Ajay Kumar Khanna

Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis

Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24 hrs of admission, whereas Ranson and Glasgow scores after 48 hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study.

Phyllodes Tumor of Breast: A Review Article

Introduction. Phyllodes tumours are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows correct surgical planning and avoidance of reoperation. Treatment can be either wide local excision or mastectomy to achieve histologically clear margins. Discussion. The exact aetiology of phyllodes tumour and its relationship with fibroadenoma are unclear. Women aged between 35 and 55 years are commonly involved. The median tumour size is 4 cm but can grow even larger having dilated veins and a blue discoloration over skin. Palpable axillary lymphadenopathy can be identified in up to 10–15% of patients but <1% had pathological positive nodes. Mammography and ultrasonography are main imaging modalities. Cytologically the presence of both epithelial and stromal elements supports the diagnosis. The value of FNAC in diagnosis of phyllodes tumour remains controversial, but core needle biopsy has high sensitivity and negative predictive value. Surgical management is the mainstay and local recurrence in phyllodes tumours has been associated with inadequate local excision. The role of adjuvant radiotherapy and chemotherapy remains uncertain and use of hormonal therapy has not been fully investigated. Conclusion. The preoperative diagnosis and proper management are crucial in phyllodes tumours because of their tendency to recur and malignant potential in some of these tumours.

Male breast tuberculosis.

Tuberculosis of the breast is rare and tuberculosis of the male breast is not a recognised entity. We describe a man with tuberculosis of the breast which was clinically thought to be a malignancy.

A Case Series Describing 118 Patients With Lower Limb Necrotizing Fasciitis

Necrotizing fasciitis of the lower limb is not uncommon, with poor outcome. This study reviewed 118 cases (78 males and 40 females) with mean age of 45 + 16.5 years (range 12-95 years) of lower limb necrotizing fasciitis admitted to the Department of Surgery, BHU in India between 1995 and 2007. Most patients (n = 97) presented with fever. Other presenting symptoms included painful swelling, bullae, erythema, ulcer, and necrosis. Comorbid conditions such as diabetes, tuberculosis, malignancy, and immunosuppressive therapy were associated in 72 (61%) cases. Amputations were done in 24 patients. Thirty one patients developed septic shock. Renal dialysis was done in 16 patients and ventilatory support was needed in 12 patients. The most common organism identified was β-hemolytic streptococci (n = 42). Eighteen patients died, a mortality of 15%. The authors consider early diagnosis and aggressive surgical intervention to be crucial for the successful treatment of disease.

Hemangiopericytoma of the spleen: Unusual presentation as multiple abscess

BackgroundHemangiopericytoma is a soft tissue vascular neoplasm arising from capillary pericytes and is found throughout the body in soft tissues and bone. It was first described in 1942. Primary vascular neoplasm of the spleen constitutes the majority of nonhaematolymphoid splenic tumors like haemangioma, lymphangioma, hemangioendothelioma, hemangiopericytoma etc. Splenic hemangiopericytoma is a rare tumor and probably first case was described in 1989. Uptill now only eight cases are reported in the English literature.Case presentationA-35-year old male presented with fever and dull aching pain in left hypochondriac region. Radiological evaluation showed presence of multiple abscesses in spleen. Investigations were done to rule out common causes of abscess in spleen. After failure of medical management, he was subjected to elective splenectomy. There were dense adhesions between the spleen and the adjacent structures and the diaphragm. The histopathology of the resected specimen showed hemangiopericytoma of spleen.ConclusionThe present case illustrate that the hemangiopericytoma of spleen can mimic as multiple abscess. Splenectomy is the treatment of choice.

Giant lymphatic cyst of omentum: a case report

BackgroundOmental cysts are rare abdominal lesions and are difficult to diagnose. Mostly they are detected incidentally during imaging studies performed for unrelated reasons.Case presentationPresentation can be both acute and chronic. Acute presentations are usually due to complication in cyst. Imaging is helpful in excluding other causes of lump abdomen.We encountered a case of giant lymphatic cyst presenting with abdominal swelling, clinically mimicking huge ovarian cyst.ConclusionThe goal of surgical therapy is complete excision of the cyst, and Omental cysts can be removed without endangering the adjacent bowel.

Squamous cell carcinoma arising from pilonidal sinus

Pilonidal sinus is usually present in the sacrococcygeal region. The common presentations are cellulitis, abscess or sinus. Rarely malignant change may be seen in chronic pilonidal sinus. We report a case of chronic pilonidal sinus complicated with squamous cell carcinoma.

A large metatarsal giant-cell tumor

A case of 14-cm giant-cell tumor of the first metatarsal bone of a 35-year-old male is reported. A ray excision was carried out. The patient has now been free from disease for 3 years.

S-phase fraction and DNA ploidy in oral leukoplakia

Background:  The risk of malignant conversion in oral leukoplakia is well documented. Histological findings are often unreliable and it is difficult to predict on the basis of clinical and histopathological changes which leukoplakic lesion will turn malignant.

Isolated splenic tuberculosis presenting with splenomegaly and pyrexia of unknown origin.

Isolated tuberculosis of spleen in young persons is an extremely rare condition. We report the rare presentation of isolated splenic tuberculosis in a patient who was young and immunocompetent, with no other organ was involved. A 15-year-old woman presented with fever of 11⁄2years. She was having pain in the abdomen off and on during last 8months. Moderate splenomegaly with fever (39.3 C) was noticed during physical examination. Ultrasound and computed tomography (CT) scan pictures were suggestive of abscesses or lymphoma. Fine-needle aspiration cytology from the splenic lesion showed Staphylococcus aureus. After 3weeks antibiotic treatment, splenectomy was carried out. Multiple small abscesses with thick, organized, purulent contents were noticed all over spleen. Gross examination of spleen showed multiple whitish nodules 1–3 cm by 1–2 cm in size, with splenic notch of 4.0 cm (Fig. 1) and histopathology confirmed tuberculosis. Splenic involvement in tuberculosis is common in miliary or disseminated tuberculosis,1 especially in AIDS patients with extrapulmonary tuberculosis.2 Pyrexia of unknown origin (PUO) is caused by tuberculosis in 5–11% of reported cases in a major series. Splenic abscess is associated with parenchymal liver disease and diabetes mellitus and affects age group >50 years.3 PUO as a result of tuberculosis is more common in patients >65 years old and those with HIV infection.4 Despite rapid advances in detection facility of tuberculosis, invasive techniques, for example, biopsy by endoscopy or operation, are needed in many cases to establish the diagnosis. Splenomegaly with PUO and investigations pointing towards abscess or lymphoma prompted us to do splenectomy, and histopathology was the final tool for diagnosing isolated tuberculosis of spleen. Diffuse hyperechogenity is shown on USG, but hypoechoic lesions are found if the lesion is necrotizing, as observed in our case. CT scan typically shows multiple rounded or ovoid lowdensity lesions 1–2 cm in diameter and without calcification. This appearance is, however, by no means specific as pyogenic splenic abscesses, lymphoma or primary or metastatic malignancies may also display similar features.5 Fine-needle aspiration under CT or ultrasound guidance is safe and often positive for acid-fast bacilli. For patients with splenomegaly and PUO, splenectomy is probably the diagnostic procedure of choice, which was carried out in our case. Our case was quite difficult to diagnose because of atypical presentations as the patient was young, immunocompetent presenting with PUO and splenomegaly without any dissemination, miliary involvement or extrasplenic foci.