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Background: Seroma, a recognized complication of modified radical mastectomy (MRM) delays the administration of adjuvant therapy and also effects adverse events. Aims and Objectives: This study was conducted to study the sociodemographic and clinical profile of patients developing seroma post MRM and compare the effectiveness of different modalities of seroma prevention since there is a dearth of literature on this matter in our sub-Himalayan region. Materials and Methods: This was an observational study conducted from February 2021 to August 2022 on 60 women with carcinoma breast who underwent MRM. They were studied for sociodemographic profile, cancer characteristics, and seroma prevention techniques and followed up during the study period. Preventive modalities used were quilting, octreotide therapy, suction drains with early drain removal, passive low suction drains, sharp dissection technique, and sclerotherapy. The results were analyzed using the Statistical Package for the Social Sciences version 22. Results: The mean age was 49.7±9.4 years, 18.3% had hypertension and 10.0% diabetes mellitus, and 58.3% presented with breast lump. Overall incidence of seroma was 23.3%; the highest was observed in sclerotherapy (50%), and the lowest was in quilting (7.1%) (P=0.235). The presence of hypertension (P=0.026) and the non-administration of neoadjuvant chemotherapy (P=0.010) was significantly associated with developing seroma. Sharp dissection was associated with wound infection (33.3%), sclerotherapy with flap necrosis (50%), and quilting with shoulder stiffness (21.4%). Conclusion: The lowest incidence of seroma was in quilting and the highest in sclerotherapy. Adverse events such as wound infection, shoulder stiffness, and flap necrosis were the lowest among patients discharged with passive drains and highest in sclerotherapy. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer (Ca Cx) the 4th common cancer has a high mortality rate. Human Papilloma Virus (HPV) is chiefly responsible for a long latent period to progress from preinvasive to invasive Ca Cx. So it can be prevented by screening procedures such as visual inspection with acetic acid (VIA), conventional cervical PAP smear (CP), liquid-based cytology (LBC), and high-risk (HPV-hr) detection along with vaccination. Aims and Objectives: The study aims to determine the socio-demographic profile of Ca Cx and the most appropriate costeffective community screening method. Materials and Methods: A prospective observational study with 80 symptomatic women of reproductive and peri/postmenopausal age groups attending the Gynecology Department who underwent VIA, CP, and LBC and thereby detected positive along with screened negative but clinically suspicious women were tested for HPV-hr detection. Results were tabulated into an Excel sheet and screening methods were compared using Chi-square test, gold standard being cervical histopathology (P<0.5 significant). Statistical software used - Graphpad Prism 9 (San Diego, CA). Results: The mean age was 43.3 years. Multiparity and early marriage were seen in 80% and 45% respectively. Inflammatory lesions were best diagnosed by CP but epithelial cell abnormality and more satisfactory smears by LBC (P<0.05). Sensitivity was highest (93.75%) in VIA, positive predictive value, and specificity in CP (91.66%, 75%). negative predictive value was highest in VIA and HPV-hr DNA (50%). Conclusion: VIA with CP/LBC is an economically viable and effective screening method for Ca Cx in developing countries along with HPV vaccination. [ABSTRACT FROM AUTHOR]

Duodenal Neuroendocrine Tumours (D-NETs) are extremely rare tumours with a propensity to be solitary and limited to the first and second parts of the duodenum, the periampullary area contributing to only about 20% of such cases. They can be discovered incidentally at imaging or at Upper Gastrointestinal Endoscopy (UGIE) for vague Gastrointestinal (GI) symptoms. The authors encountered two successive cases (55-year-old female; 50-year-old male) of D-NETs within a couple of months in which one presented with acute upper GI bleeding and another with vague upper GI symptoms. The first case was located at the second part of the duodenum with nodal metastasis, whilst the second case had multiple D-NETs at the second and third parts of the duodenum. Sub-centimetric growths may be treated by endoscopic mucosal resections but larger ones require surgery. Both cases were more than 20 mm in size and were successfully managed by classical Whipple’s procedure. Diagnoses were confirmed and graded with histopathology and Immunohistochemistry (IHC) using chromogranin, synaptophysin, and Kiel 67 (Ki67). Normally these are mucosal and submucosal lesions, however, in the first case, the tumour invaded muscularis propria and extended upto subserosa. The authors present these two cases because of their rarity, singular presentations, and successful management in a rural set-up with logistical constraints. [ABSTRACT FROM AUTHOR]

Meckel's diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited "rule of 2s" regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally. [ABSTRACT FROM AUTHOR]

Choledochal Cysts (CC), cystic dilatation of biliary tree are an uncommon finding. Generally found in pediatric age group are rarer in adults and commoner in females. They have a relatively greater incidence in a few parts of Asia as compared to the West. Even rarer are Giant Choledochal Cysts (GCC). We successfully treated an adult patient of GCC with an uncommon presentation which is the largest from the Indian subcontinent. [ABSTRACT FROM AUTHOR]

Littoral cell angioma (LCA) of the spleen, a rare vascular tumor, is usually asymptomatic, often discovered incidentally and a majority of them are benign in nature. A 20-year-old boy with a history of blunt abdominal trauma, who underwent splenectomy showed the presence of a capsular tear and variegated outer surface on gross examination of the spleen. On the cut section, multiple nodular areas with areas of hemorrhage were noted. Microscopical examination revealed the proliferation of anastomosing, irregular, tortuous blood-filled channels with plenty of histiocytes in the splenic tissue and extensive areas of hemorrhage, inflammatory cell infiltration, and fibrinoid deposits. Immunohistochemistry revealed positivity for CD31 (endothelial differentiation), CD68, and lysozyme (histiocytic differentiation) but was negative for CD34. The final diagnosis was LCA in a case of ruptured spleen after ruling out angiosarcoma. The possibility of this benign entity to have contributed to the potentially fatal splenic injury cannot be overlooked. [ABSTRACT FROM AUTHOR]

Introduction: Surgical Site Infections (SSIs) are very common and the most frequently studied Hospital-Acquired Infection (HAI) in developing countries. Up to 5% of patients undergoing surgery develop SSIs, which can cause significant morbidity and, in some cases, be fatal. Aim: To determine the prevalence of SSI and compare the factors related to its development between clean and clean-contaminated surgeries. Materials and Methods: This longitudinal study was conducted at a rural tertiary care centre in the Department of General Surgery from May 2020 to April 2021. A total of 1,020 patients who underwent clean and clean-contaminated surgeries were clinically examined, investigated, and provided standard treatment modalities. Dirty and contaminated cases were excluded from the study. Clean and clean-contaminated surgeries were defined according to the guidelines provided by the Centres for Disease Control and Prevention (CDC). Demographic and risk factors, such as sex, age, nature of surgery, wound irrigation, American Society of Anaesthesiologists (ASA) score, smoking, preoperative stay, duration of surgery, hair removal, drains, immunosuppression, Diabetes Mellitus (DM), and Hemoglobin (Hb) levels, were observed and compared between the two groups. The development of SSI was diagnosed based on CDC guidelines. SSI cases were followed up longitudinally in both groups. Continuous variables were analysed using an unpaired t-test, while categorical variables were analysed using a chi-square test. A p-value of <0.05 was considered statistically significant. Results: Out of the 1,020 patients, a total of 93 (9.11%) developed SSI. Among the males (573, 56.17%), 39 (6.8%) developed SSI, while among the females (447, 43.83%), 54 (12.08%) developed SSI. The study found that 24 (3.46%) clean operations and 69 (21.1%) clean-contaminated surgeries developed SSI (p-value<0.0001). There was a significant association between SSI and risk factors such as ASA <2 (p-value<0.01), smoking (p-value< 0.01), DM (p-value< 0.01), Hb <8 gm% (p-value<0.01), shorter preoperative stay (p-value<0.01), prolonged surgery (p-value<0.01), use of drains (p-value<0.01), and immunosuppression (p-value<0.01). The majority of SSIs were caused by Staphylococcus aureus (24 cases, 25.8%), followed by Pseudomonas aeruginosa (18 cases, 19.3%) and Escherichia coli (12 cases, 12.9%). Patients who developed SSI had a mean postoperative stay of 32.35 days, compared to 7.19 days for those who did not develop SSI. Conclusion: The study concluded that SSI was significantly more common in clean-contaminated surgeries compared to clean surgeries. Proper surveillance can help document SSI even after hospital discharge. Prompt identification of organisms can facilitate clinical recovery. [ABSTRACT FROM AUTHOR]

Background: Wounds are a major source of morbidity and sometimes, mortality and there are several ways to treat them. Negative pressure wound therapy (NPWT) is one way, and this involves the use of a suction device to aspirate and remove fluids, debris, and infectious materials from the wound bed to promote the formation of granulation tissue and wound healing. Another way is with the use of conventional wound dressings. Aims and Objectives: The aim was to compare NPWT and conventional wound dressings for the poor in a rural setting. Materials and Methods: Sixty consecutive cases clinically presenting with wounds between March 2018 and August 2019 were examined and divided into NPWT or conventional wound dressing groups. Outcome was measured by recording wound scores on day 7 or thereafter. Cases and controls were studied from admission until complete healing. Outcome and complications of NPWT and conventional wound dressings were noted. Results were tabulated in MS excel and evaluated using Graphpad Prism 9 software (San Diego, CA, USA). Results: Many patients (33.33%) were in the 5th and 6th decades of life and most (77%) were male. Many wounds were located on the foot (40%). Those patients younger than 40 years of age with a wound <10 days old had a better median wound score in both the groups. The majority of wounds (43.33%) were traumatic. Wound healing was better in non-diabetics and non-smokers. There was a considerable reduction in the organism load in the NPWT group (P=0.0078). Complications were minor. The NPWT group had a significantly shorter mean hospital stay (P=0.0001). Conclusion: NPWT enhanced granulation tissue formation leading to earlier wound healing and faster recovery compared to conventional wound dressings. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of Oesophageal Adenocarcinoma (EAC) has increased at a faster rate than any other cancer in the developed nations. Despite advances in treatment, five year survival rate for EAC is <15%. Till date, Barrett's Oesophagus (BE) is the only known precursor of EAC increasing its risk by greater than 30 to 60 fold. Most important risk factor for development of dysplasia and EAC is specialised Intestinal Metaplasia (IM) in BE. Aim: To find the association between clinical, endoscopic and histopathological features and presence of IM in patients with endoscopically suspected BE. Materials and Methods: This was an institution based descriptive study with a cross-sectional design conducted in the Departments of Pathology and Surgery, in a tertiary care centre of North Bengal for four years (2017-2021), among patients attending surgery and medicine Outpatient Department (OPDs) or Inpatient Department (IPDs), suspected on clinical basis and subsequent endoscopic detection of BE utilising Prague criteria. Periodic Acid-Schiff (PAS) and Alcian Blue (pH 2.5) stains were used to detect complete or incomplete IM and results were analysed using appropriate statistical software. Results: Among 120 cases included in the study, 72 (60%) had Short Segment Barrett's Oesophagus (SSBE) and 48 (40%) Long Segment Barrett's Oesophagus (LSBE). Hiatal hernia was significantly more frequent in LSBE patients (32 out of 48) compared to patients with SSBE (24 out of 72). The associations of tobacco and alcohol abuse with microscopically proven BE were statistically significant with p-values of 0.005 and 0.004, respectively. The association of IM with the increasing length of Columnar Lined Oesophagus (CLE) was statistically significant (p-value=0.004). Conclusion: Tobacco and alcohol abuse, presence of hiatal hernia (particularly in LSBE patients) were significantly associated with BE. Increasing length of CLE is more commonly associated with IM. Incomplete IM was observed more commonly in LSBE cases whereas complete IM was detected more frequently in cases diagnosed as SSBE by endoscopy. [ABSTRACT FROM AUTHOR]

Lymphocytic mastitis is an uncommon presentation of benign breast disease. It may present as a painful or painless lump in the breast. Clinical examination and imaging often raises suspicion of malignancy. Thus biopsy and histopathological examination is generally required. It is usually associated with diabetes mellitus or some other autoimmune disorder. However, we present an unusual presentation of lymphocytic mastitis without any association. [ABSTRACT FROM AUTHOR]

Inguinal hernia is extremely rare among girls. The hernia sac may sometimes involve intestinal structures, but ovaries in the sac are uncommon. Early diagnosis and surgery is essential to obviate the possibility of ovarian torsion. We encountered a 13 year old girl with a nonreducible groin lump that had no expansile cough impulse. An index of suspicion followed by imaging and diagnostic laparoscopy clinched the diagnosis of hernia ovary inguinale that was confirmed on exploration followed by replacement of the ovary into the pelvis. Though there might not be the usual criteria of reducibility and expansile cough impulse of hernia, we should be wary of this rare presentation especially in a young girl as it is exposed to the risk of torsion that we can prevent by early surgery. [ABSTRACT FROM AUTHOR]

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