Synchronous occurrence of primary gastric cancer with primary renal cell carcinoma (RCC) is exceedingly rare. We report a case of a 70 years old gentleman who presented with a history of epigastric fullness and tarry stools from 1 month, along with significant weight loss which he was unable to quantify. Esophagogastroduodenoscopy showed ulceroproliferative growth in the antropyloric region of stomach causing complete outlet obstruction. Histopathology revealed poorly differentiated mucinous adenocarcinoma. Contrast enhanced computed tomography (CECT) abdomen showed an asymmetrical circumferential growth in the antropyloric region leading to obstruction. A heterogeneously enhancing hypervascular mass was also visualized over the lower pole of left kidney with an initial impression of metastasis. A concomitant radical subtotal gastrectomy and radical left nephrectomy was performed. Pathological examination confirmed gastric adenocarcinoma (T4a) and renal cell carcinoma-RCC (T3a). Most of the operable synchronously occurring second primary malignancy (SPM) can be resected in a single stage.

Background: Gender dysphoria is a condition in which there is discrepancy between a person's gender identity and that person's sex assigned at birth. Gender reassignment surgery (GRS) has an important role in alleviating the distress caused by gender dysphoria and it is medically necessary. The literature on quality of life (QoL) of transgenders post-GRS is limited in India.Methods: This is a prospective study on transgender women who volunteered to undergo male to female (MtF) GRS from March 2015 to August 2017. The demographic details and the surgical complications were registered. The Quality of life using the WHOQOL-BREF questionnaire was measured both before and a year after the surgery. The data were compared and presented.Results: A total of 62 GRS were performed during the study period. In that, 43 patients are literate (69.35%) and only 31.93% are employed in a socially respectable position. Our study shows significant improvement in physical, psychological and social health domains after the Surgery. Highest improvement was observed in the psychological health domain. There were no major complications observed in our study group.Conclusions: The surgical management improved the QOL in the first three domains of WHOQOL-BREF instrument namely physical health, psychological health and social relationship. Among these three domains, there is a significant improvement in psychological health. Hence, GRS has an important role in relieving the psychological distress caused by gender dysphoria and significantly improves the quality of life postoperatively.

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

Today, diabetic foot ulcers (DFUs) are responsible for most hospitalizations compared to any other complication of diabetes. Foot ulceration is common and affects up to 25% of the diabetic population during their lifetime, resulting in the most common cause of hospitalizations (~30%). Plantar ulcers are the commonest neuropathic lesions in diabetes patients due to unrecognized trauma and chronic hyperglycemia are some of the known risk factors. In this review article, we assess the healing ability of DFUs if an offloading intervention was used.

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