Squamous cell carcinoma of the renal pelvis and ureter is a rare malignancy, having an incidence of 6% to 15% (of all urothelial tumors). Few cases of primary squamous cell carcinoma of kidney have been reported in the world literature. The insidious onset of symptom and lack of any pathognomonic sign, leads to delay in the diagnosis and subsequent treatment, resulting in grave prognosis for these patients.Herein, we report 5 cases (three males and two females) of advanced primary squamous cell carcinoma of kidney that were treated at our centre during the last 6 years. The average age was 57 years (range 50-65 years). Three of the patients had history of long standing renal calculus disease while 3 had history of smoking and 1 patient had history of analgesic abuse. These cases were unique because in few of them; all the calyces were involved by the tumor -a fi eld change type of pattern normally seen in transitional cell carcinoma of the kidney. In one patient, thrombus of the inferior vena cava was also present along with infi ltration of the duodenum by the tumor. Despite prompt nephroureterectomy, 4 out of 5 patients died within 6 months of treatment. Only one patient was surviving at 5 months of follow up.Nephrectomy with or without ureterectomy is the treatment of choice in patients suffering from squamous cell carcinoma of the kidney. There is lack of evidence of survival benefi ts of chemo-radiation following surgery but is advocated by some with the hope that it might increase survival. Biopsy from the renal pelvis or calyceal wall is advocated at the time of stone removal in patients having long-standing history of large renal calculi or staghorn calculus since such patients are capable of harboring occult or overt malignancy.

The viral hepatitis among the apparently healthy population of a relatively natural and pollution free environment refers to an alarming condition about liver infections, particularly of HCV, in Pakistan.

Three physicians who participated in an intensive education course were routinely using mesh for inguinal hernia repair 14 months after the training. This represents a significant change in practice pattern. Complication rates between patients who underwent inguinal hernia repairs with and without mesh were comparable. The present study provides evidence that short-term surgical training initiatives can have a substantial impact on local healthcare practice in resource-limited settings.

No abstract

No abstract

Objective: To assess feasibility, advantages, oncological safety, cost effectiveness and long term results of laparoscopic surgery for rectal cancer in a government sector hospital. Method: From January 2005 to May 2007, 20 patients of operable cancer rectum were subjected to laparoscopic curative resection. Surgical technique, postoperative morbidity and clinical results were reviewed in close follow-up for median period of 20 months (12 wks to 30 months). Results: Fourteen patients underwent LAPR and 6 patients LAR. Median age was 39 years. Median operating time for Lap APR was 296 minutes, initial 7 cases taking an average of 368 minutes, while subsequent 7 cases average operating time was 232.5 minutes. In Lap AR, average duration of surgery was 356 minutes, first 4 cases taking 400 minutes while for last 2 cases, and mean operating time was 300 min. There was no intraoperative complication in either group. All patients mobilized on POD: (1) Incidence of PONV was significantly less. Oral feeds were routinely started on POD, (2) Incidence of wound infection was also reduced (2/20). Hospital stay on an average was 11 days as ours being a government sector hospital, patients were discharged only after drain removal and thus stay was slightly prolonged. Of the 20 patients, 17 were diagnosed to be Adenocarcinoma, 2 with Malignant Melanoma and 1 with GIST. Two patients of malignant melanoma developed locoregional recurrence and 2 patients developed distant metastasis after approximately 1 year. No incidence of port metastasis in any patient. Conclusion: Laparoscopic colorectal surgery is safe, feasible and meets oncologic requirements of radicality. Pattern of local recurrence and distant metastasis is similar to open surgery. Lap surgery has a steeper learning curve. Cost of treatment decreased by use of Ligaclips for intracorporeal vascular control and extracorporeal division of gut whenever possible.

IntroductionLaparoscopic transabdominal pre-peritoneal (TAPP) repair is a minimally invasive technique that is becoming the procedure of choice among surgeons for inguinal hernia repair and research work is still going on comparing TAPP repair with Lichtenstein open mesh repair. The objective of our study is to compare common postoperative complications in Lichtenstein mesh repair and laparoscopic TAPP repair for unilateral inguinal hernia in our unit. MethodsBetween August 2016 and August 2018, patients with unilateral inguinal hernia and ASA grade I/II were selected in the surgical outpatient department (OPD) and prospectively randomized into two equal groups. Lichtenstein open mesh repair was done in Group-I and laparoscopic TAPP repair in Group-II. The visual analog scale (VAS) was used for the assessment of the intensity of pain. ResultsA total of 100 patients with a diagnosis of unilateral inguinal hernia were included in the study. Overall, our study showed that there was less postoperative pain in those patients who underwent TAPP repair as compared to patients with Lichtenstein mesh repair (p= <0.05). There were more postoperative complications in Group-I as compared to Group-II. ConclusionLaparoscopic TAPP repair for inguinal hernia is associated with less postoperative pain and other postoperative complications in addition to a shorter hospital stay as compared to Lichtenstein mesh repair. Thus, this is helping in the early return of patients to daily life activities.

No abstract