Basaloid squamous cell carcinoma (BSSC) is a rare and aggressive variant of squamous cell carcinoma (SCC). It has predilection for the upper aero digestive tract with common metastasis to regional lymph node and common distant metastasis to lungs. While metastasis to scalp has rarely been reported, primary occurrence of BSCC arising from scalp has hardly ever been reported. We are reporting a case of 70 year female patient, who presented with an ulceroproliferative growth in posterior scalp. Biopsy from the edge of growth was reported as malignant adnexal tumor. A wide local excision was done and that biopsy was reported as Basaloid squamous cell carcinoma. We intend to present this case, considering its rarity and its primary presentation in an very unusual and unique location for this variant.
Background: Proper documentation of the surgery done in the form of operative notes is a very important aspect of surgical practice. The aim of this clinical audit was to identify the existing standard of the operative notes written in a general surgical unit in a quaternary care hospital; and to compare it with the recommendations given by Royal College of Surgeons, England (in Good Surgical Practice, 2014) and if needed, to improve the standard of practice.Methods: In the first loop of this prospective audit, 75 consecutive operative notes which were written were compared with the RCS guidelines and the areas which had missing data were identified. These areas were informed to the residents, who are primarily involved in the documentation of the operative notes. The second loop of the audit was conducted after a gap of 4 months involving 75 consecutive operative notes again.Results: The areas which were initially deficient were better documented when analysed in the second loop.Conclusions: Documentation of operative notes does not always comply with the set guidelines as highlighted in the first loop of our audit. But by employing a clinical audit it is possible to identify the existing deficiencies and thereby improving the standards of practice. Also, operative note writing should be taught as part of surgical training. Definitions should be clearly provided, and specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.
Intestinal intussusception in adults is not considered to be common. Clinical presentations may range from an acute presentation to a chronic one and such wide variations make it challenging to establish the diagnosis on time. Adult intussusceptions usually have an identifiable pathological lead point: commonly a polyp, submucosal lipoma, or other tumors. Our patient, a 42-year-old male, presented to us with features of acute intestinal obstruction. He underwent an emergency laparotomy when intussusception of the ileum was noted; the involved bowel segment was resected. Histopathology showed that the lead point was due to tuberculous lesion. Further investigations showed that the patient had pulmonary tuberculosis (TB), which was not identified till then. The patient was started on antituberculous treatment thereafter and the patient recovered well. We intend to present this case to sensitize the readers to the unusual presentation of intestinal TB as intussusception which should be considered especially in countries with high TB endemicity.
Background: Wound closure techniques have evolved from suture material to advanced techniques that include skin staplers, skin glue and adhesive tapes. Based on efficacy of advanced suturing techniques patient may be benefited with better cosmesis, lesser postoperative pain, less wound infection and lesser hospital stay. The aim of the study was to compare the results of adhesive glue with suture material in skin closure in hernia surgeries.Methods: This study involves 100 patients undergoing open inguinal hernia surgery. In 50 of the patient’s skin closure was done with conventional suturing (3-0 ETHILON) and other 50 patients with tissue glue (2-octyl cyanoacrylate). Observation regarding postoperative pain, skin closure time and scar assessment were made, and their results were compared.Results: The mean time taken for skin closure in adhesive group was 2.72±1.32minutes and that of suture group was 4.88±1.533minutes. This difference was of great significance with p value of <0.001. The visual analogue scale shows mean value of 5.3±0.68 for suture group and for skin group it was 3.68±0.62. This value was of great significance with p value <0.001. Postoperative pain was comparatively less in tissue glue group. Postoperative scar was analysed with Vancouver scar scale at regular intervals. The mean score for suture group was 8.3±0.8 and for skin glue group it was 2.8±0.75. These differences of score was of great significance with p value <0.001.Conclusions: Adhesive glue is superior to conventional suturing in clean elective surgeries. It is a safe and an effective method of skin closure with less postoperative pain and better cosmesis of the scar.
<p><strong>Background</strong>: Primary bone tumors are very rare tumors. The true incidence of bone tumors is not well established and is under reported due to rarity and lack of accurate registries. Hence it is essential to study about the demographic, clinico-pathological features and the pattern of surgical management of bone tumors. The aim of this study is to analyze the demographic and clinico-pathological features of primary bone tumors that were managed by surgery.</p><p><strong>Methods</strong>: A retrospective analysis of all patients with primary bone tumor who were treated by surgery from 2012 to 2019 was done. The age, sex distribution, histopathology, location of the tumor and surgical procedure done were analyzed.</p><p><strong>Results</strong>: Among 103 patients analyzed, 66 (64%) were men and 37 (36%) were women. Primary bone tumors most commonly presented in 11 to 20 years of age with 35 (33.9%) patients occurring in this age group. Osteosarcoma was the most common primary bone tumor and it occurred in 49 (47.6%) patients, out of which 34 (69.3%) patients were below 20 years of age. Giant cell tumor was the most common benign bone tumor and it occurred in 22 patients, out of which nine (40.9%) patients were of age 21 to 30 years. Distal femur was the most common site with 39 (37.9%) patients. The limb preservation rate for malignant appendicular bone tumors was 69.0%.</p><p><strong>Conclusions</strong>: The diagnosis of bone tumor depends not only on histopathological features but also needs correlation with age, clinical features, tumor location and radiological features for confirmation of diagnosis.</p>
Objectives The extent of neck dissection over the years has evolved from a radical neck dissection to a super-selective neck dissection with an attempt to achieve a balance between oncological safety and acceptable morbidity. There is an ongoing debate concerning dissection of level IIB in both node negative and positive patients, primarily due to the low incidence of metastasis in this region and possible spinal accessory nerve injury. In this study, we intended to find the rate of metastasis to level IIB nodes in patients who were treated with neck dissection for oral cancers. Material and Methods Patients with squamous cell carcinoma of the oral cavity who underwent neck dissection were analyzed. Patients with clinically node negative (cN0) disease underwent selective neck dissection (SND), whereas patients with clinically node positive (cN+) disease underwent modified radical neck dissection (MRND). Results Out of the total 34 patients, 12 patients underwent MRND and 22 patients underwent SND. In the MRND group, three patients (25%) had positive level IIB nodes. The median number of IIB nodes removed was two and the median number of positive IIB nodes was one. In the SND group, the median number of IIB nodes removed was three and none of the patients had positive level IIB node. Conclusion In oral cancer with cN+, routine dissection of level IIB nodes has both therapeutic and prognostic values. Whereas, in patients with cN0, routine dissection of level IIB nodes can be omitted. Further large volume studies are needed on cN0 disease.
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