The rarity of glucagonoma imposes a challenge with most patients being diagnosed after a long period of treatment for their skin rash (months-years). Awareness of physicians and dermatologists of the characteristic necrolytic migratory erythema often leads to early diagnosis. Early diagnosis of glucagonoma even in the presence of resectable liver metastases may allow curative resection. Herein, we present a typical case of glucagonoma treated at our center and review the literature pertinent to its management.

Background: It is generally believed that multinodular goiter (MNG) is associated with a lower risk of malignancy compared to solitary thyroid nodules (STN). This will be the null hypothesis in this retrospective study and we aim to prove or reject it.Methods: Medical files and histopathology reports of 600 patients who underwent thyroidectomy over 4-year period were reviewed. Data including patient' age, gender, presentation, ultrasonography, FNAC, surgical procedures, final histopathologic diagnosis and stage of malignant tumors were collected and analyzed. The primary end point was assessment of risk of thyroid carcinoma in patients with MNG compared to those with STN. Secondary endpoints included demographic differences and prognosis.Results: There were 459 females (76.5%). Mean age was 44.3 AE 14.5 years (range 14-85). After exclusion of 33 patients, 224 (39.5%) had STN and 343 (60.5%) had MNG. The prevalence of thyroid cancer was 41.1% (92/224) in STN compared to 29.2% (100/343) in MNG (Chi-Square = 8.593, p < 0.01). However, on multiple logistic regression analysis this correlation was found insignificant ( p = 0.640). Only male gender ( p = <0.000005) and preoperative impression of malignancy ( p = 0.000082) were significantly associated with thyroid carcinoma.

m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 3 3 2 -3 3Methods: A total of 320 patients with suspected acute appendicitis were included in this study over a period of 2 years. The Alvarado score was calculated for all of these patients and 112 CT scans were requested selectively by surgeons caring for the patients. The histopathology diagnosis was used as the gold standard against which diagnostic performance of Alvarado score and CT scan were compared.Results: The complete data of 196 males and 124 females were analyzed at the end of the study period. The mean age was 26.1 AE 11.3 years. Appendectomy was performed in 263 patients with a negative appendectomy rate of 14.83% overall (12.28 in males and 19.56 in females). The remaining 57 patients were assumed to have no appendicitis. The diagnostic performance of CT scan was superior to that of Alvarado score with sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 94.2 versus 85.4%, 90 versus 65%, 9.42 versus 2.44, and 0.065 versus 0.224, respectively ( p-value < 0.05). The overall diagnostic accuracy of CT scan was 92.6% compared to 77.5% for Alvarado score. Conclusion:The Alvarado score was far from good and CT scan is more accurate in diagnosis of acute appendicitis in our patient population. #

Objective: To compare the impact of interrupted braided suture to continuous monofilament sutures on the development of abdominal wound dehiscence in high risk patients. Methods: Clinical judgment and the Rotterdam risk score of abdominal wound dehiscence were used to identify 140 patients at high risk for abdominal wound dehiscence. Seventy high-risk patients who had their laparotomy wounds closed by interrupted braided suture (intervention group) were compared to a similar group of patients who had continuous monofilament suture closure (control group). Demographic, clinical and operative data of both groups were compared. The primary outcome was the occurrence of wound dehiscence either partial or complete. Secondary outcomes include development of wound infection and the 30-day mortality rate. The mean follow up period was 3 months (range 1-6 months). Results: There were 78 males and 62 females with a mean age of 62.2±13.0 years. Both groups were equivalent in terms of demographics, Rotterdam risk score, type of surgery and surgical incision. Wound dehiscence occurred equally in both groups (24.3 in control vs 22.9% in intervention group, p value 0.842) but evisceration was significantly reduced by the use of interrupted sutures (4.3 vs 14.3%, p value 0.042). The method of closure has no significant impact on infection and early mortality. Conclusion: Although method of closure did not affect the overall incidence of wound dehiscence, interrupted braided sutures significantly reduced occurrence of evisceration. This reduced the need for urgent revisional surgery but did not affect the early mortality rate. A larger randomized control trial with a longer follow up period is advised.

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