Posterior Belly of Digastric Muscle Transposition Flap in Preventing Frey's Syndrome after Superficial Parotidectomy- A Prospective Study.

Introduction: Superficial parotidectomy is an effective management for benign and malignant tumours of the superficial lobe of the parotid gland. Frey's syndrome is one of the most common complications observed after parotidectomy. The objective of our study was to find the incidence of Frey's syndrome 6 months and 1 year postoperatively after doing posterior belly of the digastric flap during superficial parotidectomy. Materials and Methods: This is an observational prospective study done in the Department of General Surgery of the Institute from November 2018 to December 2020. Thirty-eight patients with parotid swellings (both due to benign or malignant causes) were evaluated preoperatively and planned for superficial parotidectomy with a posterior belly of digastric muscle (PBDM) flap to prevent the occurrence of Frey's syndrome. They were followed up in 6 months and 1 year. Minor's test was done in each visit to look for the occurrence of Frey's syndrome. Results: Two patients (5.2%) out of 38 patients developed asymptomatic Frey's syndrome after 6 months postoperatively out of which one patient (2.6%) developed symptomatic Frey's syndrome after 9 months postoperatively with symptoms such as sweating, flushing, and redness over the parotid area during chewing. Discussion: PBDM flap following superficial parotidectomy in a single-stage surgery is an effective and easy method to prevent Frey's syndrome. This procedure is easy to perform and requires no complex dissection. There have not been many studies regarding the use of this flap; hence, this study may be considered as a pilot study.

A prospective study of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in acute pancreatitis: an Indian perspective.

INTRODUCTION: A simple and easily applicable system for stratifying patients with acute pancreatitis is lacking. The aim of our study was to evaluate the ability of BISAP score to predict mortality in acute pancreatitis patients from our institution and to predict which patients are at risk for development of organ failure, persistent organ failure and pancreatic necrosis. METHODS: All patients with acute pancreatitis were included in the study. BISAP score was calculated within 24 h of admission. A Contrast CT was used to differentiate interstitial from necrotizing pancreatitis within seven days of hospitalization whereas Marshall Scoring System was used to characterize organ failure. RESULTS: Among 246 patients M:F = 153:93, most common aetiology among men was alcoholism and among women was gallstone disease. 207 patients had no organ failure and remaining 39 developed organ failure. 17 patients had persistent organ failure, 16 of those with BISAP score ≥3. 13 patients in our study died, out of which 12 patients had BISAP score ≥3. We also found that a BISAP score of ≥3 had a sensitivity of 92%, specificity of 76%, a positive predictive value of 17%, and a negative predictive value of 99% for mortality. DISCUSSION: The BISAP score is a simple and accurate method for the early identification of patients at increased risk for in hospital mortality and morbidity.

Cytodiagnosis of angiosarcoma of breast.

A 24-year-old female presented with swelling in the left breast for one-and-a-half years associated with pain for last 4 months. During this period, she was operated twice and once again there was local recurrence, the biopsy was interpreted as benign vascular lesion. The case was diagnosed by preoperative cytology as angiosarcoma of breast, after which, she underwent modified radical mastectomy. Angiosarcoma of breast is uncommon with extremely bad prognosis. Familiarity with the clinical and pathologic features is critical in avoiding underdiagnosis and delayed treatment.