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Diagnosis of abdominal TB is an exigent task due to variable anatomical sites and non-specific clinical manifestations that closely resemble other diseases. Most of the available diagnostic modalities yield low sensitivities and need expertise to handle the specialized equipment. Hence, there is an urgent need to develop a rapid and reliable diagnostic test, so as to reduce the unnecessary morbidity. Therefore, we designed a multi-targeted loop-mediated isothermal amplification (MT-LAMP) for diagnosing abdominal TB.We evaluated an MT-LAMP (using mpt64 and IS6110) to diagnose abdominal TB within ascitic fluids and intestinal/peritoneal biopsies and compared these results with multiplex-PCR (M-PCR) using the same targets. MT-LAMP products were analyzed by gel electrophoresis and visual detection methods, that is, hydroxy naphthol blue and SYBR Green I reaction.Sensitivities of 80.9% and 84.6% were obtained in suspected (n = 42) and total abdominal TB (n = 52) cases, respectively by gel-based MT-LAMP, with 97.3% (n = 37) specificity in non-TB controls. Notably, sensitivities attained by gel-based/SYBR Green I MT-LAMP in both clinically suspected and total abdominal TB cases were significantly higher (P 0.05) than M-PCR. Furthermore, sensitivity obtained with SYBR Green I was equivalent to that of gel-based MT-LAMP, while somewhat lesser specificity (94.6%) was attained with SYBR Green I, compared with gel-based MT-LAMP.Both gel-based and SYBR Green MT-LAMP exhibited equivalent sensitivities to diagnose abdominal TB. Because SYBR Green LAMP is easier to perform than a gel-based assay, we are currently focused on improving the specificity of this assay so as to develop a diagnostic kit.

Diagnosis of peritoneal TB is difficult owing to unusual clinical manifestations and low sensitivities obtained with most of the available diagnostic modalities. Hence, there is an urgent need to design a reliable diagnostic test so that an early therapy is initiated.We designed a quantitative real-time immuno-PCR (RT-I-PCR) assay to detect a cocktail ofA wide range of CFP-10+ HspX (0.6 pg/mL to 9.9 ng/mL) was detected in clinical samples of peritoneal TB patients by RT-I-PCR, whereas ELISA exhibited a narrow range (3 ng/mL to 11.5 ng/mL). Sensitivities of 81.5% and 65.7% and specificities of 92.5% and 90% were obtained in a total of 78 cases (comprising 38 peritoneal TB and 40 non-TB controls) by RT-I-PCR and I-PCR, respectively. Markedly, sensitivity obtained by RT-I-PCR was significantly higher than I-PCR (Our RT-I-PCR revealed good accuracy for the rapid diagnosis of peritoneal TB cases. After further improving the specificity and reducing the cost, this assay may develop into a diagnostic kit.

Abdominal tuberculosis (TB) is a common epitome of extrapulmonary TB (EPTB), wherein peritoneal and intestinal TB are the most prevalent forms. Diagnosis of abdominal TB is a daunting challenge owing to variable anatomical locations, paucibacillary nature of specimens and atypical clinical presentations that mimic other abdominal diseases, such as Crohn's disease and malignancies. In this review, we made a comprehensive study on the diagnosis of abdominal TB.Various modalities employed for abdominal TB diagnosis include clinical features, imaging, bacteriological tests (smear/culture), histopathological/cytological observations, interferon-gamma release assays and nucleic acid amplification tests (NAATs). Among NAATs, loop-mediated isothermal amplification assay, PCR, multiplex-PCR, nested PCR, real-time PCR and GeneXpert® MTB/RIF were discussed. Identification of circulatingSeveral novel molecular/immunological methods, such as GeneXpert Ultra, aptamer-linked immobilized sorbent assay, immuno-PCR (I-PCR) and nanoparticle-based I-PCR have recently been developed for detecting pulmonary TB and several EPTB types, which may also be explored for abdominal TB diagnosis. Precise and prompt diagnosis of abdominal TB may initiate an early therapy so as to reduce the complications

Cardiac herniation and torsion may rarely occur following lobectomy with partial pericardectomy. High index of suspicion is required to diagnose this near fatal event. We report an unusual case of acute right sided cardiac dextroversion with torsion in a 58-year-old female following a right lower lobectomy, pericardectomy, and excision of infiltrated part of right hemi diaphragm for recurrent soft tissue fibrosarcoma.

Background Injuries are one of the leading causes of morbidity and mortality around the world, and their burden is expected to rise dramatically by the year 2020. Tube thoracostomy is the most widely performed procedure for management of blunt and penetrating chest traumas and has a pivotal role in their management. Chest tube (Ct) drain output is the main determinant in the management and removal of chest tube. The present study was conducted to correlate drainage volume with timing of chest tube removal, with an aim to establish a safe drainage volume for chest tube removal.

Background. Retroperitoneal lymphangioma is a rare, benign mesodermal tumor arising from the retroperitoneal lymphatics which usually presents in infancy and it is worthy to report a case when it has presented in an adult. After a thorough literature search in English we concluded that less than 200 cases of adult retroperitoneal lymphangioma have been reported so far. Apart from being a rare entity it also presents as a diagnostic dilemma and final diagnosis is often made on surgical exploration.Case Presentation. We report a case of retroperitoneal lymphangioma in a 55-year-old male who presented with abdominal distension and dull aching abdominal pain.Conclusion. Retroperitoneal lymphangiomas are rare tumors of infancy but may also present in adults where they are a diagnostic challenge. Differentiating cystic lymphangiomas from other cystic growths by imaging studies alone are often inconclusive and surgery is frequently required for definitive diagnosis and to ameliorate the symptoms.

Background Methods This was a prospective study on patients who underwent esophagectomy for carcinoma oesophagus from May 2016 to August 2017. The patients who expired in immediate post operative period were excluded from study for evaluation of anastomotic leak and those patients who could not be followed up for at least six months were also excluded from study for evaluation of development of post operative stricture. End to side anastomosis was placed on the anterior surface of stomach using two suture lengths of 2–0 polyglecaprone 25. Anastomosis was done in single continuous layer with full thickness bites. At the end the stomach conduit was tucked to prevertebral fascia by a single stitch. During post operative period, Jejunal feeding was started on 2nd post operative day. Ryle's tube was removed on 5th post operative day and clear liquids were started. Gastrograffin study was done only if clinical suspicion of leak was there on day 7. Semisolid puree diet was started on day 7 and neck drain was removed on day 10. Patients were followed up for six months and specifically asked for symptoms of dysphagia.Symptoms of dysphagia were recorded and graded on the basis of Mellow-Pinkas scoring system. Results Mckeowns esophagectomy was performed in 18 patients, transhiatal in 8 patients and Ivor Lewis in 1 patient. Average time taken for anastomosis was 17 min. Anastomotic leak was seen in four patients(14.81%) and all leaks could be managed conservatively. Only two patients(7.40%) presented with dysphagia which required dilatations. The cost of suture used was least as compared to other techniques. Conclusion Anastomotic leak rate of the present technique was found to be comparable to other techniques whereas the post operative stricture formation was significantly less. Poliglecaprone 25 looses all its tensile strength by third week and this may be the reason for low stricture rates. We conclude that Esophagogastic anastomosis with a single layer continuous technique using 2–0 poliglicaprone 25 gives good results having comparable leak rates to other techniques. The rate of anastomotic stricture formation is quite low as compared to other techniques.The anastomosis takes less than seventeen minutes and is quite cost effective. Disclosure All authors have declared no conflicts of interest.

Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

Background: Various histopathological changes have been observed following neoadjuvant chemotherapy in individual tumors in the literature. Aims and Objectives: To observe histopathologic changes seen after neoadjuvant chemotherapy in breast malignancies, squamous cell carcinomas, adenocarcinomas, and Wilms' tumor using breast cancer predominantly as the model. Materials and Methods: The present prospective study was carried out on 60 patients including 40 patients with carcinoma breast and 20 patients with other malignancies who received neoadjuvant chemotherapy. Results: Post neoadjuvant chemotherapy, mastectomy specimens revealed nuclear enlargement, nuclear shrinkage, necrosis, vacuolation of nucleus, vacuolation of cytoplasm, dyscohesion, and shrinkage of tumor cells with nuclear changes of nonviability like karyorrhexis, karyolysis, and pyknosis. Stromal reactions manifested as fibrosis, elastosis, collagenization, hyalinization, microcalcification, and neovascularization. Areas of necrosis included both vascular and avascular pattern. The stroma also revealed fibrinoid necrosis and mucinous change. Hyalinization of the blood vessel wall was a common finding. The most common inflammatory host response observed in the present study was lymphocytic; others included mixed inflammation, plasmacytic, prominent histiocytic, and giant cell types. Giant cell reaction was significantly correlated to all types of tumor responses (P < 0.05). Similar changes were also observed in other malignancies. A detailed review of the literature has also been done and presented. Conclusion: The tumor grade decreases and differentiation improves, in addition to the retrogressive changes and increase in stromal component, as a result of chemotherapy in carcinoma breast as well as in other malignancies.

Introduction: Human cysteine rich secretory protein 3 (CRISP3), also known as specific granule protein (SGP28) is a small 28kDa protein. CRISP-3 is widely expressed in salivary glands, pancreas (particularly in pancreatic disease), lachrymal glands, prostate, myeloid precursors, human epididymis, ovary, thymus and colon. Human CRISP3 share similarity with snake venoms as well as Glioma Pathogenesis Related protein GLIPR1. Here we are reporting the extent of alignment of human CRISP3 protein with pancreatic enzymes and snake venom proteins and presence of GLIPR1 and CRISP3 genes containing conserved GHYTQVVW motifs in clinical samples of pancreatitis and pancreatic cancer. Material and Methods: Protein sequences with accession numbers for Human CRISP3, Snake Venom and enzymes present in pancreatic juices i.e. Trypsinogen, Cathepsin, Lipase, Amylase and Elastase were retrieved from swissprot, protein database. These sequences were aligned in silico for demonstrating the presence of 16 conserved cysteine residues and other motifs i.e. GENL and GHYTQVVW. The multiple sequence alignment (MSA) was performed. Presence of CRISP-3 conserved motifs in clinical samples of pancreatitis and pancreatic cancer was evaluated by PCR. DNA extracted from a small piece taken from inflamed pancreatic tail biopsy with confirmed diagnosis for pancreatitis and an excised pancreatic cancer tissue was subjected to PCR to conform presence of CRISP3 and GLIPR1 genes. Results: Our results show conservation of 9 Cysteine residues out of 16 Cysteine residues in majority of pancreatic enzymes and notable conservation of GENL and GHYTQVVW motifs across snake venom proteins. PCR yielded desired amplicon of expected size with the primers spanning conserved residues and core consensus motifs specifically designed to amplify CRISP3 gene in clinical samples of pancreatitis and pancreatic cancer. We also detected presence of GLIPR1 gene sequence in the DNA extracted from clinical samples of pancreatitis and pancreatic cancer thus confirming similarity between the pathogenesis related protein and CRISP3. Conclusion: Notable conservation of cysteine residues across pancreatic enzymes, snake venom and Human CRISP3 opens avenues of further research to evaluate the likely clinical potential of the conserved residues as putative biomarkers in exocrine pancreatic diseases. To the best of our knowledge this is the first report where primers designed around conserved GHYTQVVW motifs to amplify CRISP3 gene and its structural similarity with GLIPR1 gene sequence in clinical samples of pancreatitis and pancreatic cancer has been validated.

Urethral hemangioma is an exceedingly rare, benign tumor which commonly presents as urethral bleeding. Urethroscopy is the best diagnostic procedure. There are various treatment modalities and appropriate therapy is individualised depending upon site, size and number of hemangiomas. We report a case of solitary urethral hemagioma present in the bulbar urethra. The patient presented with spontaneous profuse hematuria and was managed by wide excision of the hemangioma.

Background: Blood vessel counts using CD105 staining are more informative marker of prognosis as compared with staining by other endothelial markers. We conducted a study to compare intratumoral (IT) and peritumoral (PT) microvessel density (MVD) in head and neck squamous cell carcinoma (HNSCC) using endothelial marker CD105 and its correlation with lymph node metastasis, histological grading, and other clinicopathological parameters. Materials and Methods: Fifty cases of HNSCC with modified radical neck dissection specimens were included in the study group. Representative blocks were prepared from tumor, PT tissue, tumor margins, and all the lymph nodes. Histopathological diagnosis and other parameters were established on the routine hematoxylin and eosin stain. Immunohistochemical profile of blood vessels in IT and PT tissues was assessed by subjecting one section each from a representative block of the tumor and PT tissue to CD105 immunostain. To determine MVD, four fields with the highest MVD (hotspots) were identified. The mean values were calculated by taking an average of all the measurements. Results: No significant association was seen between MVD, IT-MVD, and PT-MVD and different age groups, male/female patients, risk factors, site of tumor, size of tumor, presence/absence of inflammation, pushing/infiltrating margin, and different stages of tumors. When compared in node positive and negative groups, a significantly higher MVD, IT-MVD, and PT-MVD was seen in association with lymph node metastasis. The comparison of MVD between PT and IT area revealed significantly higher IT-MVD (P = 0.001). Conclusion: In the study, we found a significant association of IT-MVD with lymph node metastasis and also observed CD105 as a highly specific marker for IT microvessels while PT vessels were not stained or weakly stained.

Excision, suture ligation and endoscopic snaring are the recommended methods of treatment for a juvenile rectal polyp. A successful experience of a simpler technique, digital polypectomy, in 218 cases is reported.

Background: The pectoralis major myocutaneous (PMMC) flap has been used as a versatile and reliable flap since its first description by Ariyan in 1979. In India head and neck cancer patients usually present in the advanced stage making PMMC flap a viable option for reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. The aim of this study is to identify the outcomes associated with PMMC flap reconstruction. Patients and Methods: After ethical approval we retrospectively analyzed 100 PMMC flap at a tertiary care hospital from 2006 to 2013. A total of 137 PMMC flap reconstructions were performed out of which follow-up data of 100 cases were available in our record. Results: A total of 100 patients were reviewed of these 86% were of oral cavity and oropharyngeal lesions, 8% were of hypopharyngeal, 3% were of laryngeal malignancies and 3 cases were of salivary gland tumor. Most tumors (83%) were advanced (T3 or T4 lesion). 95 PMMC flap reconstruction were done as a primary procedure, and 5 were salvage procedure. PMMC flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients. Overall flap related complications were 40% with a major complication in 10% and minor complications in 30%. No total flap loss occurred in any patient, major flap occurred in 6% and minor flap loss in 12%. In minor flap loss patients, necrotic changes were mostly limited to skin. Orocutaneous and pharyngocutaneous fistula developed in 12 patients. 10% patients required re-surgery after developing various flap related complications Pleural empyema developed in 3 patients. Other minor complications such as neck skin dehiscence and intra-oral flap dehiscence developed in 26 patients. Conclusion: PMMC flap is a versatile flap with an excellent reach to face oral cavity and neck region. With limited expertise and resources, it is still a workhorse flap in head and neck reconstruction.

Context: Oral squamous cell carcinoma (OSCC) is the most common malignancy in India and tobacco and betel nut chewing are well established risk factors. Despite successful campaigns to help people shun this habit in developing countries the incidence has rather gone up and HPV and sexual practices are now definitely implicated for this. Aim: An attempt was made to generate Indian data on role of HPV and sexual practices in relation to OSCC. Settings and Design: A prospective observational study was conducted on 50 patients with oral squamous cell carcinoma. Materials and Methods: Tissue biopsies from fifty patients of oral squamous cell carcinoma (OSCC) were subjected to PCR analysis to look for presence of HPV 16 and 18. Fifty patients with benign lesions were taken as control. Statistical Methods Used: The data was statistically analysed using SPSS version 22 and chi square test. Results: 42% of OSCC patients were found to harbour HPV 16 and 18 whereas only 8% of patients with benign lesions had HPV 16 and 18. A significant number of HPV positive patients i.e. 9 out of 21 gave history of multiple sexual partners and oral sex. Conclusions: This high percentage of HPV in OSCC in an Indian population from a tertiary care centre in north India and its association with prevailing sexual practices is quite significant.

Background Primary cutaneous amoebiasis is a rare clinical entity. The lesions can be successfully treated if suspected and correctly diagnosed. We report an interesting case with review of the literature. Methods A 25-year-old man presenting with primary cutaneous amoebiasis with extensive involvement of the anterior abdominal wall is described. Correct diagnosis eluded us for 2 years. Clinical suspicion and a simple bedside test (wet drop preparation examination) were sufficient to diagnose the lesion. Successful treatment was achieved with oral Metronidazole followed by split skin grafting. Only six cases of primary cutaneous amoebiasis could be traced in the literature. Conclusions Primary cutaneous amoebiasis is extremely rare. Diagnosis is usually not suspected because of its rarity. Cutaneous amoebiasis responds readily to proper treatment, yet, if unrecognized and neglected, produces significant morbidity and may be fatal.

Aniridia (absence of iris) is a congenital, bilateral, uncommon panocular disorder. Whereas the occurrence of aniridia in the general population is 1:50000, it is present in about 1 in 70 patients with Wilm's tumor. This aniridia is sporadic and Wilm's tumor in these cases presents at an unusually early age. Aniridia was present in two cases out of 60 cases of Wilm's tumor operated at PGIMS, Rohtak. Both cases presented below two years of age. The recognition of a child with sporadic aniridia should alert to the increased risk of development of Wilm's tumor.