Liposarcomas are the most common retroperitoneal soft tissue tumors. We here in report a case of giant retroperitoneal sarcoma which weighed 24 kgs. Renal autotransplant of right kidney was done for organ preservation. The patient has done well after a follow up of 63 months. Complete surgical resection with organ preservation is the goal of treatment in patients with retroperitoneal liposarcomas.Keywords Giant retroperitoneal liposarcoma . Renal preservation . Autotransplantation Liposarcoma is the most common soft tissue sarcoma in adults and accounts for at least 10-20 % of all sarcomas. These tumours are usually late to be detected because of absence of symptoms in retroperitoneum and reach a large size (>15 cm) by time of diagnosis [1]. Complete surgical resection is treatment of choice. There are many case reports in the literature of giant retroperitoneal liposarcomas, the largest reported so far weighed 42 kg [2]. We herein report a case of retroperitoneal liposarcoma which was 24 kg in weight and autotransplantation of one kidney was done. Case Report52 years male presented with complaints of progressive abdominal distension, early satiety, weight loss and dyspnoea. Abdomen was distended by a large mass occupying whole abdomen (Fig. 1). His haemoglobin was 8 g % and renal functions were normal. Chest x-ray was normal. Contrast enhanced computed tomography (CECT) showed a mass occupying the abdomen with no infiltration of kidneys or major vessels (Fig. 2).At laparotomy, a giant 40×35×35 cm solid tumour was completely filling the abdomen (Fig. 3). 50 cm of ileum and right middle ureter were adherent to tumour. Bilateral kidneys and other intra-abdominal organs were free. Enbloc resection of the tumour along with adherent ileum and ureter was done. The bowel was reanastomosed and right kidney was autotransplanted in left iliac fossa. Tumour weighed 24 kg. Patient was discharged after 7 days. Histopathology revealed a mixed type of liposarcoma.CECT abdomen after 6 months showed no recurrence and 99m Tc Diethylene Triamine Penta-acetic acid (DTPA) scan showed good renal function in autotransplanted kidney. Patient presented again after 40 months, with a tumour recurrence in right iliac fossa. 10×15 cms tumour was found adjacent to right iliac vessels which was excised and he

Background An unscheduled emergency department (ED) revisit is defined as a patient presenting to the ED with the same problem within 72 hours of discharge. The revisits result in overcrowding and compromise the care provided by the ED. We assume that the poor quality of care provided by the ED is the reason for revisiting. However, the circumstances surrounding these revisits are not well-understood. We conducted this study to understand the characteristics associated with the revisits. Objectives We aimed to identify the common causes of ED revisits within 72 hours of discharge and determine the outcome of these patients during the revisit. Methods We conducted a prospective observational study at a tertiary care center from July 2015 to June 2017, including patients presenting at the ED within 72 hours after their first visit. Our study selected 50 patients using a simple random sampling method and identified the leading causes of revisit as doctor-related, patient-related, and illness-related. Results We found that 56% (28/50) of patients returned to the ED for illness-related reasons, 26% (13/50) for doctor-related reasons, and 18% (9/50) for patient-related reasons. In addition, we found that 62% (31/50) of patients who returned to the ED within 72 hours required in-patient admission. Conclusion The most common cause of ED revisit was illness-related causes, and more than half of the patients during a revisit required in-patient admission. The modifiable causes of the ED revisit, such as doctor-related and patient-related factors, were discovered in this study. These findings may aid in reducing ED revisits and improving the ED quality.

Background and Objectives: As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients. Methods: This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death. Results: We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39–59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease ( p < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score. Conclusion: NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.

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