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Background and objective: Chronic pancreatitis is a chronic, fibro-inflammatory condition that damages the pancreas' structural integrity permanently and impairs exocrine and endocrine function. Alcohol is a major part in the multifactorial pathogenesis. Pain in the form of recurrent attacks of pancreatitis or constant and disabling pain is usually the main symptom. Pain management is mainly empirical and involves treatment with potential potent analgesics, and duct drainage by endoscopic or surgical means. Methods: An observational study was conducted at Dr. D.Y. Patil Medical College for a period of two years, from 2020 to 2022. Cases of chronic pancreatitis were chosen for the study after taking informed consent of the patients concerned. This study aims at achieving comprehensive pain management, and seeks to assess the response to different modalities of treatment. Accordingly, a total of 36 patients were studied by commencing a medical line of management, and their responses were documented using the visual analog scale (VAS) on Day 1, Day 3, and Day 5. Pain medications were stepped up in unresponsive cases based on the World Health Organization (WHO) pain relief ladder. Celiac plexus block and surgical intervention (lateral pancreaticojejunostomy) were conducted where the pain could not be subsided by using the medical line of management. Results: Out of 36 cases with chronic pancreatitis, a majority of the cases had moderate pain (VAS score 4-7) at the time of admission, whereas severe pain (VAS > 7) was reported in 11.1% of the cases. Medical management was commenced in all cases by administering a paracetamol injection (1g IV, 8 hourly); however, pain was relieved in only 25% of the cases. In the remainder of cases, the line of treatment had to be stepped up by using a tramadol injection (1 ampule in 100ml NS IV, 8 hourly) in 61.1% (22 out of 27) of the cases, and by using a morphine injection (30mg IV, 8 hourly) in 13.9% (five) of the cases. Furthermore, celiac plexus block was required for managing pain in a total of 9 cases, and recurrence of pain after celiac plexus block was observed in 55% (5 out of 9 cases); these cases underwent lateral pancreaticojejunostomy. Cases that underwent surgical intervention showed satisfactory results with no recurrence of pain in the follow-up period. Conclusion: A majority of the patients responded to various levels of medical analgesia. Only a few required surgical intervention for pain management. Hence, a multidisciplinary approach is required for adequate management of pain to improve the quality of life. [ABSTRACT FROM AUTHOR]

Duodenal NETs (Neuroendocrine Tumours) are rare neoplasms that represent a clinical challenge due to heterogeneity of their biological behaviour, diagnosis and treatment options. They represent 1-3% of all primary duodenal tumours. Our case report aims to increase awareness and highlight some issues related to the diagnosis and management of duodenal Neuroendocrine tumours. We present the case of a 55-year-old man with a large, slowly-growing Neuroendocrine tumour of the duodenum which was incidentally identified after a screening USG of the abdomen. A Whipple's procedure with complete tumour excision was performed. Patient was comfortable on discharge and on regular follow up. The mainstay of treatment of duodenal NET is surgery with the intent to cure. The management protocol is based on ENETs guidelines. Surgical resection of D-NETs should be followed up by CECT of A+P and Chromogranin A levels performed at 6 and 12 months after surgery, and then every year for at least 3 years. [ABSTRACT FROM AUTHOR]

Venolymphatic malformations occur due to dysplasia of lymphatic and venous vessel structures. These tumour-like lesions cause tissue abnormality with impaired function and have aesthetic importance when involving the craniofacial region. Vascular lesions are classified as haemangiomas and other vascular malformations. They are named after the vessels involved in malformation like arterial, venous, lymphatic, or mixed types. Present study represents a rare case report of a 23-year-old patient who presented to our hospital with swelling over the left elbow and a lump over the left breast, which was diagnosed as venolymphatic malformation involving the left breast and left elbow joint, which is an unusually affected anatomical region by this congenital anomaly. Ultrasonography (USG), the primary tool for diagnosis, was performed. Later, the patient underwent Magnetic Resonance Imaging (MRI) for confirmation and to determine the extent of the lesion. Excision of the lesion was done over left elbow completely with a wide margin. Histopathology confirmed the final diagnosis. Venous malformations (VM) are the most common among these congenital malformations, with an incidence of over 50%. Lymphatic malformations (LM) have a much lower incidence than venous malformations, but the combination of venous and LM has a very low incidence. [ABSTRACT FROM AUTHOR]