Gyanendra S. Mittal

Abstract

Background: Ureteric calculus with a colicky pain is a common issue faced by surgeons and urologists in the ER and OPD with a major universal health and financial strain on the health care system. Different studies have shown promising outcomes for ureteric calculus with medical expulsive therapy (MET) in relation to the expulsion rate and mean duration of expulsion, decrease hospital stay and less requirements of analgesics. The aim of this study is to compare the efficacy and safety of Tamsulosin alone or in combination of Deflazacort in medical expulsive therapy of ureteric calculus of less than 10 mm (sub-centric). Subject and Methods: Effect was studied on two groups. Group-A patient received standard medical treatment plus Tamsulosin. Group-B patients received standard medical treatment and Tamsulosin plus Deflazacort. Result: MET with Tamsulosin and Deflazacort has major advantages, with very mild, reasonable side effects and substantially lower healthcare system costs. Conclusion: Medical therapy with Tamsulosin is effective and have been found to increase and hasten the expulsion of ureteric calculus, but expulsion rate is more, mean expulsion time and duration of hospital stays, and the episodes of pain is less when tamsulosin is combined with Deflazacort. Keywords: Uretric calculus, Colicky pain, Effect of tamsulosin and deflazacort.

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Background: Submental flap is an axial pattern, myo-cutaneous flap based on submental artery (branch of facial artery). We have used this novel flap for reconstruction of the intra-oral, as well of the lower and mid face defects created after resection of certain intra-oral malignancies. Materials and Methods: This study included 15 patients and done over a period of 3 years. Cases were operated by a team of surgical oncologists using the same technique and under 2.5 x magnifications (loupe). Any nodes in the region were carefully dissected and sent for frozen section for intra-operative verification of presence or absence of microscopic tumor deposits. Evaluation had been done based on the clinical and pathological staging, nodal status as well as the patient outcome. Results: Out of the 15 patients who underwent reconstruction with submental flap, one patient developed total flap loss, whereas one patient had partial flap necrosis. The remaining 13 patients showed decent clinical outcome and the flap uptake was good. In the follow up period of 2 years, two patients developed regional recurrence (none in the flap donor or recipient sites) and 2 developed distant metastasis. Conclusion: Submental flap is an excellent flap for reconstruction of small to medium size defects for intra-oral as well as lower and mid face. It is useful in medically compromised conditions, old age or low socio-economic status of the patient as these factors preclude the use of a free flap. It is oncologically safe for reconstruction and in the absence of clinical or radiological evidence of nodal disease in sub-mental region and may be considered for reconstruction in N0 as well as N1 patients. Keywords: Submental flap, Carcinoma oral cavity, Composite resection, Intra oral reconstruction.

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Introduction: In India, for the year 2012, 144,937 women were newly detected with breast cancer and 70,218 women died of it. For every 2 women newly diagnosed with breast cancer, one lady is dying of it. The aim of this study is to evaluate clinical parameters and pathological findings including various Immunohistochemistry (IHC) markers like ER, PR, HER-2 NEU, CK5/6, EGFR, Ki-67 in cases of carcinoma breast and classify them into molecular classification based on IHC markers and try to correlate them clinically. Materials and Methods: This prospective, observational study was carried out in 56 patients with early carcinoma breast (stage-I and stage-II) and IHC evaluation for various markers was done. Data was analysed by using Molecular Classification, divide them into estrogen positive (luminal HER-2, luminal A and luminal B) and estrogen negative (Triple negative or basal cell type, HER-2Neu type and normal breast like phenotype) subtypes. We had correlated this data with parameters like age of the patient, clinical and pathological staging of the breast carcinoma, presence or absence of nodes and presence or absence of other IHC parameters. Results: We used ANOVA-F test to catagories variables and measure the test of significance. On IHC in Her-2 neu equivocal cases (patients who had two “++” positive points), we performed FISH test. Out of these 17 equivocal cases, only 3 were positive, 10 were negative and 4 patients did not underwent this test due to several reasons. Finally, Ki-67 value is significantly high in triple negative and Luminal-B patients. NPI is also having low ‘P’value, although not reaching the level of significance. Conclusion: Types of breast carcinoma, which look histologically similar behaves differently in their clinical presentation and in prognosis. In our study only Ki-67 was correlated with poor prognostic subtype of molecular classification but no any poor risk of clinical or histological parameter was correlated significantly with bad prognostic subtype of molecular classification as Luminal-B or triple negative type. We can say that this molecular classification is different in terms of prognosis in patients with similar looking clinical and histological parameters. Keywords: Molecular Clssification, IHC markers, Carcinoma Breast, Triple Negative, Luminal Breast Carcinoma.

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Background: Chronic calculous cholecystitis is an inflammatory disease which affects the gallbladder wall and causes dysfunction of the biliary system. It is the most common benign disease of the gall bladder. Aim: To study the pattern of age and sex distribution, diet and clinical feature of patients, the laboratory and radiological investigations of patients presenting with the associated pathology, the intraoperative pathological changes of the gall bladder. Materials and Methods: This study was conducted from July 2021 to June 2022 at Department of General Surgery, Santosh Medical College and Hospital, Ghaziabad. 100 patients were included in this study. The age, gender, symptomatology, laboratory and radiological findings, intraoperative findings, and histopathological changes where analysed and documented. Result: In our study maximum patients were found in 31-40 years of age. It was found to be most common in females, who consumed mixed diet. The most common symptom was abdominal pain. In ultrasound whole abdomen gall bladder wall thickness was found in majority of the patients. 98% of the patient underwent laparoscopic cholecystectomy and intraoperatively gall bladder was found contracted in 51% of patients. On histopathological examination mild degree of inflammation was seen in 60%, gall bladder wall thickness seen in 50% and the most common type of gall stone was found to be mixed type in 58% patients. Conclusion: We observed the intraoperative pathological changes of the gall bladder, radiological investigations of patients, laboratory investigations of patients and the pattern of age and sex distribution, diet, and clinical feature of patients. Keywords: Gallbladder, Chronic calculus cholecystitis, Abdominal pain, Wall thickness, Pigment stones

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