Neuroendocrine carcinoma of prostate presenting with ascites.

Prostate cancer is a very common cause of morbidity and mortality in India. The commonest type of prostate carcinoma is adenocarcinoma, most of them are confined to prostate at the time of presentation. Bone is the preferred site for metastasis. The following is a case of neuroendocrine carcinoma of prostate arising in a 36 years old male who presented with ascitis and jaundice to the emergency department. The ascitic tap was positive for malignant cells. CECT done to detect primary showed osteoblastic secondaries in the spine along with lesions in the liver. DRE revealed grade 2 prostatomegaly. A TRUS guided biopsy showed neuroendocrine carcinoma of the prostate. Neuroendocrine carcinoma is a very rare type of prostatic carcinoma, with presentation of the same as ascitis is very uncommon. The following case is presented due to its rarity.

Secondary malignant fibrous histiocytoma of thigh with surface ulceration following radiotherapy for carcinoma cervix.

INTRODUCTION: Radiotherapy is known to cause rarely various malignancies including leukemia, sarcoma, and thyroid and lung carcinoma. Post-radiation sarcomas account for 0.5-5.5% of all sarcomas; and include extra skeletal osteosarcoma, fibrosarcoma leiomyosarcoma, and malignant fibrous histiocytoma. Reports on post radiotherapy malignant fibrous histiocytoma in cervical cancer patients are rare. CASE REPORT: We present a case of 45-years-old female diagnosed with squamous cell carcinoma of the uterine cervix stage IIB; she underwent a radical hysterectomy with pelvic lymphadenectomy and postoperative radiotherapy and chemotherapy. Five years later, she presented with ulcerated nodular masses in right and left medial aspect of thigh. Cytological and histological diagnosis of the masses was malignant fibrous histiocytoma which was further confirmed by immunohistochemistry. CONCLUSION: Post-irradiation sarcoma must be considered in patients of carcinoma cervix treated with radiotherapy, when soft tissue mass is seen in the previously irradiated area. It should be differentiated from metastasis from primary tumor with the help of appropriate markers as it has a grave prognosis.

Controlled tube duodenostomy in the management of giant duodenal ulcer perforation: a new technique for a surgically challenging condition.

BACKGROUND: Giant duodenal ulcer (GDU) perforation remains an extremely uncommon but a rather challenging condition to manage wherein routine surgical procedures are fraught with an extremely high incidence of failure and mortality. It therefore follows that this condition must be identified and managed differently at laparotomy than are most duodenal perforations. We describe a method by which to deal with this condition using triple-tube-ostomy. METHODS: In a prospective setting, 20 patients underwent surgery using the technique described in the article. During the same period, 20 patients with GDU perforation, who were managed in the conventional manner, were evaluated. The outcomes of the 2 groups were compared. RESULTS: The success rate was 100% in the study group compared with 30% in the control patients. CONCLUSIONS: Based on the ease of the technique and the high success of the procedure in our experience in this select group, we recommend this procedure for the management of GDU perforation as a safe, reliable, and easy technique to learn.

Hereditary spherocytosis coexisting with Gilbert's syndrome: a diagnostic dilemma.

Haemolytic anaemia generally gives rise to only a modest elevation of serum bilirubin. Unconjugated hyperbilirubinaemia of an extreme degree should raise suspicion of additional factors, such as Gilbert's syndrome, hepatocellular dysfunction or renal failure. We present a 17-year-old boy with hereditary spherocytosis coexisting with Gilbert's syndrome.

Endoscope-assisted inguinal hernia repair.

BACKGROUND: Since the advent of laparoscopic inguinal hernia repair, the procedure has invited numerous controversies, and although the procedure has some definitive advantages, no definitive indications for its use have been formulated. The objective of this study was to investigate a novel method for inguinal hernia repair (through a small 2 cm to 2.5 cm) single skin incision that combines the time-tested fundamentals of Lichtenstein's tension-free repair with the advantages of laparoscopic assistance. METHODS: The study was conducted as a randomized, controlled trial over a 1-year period and included 50 patients. Only patients with simple reducible hernias without associated comorbid conditions were included. The patients were randomized into 2 groups of 25 patients each. One group underwent conventional tension-free meshplasty, while the other group underwent the repair through a single 2-cm to 2.5-cm skin incision with laparoscopic assistance. This repair was carried out with the help of an indigenously designed steel retractor, 10-mm laparoscope, and conventional instruments; the mesh was fixed with the help of endotacks. Univariate analysis of variance techniques using SPSS 7.5 software was used for data analysis. RESULTS: Two groups were compared for time taken for the procedure, size of skin incision, postoperative pain, complications, return to work, and cosmetic appearance. The results showed a significant decrease in postoperative pain and an earlier return to work, along with much improved cosmesis for the new procedure. CONCLUSIONS: Although the study was conducted with a limited number of patients and a very short follow-up, it is worth considering this method over laparoscopic and conventional techniques, especially in reducible hernias.

Isolated common bile duct tuberculosis.

We report a patient with isolated involvement of common bile duct by tuberculosis. The diagnosis was established by histological examination of the resected specimen. Surgery and antitubercular chemotherapy resulted in complete recovery.

Jejunogastric intussusception: therapeutic options.

Acute jejunogastric intussusception is a rare complication of gastric surgery. It presents considerable difficulties in diagnosis unless the index of suspicion is high. Four cases of acute retrograde jejunogastric intussusception are reported. They were managed surgically after diagnosis had been confirmed by upper gastrointestinal contrast studies. In situ resection of the distal portion of gangrenous intussusceptum was performed in one case, while the intussusception could be reduced manually in the other three cases. The importance of early diagnosis in preventing avoidable morbidity and mortality has been stressed. In situ resection is recommended as the method of choice for the management of irreducible, gangrenous intussusception.