Characterization of genetic polymorphisms in oral cancer-related genes pertaining to oxidative stress, carcinogen detoxifying, and DNA repair: A case-control study.

Background: The genetic polymorphism in the DNA repair and maintenance genes leads to mutations and deregulated growth hormones which have implications in cancer. Apart from identified carcinogens such as tobacco, specific genetic polymorphisms correspond to an individual's risk of oral cancer. The current study aims at identification of differences in genetic polymorphisms in subjects with and without oral cancer in Karad, India. Aim/Objectives: The aim of the study was to characterize genetic polymorphisms in oral cancer-related genes pertaining to oxidative stress, carcinogen detoxifying, and DNA repair. Methodology: A hospital-based case-control was conducted with 150 subjects sorted into cases (n = 75) and controls (n = 75). The polymerase chain reaction-based restriction fragment length polymorphism assay was used to genotype the polymorphisms of selected DNA repair, detoxifying, and oxidative stress-related genes. Results: In the cases group, among the DNA repair set, Gene-1 (XRCC1), Gene-3 (XRCC3), Xeroderma Pigmentosum Group-D gene (XPD), and human 8-oxoguanine DNA glycosylase (hOGG1) showed significant genetic polymorphism. Similarly, the genetic polymorphism in the carcinogen detoxifying genes-n-acetyl transferase, GSTP1, and oxidative stress-related gene catalase were noted. Statistical Analysis: The Cramer's V/odds ratio was applied to estimate the association of genetic risk factors with oral cancer. Conclusion: The polymorphisms of XRCC1, XRCC3, XPD, and hOGG1 genes were associated with a higher susceptibility to oral cancer as compared to controls. This information may be a useful novel marker in oral oncology for primary prevention and intervention.

Fine needle aspiration diagnosis of carotid body tumor in a case of multiple paragangliomas presenting with facial palsy: a case report.

BACKGROUND: Carotid body tumors (CBTs) constitute the most common extraadrenal paragangliomas. Many lesions diagnosed as CBTs by fine needle aspiration (FNA) cytology are clinically unsuspected. The main differential diagnosis is a thyroid neoplasm. The location of the mass in the lateral neck with prolonged history, hemorrhagic FNA and cytologic features resembling the endocrine neoplasm help in arriving at a suggestive diagnosis of paraganglioma. CASE: A 32-year-old male presented with left-sided facial palsy and swelling in the left side of the neck of 8 months' duration. The FNA sample was hemorrhagic and showed loosely arranged groups and acini formed by round to oval cells. A diagnosis of CBT was suggested. It was supplemented by additional noninvasive methods, such as ultrasonography of the neck region with color Doppler, computed tomography and magnetic resonance imaging of the brain, which also revealed a neoplasm suggestive of carotid body tumor in the right side of the neck and neoplastic lesion in the left cerebellopontine angle, suggestive of paraganglioma. CONCLUSION: FNA, with the other noninvasive radiologic investigations, plays an important role in the diagnosis of CBT. We present this case of multiple paragangliomas for its unusual presentation and FNA diagnosis.

Impact of Nighttime Emergency Surgeries on Patients' Outcome: A Prospective Study.

BACKGROUND AND AIM: The aim of this study was to evaluate the relationship between the time of the day the surgery is conducted and its outcome to provide better protection for patients against fatigue-related errors and reduce the incidence of postoperative morbidity/mortality. METHODS: All general surgical emergency operations recorded prospectively on the operation theater database of Krishna Hospital and Medical Research Centre, Karad, between April 01, 2018, and March 31, 2019, were included in this study. The operations were categorized according to whether they commenced during the daytime (08:01-20:00 h), or nighttime (20:01-08:00 h). The type of procedure and grade of the participating surgical personnel were also recorded. RESULTS: In total, 1128 emergency operations were performed over the study period. The number of emergency procedures performed during the daytime and nighttime was 652 (57.8%) and 476 (42.2%), respectively. Laparotomies and complex vascular procedures collectively accounted for half of all the cases performed after midnight, whereas they represented only 30% of the combined daytime emergency workload. Thirty-two percent (n = 152) of all nighttime operations were supervised or performed by a consultant surgeon. CONCLUSION: When considering a surgical procedure, surgeons must bear in mind that cases that start after the routine hours may face an elevated risk of complications that warrants further evaluation and surgical start times are associated with risk-adjusted patient outcomes.

Mixed malignant tumor of the submandibular gland.

A 70-year-old woman presented with chief complaints of swelling in the right side of her neck for 20 years, mainly in the submandibular region, with an increase in size 2 months prior, discharge of foul-smelling pus, ulceration of the overlying skin, and pain in the swelling for 15 days. Immunohistochemical studies reported the tumor to be a mixed malignant tumor arising from the submandibular gland. Wide excision of the tumor with deltopectoral flap was done.

Gastric carcinoid presented as gastric outlet obstruction.

Carcinoids are solid tumors of entero-chromaffin origin classified as neuroendocrine amine precursor uptake and decarboxylation (APUD) cell tumors and are found throughout the gastrointestinal tract from the stomach to the rectum, with a predilection for the ileum. These tumors rarely occur in the stomach, constituting only 2% of gastric tumors and 3.3% of all carcinoid tumors of the gastrointestinal tract. Localization of gastric tumors can be done by ultrasonography, computed tomography, and magnetic resonance imaging, but endoscopic biopsy is required for confirmation; demonstration of neurosecretory granules on microscopy is the most specific feature. Early resection is the treatment of choice. Prognosis of noninvasive tumors <2 cm in size in terms of 5-year survival rate is 100%. The 5-year survival rate declines and prognosis becomes poor with increase in size and with involvement of serosa, perineural infiltration, and lymph node metastasis.

Duodenal stenosis secondary to tuberculosis.

An 18-year-old man presented with complaints of epigastric pain, vomiting after meals, loss of appetite and weight, evening rise of temperature, and irregular bowel movements. Barium meal follow-through revealed a dilated stomach and first and second parts of the duodenum and stenotic lesion in the second part of the duodenum. Endoscopic biopsy of the stenotic lesion revealed acute on chronic nonspecific duodenitis with fibrosis. Isoperistaltic antecolic gastrojejunostomy was done to bypass the obstruction, and enlarged lymph nodes were biopsied. The biopsy of the enlarged lymph nodes revealed changes consistent with tuberculosis; therefore, the patient was started on antituberculous drugs in the postoperative period.

Metastatic primitive neuroectodermal tumor involving testis.

A 40-year-old male patient presented with enlarging mass over left leg region. Incisional biopsy report revealed an undifferentiated malignant round cell sarcoma, for which above-knee amputation was done. One year later, the same patient presented with left testicular swelling which appeared to be malignant. A left high orchiedectomy was done. Biopsy report showed metastatic round cell tumor, which was confirmed by immunohistochemistry as primitive neuroectodermal tumor. Metastasis to testis is very uncommon.

Eosinophilic enteritis presenting as a rare cause for ileo-ileal intussusception.

Eosinophilic enteritis, a relatively rare entity, usually involves gastric antrum or proximal small bowel. Our case is rarer in its involvement of the distal small bowel and presents unusually as intussusception. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed, surgical modality is the treatment of choice. In our case, the patient presented with acute intestinal obstruction due to intussusception and emergency laparotomy with ileoileal anastomosis was done. Histopathology confirmed the diagnosis as eosinophilic enteritis. This case with such a presentation is discussed here.

Fine needle aspiration cytology diagnosis of aneurysmal bone cyst: a case report.

Aneurysmal bone cyst is a relatively rare tumour accounting 1 to 6% of all primary bone tumours. The involvement of clavicle is even rare with incidence of only 3% of all cases of aneurysmal bone cyst. Aneurysmal bone cyst is an expanding osteolytic lesion occurring mostly at metaphyseal ends of the long bones. Although excisional biopsy is diagnostic for aneurysmal bone cyst and FNAC (fine needle aspiration cytology) is mostly inconclusive. Still FNAC can be helpful in pre-operative diagnosis of aneurysmal bone cyst.

Giant splenic hemangioma in a 10-year-old boy treated with a spleen saving surgery.

Tumors of spleen are rare. The most common benign tumor of spleen is hemangioma. Most splenic hemangiomas (SH) tend to be discovered in mid-30s to mid-50s. SH are discovered incidentally in most of the cases as they are usually asymptomatic. Small asymptomatic SH can be managed with observation. The treatment options for large hemangiomas are embolization of the splenic arterial branch, splenectomy by laparotomy or laparoscopy. Partial splenectomy can be done if the lesion is small and located at the poles of the spleen. We present a rare case of splenic hemangioma in a 10-year-old boy who presented with a painless palpable mass in the left upper abdomen. On CT scan-A large well-defined cystic lesion with few thin enhancing septa within it is seen involving the spleen. Laparotomy was done followed by Partial splenectomy. The histopathology report was suggestive of Cavernous Hemangioma of spleen.

Retroperitoneal para-aortic paraganglioma.

Paragangliomas or chemodectomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the pheochromocytoma. Seventy-one percent of the extra-adrenal paragangliomas are located in the superior or inferior para-aortic area. This tumor usually presents as an abdominal mass producing back pain. Tumor localization has improved remarkably through the use of computed tomography and I131MIBG (metaiodobenzylguanidine) scintigraphy, particularly when tumors are hormonally active. Surgical excision remains the mainstay of treatment, although vascularity can at times make excision difficult.

Adenoid cystic carcinoma of the male breast.

We present an 82-year-old male patient who presented with complaints of gradually an increasing ulcero-proliferative lesion with persistent mucinous discharge in the left breast. Left side-modified radical mastectomy was done. This was histopathologically diagnosed as an adenoid cystic carcinoma of the left breast. Periodic acid schiff (PAS) staining confirmed the diagnosis. Three of the five axillary lymph nodes excised were positive for malignancy. Although the patient was advised to have postoperative radiotherapy, he did not comply. After 2 years, the patient again presented with local recurrence of the disease. Wide excision of the recurrent malignant nodules over the anterior chest wall was done, and the defect was covered primarily with split thickness skin grafting. Postoperative radiation was given. For the past 9 months, the patient has maintained a regular follow-up on an outpatient basis. He does not have any evidence of recurrence of the tumor--neither locally nor distant metastasis.

Acute neonatal parotid abscess: A rare case report.

Acute suppurative parotitis is uncommon in children and is very rare in neonates. Most common organism isolated is Staphylococcus aureus. We present a 15-day-old full-term breast-fed female neonate with left-sided acute parotid abscess. The baby presented with a left preauricular swelling, pain and redness. Pus was exuded from left Stensen's duct on compression of the gland externally. Early diagnosis and proper intravenous antibiotics are the keys to the treatment.

Retroperitoneal para-aortic paraganglioma.

Paragangliomas or chemodectomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the pheochromocytoma. Seventy-one percent of the extra-adrenal paragangliomas are located in the superior or inferior paraaortic area. This tumor usually presents as an abdominal mass producing back pain. Tumor localization has improved remarkably through the use of computed tomography and I131 metaiodobenzyl-guanidine scintigraphy, particularly when tumors are hormonally active. Surgical excision remains the mainstay of treatment, although vascularity can at times make excision difficult.

FNAC diagnosis of MPNST--a case report.

Malignant peripheral nerve sheath tumour (MPNST) is a relatively rare tumour arisingfrequently in patients with neurofibromatosis, type I (NF1). It is usually a high grade sarcoma. A 65 year old female patient presented with a swelling in left popliteal fossa of two months duration. She had multiple nodular lesions all over the body since childhood. She was subjected to fine needle aspiration for the popliteal mass and was reported as MPNST which was confirmed on histopathology. She developed recurrence within four months time. The prognosis of MPNST is poor. Fine needle aspiration cytology is a very useful, rapid sensitive and inexpensive investigative procedure for the diagnosis of soft tissue tumours and can replace an open biopsy for the diagnosis of MPNST in patients with neurofibromatosis-1.

High-grade myxofibrosarcoma-presented as a large mass of right upper arm.

Myxofibrosarcoma is one of the rare soft tissue sarcomas. We present a case of a 65-year-old male having large soft tissue mass over right upper arm associated with surface ulceration. On histopathological study tumor was diagnosed as myxofibrosarcoma - high grade according to modified FNCLCC grading system. Like many other tumors of connective tissue, soft tissue sarcoma exhibits high recurrence. In our case, tumor showed features of high grade with local recurrence, large size; however, no evidence of metastasis was noted. For this unpredictable clinical behavior, we are presenting this case.

Case report: A rare case of eccrine carcinoma.

INTRODUCTIONS: Sweat gland carcinoma is very rare with a reported incidence of less than 0.005% of all tumour specimens resected surgically (Tulenko and Conway, 1965) [1]. CASE REPORT: A sixty year old male patient presented to us with a solitary swelling over the left chest wall since two months. DISCUSSION: Cutaneous apocrine gland carcinoma, a subtype of sweat gland carcinoma, is a very rare malignant neoplasm arising in areas of high apocrine sweat gland density. The variability of the histological features even in the same tumour, and its rarity, have contributed to some confusion regarding the classification of sweat gland carcinoma. CONCLUSIONS: Sweat gland carcinomas are a rare group of tumours with potential for local destruction as well as distant metastasis. Wide surgical excision along with regional lymph node dissection in the presence of clinically positive nodes is the recommended treatment. However, a frequent follow up is essential to detect early recurrence as well as distant metastasis.

Isolated pancreatic tail injury: A rare presentation.

INTRODUCTION: Pancreatic injuries occur in up to 10% of all major blunt abdominal trauma events. Due to the retroperitoneal location of the pancreas, isolated pancreatic injury occurs in less than 5% of cases. PRESENTATION OF CASE: A 12 year old male child was brought to the emergency department with epigastric pain 12 days after alleged history of fall from bicycle. On admission, he had tenderness in the epigastrium. CT scan revealed a transection through the tail of the pancreas with no injury to any other organ. As there was no evidence of duct injury, he was treated conservatively. DISCUSSION: Morbidity and mortality rates for isolated pancreatic trauma are directly related to the presence of damage to the pancreatic duct. Helical multislice CT scan represents the best noninvasive diagnostic method for the detection of pancreatic injury. Hyperamylasemia should at least be considered as a sign of probable pancreatic injury in the setting of blunt abdominal trauma. CONCLUSION: Trauma to the pancreas is not common, and isolated pancreatic trauma is even less common. An isolated pancreatic injury may be missed or the diagnosis may be delayed because the initial symptoms and signs of pancreatic injury are subtle.

A comparative study of colostrum dressing versus conventional dressing in deep wounds.

INTRODUCTION: Deep wounds are extending deeper, across deep fascia into muscles or deeper structures. Understanding of nutrition, immunology, psychological issues, the physiology and the metabolic interactions require for optimal treatment of deep wounds. Wound dressing plays one of the important roles in wound healing. Newer type of wound dressings - Biological dressings like colostrum powder, collagen granules create the physiological interface between the wound surface and environment which is impermeable to bacteria. AIM: To compare the efficacy and safety of colostrum dressing and conventional dressing in deep wounds. MATERIALS AND METHODS: Data was collected from all patients with deep wounds (stage II-IV), admitted during the period of April 2013 to March 2014, considering the inclusion and exclusion criteria. RESULTS: Less number of dressings, short healing time, rapid healing and decrease pain seen in colostrum dressing group compared to conventional dressing group. CONCLUSION: Colostrum powder dressings are safe, promoter of wound healing, more patient compliance in terms of less pain, less number of dressing required. This treatment though found to be more expensive than conventional dressings; results indicate that colostrum powder dressings may be used as an adjunct in management of deep wound.