Tamoxifen in Mastalgia: A Meta-Analysis.

OBJECTIVES: Tamoxifen is prescribed for chronic mastalgia at a dosage of one 10- or 20-mg tablet for 3-6 months. A topical preparation of this drug has recently been approved. The aim of this study was to meta-analyze the effectiveness of tamoxifen and its different regimens for the treatment of mastalgia. We also sought to summarize the side effects and the follow-up results of these treatments. DATA SOURCES: We searched the databases of PubMed/ MEDLINE, Central, Embase, and EBSCO from August 2021 to September 2021. STUDY SELECTION: Articles on the effects of tamoxifen in mastalgia were searched, and randomized controlled trials were retrieved for inclusion in this study. PRISMA guidelines were followed, and we selected 9 articles for the meta-analysis. DATA EXTRACTION AND SYNTHESIS: A proforma was prepared for data collection. RevMan 5.4 software was used for methodological quality assessment, statistical analysis, and preparation of forest plots. Oral tamoxifen performed better than placebo (risk ratio [RR] 2.04; 95% CI 1.49-2.78, P < 0.001). No significant difference in efficacy was seen between the 10- and 20-mg dosages (RR 1.08; 95% CI 0.97-1.21, P = 0.18) when used for 3 months. CONCLUSION: Oral tamoxifen is helpful in long-standing mastalgia. It is safe and effective at an oral dose of 10 mg.

Clinico-Pathological Profile and Surgical Outcome of Patients of Gastrointestinal Tuberculosis Undergoing Laparotomy.

Tuberculosis is one of the earliest diseases affecting the mankind. Abdominal tuberculosis constitutes a common public health issue in developing countries like ours. Gastrointestinal tuberculosis often involves the ileocecal region. Surgery in case of abdominal tuberculosis is required to overcome the deleterious effects of the disease like tissue disorganization, obstruction and perforatio. AIMS AND OBJECTIVES: 1. To study the various clinical profiles of gastrointestinal tuberculosis in patients undergoing laparotomy; 2. To study the surgical pathology of gastrointestinal tuberculosis; 3. To study the various surgical treatment modalities based upon the intraoperative findings and its outcome. Results: This is a prospective study over 12 months at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. This study was done to study the clinic-pathological profile of gastrointestinal tuberculosis undergoing laparotomy. Incidence of gastro intestinal tuberculosis was seen highest in age group 15 to 25 years with male predominance. Most commonly presentation being intestinal obstruction with ileo-caecal as the most common area involved and right hemicolectomy as the commonest procedure done. Common surgical pathologies were ileo-caecal mass and ileal perforation and this also has relation to pulmonary tuberculosis. CONCLUSION: Inspite of specific antituberculous drugs and vast measures against the disease, including chemoprophylaxis and pasteurisation abdominal tuberculosis remains a fairly common disease even today. Gastrointestinal tuberculosis has an indolent course and the common mode of presentation is usually sub acute or chronic. Prompt surgical exploration, vigilant postoperative care and administration of ATD helped to treat the patients successfully with their complete cure and rehabilitation.

To Study the Aetiological Factors and Outcomes of Urgent Re-Laparotomy in Himalayan Hospital.

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Relaparotomy (UR), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing URs, their outcomes and factors that affect mortality. METHODS: Observational, Prospective Study. The study included all the patients who underwent urgent re-laparotomy following laparotomy (emergency, elective) in Himalayan Hospital from 01.01.2013 to 01.06.2014 and excluded those who underwent laparotomy outside. RESULTS: UR was performed for 40 out of 1050 patients (4.2%), of which males were 25 and females 15. The average time interval between the index laparotomy and urgent re-exploration was 6.4 days. The most common reason for mortality was multi organ failure with septic shock. The most common criteria for re-exploration were anastomotic leak (n=13), followed by pyoperitoneum (n=11) and persistent peritonitis (n=6). Comparing the index surgery, lower gastro-intestinal procedures were most usually involved (n=21, 47.7%), followed by hepato-pancreato-biliary surgeries (n=8, 18.2%). There were 6 cases of upper gastro-intestinal surgeries that reexplored (13.6%). CONCLUSION: UR that is performed following complicated abdominal surgeries has high mortality rates. In particular, they have higher mortality rates following GIS surgeries or when infectious complications occur.

Clinical Profile of Patients with Postoperative Adhesive Intestinal Obstruction and its Association with Intraoperative Peritoneal Adhesion Index.

UNLABELLED: Adhesions following surgery represent a major unsolved problem. They occur after 50% to 100% of all surgical interventions in the abdomen and may complicate the work of the surgeon considerably. Peritoneal adhesions are pathological bands that typically form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. These bands may be a thin film of connective tissue, a thick fibrous bridge containing blood vessels and nerve tissue, or a direct adhesion between two organ surfaces. AIMS AND OBJECTIVES: 1. To study the clinical profile of patients with adhesive intestinal obstruction undergoing laparotomy. 2. To assess and analyze the intra-operative peritoneal adhesion index (PAI) in individual cases. 3. To associate the clinical profile with peritoneal adhesion index in patients of adhesive intestinal obstruction. RESULT: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), SRH University, Dehradun, India over a period of 12 months. A total of 30 patients with diagnosis of post operative adhesive intestinal obstruction were recruited in the study. It was observed that adhesions over each abdominal region contributed equal to the total PAI. In this study it was observed that the patients who had previous emergency surgery had higher incidence of adhesions, than elective surgery whereas those patients who underwent both elective and emergency surgeries, the incidence of adhesions were lowest. Analysis of variance with respect to abdominal scar resulted that the difference between groups was observed to be statistically not significant (P 0.05), so patients with all type of abdominal scars of previous surgeries has equal chance of developing adhesions. CONCLUSION: PAI is a sensitive tool for clinical and intra-operative assessment of adhesive intestinal obstruction for the quantification of the adhesions and gives a precise description of the underlying intra-abdominal condition while planning a surgical management of the disease.

End-to-Side Ileo-Sigmoid Anastomosis and Late Onset Gangrenous Diverticulitis: A Case Report.

End-to-side ileo-sigmoid anastomosis converts the proximal colon into a blind intestinal segment which is excised during the surgery. If we do not resect the proximal colon, it is expected to behave like a colonic diverticulum, but direct evidence of this assumption is lacking. During an exploratory laparotomy, we detected an end-to-side ileo-sigmoid anastomosis and found that the proximal colon was gangrenous. The patient passed away during the postoperative period, yet their remarkably long period of symptom-free survival remained intriguing.

Fine-needle aspiration cytology of gallbladder with an attempt of cytomorphological classification.

BACKGROUND: Image-guided fine-needle aspiration has emerged as an effective diagnostic tool for precise diagnosis of deep-seated lesions. Although occasional studies have made an attempt to classify the gallbladder carcinoma on cytology, literature lacks the standardized cytological nomenclature system used for it. The present study was conducted to study the role of fine-needle aspiration cytology (FNAC) in diagnosis of gallbladder lesions with an attempt of cytomorphological classification. METHODS: The study included cases of image-guided FNAC of the gallbladder over a period of 3½ years. An attempt was made to categorize gallbladder lesions on basis of architectural and cytomorphological features along with analysis of management. RESULTS: The study included 433 cases and lesions were categorized on FNAC into five categories ranging from Category 1 (inadequate), Category 2 (negative for malignancy), Category 3 (atypical cells), Category 4 (highly atypical cells suggestive of malignancy), and Category 5 (positive for malignancy). The most common architectural pattern observed on FNAC of neoplasm was sheets and acini with predominance of columnar cells and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 93 cases with cytohistopathological concordance of 94.4% in malignant cases. CONCLUSIONS: Image-guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. The cytomorphological classification of gallbladder lesions provides an effective base for accurate diagnosis and management. Category 3 and 4 are the most ambiguous category on FNAC which should be managed by either repeat FNAC or surgery in the light of worrisome radiological features. The vigilant examination of architectural pattern and cytomorphological features of the smears may be helpful in clinching the diagnosis and precisely subtyping malignant tumors along with prognostication of these tumors.

Fluconazole Resistant Candida Oesophagitis in Immunocompetent Patients: Is Empirical Therapy Justifiable?

INTRODUCTION: C. albicans (Candida albicans) is the foremost cause of fungal oesophagitis, however other species such as Candida tropicalis, Candida krusei and Candida stellatoidea have also been implicated to cause this condition. Although, numerous studies have identified risk factors for C. albicans oesophagitis, data for non- C. albicans species is still sparse. AIM: To determine the aetiology of Candida oesophagitis in our medical centre over a two year period. Additionally, to investigate predisposing conditions for oesophageal candidiasis caused by different Candida species. MATERIAL AND METHODS: All consecutive patients posted for upper gastrointestinal endoscopy at the endoscopy unit of a tertiary care hospital in north India with findings consistent with oesophagitis were screened for the presence of Candida oesophagitis by performing KOH (potassium hydroxide) examination and culture on SDA (Sabouraud's dextrose agar). Antifungal susceptibility testing as per CLSI guidelines was performed for fluconazole, a most common empirically prescribed antifungal for the condition. RESULTS: A total of 1868 patients with no known immune-compromised condition underwent upper gastroscopy at our centre during the study period. The prevalence of Candida oesophagitis was 8.7% (n = 163). C. albicans was recovered from majority of infections (52.1%), followed by C. tropicalis (24%), C. parapsilosis (13.4%), C. glabrata (6.9%) and C. krusei (3.6%). Alarmingly, among the C. albicans isolates 8.6% were resistant to fluconazole. CONCLUSION: With rising reports of antifungal drug resistance among the isolates of Candida species, an increasing prevalence of this organism could have an impact on the treatment of Candidal oesophagitis and it should be approached with caution by the clinician.