Neuroendocrine tumour of the breast: A challenging diagnosis on cytology.

This letter describes the cytological features in a case of primary neuroendocrine tumour of breast.

Acute appendicitis secondary to Entamoeba histolytica infestation.

Acute appendicitis secondary to amoebic infestation is a rare possibility, especially in endemic areas. If left untreated, significant postoperative morbidity and mortality can result from the spread of amoebic trophozoites and subsequent tissue reaction. Histopathological examination of the resected appendix with demonstration of invasion by the parasite is mandatory for establishing a diagnosis. Careful examination of the specimen is thus of paramount importance.

Rare presentation of rectal duplication cyst as perineal hernia in an adult.

Rectal duplication cysts are rare congenital anomalies of the gastrointestinal tract. They can present with pain, gastrointestinal bleeding, infection or compressive symptoms on the rectum and urinary bladder. A 79-year-old man presented with a 8×5 cm swelling in the sacral region above the natal cleft with a positive cough impulse. During surgical exploration, there were two cysts with the posterior one presenting as the hernia. The cyst was excised and histopathological examination confirmed a diagnosis of rectal duplication cyst. Rectal duplications can lie anterior or more commonly posterior to the rectum. Differential diagnoses include dermoid cyst, diverticular cyst, sacrococcygeal teratoma or meningocele and endoscopic ultrasound is imaging of choice for diagnosis. Surgical excision is the treatment of choice. This is a rare presentation of a rectal duplication cyst as a perineal hernia with only a handful of cases in literature.

Evaluation of Clinical Outcomes after Abdominal Rectopexy and Delorme's Procedure for Rectal Prolapse: A Prospective Study.

BACKGROUND: Complete rectal prolapse is characterized by protrusion of full thickness rectal wall through the anal orifice. Despite its rarity more than 100 surgical procedures have been described and there are no good evidence based recommendations for selection of a surgical procedure. This study was conducted to evaluate the clinical outcomes of commonly used procedures for rectal prolapse at our hospital. MATERIALS AND METHODS: Twenty seven patients presenting with complete rectal prolapse between May 2011 to May 2013 were included in this prospective study. Patients underwent either Abdominal rectopexy or Delorme's procedure after evaluation, based on clinical judgment of experienced surgeons. Patient characteristics, complications, post-operative length of hospitalization and clinical outcomes were assessed. Patients were followed up for a mean duration of 14 months. RESULTS: Seventeen patients underwent Abdominal rectopexy (Posterior mesh rectopexy), ten patients underwent Delorme's procedure. No postoperative mortalities or major complications were noted. Post operative morbidity (minor) was 17% in Abdominal rectopexy group and 10% in Delormes group 0%. Incontinence improved in all six patients (100%) in rectopexy group, four patients (80%) in Delorme's procedure group. Two patients (11%) in rectopexy group reported increase in constipation post operatively. There was one recurrence in Delorme's procedure group with no recurrences in Abdominal rectopexy group. CONCLUSION: The treatment of rectal prolapse should be individualized to achieve best results. Abdominal rectopexy can be safely applied in most of patients with minimal post operative increase in constipation and recurrence by using posterior mesh rectopexy technique. Delorme's procedure can be performed with minimal morbidity and shorter hospital stay and good functional results with acceptable recurrence rate. Delorme's can be considered as an alternative to rectopexy not only in patients unfit for laparotomy but also in individuals with a short prolpase, avoiding a laparotomy.

Giant peritoneal loose body: a case report and review of literature.

A 52-year-old man was presented with discomfort in lower abdomen and irritative voiding symptoms. Computed tomography showed a well circumscribed mass with calcification in front of bladder compressing the bladder diagnosed as leiomyoma with calcifications, probably araising from rectum. Surgery revealed a giant peritoneal loose body measuring 6cm in diameter. After the removal of peritoneal loose body patient was relieved of symptoms. Peritoneal loose bodies are usually small and are found incidentally at surgery. Giant peritoneal loose bodies are rare. A comprehensive review of literature is presented.

A Critical Evaluation and Comparison of Antimicrobial Prophylaxis in Elective Surgeries Across three Hospitals.

OBJECTIVES: 1. To evaluate and compare the pattern and rationality of prophylactic antimicrobial therapy in elective surgeries. 2. To evaluate and compare the adherence of hospitals to the standard guidelines on prophylactic antimicrobial therapy. METHODOLOGY: A total of 150 patients each from a government hospital (group I), medical college teaching hospital (group II), and corporate hospital attached to the institution (group III) who had undergone elective, non-complicated surgery were included. The number & types of antimicrobials used along with duration were noted. Rationality was assessed on the basis of Kunin's criteria, ASHP guidelines & SIGN guidelines. Statistical analysis was done using appropriate tests. RESULTS: Cephalosporins were the most commonly used antimicrobials in all three groups (52.6%,85.7% & 84.8% respectively) followed by nitroimidazoles. Antimicrobial prophylaxis was appropriate in only 14.1%, 23.3% & 32.9% cases in the three groups respectively (p<0.01).The most common problem was prolonged duration of administration in 50.3%,58% & 45% respectively. The implementation of prophylaxis with respect to regimen & duration was erroneous in 20.1%, 12.7% & 4.7% respectively (p<0.01). CONCLUSION: The rationality & regimen of antimicrobial prophylaxis was comparatively better in the corporate hospital followed by medical college hospital and the government hospital. The present study calls for an urgent review on rational use of antimicrobials for prophylaxis in all the 3 hospitals.

Giant scrotal lymphoedema - A case report.

INTRODUCTION: Giant Scrotal Lymphoedema is a rare disease. Such Scrotal elephantiasis presents multiple problems both to the patient as well as the treating clinician obstruction, aplasia, or hypoplasia of the lymphatic vessels. The most common cause world wide is lymphatic Filariasis. PRESENTATION OF CASE: We present a particularly grotesque where the resected scrotal tissue weighed 32kg which is one of the largest so far mentioned in literature. The lymphoedema was progressive over 8 years duration and the testes were not palpable with the penis deeply buried. DISCUSSION: Scrotum was explored and penis was recovered deep within the pit of lymphoedema. Careful dissection done with cautery to delineate penis circumferentially from the root of scrotal lymphoedema. Foleys catheterisation was done. After the separation of penis scrotal skin flaps were raised on either side by extending the incision horizontally. De bulking of lymphoedema was done and the remaining scrotal skin was closed in Y shaped manner with root of penis in centre. Meticulous technique of dissection, cautery and ligasure use of Ligasure enabled excision with minimal blood loss. CONCLUSION: Once fibrosis sets in resectional therapy will be needed in most cases. Successful reduction scrotoplasty with acceptable cosmetic results can be obtained in giant scrotal lymphoedemas weighing as large as 32kg as in our case.