A complete spectrum of congenital cystic adenomatoid malformation of the lung deceptive clinical presentations and histological surprises; a single institutional study from a tertiary care hospital in North India.

Background: Congenital Cystic Adenomatoid Malformations (CCAM) are rare congenital anomalies of the lungs characterised by bronchopulmonary foregut malformations due to a sudden arrest in the development of the bronchial tree in the first trimester of the gestational period. Aim: : The present study was aimed to describe the clinical and histopathological profiles of the patients and study patient outcomes after 1 year of surgical resection. Methods: All patients diagnosed with CCAM by histological examination of tissue obtained on surgical resection during the study period were included in the study. Data, such as patient demographics and clinical, radiological and histopathological findings, were recorded, and follow-up information was taken on OPD follow-up till 1 year after surgery regarding respiratory infections, haemoptysis or mortality. Results: : Out of 21 patients, 11 were female and included in the study between the ages of 1 month and 32 years, with >50% younger than 2 years. Most patients in the study had recurrent pneumonia, with difficulty in breathing being the second most common presenting complaint. All patients had undergone computed tomography (CT) of the lungs, which was able to diagnose cystic lesions accurately in >80% of cases. Histologically, all cases were classified based on recent Strocker's classification, and Type 1 was the most commonly observed with 13 cases, followed by Type 2 in five and Type 3 in three patients. There was no evidence of malignant transformation in any of the cases. There was 100% survival at the end of 1 year, with six patients having respiratory infections and none of the patients getting hospitalised over 1 year after surgery. Conclusion: CCAM is a rare congenital anomaly associated with significant morbidity and may present at any age. It can be histologically classified into three subtypes, with Type 1 being the most common. Early surgical management is mandatory to prevent complications such as recurrent infections, respiratory distress, pneumothorax, lung abscess and malignant transformation. All patients included in the study had undergone surgical resection, and there was 100% survival at 1-year follow-up.

Lung schwannomas, an unusual entity: A series of five cases.

Schwannomas are benign slow-growing tumours arising from the Schwann cells of the nerve sheath. They may arise anywhere in the course of the nerves in the body. The clinical presentations are non-specific, and when present in rare locations such as lungs, the diagnosis becomes difficult. The present case series describes the clinical presentation and diagnosis of five cases of lung schwannoma. The diagnosis was mainly assisted by the immuno-histochemical examination comprising markers such as S-100, Calretinin, CD34, CD56, Desmin, and EMA. A definitive diagnosis of benign nerve tumours in such rare locations may help in better pre-operative assessment and surgery for complete recovery of the patients.

Percutaneous Transluminal Angioplasty of Dysfunctional Hemodialysis Vascular Access: Can Careful Selection of Patients Improve the Outcomes?

Introduction: Our study aimed to evaluate the role of endovascular intervention in salvaging hemodialysis access in patients of end-stage renal disease with specific attention to features that may predict a poor outcome. We also evaluated the role of ultrasonography (USG) in the management of these patients. Methods: Forty-two patients with dysfunctional hemodialysis arteriovenous fistulas (AVF) were taken up for percutaneous transluminal angioplasty (PTA) with or without stent placement. All patients underwent a pre- and postprocedural USG Doppler to assess parameters such as mean flow, mean peak systolic velocity, and vessel diameter. Technical and clinical success rates were calculated, and characteristics causing increased failure rates (long-segment and multisite stenosis and diabetes) were noted. Results: The most common sites of stenosis were the anastomotic and perianastomotic sites (n = 27, 63%) on the venous side followed by distal venous drainage site (23%) and central venous stenosis (14%). The technical and clinical success rates were 98% and 92%, respectively. Three- and 6-month patency rates were 83% and 71%, respectively. Common characteristics in patients with failure (primary or secondary) were diabetes, increased age, increased length of stenosis (>2cm) and multisite stenosis. USG Doppler parameters showed a significant improvement post-PTA (P < 0.001) indicating clinical success. No major complication was noted in our study. Conclusion: PTA is successful for dysfunctional hemodialysis access. Careful selection of patients can improve the success rates and decrease economic burden in a resource-constrained country like ours. USG Doppler is essential in the assessment of iatrogenic hemodialysis AVFs.

The "Flip-Flap" Technique for Laparoscopic Port-Site Closure-Description of a Novel, Cost-Effective Technique with Review of Literature.

Overview Laparoscopic approach has changed the face of surgical care offered to patients. Almost all surgical procedures across specialties are now undertaken by the laparoscopic approach. Closure of port sites to prevent trocar-site hernias (TSHs) forms an integral part of the laparoscopic procedure. TSH is an area of preventable surgical morbidity. We hereby report our technique that is easily applicable, simple, safe, and highly cost-effective. It requires no additional instruments or retractors, is easy to learn, and has a very favorable safety profile. Materials and Methods This prospective case series enrolled a total of 454 port-site closures in 255 patients undergoing different laparoscopic procedures over a period of 2 years. The intraperitoneal tissue forceps were used in the reverse direction to lift the fascia up and a right-angled retractor was used to retract back the skin and subcutaneous tissue. The port-site closure is done under vision and no adverse events were reported. Results This technique was used in 454 port sites in 255 patients. No intraoperative incidents were noted. There is no requirement of any specialized instruments or retractors. No additional tissue trauma or dissection is required. There is no extension of operative time. The technique is simple to learn and easy to teach. No bowel injuries or TSHs were reported during a follow-up of 26 months. Conclusion The described technique is easy, simple, cost-effective, and has a good safety profile.

recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Annular pancreas in adults: a report of two cases and review of literature.

CONTEXT: Annular pancreas is one of the rare congenital anomalies that can manifest itself in adulthood also. No specific guidelines and protocols exist about management of such cases. We hereby discuss our experience with two such cases along with a brief review of literature about the subject. CASE REPORTS: The first patient was a male aged 27 years and presented with features of duodenal obstruction. He underwent duodenoduodenostomy . The second patient, a male aged 32 years, also presented with features of gastric outlet obstruction. He underwent Billroth type 2 reconstruction. Both patients had an uneventful recovery. CONCLUSION: Annular pancreas in adults is a rare clinical scenario. Advancements in imaging modalities have brought to forefront an even larger number of such cases. In adults it is diagnosed mainly because of the complications that arise thereof. Gastroduodenal tuberculosis can be an important differential diagnosis in endemic areas. Treatment and operative protocols have to be individualized.