Arun Kakar

Comparative study of free omental, peritonenal, Dacron velour, and Marlex mesh reinforcement of large-bowel anstomosis

The comparative role of free ometal, peritoneal, Dacron® velour, and Marlex® mesh grafts in reinforcement of an extremely vulnerable experimental model of large-bowel anastomosis was studied in dogs. While both the omentum and peritoneum proved not to be effective in preventing anastomotic leakage, Dacron velour did considerably lower this incidence to within reasonable limits but led to formation of low-grade lymphoma at the reinforcement site in two animals. Only Marlex mesh was found to be highly effective in sealing the suture line, and it is anticipated that, with the usual teachnique of anastomosis, this sealing effect will be foolproof, thereby nullifying any risk of suture-line breakdown

CD-30(Ki-1)-positive anaplastic large cell lymphoma in a pleural effusion : A case report with diagnosis by cytomorphologic and immunocytochemical studies

BACKGROUND Reports on cytodiagnosis of Ki-1-positive anaplastic large cell lymphoma (ALCL) are rare. This report describes one such case diagnosed by cytologic examination of a pleural effusion and confirmed by immunocytochemistry. CASE An 87-year-old male presented with breathlessness, fever and a cough. Computed tomographic scan of the thorax showed a small, right, pleura-based nodule with infiltration of the immediate surroundings in addition to a massive, right-sided pleural effusion. Cytologic examination of pleural fluid revealed a heterogeneous population of cells comprising small mature lymphocytes, and numerous medium and large atypical lymphoid cells having frequent nuclear irregularity. Occasional very large cells resembling Reed-Sternberg cells or multinucleated cells with a horseshoe or wreathlike arrangement of nuclei (doughnut cells) were also present. Cytomorphology was suggestive of Ki-1 anaplastic large cell lymphoma (ALCL). Immunocytochemistry revealed intense positivity for CD-30, positivity for LCA and EMA in a variable number of cells and a negative result for cytokeratin except for occasional cells. CONCLUSION Cytologic examination of pleural fluid can serve as a useful tool for the initial diagnosis of Ki-1-positive ALCL.

Evaluation of the Role of Magnetic Resonance Spectroscopy in the Diagnosis of Follicular Malignancies of Thyroid

OBJECTIVES To evaluate role of magnetic resonance spectroscopy in differentiating benign from malignant follicular nodules. DESIGN Prospective study. SETTING Department of Surgery in collaboration with Department of Radio Diagnosis, Maulana Azad Medical College, Delhi, India. PATIENTS Twenty-five patients with a solitary thyroid nodule with follicular etiology. INTERVENTIONS Magnetic resonance spectroscopy was carried out in all the cases, and its findings were compared with the final diagnosis based on histopathological examination of sample obtained at surgery. MAIN OUTCOME MEASURES Choline peak detected on MRS. RESULTS There were 17 benign cases, 16 follicular adenomas, and 1 colloid goiter. Of the 17 benign cases, only 1 showed choline peak; however, all 8 follicular carcinoma cases showed prominent choline peak. Hence, the sensitivity is 100% while the specificity is 94.11%. CONCLUSION Magnetic resonance spectroscopy may prove to be a sensitive diagnostic tool in differentiating follicular adenomas from carcinomas.

Role of dynamic MRI in differentiating benign from malignant follicular thyroid nodule.

OBJECTIVES Thyroid nodular swellings are very common, consisting of both benign and malignant ones. Fine needle aspiration cytology is an excellent diagnostic modality for papillary cancers, medullary cancers, colloid goiter and lymphoma but fails in differentiating follicular adenomas from carcinomas. The purpose of this study was to evaluate role of Dynamic MRI with signal intensity time curve evaluation in differentiating benign from malignant follicular nodules. MATERIALS AND METHODS This study was carried out in Department of Surgery in collaboration with department of Radiodiagnosis, Maulana Azad Medical College, Delhi. 28 patients with solitary thyroid nodule (STN) having follicular etiologies were included in the study. Dynamic MRI with signal intensity time curve analysis was carried out in all the cases and findings were compared with the final diagnosis based on histopathological examination of surgical specimen. RESULTS In the present study, rapid enhancement was seen in 87.5% of malignant cases and washout pattern was seen in 87.5% of malignant STN (p=0.019). Only 20% of the benign lesions showed washout pattern (p=0.0034). Benign cases demonstrated gradual enhancement in 85% cases as compared to 12.5% in malignant STN (p=0.0098). CONCLUSION This study suggests that signal intensity time curve may help in differentiating benign from malignant follicular thyroid nodules.

Sigmoidal volvulus in childhood: Report of two cases

SummaryVolvulus of the sigmoid colon is a very uncommon cause of acute obstruction in children. Although common in adults in India, it was found to account for only 0.8 per cent of all acute obstructions in infants and children in this institution. It causes a proximal torsional obstruction of the colon with an acute onset of symptoms. the onset of volvulus is characterized by colicky pain over the left lower quadrant, vomiting, tenderness, and rigidity in the left lower quadrant. A scout film of the abdomen may be inconclusive, but a barium-enema examination is diagnostic. The number of cases reported is too small to allow conclusions about the best treatment for children who have sigmoidal volvulus.

Radionuclide angiography in evaluation of cold solitary thyroid nodules. Improved diagnostic accuracy using flow and washout analysis.

Radionuclide thyroid angiography was performed in 252 patients with hypofunctioning thyroid nodules to evaluate differences in vascular flow and washout patterns in benign and malignant disease. Time activity curves of Tc-99m pertechnetate flow through the cold nodules were generated using region of interest software. Retention ratios of counts in the nodule at 2 minutes after radionuclide administration versus those at peak activity were derived. Patients subsequently underwent surgical excision and histopathologic examination. One hundred forty-four of the 204 benign nodules were avascular with absent radionuclide flow through the nodule. Fifty-six benign nodules were vascular with a prolonged radionuclide washout pattern with retention ratios ranging from 0.60−0.92. Forty-six of the 48 malignant nodules displayed increased perfusion with rapid radionuclide washout with retention atios ranging from 0.28−0.48. Four benign nodules exhibited a similar flow and washout pattern. Radionuclide thyroid angiography with vascular flow and washout analysis appears to be a useful technique to differentiate between benign and malignant thyroid nodules with a high degree of sensitivity and specificity.

Primary carcinoma of the cystic duct: a case report and review of classifications

BackgroundThe incidence of extrahepatic bile duct malignancies is about 2–3.6% of all gastrointestinal malignancies. Primary carcinoma of cystic duct is a rare condition comprising a fraction of all extrahepatic bile duct malignancies with less than 70 cases reported worldwide. Majority of these cases were reported from East Asia. There is paucity in such case being reported from Indian subcontinent. We present a case of primary carcinoma of the cystic duct encountered during laparoscopic cholecystectomy.Case presentationA 65-year-old lady presented to us with symptomatic gall stone disease. Investigations revealed a distended gall bladder with multiple stones. Patient was taken up for laparoscopic cholecystectomy, during surgery a stony hard structure was found at cystic duct-common bile duct junction which was not amenable for clear dissection. Procedure was converted to open, and the patient underwent cholecystectomy with resection of common bile duct with Roux-en-Y hepaticojejunostomy and regional lymphadenectomy. Histopathological findings revealed it to be moderately differentiated adenocarcinoma of the cystic duct.ConclusionPrimary carcinoma of cystic duct is a rare condition where early diagnosis can be difficult and if accidentally detected may add to surgeon’s dilemma. Proper surgery with en-bloc resection of gallbladder, cystic duct, common bile duct, and regional lymphadenectomy is the mainstay of treatment. The prognosis of carcinoma of cystic duct is better than extrahepatic bile duct malignancies. The old classification system has outlived its time and is more rigid in definition which is not practical in advanced cases; the new classification systems of this century offer better insight into understanding the tumor characteristics and prognosis.

Postoperative hypothyroidism after thyroidectomy for nontoxic multinodular goiter: Can we prevent it by leaving more?

Introduction: A study was done to evaluate the function of the thyroid remnant after subtotal and near total thyroidectomy (STT and NTT) in nontoxic multinodular goiter (MNG) by using radioactive iodine uptake (RAIU) and serum thyroid stimulating hormone (TSH), after leaving variable amounts of remnant thyroid tissue. Materials and Methods: A prospective study included 25 patients with nontoxic MNG over a period of 18 months where in STT and NTT was performed. Depending on the availability of the normal thyroid tissue found intraoperatively, a definite volume of thyroid tissue was left in the tracheoesophageal groove along the recurrent laryngeal nerve. Serum TSH and RAIU were performed 4 weeks after surgery. Patients were divided into three groups A, B, and C depending on the size of thyroid remnant left during surgery that is a volume of <2, 2-5, and >5 mL, respectively. Results: There is no statistical significant correlation seen between the size of the remnant thyroid tissue, hypothyroidism, and the postoperative serum TSH value. RAIU study conducted at 4 weeks postsurgery showed no correlation between the volume of the thyroid tissue remnant and its RAIU uptake. Conclusion: The thyroid function of the patients after thyroidectomy does not depend on the volume of the thyroid remnant left. There may be many other factors which determine the thyroid function like the total preoperative gland mass, histopathological nature of the gland, sex, and preoperative thyroid function.

Infraction of the greater omentum

Infraction of the greater omentum is an uncommon entity in children. The etiology of this disease is unknown. It is difficult to differentiate this condition from acute appendicitis in children. Two cases from the pediatric age group are reported.