Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown aetiology. The common mode of clinical presentation is in the form of painless subcutaneous nodules usually seen in the head and neck region and is associated with regional lymphadenopathy and occasional involvement of the major salivary glands. It is often accompanied by peripheral eosinophilia and markedly elevated serum IgE levels. Histologically, it is characterised by reactive lymphoid follicles with eosinophilic infiltration, sometimes forming eosinophilic abscesses and prominent postcapillary venules. There is no consensus about optimal treatment of this disease in the reported literature. This condition seldom resolves spontaneously but the prognosis is good. Malignant transformation has not been reported. Early diagnosis of KD could spare the patient unnecessary and potentially harmful diagnostic procedures. A high index of clinical suspicion can help in diagnosing this disease and aid in better management.
Oral Submucous fibrosis (OSMF) is a well-known debilitating precancerous condition of oral cavity which results due to chewing tobacco, areca nuts and its related products. It is an irreversible condition with very high malignant potential. There is a dire need to curb this common but avoidable condition that is increasingly observed in the younger age groups which leads to early development of oral cancer. The purpose of this article is to comprehend OSMF in totality and help the health professionals to get acquainted with the possible etiology, clinical features, differential diagnosis and current treatment modalities of OSMF along with the planning of promotive and preventive research to elucidate the solutions to the problem.
Traumatic pancreatic injury is a rare entity which is associated with severe morbidity and mortality. The management varies according to the American association for the surgery of trauma-organ injury scale (AAST-OIS) grading of injury, hemodynamic status and time of definitive diagnosis. Non-operative versus operative management has potential risks and benefits and long term debate on the ideal management is still ongoing. A 19-year boy, with severe, generalised pain abdomen was admitted after road traffic accident. Upon admission, the investigations: ultrasonography (USG) and computed tomography (CT) scan abdomen, showed traumatic pancreatic injury (AAST-OIS, grade V), was taken for exploratory laparotomy which revealed lacerated head of pancreas along with normal distal segment of pancreas with no associated injury to nearby hollow viscera, vascular structures. He underwent primary closure of head of pancreas with distal segment pancreaticogastrostomy. Postoperatively he recovered well with no complications. In the present case, as he had traumatic pancreatic injury (AAST-OIS, grade V) and there was no involvement of hollow viscera and vascular structures, the operative intervention can decrease morbidity as by pancreaticogastrostomy we have diverted the pancreatic fluid into stomach, subsequently decreasing the chances of pseudocyst, fistula, necrosis of pancreas. Thus we conclude, high grade blunt traumatic abdomen injuries should be managed with adequate resection and subsequent reconstruction and/or drainage procedure. Pancreaticoduodenectomy, distal pancreatectomy, pancreaticogastrostomy, pancreaticojejunostomy are the available options to be used according to the grading of injury and associated injuries.
Colorectal Carcinoma is most common malignancy in GIT, 3 rd most common after lung and Breast. (1) These patients commonly present with altered bowel habits, bleeding PR, pain, lump abdomen. (2) In the present study 245 cases from west Rajasthan over a period of 26 months were studied for Age, Sex, Clinical presentation, Investigation, Subsequent management, Complication and Follow-up. Peak incidence of disease is in 6 th decade of life with M/F ratio 1.8:1. Most common presentation was altered bowel habits. Most patients presented in advanced Duke's C with moderately differentiated Adenocarcinoma. CEA levels were <5 ng/mL. Preoperative surgical feasibility for curative resection was present in 64.44% pts. CEA level is good indicator to monitor recurrence of the disease. Surgery is the mainstay of the treatment. There is a role of adjuvant chemotherapy in all cases of colorectal cancer. Follow-up study is mandatory in all patients for early management of recurrent disease.
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