We describe obstructive jaundice as the presenting feature in a 55-year-old male with a peri-ampullary Brunner's gland hamartoma. Duodenal obstruction and bleeding from such lesions have been noted previously, but obstructive jaundice has not yet been reported. This case is being described for its unconventional presentation and for consideration in the differential diagnosis of obstructive jaundice.
Wound healing is a complex and dynamic process and is influenced by surgical technique. Optimal wound healing, with a minimal scar that compromises neither appearance nor function, is the desired result. This process is affected by both local and systemic factors. Many local conditions are readily controlled at the time of wound closure, and several fundamental principles of surgical wound closure exist that should be adhered to in the management. Skin is usually closed with sutures then later with skin staplers.Skin staplers are quick and easy to use, but an assistant is usually required to hold the skin edges accurately with forceps or skin hooks.Stapler's closure also causes considerably less damage to wound defenses than closure with least reactive non-absorbable suture. Standard suturing causes significantly more necrosis than stapling in myocutaneous flaps. We did this study to compare the time required for the closure of skin, infection rate, pain at the operated site with sutures and staplers in open inguinal hernia repair. 80 patients who were posted for elective open inguinal hernia surgery at Sri Ramachandra Medical College & Research Institute, porur, Chennai was included in this study. Time taken for closure of skin, infection rate and the pain was less in patients with stapler closure than with skin sutures
Sarcoma of the breast is a rare condition. The biological differences from other primary breast tumours necessitate a corresponding difference in approach to diagnostic and management strategies. The rarity of the condition has made clinicopathological study difficult. Authors report a case of primary leiomyosarcoma in a 40-yr-old-women, with a 15x9 cm bosselated swelling, involving all 4 quadrants of the left breast. Her clinical features, sonography and trucut biopsy were compatible with cystosarcoma phyllodes and she underwent a left mastectomy for the same. Later the histological and imunohistochemical studies established the diagnosis of leiomyosarcoma, grade 2.
PRESENTATION OF CASEHere we present a 68-year-old female, who was diagnosed with GIST. Pre-operatively, the patient underwent a CT abdomen with contrast. This showed multiple deposits over the spleen.We prepared her for a splenectomy by giving her pneumococcal and meningococcal vaccines. Three weeks later she underwent sleeve gastrectomy with omentectomy and splenectomy. Post-operative period was uneventful. She was started on diet on POD 3 and she tolerated it well.
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