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Oral cavity cancer is one of the most common cancers in India responsible for significant morbidity and mortality in Indian subcontinent. Majority of cases present in advanced stages which requires extensive reconstruction following tumor resection. Microvascular free flap reconstruction is now considered standard of care for reconstruction for major head and neck skin-mucosal defects but, many factors still act as hindrance like patient's comorbidities, long operating hours for microvascular reconstruction, logistic and financial issues from patient's side. In such situation it is better to have a backup plan for reconstruction of major head and neck defects using pedicled flaps. Pectoralis major myocutaneous (PMMC) flap has been the workhorse flap for head and neck reconstruction since its introduction four decades ago. But relying too much on PMMC flap for major skin-mucosal defects especially in female patients is associated with complications and risk for flap failure leading to catastrophic and significant patient morbidities. Our study involves the use of two flaps for head and neck reconstuction involving skin-mucosal defects i.e PMMC flap for mucosal defect and cervicodeltopectoral (CDP) flap for skin defect. As of now there has been no retrospective or prospective study done which has given a conclusive statement regarding use of these two flaps simultaneously for head and neck reconstruction to the best of our knowledge. In our experience from the present study, CDP flap offers an excellent alternative for extensive head and neck reconstruction and can be readily included in the surgeon's armamentarium with proper planning and meticulous handling. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) scan has been an integral part of the diagnostic workup for patients with head and neck squamous cell carcinoma. Our study was designed to find out the incidence of distant metastasis and second primary tumor and to correlate the cost-effectiveness of CT thorax in detecting the same. This study was conducted among 326 cancer patients who visited our center with curative intent in the year 2021, with lesions in various head and neck subsites. Data were collected based on their pathological TNM staging and the presence of distant metastasis as evident on their CT thorax imaging with various variables related to the disease. Incremental cost-effectiveness ratio (ICER) was calculated for detecting a single metastatic deposit and second primary tumor in terms of Indian currency and was correlated to each subsite and stage of disease at presentation. Out of these 326 patients, 281 patients were included in our study after considering the inclusion criteria, and among these 281 patients, 235 of them underwent CT thorax for metastatic workup. No patient was found to have a second primary. Metastases were found in 12 patients. The site of primary lesion and clinical tumor (cT) staging were found to be significantly influencing the incidence of metastasis on CT thorax. ICER was least for larynx, pharynx, and paranasal sinuses and was highest for oral cavity primaries and early-stage disease. As per our observations and results of ICER, CT thorax is indeed a valuable modality but should be used judiciously when it comes to initial diagnostic workup. [ABSTRACT FROM AUTHOR]

Purpose: We here describe our technique of contralateral based cervico-pectoral (CCP) flap for the reconstruction of large neck defect following resection of primary tumour or recurrence particularly due to the lymph node mass. Methods: The study included the patients who underwent major head and neck surgical ablative procedures followed by CCP flap reconstruction between July 2020 and November 2020. Patients were kept on rigorous regular follow-up to evaluate for flap related complications like flap necrosis, flap dehiscence and oro-cutaneous fistula. Among the 5 patients included and presented in the series, 2 patients were salvage cases post adjuvant treatment. Results: Five patients who have undergone head and neck reconstruction using CCP flap were included. No major flap related complications occurred in post-operative period. Conclusion: The CCP flap is simple to perform and reproducible and can be added to the armamentarium for the reconstruction of large upper neck defect following resection of primary tumour or recurrence involving the cervical skin in resource limited setting and in contraindication for microvascular reconstruction. Proper planning, meticulous dissection and adequate release or rotation and tension free closure would provide best outcomes. [ABSTRACT FROM AUTHOR]

Purpose: There has been an increase in the incidence of signet ring cell cancer (SRCC) of the stomach and gastro-esophageal junction (GEJ). The multistage carcinogenesis involving genetic and epigenetic aberrations may have a major role in the increasing incidence of SRCC. Although there are numerous studies on the prognostic value of SRCC, they are markedly inconsistent in their results, making it impossible to draw any meaningful conclusions. We aimed to examine the available evidences on molecular alterations and stage-stratified treatment approaches in SRCC of the stomach and GEJ. Methods: A systematic search was carried out in PubMed. Studies available in English related to SRCC of stomach and gastro-esophageal junction were identified and evaluated. Results: This study reviewed the current evidence and provided an insight into the molecular alterations, stage-stratified treatment approaches, and future challenges in the management of SRCC of the stomach and GEJ. Specific therapeutic strategies and personalized multimodal treatment have been recommended based on the tumor characteristics of SRCC. Conclusion: Multistage carcinogenesis involving genetic and epigenetic aberrations in SRCC is interlinked with stage-dependent prognosis. Specific therapeutic strategy and personalized multimodal treatment should be followed based on the tumor characteristics of SRCC. Endoscopic resection, radical surgery, and perioperative chemotherapy should be offered in carefully selected patients based on stage and prognostic stratification. Future studies in genetic and molecular analysis, histopathological classification, and options of multimodality treatment will improve the prognosis and oncological outcomes in SRCC of gastric and GEJ. [ABSTRACT FROM AUTHOR]

Personnel protective equipment (PPE) are recommended during surgery even in COVID-19 negative patients especially in a high-prevalence region due to its higher false-negative rates. However, the use of PPE has not been universal mainly due to the perception of discomfort and associated stress and fatigue. This study was done to understand the pattern of PPE use by cancer surgeons during the pandemic and the associated discomfort, stress, and fatigue with its use. The survey, consisting of 29 questions, was circulated widely across the country by email and chat groups among cancer surgeons. The study was registered with the Clinical Trials Registry of India (CTRI/2020/08/027050). We received a total of 342 evaluable responses that could be included for analysis. All the respondents used appropriate PPE in different combinations. N-95 mask and the face shield were the two components of the PPE that gave rise to a lot of discomforts. Fogging (of face shields) (p < 0.001,OR 3.61), dryness of mouth (p < 0.001,OR 3.35), and breathing difficulty/feeling of suffocation (p = 0.034,OR 1.68) contributed to the stress, whereas headache (p < 0.001,OR 11.34) and breathing difficulty/feeling of suffocation (p < 0.001,OR 4.24) contributed to the fatigue associated with PPE use the most. PPE was routinely used during cancer surgery in COVID-19 negative patients during the pandemic. However, most surgeons experienced different degrees of discomfort, especially with the N-95 masks and eye protection. [ABSTRACT FROM AUTHOR]

This work presents failure analysis of a heavy-duty, four-stage, double-action, reciprocating CO2 compressor, which resulted in the shutdown of an ammonia plant. The failure occurred in the fourth stage of the compressor, during which the piston rod, piston rings, a suction valve, and associated valve cage are found fractured. The failure analysis includes details of site visit, visual inspection, dye penetrant test, fractography, and microstructural analysis. Furthermore, Xanthoproteic test was conducted on the extracts of the failed piston rings that confirmed the presence of bacterial cellular protein. When the morphology of the failed piston ring was studied using a scanning electron microscope, unique degradation features and the presence of bacterial metabolic products were observed conforming to the growth of bacteria. In-service biodegradation of the piston ring material (polyether ether ketone composite) is adjudged as the root cause for the compressor failure. [ABSTRACT FROM AUTHOR]

Cancer of uterine cervix is one of the most common malignancies in women. Metastatic recurrence of cervical cancer in spleen is rare, mostly seen in autopsies. Splenic metastasis from cervical cancer in a living patient without disseminated metastases is rarer. Here, we present the case of a lady aged 46 years with cervical cancer-squamous cell carcinoma-who had undergone radical hysterectomy and postoperative 50 Gy of intensity modulated radiation therapy in 25 fractions and 50 mg of weekly cisplatin for 6 weeks. She was doing well for 17 months. Then, she developed fever and anorexia, and was detected to have splenic lesion and a lesion in the pelvic mesentery in PET/CT (positron emission tomography-computed tomography). Laparoscopy showed enlarged spleen with a mass lesion and a mass in ileal mesentery adherent to the peritoneum over the fundus of bladder and greater omentum. She underwent resection of a segment of ileum with the mesenteric lesion and omentum and bladder peritoneum laparoscopically and splenectomy. Histopathological examination revealed both the mesenteric and splenic lesions to be metastases from poorly differentiated carcinoma, which was from the cervical cancer. Immunohistochemistry was suggestive of squamous cell carcinoma associated with high-risk human papilloma virus. After the postoperative recovery, patient was started on ciplatin with paclitaxel chemotherapy. [ABSTRACT FROM AUTHOR]

Castleman's disease (CD) is a relatively singular disorder. Usually presenting as a mediastinal mass, peri pancreatic localization of CD is even rarer. Diagnosis is seldom established pre-operatively. We report two such cases of CD in which peri pancreatic region was involved and were diagnosed on biopsy, hence avoiding complex and high risk surgery. [ABSTRACT FROM AUTHOR]