Sukria Nayak

Selective histopathology in cholecystectomy for gallstone disease.

Background Incidental gallbladder cancer is found in upto 1% of cholecystectomy specimens for gallstone disease. Currently, in our institution, all gallbladder specimens are sent for routine histopathology, to rule out incidental gallbladder carcinoma. This study was aimed at assessing the need for routine histopathology of gallbladder specimens after cholecystectomy for gallstone disease.

Surgical management of thoracic outlet syndrome: a 10-year experience

Background:  Thoracic Outlet Syndrome (TOS) refers to compression of the neurovascular structures in the region between the scalene muscles and the first rib, or by anatomical abnormalities such as cervical rib, fibrous bands and other variations in the scalene musculature.

Retroperitoneal lymphatics on CT and MR

We report the CT and MRI appearances of dilated retroperitoneal lymphatic channels in six patients. In two patients, these dilated channels resembled a mass of confluent low-density lymph nodes on CT. On MR urography the lymphatic channels in all six patients were seen as a meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum of the abdomen and pelvis. On axial T1W images, these channels were seen as numerous, interconnected small, nodular and streaky intensities and as a cloak of diffuse homogenous hyperintensity on T2W axial images. The lymphatic nature of these abnormalities was confirmed at surgery in one patient. In another patient, the calibre and number of the dilated retroperitoneal channels reduced following anti-filarial therapy. The remaining four patients presented with chyluria.

Thyroidectomy under local anaesthesia in India

Thyroid surgery under local anaesthetic seems to be a forgotten skill. We share our experience and suggest that it is a safe and economical option with negligible morbidity.

Oxytetracycline as a sclerosant in the management of Morel-Lavallee lesions

Morel-Lavallee lesions are haemolymphatic collections that occur following blunt trauma. These are due to closed degloving injuries which cause shearing injury deep to the subcutaneous plane, causing disruption of capillaries and lymphatics. This results in a persistent collection containing blood, lymph and necrotic fat. Magnetic resonance imaging is the investigation of choice in the evaluation of these post-traumatic lesions. Early diagnosis and management is beneficial and can avoid infection or skin necrosis. Surgical excision, including complete excision of the capsule of the Morel-Lavalle lesion, is required. For recurrent lesions and to prevent recurrence after the primary excision, oxytetracycline instillation, as a sclerosant, is a novel adjunct and we report two successful cases.

Castleman's disease: a rare presacral tumour.

A 45-year-old man presented with worsening constipation and a feeling of incomplete evacuation for 6 months. Digital rectal examination revealed a large presacral mass, 5 cm from the anal verge. Rigid sigmoidoscopy showed extrinsic compression of the rectum with normal mucosa. MRI revealed a 7.3 · 6.6 · 7.4 cm solid presacral mass without rectal infiltration (Fig. 1a). CT-guided biopsy showed lymphoid proliferation, with a differential diagnosis of lymphoma or Castleman’s disease. At laparotomy the mass was found to be arising from the mesorectum and filling the pelvic cavity. Attempts to get below the lesion were unsuccessful; a loop sigmoid colostomy was performed, along with wedge biopsy of the lesion. Histopathology analyses confirmed the lesion as a hyaline vascular type of Castleman’s disease (Fig. 1b). The patient underwent external radiotherapy (45 Gy in 25 fractions), which significantly reduced the size of the mass. Six weeks after completion of radiotherapy, the patient was re-explored and the tumour excised; the colostomy was also closed at the same operation. At 8 months of follow up, the patient was asymptomatic and recurrence free.

Venous Aneurysms - A neglected pathology

Venous aneurysms are not often recognised nor given importance due to the more serious and challenging nature of their arterial counterpart. They are uncommon entities that generally present as a painless swelling, can be accurately diagnosed by duplex venous scanning and are completely cured by surgical excision. We present a short report of 14 cases treated at a tertiary care centre in India over seven years from June 2001 to June 2008, to increase awareness of this easily treatable condition.

Jejunal Diverticulosis Presenting as an Obscure Gastrointestinal Bleed—a Challenge in Diagnosis and Management

Obscure gastrointestinal bleeding is defined as persistent or recurrent bleeding without an obvious cause after endoscopic and radiological evaluation. Obscure gastrointestinal bleeding originates most commonly from the small intestine. Jejunal diverticulosis is an uncommon diagnosis in which multiple mucosal herniations are present in the mesenteric border of jejunum. There is always a delay in diagnosis as it is a rare clinical entity. This is a case report of a 35-year-old male who presented with overt gastrointestinal bleeding and was managed at another center with surgery and embolization. He was evaluated, and a bleeding jejunal diverticulum was identified as the source of bleed during on-table enteroscopy after exhausting other investigation modalities and having delay in definitive management due to difficulty in localizing the source of bleed. Awareness of jejunal diverticulosis and its complications is very important in obscure gastrointestinal hemorrhage to prevent the diagnostic delay. A stepwise approach is very important to identify the source of obscure gastrointestinal bleed.

Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle

Introduction: Satellite cells are a resident population of stem cells beneath the basal lamina of mature skeletal muscle fibers. Their capacity to regenerate muscle makes them a potentially ideal source for human cell therapy with respect to muscle-related diseases such as urinary and fecal incontinence, and others. In this study, we describe a protocol to isolate, expand in-vitro, and characterize human muscle satellite cells from the rectus abdominis muscle. Materials and Methods: Muscle biopsies from human donors were harvested, digested using collagenase type II, and then plated on extracellular matrix-coated plates. Results: Immunocytochemistry revealed that satellite cells on day 8 were 70–80% Pax7 positive; in contrast, cells expanded until day 12 showed 50–75% positivity for Pax7. The real-time polymerase chain reaction for day 8 culture indicated four-fold increase in Pax3 and Pax7 gene expression, four-fold increase in MyoD gene expression, and five-fold increase in Myf5 gene expression. Conclusion: These findings suggest that satellite cells can be cultured until day 8 for translational purposes. The protocol described here is modest, operational, and reproducible and involves only basic cell culture equipment.

Spontaneous liver rupture: A report of two cases

Spontaneous bleeding due to a non traumatic liver rupture is a rare occurrence. However, it is associated with high morbidity and mortality. Usually the predisposing factors are like Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome in pregnant women and other liver diseases. It is generally diagnosed by imaging studies such as ultra sonogram or computerized tomogram (CT). Due to its rarity no standard treatment has been described. Here, we report two cases of spontaneous rupture of normal liver in two young males. They presented with severe shock and hemoperitoneum. The diagnosis was confirmed by CT. They were managed surgically. In case of hemoperitoneum, spontaneous liver rupture should be considered. An early aggressive resuscitation and appropriate intervention gives better outcome.