Madhusmita Sethy
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
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Panigrahi C, Mishra TS, Adhya AK. Cytology of a subcutaneous nodule on hand: A rare case. Cytopathology 2021; 33:273-275. [PMID: 34245610 DOI: 10.1111/cyt.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Chinmayee Panigrahi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Amit Kumar Adhya
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Ayyanar P, Behera G, Mishra TS, Purkait S, Patra S, Mitra S. The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception. J Gastrointest Cancer 2021; 53:511-519. [PMID: 34014410 DOI: 10.1007/s12029-021-00647-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. AIMS We aimed to study the clinico-histopathological spectrum of the tumors and tumor-like lesions in the intussusception in adults. MATERIAL AND METHODS A retrospective review of the adult (> 18 years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. RESULTS Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5 years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.
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Affiliation(s)
- Pavithra Ayyanar
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Gayatri Behera
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | | | - Suvendu Purkait
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Susama Patra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Suvradeep Mitra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India.
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Singh S, Gupta S, Mishra TS, Banerjee BD, Sharma T, Sharma S. 745 Risk Factors of Incident Renal Stones in Indian Population: A Hospital-Based Case-Control Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Nephrolithiasis is pathological calcification in the excretory passages of the body and is prevalent among 7.6% of Indians. We aimed to study the various risk factors associated with renal stones from India.
Method
It was a hospital-based case-control study conducted over 18 months in a tertiary hospital in Delhi. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological examination. Controls were similar to cases in all respects except for the diagnosis and selected from the hospital. A total of 18 risk factors, including age, gender, heavy metals, stress, metabolic factors, alcohol intake, dietary habits, co-morbidities, etc. were assessed. Logistic regression analysis was performed to calculate the strength of the risk associations.
Results
In the analysis of 60 cases and controls, we found 6 times, 5.5 times, and 2.4 times increased odds of renal stones in patients with increased arsenic, cadmium, and lead concentrations in blood, respectively. Similarly, there are 3 times increased odds of renal stones in patients suffering from stress.
Conclusions
Exposure to smoke, occupation dust, and contaminated water may lead to an increased ingestion/inhalation of heavy metals like cadmium, arsenic, and predisposing people to an increased risk of renal stones.
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Affiliation(s)
- S Singh
- Department of Surgery, University College of Medical Sciences, Delhi, India
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, United Kingdom
| | - S Gupta
- Department of Surgery, University College of Medical Sciences, Delhi, India
| | - T S Mishra
- Department of Surgery, University College of Medical Sciences, Delhi, India
| | - B D Banerjee
- Department of Surgery, University College of Medical Sciences, Delhi, India
| | - T Sharma
- Department of Surgery, University College of Medical Sciences, Delhi, India
| | - S Sharma
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Abstract
Background Thromboangiitis obliterans or Buerger’s disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented. Case presentation Our Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery. Conclusion Acute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger’s disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.
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Affiliation(s)
- Swastik Sourav Mishra
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar Subhadarshan Mishra
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. .,AIIMS Bhubaneswar, Room No. 403, Academic building, AIIMS Road, Patrapada, Bhubaneswar, Sijua, 751019, India.
| | - Suvradeep Mitra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pankaj Kumar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Mishra S, Kumar P, Sasmal PK, Mishra TS. Iatrogenic injury of duodenum: malady of a therapeutic misadventure. BMJ Case Rep 2021; 14:14/4/e242294. [PMID: 33858906 PMCID: PMC8054064 DOI: 10.1136/bcr-2021-242294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endoscopic procedures are the front-runner of the management of bleeding duodenal ulcer. Rarely, surgical intervention is sought for acute bleeding, not amenable to endoscopic procedures. Oversewing of the gastroduodenal artery at ulcer crater by transduodenal approach is the most acceptable and recommended method of treatment. We describe a case of an intraoperative duodenal injury that occurred during an attempt to oversew the gastroduodenal artery after a duodenotomy, leading to an unsatisfactory and meagre duodenal stump. This case will highlight the intraoperative turmoil, postoperative complications and management of a series of anticipated but unfortunate events that have rendered us wiser in terms of surgical management of a bleeding duodenal ulcer.
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Affiliation(s)
- Swastik Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Purushotham P, Mohanty S, Chappity P, Mishra TS, Mahapatra A. Identification and Characterization of Burkholderia pseudomallei from Localized Pyogenic Infections in Eastern India: A Clinico-Microbiological Study. Am J Trop Med Hyg 2021; 104:1252-1259. [PMID: 33534740 DOI: 10.4269/ajtmh.20-1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/15/2020] [Indexed: 11/07/2022] Open
Abstract
Melioidosis, caused by Burkholderia pseudomallei, is increasingly recognized in several regions of the globe. The present study was performed to identify and determine the frequency of B. pseudomallei infection in localized pyogenic lesions in eastern India and describe their clinico-microbiological profile. Pus samples were subjected to standard microbiological techniques for isolation and identification of various bacteria, including B. pseudomallei, which were confirmed by PCR. The clinical and demographic details of patients with melioidosis and antimicrobial susceptibility pattern of B. pseudomallei isolates were analyzed. Of 245 samples, 126 (51.4%) were culture positive, yielding 137 isolates. Staphylococcus aureus was the predominant pathogen accounting for 54 (39.4%) isolates, followed by B. pseudomallei accounting for 34 (24.8%) isolates. The mean age of the patients with melioidosis was 39.1 years, with males (24/34; 70.6%) being affected more than females (10/34; 29.4%). A majority of the patients were laborers (12/34; 35.3), followed by homemakers (8/34; 23.5%). Head and neck abscesses (35.3%) were the most common presentation followed by pyogenic lesions of the musculoskeletal system (32.3%) and deep organ abscesses (23.5%). Clinical resolution of infection was observed in 31 (91.2%) patients, relapse in two (5.9%) patients, and death in one (2.9%) patient, respectively. Susceptibility testing revealed all B. pseudomallei isolates to be completely susceptible to the following antimicrobials: ceftazidime, trimethoprim-sulfamethoxazole, imipenem, and doxycycline, with one (2.9%) resistant to amoxicillin-clavulanic acid. Burkholderia pseudomallei is an emerging etiological agent of localized pyogenic infections in eastern India, affecting a mainly adult male population. An increased vigilance along with appropriate diagnostic techniques helps in accurate diagnosis facilitating appropriate therapy.
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Affiliation(s)
- Prashanth Purushotham
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Srujana Mohanty
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- 2Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Ashoka Mahapatra
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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14
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Mishra TS, Jena SK, Kumari S, Purkait S, Ayyanar P, Nayak P. Cecal dermoid masquerading dermoid cyst of ovary: a case report and review of the literature. J Med Case Rep 2021; 15:38. [PMID: 33514417 PMCID: PMC7847138 DOI: 10.1186/s13256-020-02570-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background The ovary is the most common site of occurrence of mature cystic teratomas (dermoid cysts). These are the most common ovarian germ cell tumor in the reproductive age group, accounting for 10–20% of all ovarian neoplasms, with a 1–2% risk of malignancy. A cecal dermoid cyst is a rare entity with only ten cases having been reported so far, eight of which could be retrieved as the rest were reported in different languages. None of these cases were managed laparoscopically. Here we present the first case of cecal dermoid managed laparoscopically. Case presentation A 35-year-old nulliparous Indian Hindu woman presented with complaints of on and off abdominal pain for 10 months. The abdominal examination revealed a well-defined mass of about 10 × 5 cm size, palpable in the right iliac fossa. On sonography, it was suggestive of a right-sided ovarian dermoid cyst. The lesion measured 10 × 7 × 5 cm on a contrast-enhanced computed tomogram (CT) scan. It was well defined and hypodense and located in the right lower abdomen. The ovarian tumor markers were normal. On laparoscopy, the uterus, bilateral tubes, and ovaries were found to be healthy. The cyst was seen arising from the right medial wall of the cecum at the ileocecal junction, which was excised laparoscopically. Histopathological study revealed it to be a mature cystic teratoma. Conclusion Ovarian mature cystic teratoma commonly has an indolent course and can present with palpable abdominal mass, pain, or vomiting due to complications like torsion, hemorrhage, or infection. Alternatively, these cysts can be asymptomatic and incidentally detected. Clinicians should be aware of the variety of presentations of dermoid cysts of the bowel as well as mesentery. The exact location of the teratoma eluded us till the laparoscopy despite adequate imaging including a contrast-enhanced CT scan having been performed preoperatively. We are reporting this as it is a rare entity, and this knowledge will help gynecologists and surgeons make an appropriate surgical decision.
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Affiliation(s)
- Tushar Subhadarshan Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Room No 403, Academic Building, AIIMS Road, Patrapada, Sijua, Bhubaneswar, Odisha, 751019, India.
| | - Saubhagya Kumar Jena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Supriya Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suvendu Purkait
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pavithra Ayyanar
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pallabi Nayak
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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15
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Kumar P, Mishra TS, Sethi M, Mishra S. Giant desmoid tumour of abdominal wall: resection and reconstruction by posterior component separation. BMJ Case Rep 2021; 14:14/1/e239046. [PMID: 33509884 PMCID: PMC7845713 DOI: 10.1136/bcr-2020-239046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Management of large abdominal wall desmoid tumours is complicated due to the unpredictable behaviour of desmoids and the need for laborious reconstruction of the abdominal wall after wide local excision. A multidisciplinary team approach, including surgeons, oncologists and plastic surgeons, is necessary for proper management. This case highlights the diagnostic and surgical challenges related to the reconstruction of abdominal wall defect, after radical excision of a 30×30×25 cm desmoid tumour, originating from left rectus muscle. The defect was closed successfully by a perspicuous technique of posterior component separation. The awareness of this straightforward technique will allow the surgeons to do these radical procedures with confidence and without any consternation of complex reconstructive procedures.
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Affiliation(s)
- Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Mahesh Sethi
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swastik Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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16
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Mitra S, Ayyanar P, Purkait S, Mishra SS, Mishra TS. Clinical and Histopathological Spectrum of Adult Gastrointestinal Inflammatory Neuropathy. Int J Surg Pathol 2020; 29:246-256. [PMID: 32964744 DOI: 10.1177/1066896920960515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gastrointestinal inflammatory neuropathy, namely, eosinophilic myenteric ganglioneuronitis (EMG) and lymphocytic ganglioneuronitis (LG), is a form of chronic intestinal pseudo-obstruction and results from the infiltration of the myenteric plexus by eosinophils and lymphocytes, respectively. The literature related to the clinicopathological features of adult inflammatory neuropathy is scarce. We aim to elucidate the clinical and histological details of 7 cases of inflammatory neuropathy (EMG, n = 4, and LG, n = 3) and compare the features of EMG and LG retrospectively. There was no difference between these two entities in terms of clinical, hematological, or biochemical parameters. Histologically, almost all cases (n = 6/7) showed accompanying elements of ganglion cell vacuolization, mesenchymopathy, and partial/complete desmosis in addition to the disease-defining pathology. Besides, all cases of EMG showed infiltration of the inner circular muscle of muscularis propria by eosinophils. Two cases of LG showed additional muscular pathology pertaining to the muscularis propria. Inflammatory infiltration of the myenteric plexus is pathognomonic for the diagnosis of gastrointestinal inflammatory neuropathy although additional features in the form of ganglion cell vacuolization, reduction in the number of ganglia, desmosis, mesenchymopathy, and inflammation of the muscularis propria (eosinophils in EMG) can be seen. The pathologists need proper awareness along with judicious use of special and immunostains for clinching the diagnosis.
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Affiliation(s)
- Suvradeep Mitra
- 410775All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pavithra Ayyanar
- 410775All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suvendu Purkait
- 410775All India Institute of Medical Sciences, Bhubaneswar, India
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17
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Majumder R, Biswas D, Mishra TS, Mitra S. A Subcentimetric Nodule on the Penile Shaft. Int J Surg Pathol 2020; 28:688-690. [PMID: 32338090 DOI: 10.1177/1066896920916242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a benign histiocytic disorder usually affecting the head and trunk region of a child. The isolated occurrence of JXG in the penile shaft of a young adult is hitherto unreported. This lesion is amenable to surgical resection although systemic and/or internal visceral involvement can occur. The clinical differential of this solid cystic lesion may include other solid cystic lesions of the penile shaft, namely, epidermal inclusion cyst. A typical yellowish color can aid in the diagnosis though it is not a constant feature. In this article, we discuss a case of isolated penile JXG in a young adult with salient clinical and histopathological differentials.
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18
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Ayyanar P, Purkait S, Mishra TS, Patra S, Mitra S. Histopathologic Spectrum of Neuromuscular and Vascular Hamartoma With Special Reference to the Vasculopathic Phenomenon. Int J Surg Pathol 2019; 28:382-392. [DOI: 10.1177/1066896919890129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuromuscular and vascular hamartoma (NMVH) is an unusual lesion presenting as intestinal obstruction by stricture formation. It is characterized by a hamartomatous mass comprising haphazardly arranged mesenchymal tissue native to the intestinal mucosa and submucosa. We aimed to characterize the clinicohistopathological spectrum of NMVH in adult subjects with a search for an etiological clue. We reviewed 84 resected specimens (adult cases) of intestinal obstruction in our institute and diagnosed 4 cases with NMVH. A panel of special stains (Masson trichrome, Verhoeff-van-Gieson, and periodic acid–Schiff) and immunohistochemistry (smooth muscle actin, S100, Bcl2, CD34, vimentin, desmin, CD117, and CD3) were performed in all cases. All cases of NMVH showed characteristic hamartomatous mounds comprising haphazardly arranged smooth muscle, nerves, ganglia, vessels, and collagen with overlying mucosal ulceration. Adjacent bowel showed submucosal fibrosis, muscularis mucosae thickening, and duplication along with vasculopathy. A typical vasculopathy (“vessel-in-vessel” appearance) was seen in the submucosal and/or subserosal veins. Besides, different other forms of vasculopathic changes like obliterative venopathy and concentric myohypertrophy were also seen. One case had vasculitis and the patient died despite successful surgery. One other case was associated with lymphocytic ganglioneuronitis and granulomatous etiology. We conclude that NMVH can be multifactorial in origin although ischemia resulting from vasculopathy appears to be directly causative. The characteristic vasculopathy in the submucosal location may aid in the diagnosis of NMVH in small biopsy samples.
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Affiliation(s)
| | | | | | - Susama Patra
- All India Institute of Medical Sciences, Bhubaneswar, India
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19
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Kumar Sinha M, Mohakud S, Mishra TS, Barman A. An unusual presentation of gastric fistula following peptic perforation repair: A case report. Int J Surg Case Rep 2019; 56:29-31. [PMID: 30818159 PMCID: PMC6393669 DOI: 10.1016/j.ijscr.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/03/2022] Open
Abstract
Late onset Gastrocutaneous fistulas are rare following the peptic perforation repair. A non-healing burst abdominal wound should be thoroughly investigated. It can be because of an underlying fistula. CT fistulogram is the investigation of choice to confirm the diagnosis. Operative intervention is difficult but the only method of cure in most of the circumstances.
Introduction Peptic perforation repair is a common stomach surgery. This surgery has not been associated with delayed onset gastrocutaneous fistula formation. However such a complication has been reported following a variety of other stomach surgeries. We are reporting this case as it is a rare complication. Also its diagnosis and management is challenging. Case summary We are presenting a case of peptic perforation repair where burst abdomen happened in the immediate post-operative period. The patient was put on conservative management. He responded well to it but his abdominal wound was not healing. After a wait of four months the wound was covered with a skin graft. The graft uptake was satisfactory but a discharging ulcer appeared on it. This condition persisted for one month. Finally a computed tomography Fistulogram (CT Fistulogram) was performed. It revealed an underlying complex gastric fistula. A repeat surgery was performed. Conclusion A gastrocutaneous fistula diagnosed at sixth month following the peptic perforation repair and causing minimal discomfort to the patient is a rare presentation. The abdominal wound following the surgery was possibly not healing because of the underlying fistula.
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Affiliation(s)
| | | | | | - Apurba Barman
- Department of Physical Medicine and Rehabilitation, AIIMS Bhubaneswar, India.
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20
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Pattnaik SA, Mitra S, Mishra TS, Purkait S, Kumar P, Naik S. A Vasculitis-Associated Neuromuscular and Vascular Hamartoma Presenting as a Fatal Form of Abdominal Cocoon. Int J Surg Pathol 2018; 27:108-115. [PMID: 29992844 DOI: 10.1177/1066896918786582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuromuscular and vascular hamartoma (NMVH), also known as neuromesenchymal hamartoma, is a rare hamartomatous condition of the intestine. It usually presents with submucosal humps protruding in the intestinal lumen causing obstructive features. The other clinical manifestations are hematochezia or melena and protein-losing enteropathy. The etiopathogenesis of these lesions is not well known, although an association with small bowel Cröhn's disease and diaphragm disease had been postulated, the latter related to chronic nonsteroidal anti-inflammatory drug intake. Only 24 cases of NMVH are reported in the English literature and all of them could be adequately cured by resection of the affected part of the bowel. Moreover, none of these cases presented with abdominal cocoon or showed any evidence of vasculitis. We describe a peculiar case of NMVH in a 45-year-old male who presented with abdominal cocoon with symptomatic recurrence and fatal outcome within a month of surgery. Histopathology revealed classical histomorphology of NMVH with evidence of vasculitis. This appears to be the first case of a fatal form of NMVH, presenting with abdominal cocoon and associated with vasculitis.
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Affiliation(s)
| | - Suvradeep Mitra
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Suvendu Purkait
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pankaj Kumar
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suprava Naik
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
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21
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Meher S, Mishra TS, Sasmal PK, Rath S, Sharma R. An Ulcerated Giant Malignant Phyllodes Tumour Presenting in Septic Shock. J Clin Diagn Res 2017; 10:PJ01-PJ02. [PMID: 28208937 DOI: 10.7860/jcdr/2016/20252.8945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Susanta Meher
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
| | | | | | - Satyajit Rath
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
| | - Rakesh Sharma
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
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22
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Meher S, Mishra TS, Sasmal PK, Rout B, Sharma R. Post-Traumatic Ectopic Nail: A Case Report and Review of Literature. J Clin Diagn Res 2017; 10:PD01-PD02. [PMID: 28050430 DOI: 10.7860/jcdr/2016/20241.8770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
Ectopic nail or Onychoheterotopia is an uncommon clinical entity. They are usually congenital; the acquired variety is very rare. The exact pathogenesis of the disease is not clear. They present as a nail like outgrowth, distinct from the classic nail units which is usually asymptomatic. The dorsal aspect of fingers and toes are mostly affected. We present a case of a 24-year-old male with post-traumatic ectopic nail of right middle finger. Complete surgical excision of the ectopic nail was done with its germinal matrix. The patient didn't have any evidence of recurrence after one year of follow-up, with satisfactory cosmetic outcome. This article highlights the classic presentation of a case of ectopic nail with its surgical management and brief review of literature.
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Affiliation(s)
- Susanta Meher
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
| | | | | | - Bikram Rout
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
| | - Rakesh Sharma
- Senior Resident, Department of Surgery, AIIMS , Bhubaneswar, Odisha, India
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23
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Meher S, Mishra TS, Rath S, Sasmal PK, Mishra P, Patra S. Giant dedifferentiated liposarcoma of small bowel mesentery: a case report. World J Surg Oncol 2016; 14:250. [PMID: 27654578 PMCID: PMC5031279 DOI: 10.1186/s12957-016-1007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022] Open
Abstract
Background Dedifferentiated liposarcoma is an uncommon variant of liposarcoma, with poor prognosis and higher preponderance to local recurrence. Only nine cases of dedifferentiated liposarcoma of small bowel mesentery have been reported till now. This is a case of giant dedifferentiated liposarcoma of the small bowel mesentery, weighing nearly 9 kg (19.8 lbs), with synchronous lesions in the extraperitoneal space, which is the first such case to be reported. Case presentation We report a case of a 62-year-old man, who presented with a huge abdominal mass occupying nearly the entire abdomen. A contrast enhanced computed tomography of abdomen and pelvis revealed a large, poorly enhancing, heterogeneous, lobulated mass of size 27 × 16 cm, displacing the bowel loops peripherally. At laparotomy, a large mass arising from the small bowel mesentery was found. In addition, many other smaller synchronous lesions were studded in the entire small bowel mesentery and a couple more in the extraperitoneal space. A palliative excision of the giant mass along with the adjacent small bowel was done. The other smaller swellings were not causing any mass effect and were left behind as they were numerous, virtually ruling out any possibility of a curative excision. The histopathological examination suggested the diagnosis of dedifferentiated liposarcoma. On immunohistochemistry, S-100 was positive in the well-differentiated sarcomatous areas. The CD 117 and SMA were strongly negative ruling out the possibility of a gastrointestinal stromal tumour. The CD 34 however was positive in the tumour cells. Conclusions Dedifferentiated liposarcoma of the small bowel mesentery is rare. Involvement of nearly whole of the small bowel mesentery in the disease process virtually rules out the possibility of a curative resection, the mainstay of management. This report would add to the knowledge of this rare disease and the possible therapeutic problem that may be encountered in case of multifocal disease.
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Affiliation(s)
- Susanta Meher
- Department of General Surgery, All India Institute of Medical Sciences, Room no. 403, Academic Block, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Tushar Subhadarshan Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Room no. 403, Academic Block, Sijua, Bhubaneswar, Odisha, 751019, India.
| | - Satyajit Rath
- Department of General Surgery, All India Institute of Medical Sciences, Room no. 403, Academic Block, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Room no. 403, Academic Block, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Pritinanda Mishra
- Department of Pathology, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, 751019, India
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24
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Meher S, Mishra TS, Sasmal PK, Sharma R, Rout B. Umbilical Pilonidal Sinus: A Report of Two Cases and Recent Update of Literature. J Clin Diagn Res 2016; 10:PD20-PD22. [PMID: 27790519 PMCID: PMC5072019 DOI: 10.7860/jcdr/2016/20251.8569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
Umbilical Pilonidal Sinus (UPS) is a rare differential diagnosis of umbilical disease as encountered by general surgeons. They usually present with history of pain and umbilical discharge. Young active adolescent males with dense hairy abdomen with a deep naval are at risk of developing this disease. There are no consensus guidelines for the management of this disease probably because of its rarity. Treatment depends on the type of presentation. Most of the cases are managed by conservative treatment with hair extraction and personal hygiene. Surgery is indicated in case of failure of conservative management. Although umbilectomy is a commonly done procedure, complete sinus excision with reconstruction which can be done to have better cosmesis. Incomplete hair extraction from the sinus tract has been found to be the commonest cause of failure of conservative management. In this paper we have presented two cases of UPS, managed conservatively, with no recurrence after one year of follow-up. We have also presented a recent update on current literature about this uncommon disease.
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Affiliation(s)
- Susanta Meher
- Senior Resident, Department of Surgery, AIIMS, Bhubaneswar, Odisha, India
| | | | | | - Rakesh Sharma
- Senior Resident, Department of Surgery, AIIMS, Bhubaneswar, Odisha, India
| | - Bikram Rout
- Senior Resident, Department of Surgery, AIIMS, Bhubaneswar, Odisha, India
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Abstract
Urethral catheterisation is a common bedside procedure in hospitals. After they have served their purpose, indwelling Foley catheters can be removed by deflating their balloon. The incidence of a retained Foley catheter, however, is not uncommon, failure to deflate the intravesicular balloon being the most common reason. Causes of retained Foley catheters are many and the method to deal with each varies with the inciting cause. Pericatheter concretion or encrustation, an unusual cause of difficulty in removal of the catheter, is often difficult to recognise and hence is prone to faulty management. We report a case of a patient with a retained Foley catheter due to pericatheter encrustations; multiple attempts to remove it were made before the patient presented to our hospital. The case is being reported for the unusual location of retention, and the associated diagnostic and therapeutic dilemma.
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Affiliation(s)
- Satyajit Rath
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
| | | | | | - Susanta Meher
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
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26
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Tripathy S, Hansda U, Seth N, Rath S, Rao PB, Mishra TS, Subba SH, Das R, Nayak S, Kar N. Validation of the EuroQol Five-dimensions - Three-Level Quality of Life Instrument in a Classical Indian Language (Odia) and Its Use to Assess Quality of Life and Health Status of Cancer Patients in Eastern India. Indian J Palliat Care 2015; 21:282-8. [PMID: 26600695 PMCID: PMC4617034 DOI: 10.4103/0973-1075.164896] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives: The EuroQol five-dimensions – 3-level (EQ5D) is a versatile quality of life (QOL) instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analog scale. It can be used to calculate quality-adjusted life years. We aimed to evaluate the validity, reliability, and responsiveness of an Odia version of EQ5D and to study the QOL of cancer patients in our part of the country as cancer treatment in India still focuses largely on longevity due to scarcity of resources. Materials and Methods: The EQ5D tool was translated into Odia language in collaboration with the EQ group. This tool and the World Health Organization-5 (WHO-5) questionnaires were administered to 155 surgical outpatients and 150 cancer patients in two hospitals of Eastern India. The convergent and discriminant validities (construct validity), concurrent validity, reliability (test-retest method of administering the tool to a part of the population after 7–14 days), and the internal consistency (Cronbach's alpha) were measured using preestablished hypotheses. The data from the cancer patients were analyzed separately. Results: The QOL worsened with age and was worse in cancer patients proved that the tool had good construct validity. The Anxiety Depression dimension had good correlation with all the dimensions WHO-5 (rho > 0.4) indicating a good concurrent validity. Internal consistency and reliability of the tool were good (Cronbach's alpha > 0.7). Cancer patients had a poor QOL (mean EQ5D index 0.37SD 0.4) with male patients, patients with Grade II cancer or referred for pain care services and those with living spouses reporting worse QOL. Conclusions: The Odia version of the EQ5D has good reliability and validity for the measurement of health status in cancer and outpatient department patients. Cancer patients in this part of the country have a poor QOL and may need a closer look at pain management and improved societal support systems.
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Affiliation(s)
| | - Upendra Hansda
- Department of Anaesthesia, Acharya Harihar Regional Cancer Centre AHRCC, Cuttack, India
| | - Newfight Seth
- Department of TEM Critical Care, Medical Student in 7th Semester, AIIMS, Bhubaneswar, India
| | - Satyajit Rath
- Department of General Surgery, AIIMS, Bhubaneswar, India
| | - P B Rao
- Department of Anaesthesia, AIIMS, Bhubaneswar, India
| | - T S Mishra
- Department of General Surgery, AIIMS, Bhubaneswar, India
| | - S H Subba
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, India
| | - Rekha Das
- Department of Anaesthesia, Acharya Harihar Regional Cancer Centre AHRCC, Cuttack, India
| | - Sukdev Nayak
- Department of Anaesthesia, AIIMS, Bhubaneswar, India
| | - Nilamadhab Kar
- Department of Psychiatry, Black County Partnership NHS Foundation Trust, Wolverhampton, UK ; Quality of Life Research and Development Foundation, Bhubaneswar, India
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