Large incisional hernias are difficult to treat surgically because of the post-operative respiratory complications and abdominal compartment syndrome. Pre-operative progressive pneumoperitoneum is a technique which has been used in such cases. We describe a case of a large incisional hernia, where this technique was employed by objectively calculating abdominal and hernial sac volumes on the basis of computerized tomography scan of abdomen with a satisfactory outcome. A review of literature and issues involved in pre-operative progressive pneumoperitoneum have been discussed.
Background: Carcinoma breast is the commonest malignancy in females worldwide. Although a disease of postmenopausal age, occurrence in young age is a poor prognostic factor. Hence this study was undertaken to study clinical presentation, extent of disease, treatment modalities, histopathological typing and grading of carcinoma breast in females upto 40 years and to compare tumor characteristics between very young (≤30 years) and young (30- 40 years) patients.Methods: This was a hospital based observational study conducted at Department of Surgery, GMC Nagpur, from July 2009 to November 2011. All cytologically or histologically proven cases of carcinoma breast in females ≤40 years of age giving consent were included. All the patients were evaluated by detailed clinical evaluation and investigated, treated with different modalities according to clinical stage and were followed up for a period of two months. Data was collected and tabulated into a master sheet and statistical tests were applied to test the significance of association.Results: Mean age was 35.24 years (19-40 years), 12 patients being under 30 years (very young). Mean duration of presentation 3.08 months. Mean lump size was 5.32 cm, 56% had lump >5 cm. Only 1/3rd of patients had EOBC, 2/3rd had LOBC/LABC. FNAC was 87% sensitive, ER positivity was low. All patients received multimodality treatment, 84% underwent mastectomy and none underwent BCT. We report two deaths. Very young group showed more incidence of node positivity, advanced stage of the disease and positive margin of resected specimen than young age group but had no significant difference with respect to tumor size and histopathological characteristics. Nulliparity, breast feeding and protective effect of early age at 1st pregnancy when were independently tested in operable and advanced staged cancer groups no statistically significant association was found.Conclusions: Carcinoma of breast in young females, although less common, is an aggressive disease. In India more patients present in advanced stage precluding BCT. Early diagnosis can improve outcome.
Plexiform Neurofibroma (PNF) presents as a growth of unexplained excess that does not pertain to any other organic causes and is hereditary. The iconic ‘bag of worms’ appearance is native to its diffuse and pliable character. Region of occurrence being the face adds the challenge of aesthetics to infiltration into vital structures and recurrence rate. The patient presented here is that of serial reconstructions done in order to satisfy the aesthetic demand of the patient. Initial reconstruction done with split thickness skin graft was later augmented with radial forearm flap. No signs of recurrence were seen during the follow-up of six years.
Breast cancer among young women is a relatively uncommon. Many of the times the diagnosis is delayed in these patients owing to the reluctance of surgeons to subject young females to mammography because of the involved radiation. Current study was conducted to study various aspects of carcinoma breast occurring in patients younger than 40 years of age. Material and Methods: This was a prospective study conducted in the surgery department in which 57 patients less than 40 years of age and diagnosed to be having carcinoma breast were included on the basis of a predefined inclusion and exclusion criteria. The risk factors, clinical presentation, staging and outcome were studied in these cases. Statistical analysis was done using SPSS16.0 version software. P-value less than 0.05 was taken as statistically significant. Results: The most common affected age group was found to be between 35-40 years (56.14%). Common symptoms included lump in breast (100%), pain (19.29%) and discharge (17.54%). Majority of the patients had their first child birth at age less than 20 years. Upper outer quadrant was the most commonly affected site (56.14%) and nipple retraction (19.29%) was the most common sign in the studied cases. Most common tumor and clinical staging were found to be T3 (33.33%) and T III B (28.07%) respectively. Surgery and hormonal therapy were the most common treatment modalities given to these patients (85%). Most common histopathological type was found to be infiltrating ductal carcinoma. Conclusion: Our study concludes that age less than 40 yrs is associated with diagnosis of breast cancer at an advanced stage and young patients presenting with breast lumps should not in any way be considered different from relatively older patients and all standard screening and diagnostic investigations must be carried out for early diagnosis and proper interventions.
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