The aim of this observational prospective study was to determine the technical feasibility, safety, and adequacy of robotic hemithyroidectomy. From April 2015 to May 2016, 16 patients with solitary thyroid lesion underwent robotic hemithyroidectomy using the Da Vinci® Si Surgical system. Patients were observed and data were recorded on surgical time, blood loss, complications, and functional outcome of the patients. A total of 16 patients (3 males and 13 females; mean age 39.9 years) underwent robotic hemithyroidectomy after evaluation for solitary thyroid nodule with a mean nodule size of 2.2 ± 0.3 cm. Fiber-optic laryngoscopy (FOL) was normal in all cases pre-operatively. Five patients were operated by transaxillary approach, the rest by retroauricular (facelift) approach. Mean pocket dissection time was 42 min for transaxillary and 40 min for retroauricular approach. Mean operative console time was 59.4 min for transaxillary and 52.6 min for retroauricular approach. Average blood loss was 45 ml. Mean hospital stay was 1.5 days. None of the patients had any post-operative complication on follow-up. One patient had restricted left vocal cord mobility which improved in 3 months. Mean pain score was 0.25 ± 0.4 and average speech score was 0.5 ± 0.2 at 3 months. Post-operatively, all patients had adequate swallowing with no episode of aspiration. Robotic hemithyroidectomy is a safe, feasible, and oncologically safe procedure. It has benefits in terms of better scar cosmesis than open surgery.

Addition of adjuvant therapy based on depth of invasion does not influence survival in patients with early carcinoma of the tongue.

No abstract

No abstract

A 27-year-old female presented to thoracic outpatient clinic with complains of breathing difficulty, cough and pain in back of 2-weeks duration. Her physical examination revealed reduced air entry in left upper lung field with no evidence of toxaemia. Chest X-ray showed large left upper zone opacity. CT chest showed well circumscribed anterior mediastinal mass with internal fat fluid level and calcified component with evidence of localised rupture to anterior segment of left upper lobe of lung showing air fluid level. Lesion was inseparable from pericardium medially and chest wall laterally with fistulous tract between left upper lobe intra parenchymal component and anterior mediastinal mass, likely mature teratoma with pulmonary parenchymal fistula [Table/ Fig-1 AbSTRACTTeratoma is the most frequent mediastinal germ cell tumour amongst young population. They are often detected due to pressure symptoms or as an incidental finding on chest X-ray done for any other reason. Mediastinal teratoma is usually benign and rarely possesses diagnostic or therapeutic challenge unless they rupture into surrounding viscera. In such scenario, they may lead to acute life threatening condition and need prompt diagnosis and surgical extirpation. Here, we are reporting our experience of managing a young lady, who presented with short duration breathing difficulty and cough, and was diagnosed with ruptured mediastinal teratoma on imaging, which was further confirmed intraoperatively and histopathologically.gonads, which showed bilateral ovarian simple cysts and was negative for retroperitoneal lymph nodes. Gynaecological opinion was taken and patient was planned for diagnostic laparoscopy during definitive surgery. On laparoscopy, benign looking left ovarian cyst was seen, for which laparoscopic drainage was done. Midline sternotomy was done for the mediastinal mass. There was a large multilobulated anterior mediastinal mass with left phrenic nerve invasion. The whole of left upper lobe was replaced by cystic mass leaving thin rim of lung parenchyma in the apico-posterior segment and lingua with focal infiltration. Non anatomical stapled resection of the left upper lobe was done to remove the mass en block. Perioperative period was uneventful.On gross pathological examination, a solid cystic mass containing pultaceous material with hair was noted. On microscopic analysis multiple components derived from all three germ cell layers in variable proportion was noted, suggesting mature cystic teratoma with a ruptured and infiltrative interface with lung, measuring 6×2 cm area with cystic areas [Table/ Fig-2]. Patient was kept on regular follow up and was well six months after the surgery.[ Table/

Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting both sexes & can occur at any age. The aim of the study was to study the effectiveness of suture ligation of hemorrhoids and mucopexy as an outpatient treatment for symptomatic hemorrhoids.Methods: This prospective observational study was carried out in the department of surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India on 64 adult patients of hemorrhoids treated by suture ligation of hemorrhoid pedicle without Doppler guidance and mucopexy from July 2012 to December 2014. The patients were managed as outpatient or day care cases. The observations and follow up data were recorded and descriptive analysis was done to study the clinical presentation of hemorrhoid disease and effectiveness of hemorrhoid ligation and mucopexy in an ambulatory, outpatient or day care setting.Results: Total 64 patients of hemorrhoids who underwent suture ligation of hemorrhoids and mucopexy were studied. Most of the patients were between 31- 60 years of age (74.28%) with males predominance (64.06%). All the patients in this study had bleeding per rectum as the main symptom. All patients had hemorrhoids in primary 3, 7 or 11 ‘o clock positions and 21 patients (32.8%) had secondary hemorrhoids as well. Majority the patients had 1-3 degree hemorrhoids. However hemorrhoid ligation was also done in 7 patients with fourth degree hemorrhoid who were severely anemic and unfit for surgery due to co morbidities. Over all 82.81% patients were free from symptoms at 1 year follow up after the procedure and only 7.81% of the patients had recurrence of bleeding or prolapse.Conclusions: Hemorrhoid suture ligation with mucopexy is a simple, safe & cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

Context: Small cell cancer of the urinary bladder. Aims: Small cell carcinoma of the bladder is a rare histological subtype, which is particularly aggressive and global literature available describing this entity is sparse. This review of our database was to evaluate clinicopathological and survival outcomes of these patients. Subjects and Methods: The present study was a retrospective analysis of patients with small cell bladder cancer for past 6 years at Rajiv Gandhi Cancer Institute and Research Center, New Delhi. Results: : Most of the patients in our study presented with limited stage disease. The overall survival and disease-free survival (DFS) was 49% and 51.07% at 2 years, respectively. Preoperative chemotherapy with surgical resection has shown significant survival and DFS benefit. Stage at presentation also affected the survival and DFS though it did not reach statistical significance. Conclusions: Small cell bladder cancer is a rare disease with dismal prognosis. Multimodality treatment with neoadjuvant chemotherapy should be the preferred treatment for limited stage disease.

BACKGROUND:The management part of patients of diffuse brain injury is always critical and is associated with the high mortality and morbidity. Many prediction model for prognosis evaluation in diffuse brain injury patients have been developed. These prediction models so far has shown no promising role in therapeutic part of management but sensitivity and specificity of such model in detecting outcome has been observed and validated. In our study we have compiled the data of 400 patients with diagnosis of diffuse brain injury and evaluated their predicted outcome based on prediction scoring developed by National Institute of Mental Health and Neurosciences (NIMHANS) in 2003 and observed the actual outcome at the end of one month of observation. MATERIAL &METHODS: The outcomes of 400 patients with severe diffuse brain injury (GCS<8) were analyzed prospectively. On admission their prediction scoring were done based on the NIMHANS prognostic predictive model .Patients with scores of less than zero were graded to have unfavourable outcome. The actual outcomes of the patients at the end of one month were observed -death or persistent vegetative state was grouped in unfavourable outcome whereas patients those who showed improvement with or without disability were said to have favourable outcome. The percentage of unfavourable outcome was measured and the sensitivity, specificity. Predictive value for favourable and unfavourable outcome of the model in our study was measured and compared to the original study of NIMHANS. RESULTS: The sensitivity, specificity, negative and positive predictive value for the model calculated were 71.68, 83.33, 53. 98 and 91.52 respectively which showed the good efficacy of the model in predicting the outcome in our patients of head injury. CONCLUSION: The prognostic model developed by NIMHANS is a good outcome prediction model which can guide towards the prognosis and further intensive care of the patient but at the same time cannot be used to guide initial therapy .Moreover inclusion of MRI findings can improve accuracy of the study as CT Scan may not show obvious changes in thin patient.