Jasneet Singh Bhullar

Setons in the Treatment of Anal Fistula: Review of Variations in Materials and Techniques

Aim: Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practicedsuccessfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature. The selection of a seton type and technique depends on personal preferences. Our aim was to put together all the available variations in materials and techniques for seton treatment. This comprehensive review will help the surgeon to become more familiar with the various options available with regard to materials and techniques. Methods: A review of the literature using Medline was done using the Key Words ‘anal fistula’ and ‘seton’. All articles published in English were reviewed. The articles which had variations in materials and techniques for seton treatment were studied. Results: Various aspects of variations in materials, insertion techniques, maintenance of tension, mechanisms of action, drainage techniques and changing the seton have been elaborated in detail. Conclusions: Throughout this paper we present the various available variations in setons with regard to materials, placement and maintenance techniques. This study will help clinicians in choosing a new seton variation or modifying their current method of treatment with setons.

Topical gentamicin does not provide any additional anastomotic strength when combined with fibrin glue

BACKGROUND We evaluated the effect of a combination of fibrin sealant and topical gentamicin on a colonic anastomosis in a rat model. METHODS Partial anastomosis in the transverse colon was performed in 70 male Sprague-Dawley rats aged 6 to 10 weeks using 5 interrupted sutures. The rats were divided into 4 groups (control, gentamicin, fibrin glue, and combination). On postoperative days 3 and 5, the rats in each group were killed, anastomotic bursting pressures scores and bowel loop adhesions were determined, and histologic examination was performed. RESULTS No significant difference was noted in the bursting pressures, adhesions, inflammatory infiltrates, fibroblasts, or neoangiogenesis between the fibrin-glue only and the combination groups for both the day 3 and day 5 subgroups. CONCLUSIONS The combination of topical gentamicin and fibrin glue had little effect because the combination did not provide additional anastomotic strength or decrease the number of adhesions when compared with fibrin glue alone.

A New Type of Renal Cancer--Tubulocystic Carcinoma of the Kidney: A Review of the Literature.

In 2004, A new peculiar subtype of renal cell carcinoma, which later received the name of tubulocystic carcinoma (TCC-RC), was recognized. Though the tumor has distinct macroscopic, microscopic and immunohistochemical features, the tumor was previously considered to have some similarities to various other renal cancers. We did an extensive review of literature using PubMed and CrossRef, which yielded more than 80 cases reported from various parts of the world. We evaluated the epidemiology, tumor presentations, pathological characteristics, treatment, and outcome of TCC-RC.

A Review of Von Hippel-Lindau Syndrome

Von Hippel-Lindau syndrome (VHL) is a familial neoplastic condition seen in approximately 1 in 36,000 live births. It is caused by germline mutations of the tumor suppressor gene VHL, located on the short arm of chromosome 3. While the majority of the affected individuals have a positive family history, up to 20% of cases arise from de novo mutations. VHL syndrome is characterized by the presence of benign and malignant tumors affecting the central nervous system, kidneys, adrenals, pancreas, and reproductive organs. Common manifestations include hemangioblastomas of the brain, spinal cord, and retina; pheochromocytoma and paraganglioma; renal cell carcinoma; pancreatic cysts and neuroendocrine tumors; and endolymphatic sac tumors. Diagnosis of VHL is prompted by clinical suspicion and confirmed by molecular testing. Management of VHL patients is complex and multidisciplinary. Routine genetic testing and surveillance using various diagnostic techniques are used to help monitor disease progression and implement treatment options. Despite recent advances in clinical diagnosis and management, life expectancy for VHL patients remains low at 40–52 years. This article provides an overview of the major clinical, histological, and radiological findings, as well as treatment modalities.

Intranodal Palisaded Myofibroblastoma A Review of the Literature

Intranodal palisaded myofibroblastoma is a rare benign primary mesenchymal neoplasm originating from differentiated smooth muscle cells and myofibroblasts. The precise etiology and pathogenesis has not been adequately explained as yet. Very few series and cases have been reported in the literature. Though inguinal region is the commonest site of this rare tumor, but the tumor at other diverse sites have been reported. Because of its rarity, it can be often misdiagnosed and confused with other disorders and more commonly with metastasis. We report an extensive review of literature about intranodal palisaded myofibroblastoma—its characteristics, presentations, features, and management.

Animal models of human colorectal cancer: Current status, uses and limitations

AIM To make orthotopic colon cancer murine models a more clearly understood subject. The orthotopic tumor models have been found to be more relevant in replicating the human disease process as compared to heterotopic models, many techniques for making orthotopic colorectal murine models have been reported. METHODS We evaluated the current literature for various reported orthotopic colon cancer models to understand their techniques, advantages and limitations. An extensive literature review was performed by searching the National Library of Medicine Database (PubMed) using MeSH terms animal model; colon cancer; orthotopic model; murine model. Twenty studies related to colon cancer orthotopic xenograft model were evaluated in detail and discussed here. RESULTS The detailed analysis of all relevant reports on orthotopic model showed tumor take rate between 42%-100%. While models using the enema technique and minimally invasive technique have reported development of tumor from mucosa with tumor take rate between 87%-100% with metastasis in 76%-90%. CONCLUSION Over the years, the increased understanding of the murine models of human colon cancer has resulted in the development of various models. Each reported model has some limitations. These latest models have opened up new doors for continuing cancer research for not only understanding the colon cancer pathogenesis but also aid in the development of newer chemotherapeutic drugs as they mimic the human disease closely.

The disappearing abdominal mass: mesenteric pseudocyst.

Introduction: Mesenteric pseudocyst is a term used to describe an abdominal cystic mass with an unknown abdominal origin. They are rare intra-abdominal masses, with a reported incidence of approximately 1 per 100,000 to 250,000 hospital admissions. Most cysts are benign and they may present differently, such as a disappearing mass or a mass that changes locations, thus posing a diagnostic challenge to the clinician. Case Report: We describe a case of a 29-year-old woman who presented with a 2-year history of feeling a large mass within her abdomen, which would then disappear for several days and would frequently change position and be felt in different quadrants of her abdomen. Computed tomography scan of the abdomen revealed a large cystic structure, and a computed tomography–guided biopsy was inconclusive. Diagnostic laparoscopic surgery revealed a firm mass arising from the jejunal mesentery; the patient underwent an en bloc resection. Histopathologic examination of the resected mass revealed a rare diagnosis of mesenteric pseudocyst. Mesenteric pseudocyst should be should be kept high on the list of differential diagnoses when a patient presents with a disappearing mass and/or an abdominal mass that changes location.

Delayed Presentation of a Bowel Bovie Injury After Laparoscopic Ventral Hernia Repair

Slow transmural tissue necrosis may occur after an electrosurgical Bovie injury and lead to eventual bowel perforation.

Tubulocystic Renal Cell Carcinoma: A Rare Renal Tumor

Tubulocystic renal cell carcinoma of the kidney is a rare entity with less than one hundred cases reported so far. It was previously considered to have some similarities to various other renal cancers although this tumor has distinct macroscopic, microscopic and immuno-histochemical features. It is now a well-established entity in renal neoplastic pathology and has been recognized as a distinct entity in the 2012 Vancouver classification of renal tumors. This review aims to give an overview of tubulocystic renal cell carcinoma after extensive literature search using PubMed and CrossRef.

Receptor changes in metachronous breast tumors—our experience of 10 years

INTRODUCTION Patients with primary breast cancer (PBC) are at 2 to 6 times higher risk for developing synchronous and metachronous breast cancer (MBC). The pathology and behavior of MBC still remains unclear. METHODS We reviewed the charts of 108 women with MBC at our hospital over the past 10 years. Profile patterns of the estrogen receptor (ER), the progesterone receptor (PR), and Her2/neu receptors were explored. RESULTS Of 33 patients with ER(+)/PR(+) in the primary tumor, 23 (70%) retained the status in MBC. Forty-five (92%) of 49 patients with ER(-)/PR(-) in the primary tumor remained the same in MBC. Most Her2(-) tumors (22/31, 71%) remained negative, but 50% (8/16) of Her2(+) tumors became negative. CONCLUSIONS Most MBC retained the ER/PR expression patterns irrespective of the treatment for the primary tumor, thus suggesting a common origin. Because MBCs tend to be triple negative and thus more aggressive, early detection and close surveillance techniques must be devised.