Kamal Kataria

Leiomyosarcoma of inferior vena cava: A case series of four cases

Vascular leiomyosarcomas are rare tumors, arising most frequently from inferior vena cava (IVC). They are mostly seen in sixth decade, with a female predominance. Their diagnosis is often challenging, as patients may present with non-specific complaints such as dyspnea, malaise, weight loss, abdominal pain, or back pain, preceding the diagnosis by several years. Leiomyosarcoma of the IVC most frequently occurs in the middle segment. The final diagnosis can be made by an ultrasound or computed tomography guided biopsy. Because of limited experience with this disease, optimal management of IVC leiomyosarcoma is unknown. Curative surgical resection remains the current treatment of choice for primary leiomyosarcoma of IVC. Neoadjuvant therapy may be given to downsize the tumor and increase resectability rates. Nonetheless, when complete resection is not possible, debulking combined with radiation therapy still provides good palliation. We, hereby, report four cases of this rare entity with emphasis on management.

Comparison of quality of life in patients undergoing transhiatal esophagectomy with or without chemotherapy

Background/Aim: To compare the quality of life (QOL) in patients undergoing transhiatal esophagectomy (THE) with or without chemotherapy, who were admitted to the Post Graduate Institute of Medical Education and Research, Chandigarh and enrolled in the study, from July 2004 to October 2005. Patients and Methods: Thirty patients of esophageal carcinoma by purposive sampling were randomized into two groups i.e., patients undergoing THE after chemotherapy and patients undergoing THE without chemotherapy. Two QOL questionnaires, one generic i.e., EORTC-QLQ C-30 (European Organization for Research and Treatment of Cancer) and other esophageal cancer-specific i.e., EORTC OES-18 were utilized to assess the QOL. Result: Physical functional scales were better in patients, who received neoadjuvant chemotherapy. The role and social aspects of functional scales deteriorated after completion of treatment in both groups. This was primarily due to the effect of surgery. However, they were better from an emotional and cognitive point of value after surgery and radiotherapy. Fourteen out of 30 patients experienced vomiting and diarrhea due to radiotherapy. Conclusion: THE in esophageal carcinoma improves global health scales and majority of symptom scales in all patients. QOL improvement in general was better in patients who were administered neoadjuvant chemotherapy along with surgery.

Sarcomatoid carcinoma of the gall bladder

Primary gallbladder carcinoma is a malignant neoplasm with an incidence of 1.2 cases per 100 000 people each year. Its occurrence increases with age, particularly in women. It is the fifth most common cancer of the gastrointestinal tract, and the most common malignancy in the biliary tract. Adenocarcinoma is the most common type of gallbladder neoplasm whereas sarcomatoid carcinoma is rare with an incidence of less than one percent of all malignant gall bladder neoplasms. Sarcomatoid carcinomas are composed of malignant epithelial and sarcomatous components, sometimes with heterologous sarcomatous elements. In general, conservative treatments are thought to be unfavourable to the tumor. Prognosis is poor following curative resection for carcinosarcoma of the gall bladder because of recurrence as systemic metastasis of the liver and peritoneal dissemination.

Surgical Resection of Phyllodes Tumour: a Radical Approach as a Safeguard Against Local Recurrence

Phyllodes tumour is a rare benign neoplasm of the breast. It is a mixed tumour of epithelial and mesenchymal origin. The epithelial element is characterized by proliferation of ductolobular units. The fibrous tissue and collagen bundles represent the mesenchymal element. It is also known as “cystosarcoma” phyllodes to characterize some important features, viz. cyst-like or cleft-like spaces within the mass along with a leaf- or frond-like pattern of the stromal element. The tumour is well known for its high potential for local recurrence. Most patients in developing countries present with very large breast tumours with close proximity to the skin and pectoralis major. In these cases, there is a need to perform a three-dimensional en bloc removal of the mass with overlying skin and underlying muscle(s). If a skin flap is raised in the vicinity of the tumour, there is a risk of cutting close to the tumour, increasing risk of local recurrence. Here, we describe a surgical technique that permits a three-dimensional en bloc removal of phyllodes tumour.

Prevention of Gossypiboma

Dear Sir,We read the article entitled “Gossypiboma and surgeon—current medicolegal aspect—a review” by Biswas et al. [1]in the Indian Journal of Surgery(July–August 2012)74:318–322.The authors are right that it is an infrequent butavoidable complication. This complication is a cause forincreased morbidity, mortality and financial burden topatients. It is also a source of mental agony, humiliation,financial loss and imprisonment for a surgeon. So, weshould always try to avoid this complication. We practicea simple method of avoiding this dreaded problem. Assoon the peritoneum is opened, all the single spongesand swabs are removed and are replaced by a pack offive sponges. We tie the tail ends of five sponges togeth-er and use it to absorb the blood or other secretions inthe peritoneal cavity. Once all the five sponges are satu-rated, the nurse replaces the “pack of five” or pantch kimala. Since 1995, we have utilized this method and hadno case of gossypiboma. The technique is simple, inex-pensive and quick to use in all operation theatres. Iteliminates the human error involved in counting thesponges, as the “pack of five sponges” is so big that itis physically impossible to leave inside the abdomen.

Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

Paraneoplastic cerebellar degeneration as a manifestation of metastatic recurrent carcinoma breast: rare scenario

Carcinoma breast presenting with paraneoplastic cerebellar degeneration is a rare scenario. We report a case of a 52-year-old woman, which is a follow-up case of completely treated carcinoma breast presenting with paraneoplastic cerebellar degeneration which, on investigation, revealed metastatic disease with recurrence at previous scar site and metastasis to contralateral axilla. The patient was given pulse methyl prednisolone therapy and underwent wide local excision of nodule and right axillary lymph node dissection with 14 cycles of trastuzumab and paclitaxel as adjuvant therapy. However, there was no detectable change in neurological symptoms at 6-month follow-up postoperatively. This case report highlights the need for clinicians to be aware of all possible presentations of carcinoma breast and its recurrence, including rare manifestations as in this case.

Splenectomy for Haematological Disorders

The spleen in haematological conditions is enlarged often. This leads to destruction of cell lines and especially platelets, and becomes the cause of red cell destruction and iron overload in haemolytic conditions. Massive enlargement also places the spleen at risk of injury and exsanguinating intraperitoneal haemorrhage. Rarely, it becomes so large that it restricts the daily activities of the patient. Usually a total splenectomy is done for hematological disorders. Rarely, partial splenectomy may be indicated in some metabolic conditions such as Gaucher’s disease.

Validation of Different Techniques in Physical Examination of Breast

The majority of patients attending breast clinics are found to be suffering from benign conditions. The detailed investigations of every patient would add to the cost of care and burden the laboratories. A detailed clinical evaluation might limit the use of thorough investigations for suspicious lesions only. This cross sectional study involved the patients with various benign and malignant conditions of breast, who attended outpatient clinic and surgical ward at All India Institute of Medical Sciences, New Delhi from June 2009 to May 2011. The study started with a training of the resident (observer 2) in various breast examination techniques by a professor of surgery (observer 1), who was well trained in the discipline of breast surgery by internationally renowned breast experts. The different techniques of breast examination were validated after calculation of intra and inter-observer variation. Excellent agreement was observed between both the observers. The diagnostic accuracy ratio for most variables ranges from 0.9 to 1. The dimpling of skin on inspection had a low kappa (coefficient of agreement = 0.48) and consistency of lymph node on palpation had a kappa 0.38. All other variables showed high agreement. The present study was successful in training the resident and validating the different techniques in physical examination of breast.

Stop Suturing Like Cobbler

Suturing is the joining of tissues with needle and thread so that the tissues will bind together and that healing occurs by primary intention with least scarring. Professionals like tailor and cobbler are also involved with suturing. Although both professions are involved with suturing, they are not dealing with live tissue, so there are no problems like poor healing, ischemia and wound edge necrosis. These complications, which are common with live tissue, may finally lead to wound dehiscence and increased risk of surgical site infection, and ugly scar. Every surgeon should be cognizant of principles of wound healing and aesthetics.