The Safety and Efficacy of Clipless versus Conventional Laparoscopic Cholecystectomy - our Experience in an Indian Rural Center.

BACKGROUND: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. There are lot of advances in closure of cystic duct and artery (clip ligation, suture ligation), but it remains an enigma regarding efficacy, safety and postoperative complications for using non-absorbable suture material or Liga clip for the operating surgeon in laparoscopic cholecystectomy. OBJECTIVES: Our study aimed to evaluate the efficacy, safety and complications of non-absorbable sutures ligation versus clips application in laparoscopic cholecystectomy, and to compare the operative time and cost effectiveness of the two surgical approaches in laparoscopic cholecystectomy. METHODS: This prospective study was performed between August 2014 and February 2015 in M. M. Institute of Medical Science and Research, in a rural center, Mullana, India. The study included 160 patients who were diagnosed with chronic cholecystitis in a single unit. Subjects were divided into two groups and all cases were operated by a single surgeon. The cystic pedicle was tied with non-absorbable material (silk 2-0) in group A and with Titanium clips using a clip applicator in group B. RESULTS: The application of silk and clips for cystic duct and artery ligation in laparoscopic cholecystectomy can be safely used. The mean time for ligation of cystic duct was 2.50 (SD ±0.25) in group A and 1.50 min (SD ±1.85) in group B, with P<0.001, which was significant. Similarly, the mean time for ligation of cystic artery was 1.50 min (SD±0.20) in group A and 1.36 min (SD ±0.11) in group B, with P>0.001. There were no postoperative complications, such as wound infection or bile leakage, in any of the two methods. The cost of material for silk suture (40-60 Rupees or 0.62-0.92 $) is definitely much lower than that for Liga clips (790-1000 Rupees or 12.28-15.55 $). For the use of clips, a clip applicator is required, but in case of silk ligation no special instrument is required and silk is also easily available. CONCLUSION: In laparoscopic cholecystectomy, ligation of cystic duct and cystic artery with clips takes less time than by silk suture. We conclude that both ligation techniques can be safely and effectively used. Training for junior surgeons is necessary to avoid potential complications.

Role of Multidetector Computed Tomography (MDCT) in Evaluation of Gallbladder Malignancy and its Pathological Correlation in an Indian Rural Center.

OBJECTIVES: Clinically or sonographically suspected gallbladder carcinoma was evaluated on multidetector computed tomography. Based on the spectrum of multidetector computed tomography findings, staging of gallbladder carcinoma was done. Multidetector computed tomography diagnosis was compared with pathological diagnosis. MATERIAL AND METHODS: This is a prospective study carried out in 100 patients at a rural Indian center between May 2012 and June 2015. Multidetector computed tomography was performed in all the cases and the findings were observed. Based on the radiological spectrum, staging of gallbladder carcinoma was done. The diagnosis was confirmed by ultrasound guided fine needle aspiration cytology/histopathological examination of surgical specimens. RESULTS: The most common multidetector computed tomography findings noted by us were mass replacing gallbladder, followed by diffuse/focal gallbladder wall thickening and polypoidal mass. Other findings noted were cholelithiasis, liver infiltration, intra hepatic biliary dilatation, liver metastases, portal vein invasion, antroduodenal and hepatic flexure involvement. Ultrasonography guided fine needle aspiration cytology done in all cases was positive in 92 cases and inconclusive in eight cases. Surgery was performed in only 22 patients, and histopathological findings were correlated with multidetector computed tomography findings. CONCLUSION: Multidetector computed tomography is also reliable in detection of extension of tumor and lymph nodes. multidetector computed tomography plays a major role in evaluating and staging of carcinoma gallbladder. It also guides the surgeons for operatibility and resectability of tumour.

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

BACKGROUND: The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. AIMS AND OBJECTIVES: To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. METHODS: This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. RESULTS: The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. CONCLUSION: Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

Evaluation of Multidetector Computed Tomography in Haematuria.

AIMS AND OBJECTIVES: (1) To study the role of multidetector computed tomography in patients with haematuria. (2) To correlate multidetector computed tomography findings with clinical outcome/laboratory findings/FNAC and/or operative findings (wherever performed). MATERIAL AND METHODS: The present study was carried out in the Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from April 2014 to 2016. Fifty patients with complaint of haematuria, referred from various wards and outpatient departments of this institution, were included. Multidetector computed tomography was performed in ultrasonography positive cases, in symptomatic patients with negative ultrasonography scans and in those with suboptimal ultrasonography scans. The equipment used in our study was a HD 11 XE (Philips medical systems) ultrasound unit with convex and linear probes and a 128 slice Multidetector CT (Philips Ingenuity). RESULTS: Maximum number of patients (30%) in the 51-60 years age group with a male preponderance. The prevalence of malignancy in patients with haematuria in this study was 28% which included bladder urothelial carcinoma (18%), renal cell carcinoma (6%), UTUC (4%), prostatic carcinoma (2%) and one case of TCC which turned out to be non-Hodgkin's lymphoma on histopathology. Calculi were more prevalent in the younger age group and overall constituted 20% of the causes of haematuria. Other causes of haematuria detected on multidetector computed tomography were pyelonephritis, renal trauma (grade V renal injury), bladder diverticulum, benign prostatic hyperplasia and cystitis. CONCLUSIONS: Multidetector computed tomography by using its multiplanar and 3D capabilities is highly accurate and specific in detecting the causes of haematuria. It can demonstrate the exact site of involvement in very high percent of cases. In addition to haematuria, multidetector computed tomography can detect various associated and incidental findings which may not be suspected clinically.

Concomitant Lung and Liver Hydatid Cyst Managed as One-Stage Surgery.

OBJECTIVE: Over the world, hydatidosis is endemic in many countries. It is more prevalent in Turkey. We came across with concomitant hydatidosis of the lung and liver and reviewed the management. MATERIAL AND METHODS: This is a prospective study that was carried out in the Government Medical College and Hospital, sector-32, Chandigarh, India, between 2004 and 2010, in the Department of Surgery. A total of five patients diagnosed with concomitant liver and pulmonary hydatid disease underwent surgery. They were operated by thoracotomy and laparotomy in the same sitting. RESULTS: Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. Excessive biliary drainage occurred in one patient who was managed successfully. CONCLUSIONS: We believe that simultaneous management of pulmonary and hepatic cysts through the thoracic route and by laparotomy is convenient and should be encouraged in patients because this approach decreased morbidity and mortality by deferring second operation. Needle aspiration can be applied only for liver cysts but it is absolutely contraindicated in lung hydatid cysts.

Unusual Entities of Appendix Mimicking Appendicitis Clinically - Emphasis on Diagnosis and Treatment.

BACKGROUND: Abdomen is considered a magic box or a Pandora box where you will get different, unexpected pathologies along with rare entities. Appendicitis is the commonest emergency in surgery which presents challenges to surgeons because of a myriad list of differential diagnosis including both medical and gynaecological pathologies. Preoperative imaging plays an important role in diagnosis and management. AIMS AND OBJECTIVES: To study the rare atypical anatomical and surgical presentations of appendix in patients with clinical features of appendicitis. We focus on the clinical features and the role of investigations for the radiological part and management. MATERIAL AND METHODS: This study was done in M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from November 2014 to July 2016. This was a retrospective study. We found 168 cases with the diagnosis of appendicitis, out of which 19 were with rare entities. RESULTS: Subjects of both genders were aged between 20 and 60 years. Out of 19, 15 were males and 4 females. Four patients were operated for inguinal hernia but incidentally we found appendix in the hernial sac termed as Amyand's hernia. Another patient presented with obstruction and appendix was forming a band diagnosed as torsion of appendix. Two most interesting cases were diagnosed as appendicular neuralgia and relieved by appendectomy. Out of 19 cases, 7 cases were operated for appendicitis diagnosed as appendicolith. In all the cases appendectomy was done without encountering any complications. Symptom free patients were operated for appendicular neuralgia. No malignancy was found in mucocele appendix at follow up. There were no complications by the 6-month follow-up. CONCLUSION: As we came across with different entities of appendix presented with appendicitis, patients should be investigated before proceeding for surgery. In our study, there were incidental findings for which surgeons were not aware of the diagnosis and even for the patient. In inguinal hernia, ultrasonography was not done, diagnosis being made on clinical basis. Clinical and radiological investigations play an important part in early diagnosis and management.

To compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones.

AIMS AND OBJECTIVES: This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone. MATERIALS AND METHODS: The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined. RESULTS: Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension. CONCLUSION: There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.

Tubercular abdominal cocoon in children - a single centre study in remote area of northern India.

BACKGROUND: Amongst the numerous causes of intestinal obstruction listed in the literature, sclerosing encapsulating peritonitis also called Abdominal Cocoon (AC) is one of the rarest entities. Its characteristic feature is a thick fibrotic membrane encasing varying lengths of the small and large gut in a cocoon. In India, there is an increasing incidence of tuberculosis, especially in the rural areas. AIMS AND OBJECTIVES: The aim of this study was to investigate the clinical presentation and evaluate the operative findings of tuberculous AC. We also evaluated the outcomes and response to anti tuberculous treatment (ATT) in all the patients diagnosed with this condition. MATERIAL AND METHODS: This study was carried out at M.M. Institute of Medical Sciences and Research, Mullana, Ambala, India between April 2013 - March 2016 in the Department of Pediatric Surgery. This is a prospective study. A total of 17 patients diagnosed with abdominal cocoon secondary to tuberculosis have been included in the study. RESULTS: A total of 17 patients presented to the emergency ward with features of acute intestinal obstruction. The average age was 15.3 years (range 9 years to 16 years). There were 14 females and 3 males. All patients presented with abdominal pain, bilious vomiting, constipation and abdominal distention. The patients were operated in our hospital and relieved of their obstruction. Based on their operative findings and after histopathological confirmation, patients were given ATT. In the follow-up, all patients did well, without recurrence of tuberculosis or intestinal obstruction. CONCLUSION: Tuberculosis as a cause of childhood AC is rather common in developing countries and is potentially a fatal condition. A strong clinical suspicion, sonographic and computed tomography scan findings help establish a pre-operative diagnosis. Tuberculous AC has a strong prevalence in females. Surgery is the mainstay of treatment followed by anti-tuberculous drugs.

Unusual location of primary hydatid cyst diagnosed on aspiration cytology.

Hydatid cyst (HC) is a parasitic infection caused by Echinococcus granulosus. It occurs frequently in liver and lungs. Hydatid cyst of neck is extremely rare occurrence, and here, we report it with this unusual location. A 25-year-old male nonhypertensive and nondiabetic presented with slowly growing painless swelling in right side of neck for 4-5 years. The swelling measured 5 × 3 cm and was of soft to firm consistency. Fine needle aspiration cytology yielded fluid aspirate and smear showed features suggestive of HC. The intact cyst was removed surgically, and histopathological examination confirmed the diagnosis of hydatid cyst.

Identification of foramen of Huschke with reversible herniation of temporomandibular joint soft tissue into the external auditory canal on multidetector computed tomography.

The foramen of Huschke, or foramen tympanicum, is a developmental defect in the bony part of the external auditory canal (EAC) due to a defect in ossification of normal bone in the first 5 years of life. Seen in the anteroinferior part of the EAC, it can be asymptomatic or present with salivary discharge into the EAC during mastication or as soft tissue swelling in the EAC in the absence of any inflammation, tumor, or trauma. We present a case of a man who presented with herniation of soft tissues of the temporomandibular joint into the EAC through a persistent foramen tympanicum.

Plasma Prolactin and Total Lipid Levels and Subsequent Risk of Breast Cancer in Pre- and Postmenopausal Women: Experience from an Indian Rural Centre.

AIMS AND OBJECTIVES: 1) To analyze serum lipid and prolactin levels in breast cancer patients and normal subjects; 2) to correlate those levels with risk and prognostic factors. MATERIAL AND METHODS: The present study was performed in the Department of Surgery, MMIMSR, Mullana, Ambala, from 2013 to 2014, at a rural centre. The study group comprised 40 patients with carcinoma of the breast who underwent surgery and the control group included 10 patients who underwent surgery for reasons other than carcinoma of the breast. Apart from routine tests, special investigations like estimation of serum lipids and prolactin levels were carried out in each patient to assess the general health status and detect any potential evidence of distance metastasis. RESULTS: Most patients were in the fourth and fifth decade of life. The mean value of serum total cholesterol in the study group (190.77 mg/dL) was higher than that of the control group (166.22 mg/dL), which was statistically significant. The mean value of LDL in the study group was 153.8 mg/dL, as compared to 118.4 mg/dL in the control group; therefore, the difference in LDL cholesterol levels between the two groups was statistically significant. The VLDL level was also higher in breast cancer patients, with a mean value of 35.25 mg/dL, as compared to 22.6 mg/dL in the control group. Serum triglycerides showed higher trends in the study group than in controls. The correlation coefficient of total lipids and prolactin was 0.428, which was significant (p value 0.002), and pointed to a positive relation between prolactin and total lipids, meaning that an elevation in total lipids would lead to an increase in prolactin levels. CONCLUSIONS: It was observed that significantly increased prolactin levels were found among patients with breast cancer. Serum lipids in carcinoma of the breast had higher levels of VLDL and LDL cholesterol and elevated triglyceride concentrations. Serum prolactin showed a statistically significant elevation in premenopausal patients as compared to postmenopausal subjects with breast cancer. Prolactin level may be also one of the risk factors for breast cancer, which points to its diagnostic significance.

A Study of Evaluation and Management of Rare Congenital Breast Diseases.

INTRODUCTION: Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient's fear of harbouring a malignancy. AIM: To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases. MATERIALS AND METHODS: This retrospective study on breast diseases presenting as supernumerary breasts and nipples was conducted in the Department of Surgery between January 2013 and January 2016 at MMIMS Research and hospital, Mullana, Ambala. Patients were evaluated for breast diseases, either benign or malignant in both genders. A total of 32 cases diagnosed as accessory breasts disease were retrieved from the hospital archive. The clinical and radiological evaluation was done in the form of ultrasound and mammography wherever necessary. Accessory breast tissues were excised under general anesthesia and histopathological examinations were done. RESULTS: Out of 32 cases: 1(3.125%) male patient had unilateral and 1(3.125%) male had bilateral accessory nipple, 7 (21.87%) females had unilateral and 1(3.125%) had bilateral accessory nipple, 1 (3.125%) diagnosed as accessory axillary fibroadenoma in female, 16(50%) presented as unilateral and 5 (15.62%) had bilateral swelling in the axilla as accessory breast. Patients underwent surgical excision and in 8(25%) cases z- shaped incision was made in view of better cosmesis. Patients were followed up upto 6 months postoperatively. There were no residual swelling and movements of the arm over the shoulder joint were normal. In 3(9.37%) cases, wound dehiscence occurred; in 2 (6.25%) cases lymphoedema formation was seen. These were successfully managed conservatively. CONCLUSION: As breast swellings either fibroadenoma or carcinoma are common entities to come across everywhere but accessory breasts are rarely encountered especially in rural areas because of less awareness. The study found that there was tendency to neglect the swelling as there were minimal symptoms present. We also came across a rare entity, accessory breast and accessory nipples. A clinician should not ignore such cases taking as simple swelling because of chances of discovering a malignancy can occur.

No Need of Fascia Closure to Reduce Trocar Site Hernia Rate in Laparoscopic Surgery: A Prospective Study of 200 Non-Obese Patients.

BACKGROUND: Laparoscopy is widely practiced and offers realistic benefits over conventional surgery. Port closure is important after a laparoscopic procedure to prevent port site incisional hernia. Larger port size and increasing numbers of ports needed to perform more complex laparoscopic procedures are likely to increase the incidence of port site hernias (PSHs). PSHs tend to develop more frequently at umbilical and midline port sites due to the thinness of the umbilical skin and weaknesses in the linea alba. More than 90% of PSHs occur through 10 mm and large ports can occur through 5 mm ports also. The aim was to study the outcomes and complications in laparoscopic surgery without fascial sheath closure of port site. We compared the results with another group in which fascial closure was done by a standard method. METHODS: This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala, from August 2013 to 2015 in a single unit by a single surgeon. A total of 200 patients were selected randomly for the different laparoscopic procedures. Patients were divided into group A (only skin closure was done without fascia closure) and group B (fascial closure of the port in addition to skin closure). In both groups, we used blunt trocar for the 10 mm port. Skin of the 5 mm port was closed simply. The results in two groups were compared in terms of complications like PSH, bleeding, and wound infection. RESULTS: The outcomes in two groups were compared with and without fascia closure of 10 mm trocar port site. Patients operated for lap cholecystectomy were 170 (85%), 10 (5%) for lap appendicectomy, and 20 (10%) for lap hernia. The study compared the results in two groups mainly for PSH formation. The P value was insignificant and Fischer's exact test result came as 1.00. There were no significant differences between the two groups in terms of PSH, bleeding and infection in non-obese cases. CONCLUSION: In both groups, blunt trocar was introduced into the abdomen. We concluded that this is safe, without visceral injury, and no bleeding was seen in both the groups. We had not encountered any case with PSH formation in follow-up of 6 - 8 months. There was no infection over the port site.

A giant splenic hydatid cyst.

A 16-year-old girl presented with pain in the left hypochondrium, which had been progressing for 5 months. Examination revealed large splenomegaly, and ultrasonography showed a huge hydatid cyst in the spleen. Preoperative planning and postoperative care lead to successful management of this entity. Radiological investigations also play a major role in diagnosis and decrease morbidity.

Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO2) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. AIMS AND OBJECTIVES: To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. MATERIALS AND METHODS: The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. RESULTS: In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). CONCLUSIONS: Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree.

Primary germ cell tumor of the mediastinum - presenting as a huge mass.

Germ cell tumors compromise 15-20% of all anterior mediastinal masses; 50-60% of these are benign mediastinal teratoma. There may be mature, immature, and rarely with malignant component within the tumor mass. There are more chances of malignancy with immature type. We are reporting a case in 20-year young male diagnosed as giant benign cystic teratoma which was adherent to superior vena cava. The patient underwent surgical excision. In follow up of 2 years, the patient is not having any complaints.

The clinical challenges in the management of deep lymphangioma of the foot.

A 12-year-old girl presented with swelling on the lateral aspect of the left foot since early childhood, progressively increasing in size and now causing pain on walking. Pain was relieved with medication only. There was also history of a single episode of blood-tinged discharge from the swelling 3 years prior. There was no history of trauma, diabetes, or hypertension.

A rare clinicopathological presentation of the breast carcinoma; implications and outcome.

In females, the most common cancer is breast carcinoma in which squamous cell carcinoma (SCC) is a rare type of malignancy. Histologically, infiltrating ductal carcinoma is the most common type and lobular, mucinous, and medullary types have lower incidence. Pure SCC of the breast can originate from the skin, nipple, or epithelium of a deep-seated dermoid cyst or squamous metaplasia on chronic inflammation background. We are reporting a rare case of primary SCC of the breast in a 45-year-old female. In follow-up of 8 months, patient is doing well. We discussed our approach for treatment with review of the literature. We have treated this patient successfully with surgical and adjuvant chemotherapy.

A huge immature cervical teratoma; antenatal diagnosis, and its management - an unusual entity.

Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.

A unique case of cervical osteochondroma causing dysphagia.

Osteochondroma of the spine is a rare condition. It may present in solitary form or with multiple exostoses or hereditary multiple exostoses. In this article, we report a 22-year-old male case who was diagnosed with cervical osteochondroma, originating from the third and fourth cervical vertebra.