No abstract

Gall bladder carcinoma is an exceedingly rare and fatal cancer with a high mortality rate.  Detecting gall bladder carcinoma in early stages can be difficult, despite improvements in ultrasound and computed tomography (CT) imaging. Most diagnoses of gallbladder carcinoma are made at advanced stages, with majority being found incidentally during surgery for cholelithiasis.  The presented case demonstrates suspicion of Gallbladder carcinoma pre-operatively.

Background: Pseudomeningocele is a considerable morbidity after posterior fossa surgery. Its incidence and optimal management strategies are quite unclear. Hence the objective of this study is to define the risk factors and evaluate the management strategies and to study the incidence and morbidity of postoperative posterior fossa pseudomeningocele.Methods: A retrospective study of 33 patients undergone posterior fossa surgery for variety of diseases in the department of neurosurgery, Saveetha Medical College and Hospital from January 2015 to December 2018 with emphasis on incidence of pseudomeningocele,its morbidity and treatment strategies.Results: Out of 33 posterior fossa surgeries performed, 9 developed pseudomeningocele. Hence the incidence of pseudomeningocele in hospital is 27.27%. Out of 9 patients who developed pseudomeningocele, 6 patients were symptomatic, and aspiration was done to 5 patients and one patient underwent resurgery. That one patient underwent subgaleal-peritoneal shunt, excision of recurrent tumor was performed after which the symptoms subsided.Conclusions: Psudomeningocele is a well-known complication of posterior fossa surgery. The risk factors for pseudomeningocele formation after posterior fossa surgery has been evaluated. Age, sex and type of surgery are found to be a risk factors in our study. Conservative management is effective in most cases to reduce the symptoms. Surgical intervention is advocated, only when conservative treatment fails. Preventive measures like careful perioperative planning, strict adherence to aseptic techniques, usage of autologous pericranium with dural sealant augmentation, polyethylene glycol hydrogel dural sealant can be adopted.

10764 Background: To report a unique case of papilloma of the breast with metastases to the axillary lymph node. Methods: Case report and review of literature. Results: 80 year old Caucasian male presented with right gynacomastia of 3 months duration. The lesion was resected. Pathology was consistent with intraductal papilloma with hyperplasia and no evidence of malignancy. Subsequently, after 2–3 weeks a mass was noted in the right axilla. This mass was resected and was found to be consistent with papilloma of the axillary lymph node and had the pathological characteristics of the original breast papilloma. Conclusion: Solitary papillomas are generally lesions of the large ducts usually located in the subareolar region of the breast. They are among the commonest cause of spontaneous nipple discharge. After resection of the primary lesion, local recurrence is fairly common. Recurrence is especially common if hyperplasia is associated with the papilloma. There is also an increased incidence of carcinoma in the affected breast. Due to the benign nature of papillomas, they do not metastasize. We did an extensive review of literature and did not find any cases of metastatic lesions from a papilloma of the breast. The underlying reason and pathogenesis for the metastases is not known. No significant financial relationships to disclose.

BACKGROUND Metastatic Spine Tumour Surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is mainstay of blood replenishment but with immune-mediated post-operative complications. Alternative blood management techniques (salvaged blood transfusion (SBT)) allow us to overcome such complications. Despite widespread use of intra-operative cell salvage (IOCS) in oncological and non-oncological surgeries, surgeons remain reluctant to employ IOCS in MSTS. OBJECTIVE This study will analyse the safety of IOCS-LDF processed blood transfusion to patients undergoing MSTS by assessing clinical outcomes – disease progression: tumour progression and overall survival (OS). We will also evaluate whether reinfusion of IOCS-LDF processed blood can reduce the ABT rates in patients undergoing MSTS by comparing the proportion of MSTS patients requiring ABT in those patients who consent to receive SBT, and those who do not consent for SBT. METHODS We aim to recruit 90-patients (minimum)-30 SBT, 30 ABT and 30 with no blood transfusion (NBT). SBT and ABT form the two experimental arms, while NBT forms the control cohort. All available patient data will be reviewed to determine tumour burden secondary to metastasis and post-operative survival and/or disease progression, improvement in pain, neurology and ambulatory status. Collected data will be studied at 3, 6, 12 and 24 months post-operatively, or until demise, whichever occurs first. Collected outcomes of the experimental groups will be compared with that of the control group. Statistical Analysis: Outcomes will be analysed using one-way ANOVA and Fisher’s exact test. OS will be studied by Kaplan-Meier curve and log rank test. Multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumour progression. All statistical analyses will be done using STATA/SE14.0 RESULTS This is the first clinical study on the use of IOCS in MSTS from various primary malignancies. It will provide major clinical evidence regarding safety and applicability of IOCS in MSTS. It will help reduce ABT usage; thus improving overall blood management of MSTS patients. However, limitation of this study is that not all patients undergoing MSTS will survive for the total follow-up period (two years), thereby theoretically leading to under-reporting of disease progression. CONCLUSIONS Results will be disseminated via peer-reviewed publications and will pave the way for future studies CLINICALTRIAL This study did not involve a healthcare intervention and hence, did not need to be registered