Cutaneous squamous cell carcinoma is a malignant tumour of the keratinising cells of epidermis or its appendages. It constitutes of 20% of skin malignancy. UV radiation exposure is the most common cause of skin cancer with sun exposed skin of the face and upper trunk being the common site for occurrence. Long term exposure to chemical carcinogen, burn scar, chronic ulcer is among the other risk factors. Skin biopsy is the mainstay of diagnosis in a suspected lesion of SCC. Most SCC can be treated with local excision with margin of 5 mm and a margin of around 10 mm in high risk lesion. Other treatment modalities which do not define the margin status such as radiation therapy, cryosurgery, photodynamic therapy, electro dissection, topical agents like imiquimod can be used in small superficial lesions. The following is a case of 32-year-old male patient with atypical presentation of bilateral lower limb squamous cell carcinoma.
Background: Peritonitis due to hollow viscus perforation is one of the frequent cause of patient presenting as acute abdomen in clinical practice. The cause of this perforation can be traumatic perforation or an underlying diseased viscus.Methos: The study was conducted in Sir J J group of hospitals, Mumbai between January 2021 to June 2021. A total of 50 cases with peritonitis due to gastrointestinal tract perforation were studied. The patient were studied on the basis of clinical presentation, radiological findings, cause and site of perforation, treatment given, postoperative complication and mortality.Results: Perforated duodenal ulcer (32%) and illeal perforation (24%) were most common in our study which is in contrast to the pattern seen in western part of the world. Perforations due to malignancy were the least commonly seen.Conclusions: As indicated on our study the spectrum of perforation peritonitis in India continues to be different from its western counterpart with duodenal ulcer perforation, perforating appendicitis, typhoid perforation and tubercular perforation being the major causes of generalized peritonitis.
Background The aim of this study was to validate the pros of laparoscopic appendectomy (LA) over open appendectomy (OA) and to compare various primary outcome measures in the management of acute and recurrent appendicitis. Study Design Prospective comparative study. Place and Duration Between June 2015 and October 2019 in JJ Hospital, Mumbai. Materials and Methods Total of 60 patients with acute and recurrent appendicitis were included in the study. Thirty patients underwent OA and 30 underwent LA. Both groups were comparable clinicopathologically and demographically. Various intraoperative and postoperative parameters were compared. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Mann–Whitney U test was used to compare continuous variables and chi-squared test was used to compare categorical variables. p-Value≤0.001 was considered to be statistically significant. Results The median age of patients undergoing OA and LA was 24.9 and 25.2 years (p = 0.221), respectively. Female: male ratio in OA and LA was 1.30 and 1.14, respectively (p = 0.795). Mean operative duration in LA and OA group was 47.17 ± 14.39 minutes and 36.9 ± 12.33 minutes (p = 0.001), respectively. Mean length of postoperative stay in LA and OA group was 3.69 ± 0.71 days and 5.28 ± 0.63 days (p = 0.000), respectively. Median visual analogue scale score in LA and OA group was 3.5 and 5 (p = 0.001), respectively. Mean time to return to normal activity in LA and OA group was 8.13 ± 1.33 days and 10.10 ± 2.20 days (p = 0.000), respectively. About 6.66% patients in LA group and 13.33% in OA group had postoperative wound infection (p = 0.652). Mean scar scale scoring done on 30th postoperative day was 4.23 in LA and 8.23 in OA (p = 0.000). Discussion and Conclusion LA is more promising than OA in the management of acute and recurrent appendicitis. LA offers lesser operative site pain in the postoperative period, shorter postoperative hospital stays, earlier recovery, and return to normal activities and cosmetically better scars on 30th day follow-up. No conversions or significant difference in wound related complications were seen in both groups. Prolonged intraoperative duration was the only drawback of LA.
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