Secretory carcinoma of the breast is an extremely rare subtype of breast cancer characterized by intracellular or extracellular secretion and granular eosinophilic cytoplasm of the neoplastic cells. The disease which was considered to be predominant in younger age group has been recognized in adult population too and tends to show slow growth and indolent behavior. The disease occurs preferentially in females and only 27 cases have been reported amongst males. An optimal treatment for the disease subtype has been debated because of the paucity of data. We report two cases (one female and one male) of this rare disease that underwent treatment at our institution.

Telementoring as a subset of telemedicine has evolved over the past few years, but it is yet to be utilized to its full potential. The technology holds promise in bridging divides of distance and enables far-flung areas to be mentored in operative advances. It thus has a special bearing in countries like India where health care is short staffed and many areas lack availability of quality care. We describe the setting up of a telementoring facility at our centre. As against a 'routine' facility with dedicated equipments which cost heavily, our facility was set up using mostly equipments commonly available in an operating room. The facility is presently functional and allows telementoring through an encrypted Web-based service. Our set-up design can be emulated in centres with financial constraint and can help raise the standard of surgical care.

Background: Solid pseudopapillary neoplasm (SPN) of the pancreas is a low-grade malignant neoplasm with unpredictable behavior. Factors associated with recurrence were not conclusively identified. The aim of this study is to define the clinicopathological criteria for recurrence risk prediction in SPNs based on the most recent scientific evidence and to present our experience with SPNs.Methods: A retrospective review of patients with SPNs operated on in our institution from June 2012 to June 2018 was completed. Patient characteristics and clinical outcomes were analyzed. A detailed literature review was performed to evaluate the factors associated with the recurrence of SPNs.Results: The cohort consisted of 13 female patients with a median age of 24 years and a mean tumor size of 7.7 cm. Body and tail (53.8%) were the most common location, and distal pancreatectomy with splenectomy was the prevalent surgical procedure. One patient of SPN operated on for local recurrence after 11 years which had high-grade malignant histological features on the previously resected tumor. At a median followup of 42 months (range 36 to 108), all patients were disease free and alive. The proposed criteria for predicting recurrence in SPNs include tumor size >8 cm, synchronous metastasis, malignant SPN (according to 2000 or 2010 World Health Organization [WHO] criteria), lymphovascular invasion, pancreatic parenchymal invasion, and high Ki-67 index (>4%). All these are worse prognostic factors and should be considered as high-risk factors for postoperative relapse. Conclusion:The above-mentioned criteria can better predict SPN recurrence. Patients with high-risk features should undergo an extended follow-up.

Urolithiasis is a common problem in general population. It is treated conservatively as well as surgically. Aim of this study is to see the effects of forced diuresis in relieving acute symptoms or descent of ureteric stone or passing of stone. Study was done on 207 cases of all age group selected by simple method with symptoms of pain, burning micturition, increased frequency, haematuria, etc. In our study forced diuresis given in all 207 patients and after giving treatment, relief in symptoms, any descent or passage of urinary stone or any changes in urine routine and microscopic examination was noted and compared. In this study, symptomatic relief and gradual decline in pus cells was found in most of the cases with renal calculi, vesical calculi, ureter calculi and uretheral and multiple sites of urinary tract system. In most of the ureteric calculi, it worked as a definitive treatment as stone passed out in most of these cases. In this study author concluded that in acute symptomatic patients, relief can be obtained by forced diuresis and then patient can be planned for elective management.

We describe a family in which 5 of its members of 2 successive generations presented with multiple giant liver hemangiomas (GLH). A 30-year-old woman in 2013 presented with abdominal pain, increasing abdominal distension, and respiratory discomfort. Multidetector computed tomography revealed multiple (8-10) hepatic hemangiomas (HH) involving almost the entire right hemiliver and caudate lobe with the largest measuring 33 3 19 3 15 cm (Figure 1), which was complicated by Kasabach-Merritt syndrome. In an attempt to reduce the hemangioma volume for safer resection, transcatheter arterial embolization of the right hepatic artery was performed but failed to cause sustained regression. Right hepatectomy was performed through a thoracoabdominal approach, without any complication (Figure 2). A histopathology report confirmed the diagnosis. She lost follow-up after 3 years and again presented in 2019 with another fresh giant hemangioma of 23 3 12 3 15 cm size arising from segments 2 and 3. Enucleation was performed successfully preserving the functional liver volume (Figure 3).