Kamran Ahmad Malik

Amyand’s Hernia: Study of four cases and literature review

The presence of the appendix in an inguinal hernial sac is described as Amyands hernia. It is a rare entity which presents mostly at the exploration of the inguinal canal. The appendix may be apparently normal or have all the features of acute appendicitis with its possible complications. We report four cases of Amyands hernia which were treated at Sultan Qaboos University Hospital, Oman. All patients underwent appendectomy. In three cases, the inguinal hernia were repaired with Vipro mesh while, in the remaining case, a darning repair was done with Prolene sutures.

Solid pseudopapillary neoplasm of the pancreas: a case report with review of the diagnostic dilemmas and tumor behavior.

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Ovarian Hernia: A rarity.

Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh.

Mucinous Breast Cancer with Solitary Metastasis to Humeral Head: A Case Report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Leiomyoma of the Round Ligament of the Uterus : Case Report and Review of Literature = تم رصد حالة و مقارنتها بالدراسات السابقة : إكتشاف ورم عضلي أملس في الرباط المستدير بالرحم

Smooth muscle tumours of the round ligament of the uterus are rare and can mimic an inguinal hernia. Preoperative diagnosis can be established by a computed tomography scan of the abdomen or an exploration of the inguinal canal. Surgical excision is the curative treatment.

Torsion of an Epiploic Appendix Pretending as Acute Appendicitis

Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis.

Lap Mentor-based assessment of laparoscopic surgical skills: a validation study

Objective: To validate the scores of assessments of basic laparoscopic surgical skills obtained through performance on LAP Mentor. Design: Cross-sectional validation study. Setting: Oman Medical Specialty Board (OMSB) skills lab, Muscat, Oman. Participants: Twenty-three surgical residents, registered with OMSB, at different years of residency, underwent assessment of basic laparoscopic surgical skills on the LAP Mentor. A construct validation model was used to validate the scores. Results: 35% of the candidates, all belonging to the senior group, passed the assessment. Cronbach’s alpha was 0.87 with a standard error of measurement of 1.53 (95% confidence interval). The intra-class coefficient varied from 0.88 to 0.95 for different scales. Factor analysis revealed two underlying constructs, i.e. technical skills and patient safety skills, that explained competency in laparoscopy surgery. A review of the literature supported content validity evidence. Relationships with other variables were documented through convergent and divergent evidence. A correlation for the data revealed that actual residency year and total score achieved were significantly related (r = 0.51, N = 23, P = 0.01, two-tailed). Senior residents scored significantly higher than junior residents on overall performance. Fisher’s exact test showed that more seniors than juniors passed on overall performance using specific criteria determined by factor analysis and Angoff’s method for standard setting. The majority of residents and raters agreed or strongly agreed on feasibility, conducting such tests regularly, meaningful feedback, and objectivity and reuse of the tools. Conclusions: Assessment on LAP Mentor using different rating scales and construct-based standard setting methods provides meaningful scores. Periodic summative assessment is acceptable to residents.

Diagnostic dilemmas in Intraductal papillomas of the breast - Experience at Sultan Qaboos University Hospital in the Sultanate of Oman

Objectives: The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma. Methods: This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital (SQUH) in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software (version 20). Results: The mean age of the patients was 44(27-73) years old. Twenty-seven out 36 (75%) patients had presented with nipple discharge, 14 out 27 (52%) had blood stained nipple discharge and 13(48%) with coloured discharge (yellow, brown and green), 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 (36%), duct ectasia 18(50%), DCIS 1 (2.7%), fibrocystic disease 3(8.3%) and LCIS 1(2.7%). Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant (p=0.44). Conclusion: Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment.