Akshay Anand

Papillary Thyroid Cancer and Hashimoto's Thyroiditis: An Association Less Understood.

Hashimoto’s thyroiditis (HT), part of the spectrum of autoimmune thyroid diseases is a major cause of thyroid hypofunction worldwide. Papillary thyroid carcinoma (PTC), the most prevalent of all thyroid carcinomas has been associated with HT. Literature on this association are based on preoperative FNA or post thyroidectomy histopathology reports, which are subject to potential biases. Molecular, hormonal and histopathalogical basis of this association has been hypothesized, however a definite causal association has not been proved till date. This review aims to study the basis of this association and clinical features and management of HT concurrent with PTC. There are no distinctive clinical or radiological features that categorically differentiates HT concurrent with PTC from PTC or which can pick up a nodule harboring PTC in setting of HT. Smaller nodule size and radiological features like hypoechogenecity; hyper vascularity and calcification in a clinical setting of hypothyroidism have a higher odds ratio for malignancy and merit further investigations. PTC associated with HT has been seen to be less aggressive with earlier presentation with lesser chances of extra thyroidal extension and lymph nodal metastasis. The management and follow up of PTC in HT is no different from that of PTC alone. The prognosis of PTC concurrent with HT is better compared to age and stage matched PTC in terms of lower recurrence and disease free and overall survival.

A study to compare outcomes of Sodium tetra-decyl sulphate and Polidocanol in the treatment of varicosities due to incompetent tributaries of superficial vein of leg: a randomized controlled trial

Varicose vein (VV) is defined as dilated, elongated, tortuous superficial vein of leg having reflux with a prevalence rate of 50-55% in females and 40-50% in males. Reflux may be due to incompetent valves at saphenofemoral junction (SFJ) or in the main trunk/axis of great saphenous vein (GSV) or short saphenous vein (SSV) or due to incompetent perforators as well. Often bunches of varicosities are found on lateral or medial aspect of leg due to incompetent tributaries. Main trunk or main axis of incompetent superficial vein of leg is treated by endovenous thermal ablation, foam sclerotherapy, crossectomy and stripping of GSV. ABSTRACT

Patient related outcomes and ergonomic evaluation of triangular 3-port or ‘two-hand’ TEP hernioplasty: a preliminary analysis in a university hospital

Endoscopic inguinal hernia repair originated in the early 1990s as minimal invasive surgery gained a foothold in general surgery. Endoscopic approaches have potential benefits that include a better visualization of anatomy, usefulness for fixing all inguinal hernia defects, reduction in post operative pain, shortening of recovery period, reduced postoperative morbidities and decreased surgical site infections. Endoscopic repair has some disadvantages as well, including the following: increased cost, increased duration of operation, steeper learning curve, and high recurrence and complication rates particularly early in a surgeon’s experience. The term endoscopic inguinal hernioplasty can refer to any of the following two techniquesTotally extraperitoneal (TEP) repair or Transabdominal preperitoneal (TAPP) repair.

P-Glycoprotein Expression in Indian Breast Cancer Patients with Reference to Molecular Subtypes and Response to Anthracycline-Based Chemotherapy—a Prospective Clinical Study from a Developing Country

Chemo-resistance is an important factor determining the response of tumor to neoadjuvant chemotherapy (NACT). Our study was aimed to determine the role of P-glycoprotein (P-glyp) expression as a predictor of response to NACT in locally advanced breast cancer (LABC) patients with special reference to molecular subtypes. Sixty cases of locally advanced breast cancer (LABC) were subjected to trucut biopsy and the tissue samples were evaluated immunohistochemically for P-glyp, ER, PR, and Her 2 neu status. Pre- and post-NACT P-glyp expression was correlated with clinical response (using WHO criteria after three cycles of CEF regimen) and molecular subtypes. The change in the P-glyp expression before (pre-) and after (post-) NACT was statistically significant with higher stage (p = 0.02), hormonal negative molecular subtypes (p = 0.01), and poor clinical response (p = 0.01). Pre-NACT-positive P-glyp expression is associated with higher stage and hormonal negative molecular subtypes and poor clinical response. The increased expression of P-glyp induced by NACT likely explains the concept of acquired chemo-resistance and may prove as an intermediate checkpoint in determining chemo-sensitivity for further treatment so that additional doses of ineffective chemotherapy may be avoided in non-responders translating into better patient safety.

Expression of vitamin D receptor and vitamin D status in patients with oral neoplasms and effect of vitamin D supplementation on quality of life in advanced cancer treatment

Aim of the study Vitamin D receptor (VDR) expression and serum vitamin D scores in oral premalignant lesions and oral cancer have not been widely analyzed. The role of vitamin D supplementation in advanced oral cancer for improving quality of life (QOL) is also a matter of research. Material and methods Vitamin D receptor expression and vitamin D scores were analyzed in normal oral mucosa (n = 95), leukoplakia (n = 23) and oral cancer (n = 87). 45 patients with advanced oral cancer subjected to chemoradiation were evaluated for the effect of vitamin D supplementation on most observable QOL parameters such as oral mucositis, swallowing performance and overall QOL. Results Vitamin D receptor expression was increased in oral neoplastic lesions. Vitamin D scores were significantly lower in cases compared to healthy controls (p = 0.002). Vitamin D supplementation significantly reduced the therapy-related toxicities in advanced cancer, thus reducing morbidity and improving QOL. Conclusions Vitamin D receptor expression is increased in premalignant lesions and oral cancer. Vitamin D insufficiency and deficiency are prevalent in patients with oral neoplastic lesions. Vitamin D supplementation has a role in reducing treatment-related toxicities, especially in advanced cancer.

Surgical Techniques for Dealing with Intraluminal Thrombus of Great Vessels in Advanced Differentiated Thyroid Carcinoma

Aim: We aim to define and refine the surgical technique for dealing with intraluminal thrombus of great vessels in advanced differentiated thyroid carcinoma (DTC) to reduce the morbidity. Background: Venous tumor thrombus from DTC is a rare occurrence with sequelae that cause increased morbidity and early mortality. Management of such patients poses a challenge to surgeons. Materials and methods: We define the surgical planning and road map for surgical management of advanced DTC with tumor thrombus involving the internal jugular vein (IJV) and superior vena cava (SVC) by sacrificing one IJV and retrieving the thrombus from the SVC by Fogarty catheter. This technique has minimal morbidity with good outcome. Conclusion: By appropriate planning and meticulous surgical techniques, we can aggressively manage patients of advanced DTC with venous tumor thrombus and reduce the morbidity. Clinical significance: By surgical techniques leading to complete surgical resections and saving native vital structures, we can aim for successful aggressive surgical management of advanced DTC with venous tumor thrombus.

A Prospective Randomized Controlled Trial Comparing Quality of Life Following Endoscopic Totally Extraperitoneal (TEP) Versus Open Stoppa Inguinal Hernioplasty

In inguinal hernia surgery, quality of life (QOL) has emerged as a striking issue. Evidence suggests better QOL of patients operated with laparoscopic procedure as compared with open anterior hernia repairs. However data are scarce with relation to open posterior repair in terms of QOL issues. A prospective randomized single-blind study from November 2014 to October 2015 including all patients who underwent elective primary endoscopic [totally extraperitoneal (TEP)] or open Stoppa inguinal hernia repair was undertaken. Mean operating time, intraoperative and postoperative complications, and QOL using short form-36 and Carolinas equation of QOL were analyzed. Physical functioning, mental health, bodily pain, and general health showed advantages of TEP over Stoppa repair in first month of postoperative period. Postoperative prediction of hernia discomfort after 1 year was found to be significantly more in Stoppa repair. Complications were slightly higher with open repair. To conclude TEP is associated with significant increased operative time, better QOL in early postoperative period, and less predicted discomfort after 1 year of surgery.

Androgen Receptor Expression in an Indian Breast Cancer Cohort with Relation to Molecular Subtypes and Response to Neoadjuvant Chemotherapy - a Prospective Clinical Study

Background: Breast cancer (BC) is associated with advanced presentation in developing countries like India due to various socio-economic factors. The presence of BC molecular subtypes such as the triple-negative (TN) subtype adds to this menace. Androgen receptor (AR) is emerging as a new biological marker. The aim of this study was to examine the prevalence of AR with relation to different BC subtypes, and its role in predicting response to neoadjuvant chemotherapy. Methods: 116 cases of invasive BC (infiltrating ductal carcinoma, not otherwise specified) were evaluated. AR expression was correlated with clinicopathological factors, established prognostic markers, BC subtypes and it ability for predicting response to neoadjuvant chemotherapy. Results: AR was expressed in 56% of the cases. AR expression was significantly associated with early stage (p < 0.03), low axillary burden (p < 0.04), estrogen receptor (p = 0.002), progesterone receptor (p = 0.001) expression and luminal A molecular subtype. No significant association was observed with age, tumor size and HER2/neu status. One-third of TNBC cases expressed AR. Higher AR expression corelated to good clinical response to neoadjuvant chemotherapy. Conclusion: AR can be utilized as a predictor of response to neoadjuvant chemotherapy especially in developing countries such as India where the load of advanced disease is high.

Morel-Lavallee seroma (post-traumatic pseudocyst) of back: a rarity with management conundrum.

Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing force that causes separation of subcutaneous fatty layer from the deeper muscular fascia resulting in collection of fluid in the created space. Presentation is usually fluctuant swelling following history of injury. More frequently described in orthopaedic literature, it occurs more commonly over gluteal and trochanteric regions, knee and flanks with occurrence over back, thorax being a rare entity. Despite mimicking several other similar presenting conditions, diagnosis of MLS can be made by meticulous history and physical examination with classical findings on ultrasonography, CT scan and MRI. Treatment modality may vary from conservative management to open surgical debridement of the wound with percutaneous aspiration and sclerodhesis forming useful adjuncts to conservative management.

Prevalence of derangement of coagulation profile in surgical patients and its outcome in India.

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