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Castleman disease (CD) comprises a rare group of heterogenous benign lymphoproliferative disorders with pathologic similarities. However, they present with diverse clinical manifestations. Renal involvement is rare in CD and is mainly reported with plasma cell type of multicentric disease. Various glomerular pathologies, interstitial involvement, or thrombotic microangiopathies have all been reported, some of which progress to end-stage renal disease (ESRD). Progression of CD to ESRD is well documented; however, a patient on dialysis developing CD is rare. Moreover, kidney transplantations have seldom been performed on patients with CD. We report a patient with ESRD of unknown etiology who developed multicentric CD while on dialysis. He was treated with four doses of rituximab and later underwent a living kidney transplant with his wife as a donor. He has been clinically well ever since. We believe that this is possibly the first successful case of renal transplantation in CD with ESRD being reported from India. [ABSTRACT FROM AUTHOR]

Background: Early prediction of severity of acute pancreatitis (AP) is important for management of AP patients with escalation of care and aggressive therapy which can reduce complications. Bedside index of severity in AP (BISAP) score is helpful in early diagnosis of severe AP. D-dimer, a biomarker of secondary fibrinolysis may be helpful in predicting the severity of pancreatitis. Aims and Objectives: The objective of this study was to evaluate the two scoring systems - the BISAP score and D-dimer in early prediction (within 24 h) on the severity of AP and to analyze how D-dimer correlates with BISAP score. Materials and Methods: Seventy-five patients, aged 18-70 years, suffering from AP due to any cause were included for this prospective, observational study. Within 24 h of admission D-dimer was estimated and BISAP score was calculated. The severity was assessed based on D-dimer level and BISAP scoring systems within 24 h of hospital admission and data were tabulated for analysis. The D-dimer level >2.5 mg/L was considered to be suggestive of severe pancreatitis. The BISAP score >2 in first 24 h was defined as predictive of severe pancreatitis. Spearman rank correlation was used for an analysis of the association between two set of data (BISAP scores and d-dimer levels) and thus to measure the strength and direction of the relationship between the two variables. Results: In the present study, 37.3% of the patients had D-dimer ≤2.5 mg/L and 62.7% had D-dimer>2.5 mg/L' on calculating the Pearson's correlation on the ranked values of the data (BISAP scores and D-dimer levels), the correlation coefficient (Spearman's Rho, designated as "rs") was found to be 0.406 which indicates about moderate positive correlation. Conclusion: D-dimer testing can be used as an alternative test to predict the severity of AP. It shows a moderate correlation with BISAP scoring. [ABSTRACT FROM AUTHOR]

Background: Correct placement of nasogastric tube (NGT) placement often becomes difficult in anesthetized, intubated adult patients due to lack of cooperation from patient and the propensity of the tube to travel the same course of path. Preexisting throat pack is supposed to resist the normal passage of the NGT as per common belief. Only one study has evaluated this in pediatric population and the result is encouraging. Aims and Objectives: Hence, the present study has been carried out in adult population to compare the success rate of correct placement of NGT in anesthetized intubated adult patients with the pharyngeal (throat) pack in its position in comparison with no throat pack. This is to examine the effect of preexisting throat pack whether it assists or resists the normal passage of the NGT. Materials and Methods: One hundred and eighty patients were recruited for this interventional and single-blind study. After induction of anesthesia and intubation, the patients were randomized to receive NGT insertion following either blind insertion of the NGT without a pharyngeal pack (group A, n=90) or receive the NGT placement in the same technique but after placement of a pharyngeal pack. The success rate of correct placement of NGT in the first attempt (primary outcome), the procedure time, and adverse events was recorded. Results: Successful insertion of NGT in first attempt was considerably higher in throat pack in situ group compared to blind insertion without a throat pack 81 (90%) versus 63 (70%), respectively (P=0.001). The procedure time for successful placement of NGT was found comparable between the two groups. Significant decrease in coiling is seen in "throat pack in situ" group compared with blind insertion technique (P=0.003). Conclusion: In view of considerable higher success rate and reduced adverse events, it can be concluded that the pre-existing appropriately placed throat pack can facilitate the placement of NGT instead of putting any hindrance. [ABSTRACT FROM AUTHOR]

Background: Nasogastric tube (NGT) insertion is an essential procedure in the operating room for which the anesthesiologists often take the responsibility. This simple procedure often becomes difficult in anesthetized patients. Literature reveals the flooding of studies and novel techniques are in the pipeline, indicating that quest for the best is still on. Aims and Objectives: The aim of the study was to determine the proportion of patients in whom successful NGT insertion would be possible in the first attempt using either the "Reverse Sellick's maneuver (RSM) with throat pack in situ" technique or RSM alone; and to compare the proportions between the two groups. Materials and Methods: This interventional study was performed on 222 adult patients (≥18 years), undergoing abdominal surgeries requiring intraoperative NGT insertion. Patients received NGT insertion using the combined RSM with "throat pack in situ" technique (Group A, n=111) or RSM alone (Group B, n=111). The proportion of patients in whom successful NGT insertion was possible in the first attempt using either of the techniques and the time taken for correct placement of NGT in both the groups. In addition, the incidence of adverse events was noted. Results: Although, NGT placement was possible in higher proportions of patients in Group A in first attempt compared with Group B (91% vs. 83.8%), it was not significant on analysis (P=0.106). The procedure time in both the groups was comparable (30.0±4.0 vs. 29.9±4.3, P=0.859). Coiling was found to be significantly more in the RSM alone technique as compared to the combined method. (P=0.04). Conclusion: With comparable success rate and lesser incidence of adverse events, it can be commented that the RSM with throat pack in situ technique appears to be a better alternative to RSM alone. [ABSTRACT FROM AUTHOR]

Background: Various adjuvants are added to local anesthetics to increase the duration of block during supraclavicular brachial plexus (SCBP) block. Dexmedetomidine, a newer and potent alpha2 receptor agonist, has 10 times higher selectivity than clonidine. Many studies have already evaluated the efficacy of clonidine and dexmedetomidine as perineural adjuvants and have reported wide variations in the prolongation of post-operative analgesia. Some studies have reported the absence of adjuvant’s effect while a few have not focused all the facets of block characteristics. Aims and Objectives: The aim of the study was to compare the efficacy of clonidine and dexmedetomidine as adjuvant to ropivacaine during SCBP block for the upper limb surgeries, in terms of duration of post-operative analgesia (Primary outcome). The onset and duration of sensory and motor block, and adverse effects, if any, were observed. Materials and Methods: Ninety patients, aged between 40 and 60 years of either sex, undergoing upper limb surgery, were randomly allocated in to three groups to receive either 30 ml of 0.5% ropivacaine and 2 ml saline (Group R, n=30) or 30 ml 0.5% ropivacaine plus clonidine (1 mcg/kg) plus saline to make a total volume 32 ml (Group C, n=30), or 30 ml 0.5% ropivacaine and dexmedetomidine (1 mcg/kg) plus saline to make a total volume 32 ml (Group D, n=30). The duration of post-operative analgesia, other block characteristics, and adverse events, if any, was assessed. Results: Mean duration of post-operative analgesia was found to be considerably higher in dexmedetomidine group compared with clonidine group and ropivacaine alone group (664.13 vs. 551.77 vs. 465.47, respectively, P<0.001). The duration of sensory and motor block was considerably longer in dexmedetomidine group compared with clonidine and control group. Adverse events were comparable among the three groups. Conclusion: Dexmedetomidine appears to be a better alternative to clonidine as adjuvant in terms of prolonged post-operative analgesia and comparable adverse events. [ABSTRACT FROM AUTHOR]

Background: The tenet of any surgery is to reduce the morbidity and mortality. The outcome is not solely dependent on surgeon's operative expertise alone, but also significantly influenced by a lot of patient factors. The Physiological and Operative Severity Score for the enUmeration of Morbidity and Mortality (POSSUM), a risk-adjusted scoring system, has already been used in various parts of India. There is scarcity of published research using this tool in the population of Eastern India. Aims and Objectives: The aim of the study was to determine the efficacy of modified version Portsmouth-POSSUM (P-POSSUM) scoring system in predicting the postoperative morbidity and mortality in population of East India. Materials and Methods: The study was carried out in 50 patients of either gender, of age group 13-80 years, undergoing emergency laparotomy and followed up to 30-day post-operative follow-up of all patients till the sample size of 50 was reached. The physiological scores were recorded during admission and the operative severity score was recorded according to the intra-operative findings of operating surgeon. Any post-operative morbidity or death was recorded during hospital stay or on follow-up for a period of 30 days. The Hosmer-Lemeshow test was used for goodness-of-fit in logistics regression for mortality risk prediction model. The ratio of observed and expected rates (O: E ratio) was calculated. Results: Using the scoring tool, no significant difference was observed between the expected and observed mortality (Chi-square 2.166; df=8; P=0.976, O: E ratio 1.4) but a considerable difference was observed between the observed between the expected morbidity rates (X²=22.806, df=8, P=0.004, O: E ratio 1.137). Conclusion: The P-POSSUM score was able to accurately predict the mortality in Eastern India surgical settings. However, the model was not that accurate in prediction of morbidity. [ABSTRACT FROM AUTHOR]

Byline: I. Reddy, V. Somani, G. Swarnalata, Sanjay. Maitra We report a patient who developed acute renal failure following the ingestion of a hair-dye with a suicidal intent. He was [...]

We report a case of a 38-year-old male with acute renal failure, elevated anti-glomerular basement membrane (anti-GBM) antibody titres, bilateral nodular lung opacities and hypertension. In the renal biopsy examination, whereas direct immunofluorescence revealed significant peripheral linear deposits of IgG typical of anti-GBM antibody disease (Goodpasture's disease), eosin–haemotoxylin staining showed glomerular and vascular changes typical of thrombotic microangiopathy (TMA) and without crescents. We postulate that the TMA was responsible for the acute renal failure and that antibodies, though demonstrable, were not adequate at the site of the glomerular basement membrane to elicit a crescentic response, because of occlusion of the vascular lumina by the thrombotic process. The patient remained dialysis dependent at a 3-month follow-up. [ABSTRACT FROM PUBLISHER]

The study included 431 patients who underwent breast FNAC over a period of five years between 2003 and 2008. The required clinical details were obtained from the requisition forms. The Information about the level of education and occupation were collected by interviewing the subjects. The number of cases of breast carcinoma was significant constituting 14.84% (n = 64). The study showed that the peak age for breast carcinoma was between 41 and 50 years. This correlates with the national figure where most of the cases observed belonged to the reproductive age group. Most of the females were married (93.75%) and were multiparous (92.18%). Maximum number of patients had only received primary education. There was not much difference in the number regarding whether they lived in urban or rural areas. Middle and lower socioeconomic class contributed the bulk of the cases and it were the housewives who were in majority (85.93%).

Breast cancers which do not express oestrogen, progesterone, or HER-2 neu receptors are known as triple negative breast carcinomas. In western literature they have been found to be extremely aggressive with a poor prognosis. However there is scarcity of data regarding this variety of breast cancer in India.To examine the clinical and pathological character of triple negative breast carcinomas and to compare their characteristics with other variants of breast carcinomas which presented to Medical College, Kolkata, a randomised sample of 72 patients were included with breast cancer attending the department of surgery from January 2008 to June 2008.The clinical and histopathological data along with ER/PR status and HER-2 neu expression examined by immunohistochemical methods were recorded.Twenty patients (27.78%) were found to be triple negative.The mean age at presentation was 35.4 +/- 1.95 years with 17 (85%) out of 20 being premenopausal. At presentation, mean tumour size was 4.7 +/- 0.21 cm. Though 15 patients (75%) presented with stage III disease and 16 patients (80%) had grade III histology, 14 (70%) were node negative and 20 (80%) did not have involvement of nipple areola complex and 19(95%) did not have multicentric disease. Triple negative breast cancer is prevalent in eastern India.They are locally aggressive, common in premenopausal women, but strangely do not tend to present with lymph node involvement or involvement of nipple areola complex. Therefore a more conservative approach might have a role in these seemingly aggressive tumours.

Amoebiasis in endemic in the tropical countries with amoebic liver abscesses being a common complication. Different modalities of treatment of amoebic liver abscess are conservative (medical management), percutaneous needle aspiration, percutaneous catheter drainage, surgical drainage and endoscopic drainage. This study was carried out to compare the efficacy, safety and outcome of needle aspiration comparing with percutaneous catheter drainage of large (> or = 5cm diameter) amoebic liver abscesses. This was a prospective study carried over a period of two years (2006-2008) at the general surgery department of Calcutta National Medical College and Hospital, Kolkata. A total of 45 patients were included in this study. All of them had amoebic liver abscess with diameter of abscess cavity > or = 5cm. They were divided into two groups. Group A included 22 patients and they were treated with needle aspiration. Group B included 23 patients and they were treated by catheter drainage. Improvement in clinical features, liver function tests, ultrasonic evidence of decrease in the size of abscess cavity was considered as criteria for successful treatment. The sex ratio and the age incidence in the two groups were similar. In about 80% patients the right lobe was affected, in about 18% the left lobe was affected and in rest the abscess involved both lobes. Needle aspiration was successful in 15 (68.2%) and catheter drainage was successful in 23 patients (100%). The mean hospital stay of patients treated with needle aspiration was more than those treated with catheter drainage. The mean time in days taken for 50% decrease in the size of abscess cavity was significantly greater in group treated with needle aspiration than in those treated with catheter drainage (9 days versus 4 days). It is concluded that percutaneous catheter drainage is more effective in management of large amoebic liver abscess than needle aspiration.

Gastrojejunal intussusception is a rare complication of gastric surgery. It can occur in cases with gastrojejunostomy done after partial gastric resection or in cases of simple gastrojejunostomy. There are only few cases reported worldwide, Review of literature showed about 200 cases reported till 2006 and a few more cases reported after that. A rare case of retrograde gastrojejunal intussusception is reported. The patient presented in the emergency with severe pain upper abdomen and haematemesis. Contrast enhanced CT scan of abdomen showed hugely distended stomach with retrograde gastrojejunal intussusception on laparotomy, the intussusception was reduced. A jejunojejunostomy was done. The patient is doing well after 1 1/2, months.