Parwez Sajad Khan

Papillary carcinoma thyroid with metastasis to ectopic cervical thymus

Papillary carcinoma of thyroid is the most common type of thyroid neoplasm which is usually confined to the thyroid and tends to metastasize to regional lymph nodes. Distant metastasis occur in up to 15% of cases. Thymic metastasis from any malignant carcinoma is extremely rare with only four cases reported in medical literature. We report a case of papillary carcinoma of thyroid metastasizing to ectopic cervical thymus which has not been previously reported.

Primary isolated echinococcal cyst of the seminal vesicle: A rare case.

Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography (abdominal and trans-rectal), and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole (10 mg/kg/day) for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

Giant calculus formation after migration of an intrauterine device into the urinary bladder

A foreign body in the urinary bladder acting as a nidus for calculus formation is an uncommon occurrence. Calculi have been reported to form over sutures, drains, stents, staples, needles, pieces of catheter, hair pins, and candle pieces [1]. In addition, intrauterine devices (IUDs) maymigrate to the urinary bladder, leading to calculus formation [2,3]. A 60-year-old woman (gravida 6, para 6—all normal vaginal deliveries), who was 15 years postmenopausal, presented to the Sheri-Kashmir Institute ofMedical Sciences, Kashmir, India, with suprapubic pain, having been unable to pass urine for 8 hours. She had last given birth 20 years earlier and an IUD had been inserted 6 months subsequently. On initial examination, the woman had suprapubic tenderness and a full bladder. Vaginal examination was normal. Catheterization was attempted in the emergency room but was not successful. The woman underwent pelvic ultrasound, which revealed a large urinary bladder calculus obstructing the outflowof urine. An X-ray of the kidney, ureter, and bladder region indicated a large calculus containing an IUD (Fig. 1). An introducer, which displaced the calculus, was used to aid catheterization. When asked, the woman revealed that she had had an IUD inserted by a trained Dai (midwife) 20 years earlier, and had forgotten about it after her menopause. She had a history of recurrent urinary tract infections and vaginal discharge requiring frequent treatment, and had repeatedly been prescribed antibiotics and urinary alkalinizers; however, she had no history of urinary incontinence or hematuria. The woman underwent open cystolithotomy under spinal anesthesia. A calculusmeasuring 8×4×4 cmwas stuck to the posterior bladder wall; itwas freedusingfinger dissectionand extracted togetherwith the IUD. The bladder wall was examined for defects and none was found. The bladder was closed in layers and an indwelling catheter was inserted. The postoperative period was uneventful and the woman was discharged; the catheter was removed 7 days postoperatively.

Transaxillary Approach With Use of Traction Suture for Excision of Breast Fibroadenoma: A New Technique and its Results

Avoiding a scar on the breast is an inherent feminine desire. We devised a new approach for breast fibroadenoma excision:Transaxillary approach with use of traction suture (TATS), in 50 patients with breast fibroadenoma. The swelling was present in the outer breast. The wound healed without noticeable scarring and the original shape of the breast was preserved. All the patients expressed their great satisfaction with the procedure.

Clinicopathological Profile of Childhood Primary Abdominal Tumours in Kashmir

Primary abdominal tumours attract considerable notice because of their serious prognosis, high cost of treatment and the emotional and psychological trauma. Abdominal tumours can present with pain, vomiting, constipation or less commonly intestinal obstruction. The presentation of cancer in children mimic those of childhood conditions like infections particularly viral infections, urinary tract infections, gastro-oesophageal reflux, malnutrition, constipation, lymphadnenitis, glomerulonephritis and congenital urinary tract anomalies.

Predictors of mortality and morbidity in peritonitis in a developing country

OBJECTIVE Generalized peritonitis is still a common emergency managed by most general surgeons throughout the world. If the outcome in these patients can be correctly predicted, then better management can be instituted to those patients in need. This study aims to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. These factors could be later used to predict the outcome in patients with generalized peritonitis. MATERIAL AND METHODS A total of one hundred patients with peritonitis were studied. Factors including age, pulse and respiratory rate, temperature, hemoglobin, total leukocyte count, hematocrit, urea, creatinine, sodium, potassium, pH, PaO2 levels at the time of surgery along with peritoneal contamination and duration of surgery were noted. Using the Students t test, factors were identified which had a statistically significant influence on the outcome. RESULTS Thirty-six patients in the study developed complications and 17 died. Statistics showed that 8 factors influenced morbidity and 11 influenced mortality. CONCLUSION Identifying variables which influence the outcome of patients with peritonitis is an important initial step. Once these factors have been identified, the outcome of patients can be correctly predicted and better management can be instituted to those patients in need.

Finger Dissection Followed by Squeeze Method for Cosmetic Excision of Subcutaneous Lipoma and Its Results: Our Experience

Introduction: We used finger dissection followed by the squeeze method for subcutaneous lipoma excision and report the aesthetic and treatment results of this procedure. Materials and Methods: A small cosmetic skin incision was made that would allow one finger for dissection. The lipoma was freed along all its sides and base and finally delivered by applying constant but gentle squeezing until the lipoma was completely delivered. Results: From June 2008 through June 2010, a total of 200 patients with subcutaneous lipomas who were attending our outpatient department were included in the present study. The patients were subjected to cosmetic excision of subcutaneous lipomas using finger dissection followed by the squeeze method. No technical difficulties were encountered in treating any of the patients. All of the patients were satisfied with the procedure, especially with the cosmetic wound scar. Conclusions: Our study supports the use of finger dissection followed by the squeeze method for cosmetic excision of subcutaneous lipoma.