Anil Kumar Sarda

Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature.

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.

Amebic liver abscess with jaundice.

A case of an amebic liver abscess with unusual clinical manifestations is presented. A middle-aged male with an abscess in both lobes of the liver presented with obstructive jaundice due to pressure on the porta hepatis with stasis of the bile in the intrahepatic biliary radicals. The patient did not respond to repeated needle aspirations and thus required open drainage. Subsequently, the patient developed a biliary leak through the drainage sites, and an injection of contrast dye into the cavity revealed a communication between the abscess cavities and the biliary tree. The biliary leak stopped spontaneously, and the large cavities also closed completely during the followup period.

THYROID SURGERY IN AN AREA OF IODINE DEFICIENCY

The catchment area of the patients under study was the sub‐Himalayan plains, which are recognized as iodine‐deficient areas.

Prognostic Factors for Well-Differentiated Thyroid Cancer in an Endemic Area

A retrospective analysis of 215 differentiated thyroid cancers was undertaken to identify the various prognostic variables. There were 132 papillary and 83 follicular cancers; both histologic types occurred at an earlier age, with a male to female ratio of 1: 1.1 (signifies near parity in both sexes, in contrast to marked female preponderance in most of the reports and amongst benign thyroid disorders). There was a significant difference in the size of the primary tumours; 60/132 (45%) of papillary and 30/83 (36%) of follicular cancers were early T0-1 lesions and 20 (15%) papillary and 24 (29%) follicular cancers were advanced T3 lesions. Age did not affect the size of the primary tumour. Regional lymph node and pulmonary metastases were common in both types of cancer while distant metastases occurred more frequently in follicular cancers (p < 0.005). Following surgery, contralateral lobe recurrence in the remaining lobe was more common in the follicular cancer group, while loco-regional recurrence after near-total thyroidectomy was more frequent in the papillary cancer group (p > 0.05). Mortality in 26/132 (20%) papillary and 28/83 (34%) follicular cancer patients was high in both groups, but significantly higher in the follicular cancer group (p < 0.05). Although mortality among patients with papillary cancer was higher in patients older than 40 years of age (p < 0.05), age did not affect survival in patients with follicular cancer. Gender did not affect survival in either group. The extent of the disease at presentation was the most important determinant of survival, with mortality significantly higher among patients with T3N3M1 lesions (p < 0.001).

Solitary Necrotic Nodule of Liver (SNNL): A Report of Two Cases

SNNL is a rare, benign lesion which may arise from trauma, a sclerosing haemangioma or it may represent a burned out phase of various conditions like parasitic infections, or chronic infections like tuberculosis. Histopathology provides the definite diagnosis, which thus helps clinicians in allaying unnecessary anxiety of the patient and in planning proper management.We are reporting two cases here, which had solitary necrotic nodules of liver (SNNL), with emphasis on the aetiology and morphology of the lesions. SNNL was incidentally detected during cholecystectomy done in both young female patients. The lesion was solitary in one case and it was multiple in the other. The suspected aetiology in one of the cases was parasitic, whereas it was tuberculosis in the other. The clinical features in both cases were suggestive of neoplasms.

Hyperbilirubinemia in Patients with Amoebic Liver Abscess: A Study of 75 Cases

Background: Hyperbilirubinemia is a frequent occurrence in patients with amoebic liver abscess (ALA). Despite this, the cause of jaundice has not been established. It is presumed to be either due to parenchymal destruction or due to cholestatis due to pressure on the intrahepatic bile ducts by the abscess cavity or a combination of both. Aim: The present study is designed to study the incidence and the cause of hyperbilirubinemia in patients with ALA. Settings and design: prospective randomized controlled study Methods and material: Study was performed in a tertiary care centre with high volume of patients of liver abscesses. We evaluated 75 patients of liver abscess from December 2008 to March 2010 and based on presence or absence of hyperbilirubinemia, divided into Group I (serum bilirubin ≥ 1 mg/dl) and Group II (serum bilirubin <1 mg/dl). After detailed evaluation, both the Groups were compared on basis of parameters like clinical symptoms (e.g. fever, pain), alcohol intake, leucocytosis, bilirubin levels, liver enzymes, size of cavity, and response to treatment. Statistical analysis used: Chi square test/ Fischer’s exact test was used for qualitative data, and for quantitative data, t-test/Mann Whitney test was used. Results: In this study, we found hyperbilirubinemia in 23 of total 75 ALA patients with incidence of 30.7%. Overall the serum bilirubin values ranged from 0.4 to 11.7 mg/dl (mean=1.551) whereas in group 1 it ranged from 1.3 to 11.7 mg/dl (mean=3.71). The high values of bilirubin were associated with elevated alkaline phosphatase enzyme in 21 of 23 cases (91.3%) however significant biliary radical dilatation could not be found. The Jaundice responded well to the drainage of abscess cavity. Conclusions: Hyperbilirubinemia occurs frequently in cases of amoebic liver abscess which seems to obstructive in nature and it can be treated by surgical drainage of the abscess cavity. Further large volume and more detailed studies are needed to confirm the findings.

Malignant Rhabdoid Tumour of the Perineum in an Adult—A Rare Presentation

Rhabdoid tumors of extrarenal origin are uncommon. This is the first report of rhabdoid tumor presenting as a perineal mass. Furthermore, it is a disease of childhood, with adult presentation being rare. We report a case of extrarenal rhabdoid tumor and discuss its presentation and possible treatment options.