Postmastectomy Pain Syndrome: A Narrative Review.

Postmastectomy pain syndrome is a very common disorder in breast cancer survivors. The impact on the quality of patients' lives is significantly adverse. The precise pathophysiology has not been determined as yet though various risk factors have been identified that make the patient vulnerable. Required preoperative work includes the identification and possible elimination of risk factors. Treatment is multidisciplinary involving surgical and non-surgical modalities. There is a great scope of research in this field.

Tumoral pseudoangiomatous stromal hyperplasia (PASH) of the male breast: A systematic analysis.

<b><br>Aim:</b> The study was conducted to systematically analyze the recent peer-reviewed literature related to tumoral pseudoangiomatous stromal hyperplasia (PASH) in males.</br> <b><br>Materials and methods:</b> Articles published in peer-reviewed journals of repute from 2012 to 2023 were evaluated for eight variables: 1) the age of the patient, 2) clinical presentation, 3) laterality (unilateral or bilateral), 4) associated breast disorder, 5) the presence of systemic co-morbidity, 6) imaging modalities aiding diagnosis, 7) treatment, and 8) recurrence.</br> <b><br>Results:</b> There were 10 patients ranging in age from 1 year to 67 years (mean: 34.5 years). In 8 cases (80%), there were breast lumps; in 2 cases (20%), there were axillary lumps at presentation. Pain was not a prominent symptom. Six patients (60%) had another breast disorder at presentation and 3 (30%) had significant systemic co-morbidities, including diabetes and renal insufficiency. The greatest dimension of the lumps ranged from 2 cm to 12 cm, with 80% of the lumps being below 5 cm in size. Imaging modalities utilized in evaluation included breast ultrasound (USG), mammograms, computerized tomography (CT), and magnetic resonance imaging (MRI). All the cases were treated surgically, and the final diagnosis was made only after the analysis of the surgical specimen. Recurrence was recorded in 2 (20%) cases.</br> <b><br>Conclusions:</b> Tumoral PASH is a benign myofibroblastic proliferation disorder rarely reported in males. This condition should be considered a differential diagnosis of breast or axillary lumps, and an evaluation should be initiated accordingly. The recommended course of treatment is adequate surgical excision with regular clinical and radiological follow-up.</br>.

Perineal hernia after abdominoperineal resection - a systematic review.

<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.

Spilled gallstones after laparoscopic cholecystectomy: a systematic review.

<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 20122022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.

Necrotizing fasciitis a review.

Necrotizing fasciitis is an uncommon, rapidly progressive, often aggressive bacterial infection that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissues. Rapid diagnosis of the disease is mandatory because the delay in initiation of aggressive treatment negatively influences the outcome. Specific clinical signs may not be always present, which makes an accurate and timely diagnosis difficult. Based on the literature, this article presents a review of the historical background, etiology, pathophysiology, clinical findings, diagnostic strategies, treatment and prognosis of the disease.

Extraperitoneal pelvic packing in trauma a review.

Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been suggested in recent years to be an effective method for hemorrhage control. This article briefly reviews the various aspects related to this procedure with emphasis on history, outcomes, technique and complications.

Anal Fissure - an extensive update.

Anal fissure is one of the most common anorectal diseases resulting from a longitudinal tear in anoderm under the dentate line. It causes painful defecation and bleeding per anum. Most of the fissures heal by conservative means but a significant proportion turns chronic, leading to a negative impact upon the overall quality of life of a patient. The treatment options for chronic fissures are generally based on reducing the anal pressures and include non-surgical and surgical modalities. Lateral internal sphincterotomy still remains the gold standard for definitive management of anal fissure though anal incontinence is a serious complication of the procedure. In recent years, various modifications have evolved to minimize chances of incontinence besides the evolution of a wide range of non-surgical options of management. This review outlines the key points in the clinical presentation, etiopathogenesis, impact on the quality of life and management of anal fissure in the light of the recent updates in literature.

Smartphone photography for smart assessment of post-surgical wounds - an experience during the COVID-19 pandemic.

OBJECTIVE: This study was undertaken with an aim to assess the feasibility of substitution of real-life clinical follow up with a review of smartphone captured digital photographs of post-surgical wounds by a clinician to assess wound healing. METHOD: The postoperative patients who understood the objectives got enrolled in the prospective study and were followed up. They were requested to capture the digital photographs of the wounds with the smartphones and send through WhatsApp on postoperative days 3, 5, 7, 15 and 30 or else whenever they felt need for review due to symptoms like fever, pain, redness or swelling. RESULTS: 24 abdominal, 2 extremity and 1 neck wounds were followed up in 27 patients. 3 patients developed complications and all were detected with 100% accuracy. 81% of the patients were satisfied with this mode of postoperative wound assessment. CONCLUSION: The experience shows that, in the follow up of postsurgical wounds, there is good correlation between real life clinical and remote photographic review. Incorporating photographic wound assessment into a postoperative follow-up care pathway may potentially decrease the postoperative hospital visits and decrease burden on healthcare facilities.

Stump appendicitis - a systematic analysis.

<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. </br></br> <b>Methods:</b> 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. </br></br> <b> Results:</b> 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). </br></br> <b>Conclusion:</b> Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.

Smartphone photography for smart assessment of post-surgical wounds - an experience during the COVID-19 pandemic.

<br><b>Aim:</b> This study was undertaken with an aim to assess the feasibility of monitoring of wound healing by replacement of the traditional real-life clinical follow-up with a review of smartphone-captured digital photographs of post-surgical wounds by a clinician.</br> <br><b>Method:</b> The postoperative patients who understood the objectives got enrolled in the prospective study and were followed up. They were requested to capture digital photographs of the wounds using smartphones and send them through WhatsApp on postoperative days 3, 5, 7, 15 and 30 or else whenever they felt need for review due to symptoms like fever, pain, redness or swelling.</br> <br><b>Results:</b> 24 abdominal, 2 extremity and 1 neck wounds were followed up in 27 patients. Three patients developed complications and all were detected with 100% accuracy. As many as 81% of the patients were satisfied with this mode of postoperative wound assessment.</br> <br><b>Conclusion:</b> The experience shows that in the follow-up of postsurgical wounds, there is a good correlation between real-life clinical and remote photographic review. Incorporating photographic wound assessment into the postoperative follow-up care pathway can potentially decrease the number of postoperative hospital visits and decrease the burden on healthcare facilities.</br>.

Breast fibroadenomas: a review in the light of current literature.

<br><b>Introduction:</b> Fibroadenomas are one of the most common benign tumors of the breast in the adolescent females accounting for about 2/3^rd of all the breast lumps and more than half of all the biopsied breast lesions. They come into being due to overgrowth of glandular tissue under the influence of hormonal changes that the girls undergo at the time of puberty. Due to the wide prevalence of fibroadenomas and the psychosocial morbidity associated with the finding of a breast mass, it is imperative for physicians treating adolescent patients to be thoroughly familiar and updated with this disease. <br><b>Aim:</b> The article aims at providing a brief review of the classification, presentation, diagnosis, and update on the management of breast fibroadenomas on the basis of recent literature.

Umbilical hernia repair with proceed ventral patch.

Umbilical hernia is one the commonest surgical lesions and there is a variety of methods available for its repair. Proceed Ventral Patch is a recent and novel innovation in hernia management and we present a successful management of umbilical hernia in a 45 years old obese patient with this technique.

Hand Hygiene Practices in Medical Students: A Follow-Up Study.

Objective. The study was conducted to study the impact of various measures instituted to improve hand hygiene practices of the medical students after having documented poor hand hygiene awareness and compliance in a study conducted in 2012. Methods. A self-designed questionnaire based on World Health Organization's concept of "Five Moments for Hand Hygiene" was used to evaluate the awareness of the indications of hand hygiene. Compliance was observed during Objective Structured Clinical Examination (OSCE) sessions. Fifty-one students participated voluntarily in the study. Results. The awareness and compliance of hand hygiene among the medical students in 2014 had shown statistically significant improvement (P < 0.005) as compared to figures of the study conducted in 2012. Conclusion. Dedicated multifaceted intervention can improve the hand hygiene practices in medical students.

Hand Hygiene Practices among Medical Students.

Background. Hand hygiene is a cost-effective method in preventing infection transmission. Hand hygiene practices have been found to be faulty in most healthcare settings. We conducted a study to evaluate the awareness, and compliance of hand hygiene among undergraduate medical students during their clinical phase in Qassim College of Medicine, Saudi Arabia. Methods. A questionnaire based on World Health Organization's concept of "Five Moments for Hand Hygiene" was used to evaluate the awareness of the indications for hand hygiene and compliance was observed during Objective Structured Clinical Examination (OSCE) sessions. Sixty students including thirty-six males (60%) and twenty-four females (40%) participated voluntarily in the study. Results. The average awareness regarding the positive indications of hand hygiene was 56%. Rest of the 44% of students were either not sure or unaware of the indications of hygiene. Only 29% of students were able to identify all the five indications for hand hygiene in the questionnaire. Compliance as assessed during OSCE sessions was only 17% with no significant difference between the genders. Conclusion. It was concluded that serious efforts are needed to improve the hand hygiene practices among medical students.

Congenital median upper lip fistula.

Congenital median upper lip fistula (MULF) is an extremely rare condition resulting from abnormal fusion of embryologic structures. We present a new case of congenital medial upper lip fistula located in the midline of the philtrum of a 6 year old girl.

Anal cancer - a review.

Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature.

Digital gangrene in end-stage renal disease.

Ischemic complications presenting as digital gangrene occurring in a patient of end-stage renal disease undergoing haemodialysis is rarely reported in literature. We report one such case of dry gangrene of a single finger in a 53 years old male undergoing haemodialysis. The condition was likely a steal phenomenon secondary to the surgical angioaccess for dialysis.

Endometriosis: a rare cause of appendicitis.

Endometriosis is a relatively common disorder affecting about 15% females in the reproductive age group. It is a wellknown cause of infertility but endometriosis presenting as appendicitis is rare. We present a case of a 29 years old nulliparous lady in whom appendectomy was done for appendicitis and histopathological examination of the retrieved specimen revealed endometriosis.