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BACKGROUND: The role of leukotriene receptor antagonist is well documented in the management of chronic asthma. However, the efficacy in acute asthma is not yet established. AIM AND OBJECTIVES: This study was designed to evaluate the clinical efficacy of oral montelukast as an add-on drug to the standard therapy of the acute attack of bronchial asthma. MATERIALS AND METHODS: A prospective, institutional-based, single-blinded, randomized control study was done. A total of 100 (aged between 18 and 60 years) participants diagnosed with acute exacerbations due to bronchial asthma were enrolled in the study. They were divided into study and control groups randomly. The study group patients were treated with 10 mg of montelukast once in a day for 4 weeks as an add-on drug, whereas the control group received only standard medication of acute bronchial asthma (as per Global Initiative for Asthma guidelines). All the participants were monitored at baseline to every week for a month. RESULTS: All the 100 participants were assessed finally without any dropouts. The baseline characteristics were noted similarly in both groups. The mean age was 35.46 + 13.17 years in the control and 37.86 + 14.43 years in the study group. Majority were males in both the groups. At the end of the 4 weeks of oral montelukast administration, there was improvement in forced expiratory volume in 1 s (FEV1) and peak expiratory flow rate at 2 weeks and 1 month. On many occasions, there was a strong improvement in FEV1 and other clinical parameters after continuous treatment with beta-2 agonists and parenteral corticosteroids for patients with acute asthma. Even though there was no improvement in FEV1/forced vital capacity ratio among both the groups at 2 weeks and 4 weeks, statistically significant improvement was seen between 2 weeks to 1 month on baseline parameters. CONCLUSION: Administration of oral montelukast 10 mg as an add-on drug to standard therapy may help in quick recovery from acute bronchial asthma and relapse.

Background: High therapeutic dose of theophylline is not tolerated well by some patients. As it is an effective and affordable drug, the effectiveness of low-dose theophylline in pharmacological management of chronic obstructive pulmonary disease (COPD) was assessed. Aim: The aim of this study was to detect the efficacy of low-dose theophylline in COPD patients. Patients and Methods: Patients with stable COPD were enrolled. The complete blood picture (CBP), pulmonary function tests (PFTs), and St. George's Respiratory Questionnaire (SGRQ) were performed at enrolment. Patients were categorized into two groups: subjects and controls. All the participants were given medication for COPD as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. However, subjects were kept on low-dose sustained-release oral drug theophylline (150 mg twice daily) as an add-on. At every follow-up, once every 10 days up to 30 days, their parameters were recorded. The difference between the prognostic biomarkers was analyzed using the Student's “t”-test. Results: The CBP, SGRQ, and PFTs showed improvement in COPD patients treated with low-dose theophylline, i.e., subject group. Even though the PFTs improved in subjects, evidence of COPD remained. Low-dose theophylline may help to improve the quality of life in COPD patients. Conclusion: As a Cost-effective medication, low-dose theophylline can be used as an add-on drug to GOLD guidelines for the treatment of COPD. The subjects may feel better and can lead their normal life even with COPD.

This work deals with the characteristics of LM-13alloy under cyclic stress with and without 63% by weight of SiC-reinforced composite particle reinforcements both cast and tempered at ambient condition. The hardness of the composite sample before and after tempering was 112 HV and 134HV. The tempered sample shows 16.4% increment. UTS of base alloy and the composite was determined to be 165 MPa and 149 and 210, and 145 and 192, respectively. The UTS decreases by 12% in cast state and 8% in tempered condition. The tempered base alloy shows an increment of 21%, and the 0.25% proof stress increased by 28%. After heat treatment, the elongation at the break of the base alloy improved to 3.5%. The tempered specimen shows an increased fatigue performance of approximately 43%. The fatigue life was determined to be about 165 repetitions at the 75 MPa level of stress with 75% of UTS utilization. Decohesion of a silicon particulate interaction and in certain circumstances, the subsequent breakdown of SiC particles has led to fractures in composites. The preheated eutectic silicon that had an almost gain round shape will withstand crack growth development, as the aluminum matrix had a higher cohesive force compared to reinforced SiC particles which provide less strain increase locations. Stronger bonds among silica eutectic and aluminum matrices produced the fracture across their contact, silicon breaks owing to the application of the fatigue load and lead to specimen failure.

Allergic bronchopulmonary aspergillosis (ABPA) is a fungal infection of lung predisposing in long-standing bronchial asthma and cystic fibrosis patients. Due to its similar clinical and radiological findings of other pulmonary diseases such as pulmonary tuberculosis and pneumonia, ABPA is commonly misdiagnosed. The usage of anti-tubercular drugs for ABPA is exploited due to misdiagnosis. We illustrate a case of ABPA, which was misdiagnosed to be pneumonia.

Brain connectivity is studied as a functionally connected network using statistical methods such as measuring correlation or covariance. The non-invasive neuroimaging techniques such as Electroencephalography (EEG) signals are converted to networks by transforming the signals into a Correlation Matrix and analyzing the resulting networks. Here, four learning models, namely, Logistic Regression, Random Forest, Support Vector Machine, and Recurrent Neural Networks (RNN), are implemented on two different types of correlation matrices: Correlation Matrix (static connectivity) and Time-resolved Correlation Matrix (dynamic connectivity), to classify them either on their psychometric assessment or the effect of therapy. These correlation matrices are different from traditional learning techniques in the sense that they incorporate theory-based graph features into the learning models, thus providing novelty to this study. The EEG data used in this study is trail-based/event-related from five different experimental paradigms, of which can be broadly classified as working memory tasks and assessment of emotional states (depression, anxiety, and stress). The classifications based on RNN provided higher accuracy (74–88%) than the other three models (50–78%). Instead of using individual graph features, a Correlation Matrix provides an initial test of the data. When compared with the Time-resolved Correlation Matrix, it offered a 4–5% higher accuracy. The Time-resolved Correlation Matrix is better suited for dynamic studies here; it provides lower accuracy when compared to the Correlation Matrix, a static feature.

The approval of biosimilars requires demonstration of biosimilarity, which rests on the base of thorough analytical characterization of the biosimilar product. In addition to demonstration of biosimilarity, the product related impurities need to be thoroughly characterized and controlled at minimal levels. Pegylation of peptides and proteins creates significant challenges for detailed structural characterization, such as PEG (Poly Ethylene Glycol) heterogeneity, site of addition and number of attached pegylated moieties. A combination of several methods including circular dichroism, FTIR (Fourier-transform Infrared Spectroscopy), fluorescence spectroscopy, DSC (Differential Scanning Calorimetry), 1D and 2D NMR (Nuclear Magnetic Resonance), Edman degradation and peptide mapping by LC-MS (Liquid Chromatography Mass Spectrometry) were used for characterization of N-terminally pegylated filgrastim. Product related impurities such as oxidized, reduced, deamidated, dipegylated variants and monopegylated positional isomers have been characterized in detail using various HPLC (High Performance Liquid Chromatography) based methods and LC-MS techniques. The functional characterization in terms of receptor binding and cell proliferation assay was conducted for the similarity assessment and the potential impact of the product variants on the in vitro biological activity has also been assessed. In summary, this study presents, for the first time, a detailed structural and molecular level characterization of a biosimilar pegfilgrastim providing a strong base for the demonstration of overall biosimilarity of the product with the innovator product.

Competing Interests: There are no conflicts of interest.

Background: Dyshormonogenetic goiter is one of the most common causes of hypothyroidism in children and adolescents in iodine nonendemic areas. The exact genotype-phenotypic correlations (GPCs) and risk categorization of hypothyroid phenotypes of dyshormonogenetic mutations are largely speculative. The genetic studies in pediatric dyshormonogenesis are very sparse from Indian sub-continent. In this context, we analyzed the implications of TPO, NIS , and DUOX2 gene mutations in hypothyroid children with dyshormonogenetic hypothyroidism (DH) from South India., Materials and Methods: This is interdisciplinary prospective study, we employed eight sets of primers and screened for 142 known single nucleotide polymorphisms in TPO , NIS , and DUOX2 genes. The subjects were children and adolescents with hypothyroidism due to dyshormonogenetic goiter. Congenital hypothyroidism, iodine deficiency, and Hashimoto's thyroiditis cases were excluded., Results: We detected nine mutations in 8/22 (36%) children. All the mutations were observed in the intronic regions of NIS gene and none in TPO or DUOX2 genes. Except for bi-allelic, synonymous polymorphism of TPO gene in child number 14, all other mutations were heterozygous in nature. GPCs show that our mutations significantly expressed the phenotypic traits such as overt hypothyroidism, goiter, and existence of family history. Other phenotypic characters such as sex predilection, the age of onset and transitory nature of hypothyroidism were not significantly affected by these mutations., Conclusion: NIS gene mutations alone appears to be most prevalent mutations in DH among South Indian children and these mutations significantly influenced phenotypic expressions such as severity of hypothyroidism, goiter rates, and familial clustering.

Introduction: Posterior mediastinal goitres constitute of a unique surgical thyroid disorder that requires expert management. Occasionally, they require thoracic approach for the completion of thyroidectomy. In this paper, we describe the feasibility and utility of a novel thoracoscopic approach for such goitres., Materials and Methods: This is a retrospective study conducted at a tertiary care endocrine surgery department in South India over a period of 5 years from January 2010 to December 2014. We developed a novel thoracoscopic technique for posterior mediastinal goitres instead of a more morbid thoracotomy or sternotomy. All the clinical, investigative, operative, pathological and follow-up data were collected from our prospectively filled database. Statistical analysis was done with SPSS 15.0 version. Descriptive analysis was done. Operative Technique of Thoracoscopic Thyroidectomy: Single lumen endotracheal tube (SLETT) was used of anaesthetic intubation and general inhalational anaesthesia. Operative decubitus was supine with extension and abduction of the ipsilateral arm. Access to mediastinum was obtained by two working ports in the third and fifth intercostal spaces. Mediastinal extension was dissected thoracoscopically and delivered cervically., Results: Out of 1,446 surgical goitres operated during the study period, 72 (5%) had retrosternal goitre. Also, 27/72 (37.5%) cases had posterior mediastinal extension (PME), out of which 11 cases required thoracic approach. We utilised thoracoscopic technique for these 11 cases. The post-operative course was uneventful with no major morbidity. There was one case of recurrent laryngeal nerve (RLN) injury and hoarseness of voice in the third case. Histopathologies in 10 cases were benign, out of which two had subclinical hyperthyroidism. One case had multifocal papillary microcarcinoma., Conclusions: We opine that novel thoracoscopic technique is a feasibly optimal approach for posterior mediastinal goitre, especially for benign and non-invasive malignant goitres.

Stage IVB thyroid cancer includes carotid encasement or infiltration of the prevertebral fascia and mediastinal vessels. Stage IVB disease is considered unresectable due to grave consequences of attempting resection. We report a rare case of carotid artery engulfment being resected uneventfully without carotid resection.

Single-incision laparoscopic appendectomy seeks to further reduce the trauma of parietal access to abdomen. The challenge of this surgery lies in the compromised ergonomics of instrument movement and triangulation. In this context, a feasibility study of an operative technique of single-incision laparoscopic appendectomy with technical modifications was conducted. This prospective study was carried out in tertiary care teaching institute of a semi-urban area in South India over a period of 1 year from June 2010 to May 2011. Thirty-two patients of acute appendicitis were included in this study. Mean operative time was 56.7 min (40-85 min). Mean age of subjects was 41 ± 15 years. M/F ratio was 2:1. There was no significant peri-operative morbidity or mortality. Mean follow-up period was 8 months. We propose that this technique of single-incision laparoscopic appendectomy using conventional multiport laparoscopic instruments (SILACI) is feasible, safe, and cost-effective.

Background: Hashimoto's thyroiditis (HT) is the commonest cause of acquired hypothyroidism in children and adolescents in iodine non-endemic areas. The genetic analysis in HT shows two types of susceptibility genes-immune regulatory and thyroid specific genes. The exact genotype-phenotypic correlations and risk categorization of hypothyroid phenotypes resulting from these known mutations are largely speculative. The genetic studies in pediatric HT are very sparse from Indian sub-continent. In this context, we analysed the prevalence of TPO, NIS and DUOX2 gene mutations along with genotype-phenotype correlations in hypothyroid children with HT., Methods: This is inter-disciplinary study conducted by collaboration between a tertiary care endocrinology hospital, biochemistry department of a teaching medical institute and genetics lab. In this prospective study, we employed 8 sets of primers and screened for 142 known single nucleotide polymorphisms in TPO, NIS, DUOX2 genes. The subjects were children and adolescents with hypothyroidism due to HT. Congenital hypothyroidism, iodine deficiency and dyshormonogenetic hypothyroidism cases were excluded., Results: We detected 8 mutations in 7/20 (35%) children in the entire cohort (6 in NIS and 2 in TPO genes. No mutations were observed in DUOX2 gene. All our mutations were localized in introns and we found none in exons. Except for bi-allelic, synonymous polymorphism of TPO gene in child No. 18, all other mutations were heterozygous in nature. Genotype-phenotype correlations show that our mutations significantly expressed the presence of associated autoimmune manifestations and existence of family history. Clinical phenotypes of painful thyroiditis, severity of hypothyroidism and absence of goiter were statistically significant in the presence of these mutations. But, they could not reach significance on multivariate analysis., Conclusions: NIS gene followed by TPO mutations appears to be most prevalent mutations in HT amongst South Indian children and these mutations significantly influenced phenotypic expressions such as severity of hypothyroidism, goiter, auto-immune manifestations and family history.

Thyroid surgery is a prototype of operations requiring thorough knowledge of surgical anatomy. There are many vital and delicate anatomical structures such as recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands, and distinct fascial planes surrounding the thyroid gland. A protean range of pathologies such as goiter, nodules, thyroiditis, and malignancy distort or alter the location and course of these structures and planes. The distinct vascular supply and high vascularity of thyroid region challenges the surgeon's expertise. Several pathologies like malignancy, multinodularity, toxicity, and retrosternal extension further compounds this vascular aspect of surgery. Several structures of embryological importance such as pyramidal lobe, tubercle of Zuckerkandl, and ligament of Berry have decisive clinical implications in the surgical management of thyroid disorders. Surgeons attempting thyroidectomy need to have thorough knowledge of embryology and surgical anatomy of the thyroid gland. In this context, we highlight through a pictorial assay the embryological and anatomical aspects of the thyroid gland emphasizing on their clinical and surgical importance.

Laparoscopic and Minimally invasive techniques have become a routine practice for various surgical disorders in present times. Though, advanced laparoscopic procedures are feasible they are largely restricted to fewer centers due to lack of advanced instrumentation, finances and expertise at most of them. In this context, we conducted a feasibility study to evolve definite criteria for performing advanced laparoscopic surgeries in resource restricted set-ups. We present our experience with 25 cases of advanced laparoscopic procedures using conventional laparoscopic instruments. We evaluated the clinico-investigative profile and operative details of all the patients. We classified the surgical expertise, laparoscopic instrumentation, surgical set ups and patient factors systematically to evolve the criteria for feasibility of advanced laparoscopicsurgery. Out of the 22 eligible patients for the study, various laparoscopic surgeries performed were - Fundoplication (4), Cystogastrostomy (3), Endoscopic thyroidectomy (7), Thoracoscopic Thyroidectomy (2), Adrenalectomy (5) and Retroperitoneal paraganglioma excision (1). There was no mortality and two morbidities in the form of hypercarbia and a tracheo-cutaneous fistula in 2 cases of endoscopic thyroidectomy. According to the criteria, we propose our surgical set up falls in to Grade 3, for which this criteria fits in. This study demonstrates the feasibility of advanced laparoscopic procedures in semi-equipped set-up, preferably by employing institute specific criteria of CLASS.

Introduction: A range of minimally invasive endoscopic techniques (gas dependent and gasless) have been attempted for thyroidectomy in the past two decades. In this context, we evaluated the feasibility and safety of our technique of a gasless trans-axillary thyroidectomy., Material and Methods: This retrospective study from the Department of Endocrine and metabolic surgery in Southern India included 15 cases. The details of operative technique, intra and postoperative data were documented in all the cases. Only cases with benign thyroid nodules were included. Exclusion criteria were diffuse toxic goiters (Graves' disease), thyroid cancer, > 6 cm nodules, recurrent goitres and patients with shoulder joint pathology. Statistical analysis was done with SPSS software 12.0 version., Results: F:M -14:2. Mean age of the patient group was 26.4 years (15-52). Mean operative time was 123.4 (82-206) minutes. The only specific complications were induration in the infraclavicular area between axillary incision and thyroid region, prolonged wound drainage and stiffness in lower 3(rd) of sternocleidomastoid. Wound drainage lasted for 5.4 days (4 -8). There was no significant operative morbidity., Conclusion: This gasless trans-axillary technique for nodular goitres is safe and effective in the hands of an experienced thyroid surgeon.

Endoscopic thyroidectomy is fast becoming a reality with increasing experience in endocrine surgery. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, transaxillary, trans-oral, post-auricular, trans-luminal approach have been attempted. At present anterior chest wall or trans-axillary routes are favourite extra-cervical routes. In this context, we describe our operative technique of endoscopic thyroidectomy through chest wall to highlight the surgical steps of practical importance.

Large cystic renal tumours can be confused with hepatic lesions even on crosssectional imaging. Careful clinical, sonographic and imaging analysis is needed for establishing correct diagnosis. We report a case of papillary cystic renal carcinoma in a 60 year old man, which was confused with amoebic liver abcess and was initially drained. Subsequent recurrence of symptoms prompted us to re-evaluate the case and repeat sonography confirmed the extrahepatic origin of mass based on simple observation that the liver and mass were moving separately on inspiration. Later guided aspiration from solid component of the mass confirmed the diagnosis as renal cell carcinoma. He was successfully treated with radical nephrectomy with uneventful post-operative recovery.

We report the surgical management of a case of Zenker's diverticulum in a 64 year old man, complicated by metallic nail penetration and surgical scarring due to previous surgery for cervical vertebral trauma.

Introduction: More reports of single-incision laparoscopic appendectomy are appearing in literature as it is an improvement over multiport laparoscopy in further reducing the trauma to abdomen. But, most of techniques require expensive gadgets like commercial ports and manoeuverable instruments, which are not available at many centres. In this context, a feasibility study of our own operative technique of single-incision laparoscopic appendectomy with less expensive conventional instrumentation was conducted at a single centre., Materials and Methods: This prospective study was carried out in tertiary care teaching institute of a semi-urban area in South India over a period of 1 year from March 2011 to February 2012. Twenty-nine patients of appendicitis were included in this study. Based on the principles of single-incision laparoscopy, we developed a glove port utilizing readily available operation theatre equipment., Results: Mean operative time was 56±12 minutes. Mean age of subjects was 34±15 years. M: F ratio was 2:1. There was no significant perioperative morbidity or mortality. Mean follow-up period was 8 months., Conclusion: Our initial experience with this technique of single-incision laparoscopic appendectomy demonstrates its feasibility, safety at a very low cost.

We report a case of complicated Meckel diverticulum presenting with subacute intestinal obstruction in a 21-year-old man managed successfully by laparoscopic surgery. Despite a diagnostic laparoscopy and laparotomy performed elsewhere in the past, main pathology was missed. Diagnostic laparoscopy in our center revealed a fusiform mass arising from terminal ileum, which was treated by laparoscopic-assisted resection and end-to-end ileo-ileal anastomosis. Gross and microscopic examination revealed an encapsulated localized cocoon containing 40 cm of ileum entangled around an inflamed Meckel diverticulum. His intestinal obstruction and hematochezia got relieved.

Hashimoto's thyroiditis (HT) is usually treated conservatively with thyroxine. Its incidence is higher in Iodine sufficient areas and may require surgery for associated nodularity or complications. A retrospective study on surgically treated HT cases was conducted in a teritiary care teaching hospital in an Iodine sufficient area of Southern India. 34 cases of goiter with associated HT, who underwent thyroidectomy between 2007 and 2010 were analysed for indications of surgery. Minimum follow-up period was 6 months. F:M ratio was 31:3 with mean age of 41.3 years. Goiter was diffuse in 41% and nodular in 59%. 16 (47%) of patients were hypothyroid. Autoimmune association was found in 35%. Commonest surgery done was hemithyroidectomy in 12 (35%) followed by subtotal thyroidectomy in 10 cases. Most frequent indication for surgery was nodular goiter in 12 (35%) followed by associated malignancy, persistent goiter, pressure symptoms and painful thyroiditis. Histopathology showed diffuse HT alone in 12 (35%) and rest of the cases had HT as a component synchronous with other pathologies. Associated pathologies were benign multinodular goiter (6), colloid nodule (6), papillary cancer (5), follicular adenoma (4), cyst (1). Surgery for HT is primarily indicated for associated pathologies like dominant nodule, suspicious or proven malignancy, persistent goiter, painful thyroiditis, pressure symptoms and rarely for HT perse. Rate of surgery for HT associated goiter appears to be higher in Iodine sufficient areas, the cause of which needs to be studied further.

We present a case of Graves' disease with a image of plain radiograph of neck showing bilateral carotid calcifications and briefly discuss the pathophysiology of vascular calcification in Graves' disease.

We report a case of benign multinodular goiter with right sided posterior mediastinal extension managed by a simplified anaesthetic and surgical protocol. Single lumen endotracheal tube was used for intubation. Access to mediastinum was obtained by 2 working ports in 2nd and 4th intercostal spaces. Mediastinal extension is dissected thoracoscopically and delivered cervically. Post operative course was uneventful with no pulmonary and surgical morbidity.

Background: The presentation and outcome of differentiated thyroid carcinoma (DTC) in developing countries are different from the developed nations. We report the clinicopathologic profile and long-term outcome of DTC in an iodine-deficient area (IDA) in a developing country., Methods: This retrospective study included 302 patients with DTC operated between 1989 and 2002. These patients had been followed up for a minimum period of 5 years after surgery. Clinicopathological profile, intervention, and follow-up details were noted., Results: Mean age of the patients was 42 +/- 14 years. Mean follow-up period was 80 +/- 34 (24-196) months. Papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and poorly differentiated thyroid carcinoma (PDTC) was present in 62, 30, and 8% patients, respectively. Mean tumor size was 3.5 cm. Tumor multicentricity was noted in 40% of PTC, 22.2% of FTC, and 25% of PDTC patients. Lymphadenopathy was observed in 45, 10, and 67% patients with PTC, FTC, and PDTC, respectively. Extrathyroidal invasion and distant metastasis were observed in 36.8% (PTC 33%; FTC 36%; PDTC 71%) and 27% (PTC 17%; FTC 44%; PDTC 42%) of cases, respectively. Twenty percent of patients had synchronous metastases. Risk stratification ratio was 1:1.8 (high-risk vs. low-risk). Initial operative procedure was total thyroidectomy in 86.5% cases, and therapeutic lymph node dissection was performed in 37% cases. A total of 77.2% patients received adjuvant radioiodine therapy. Disease recurred in 26.6% of patients (thyroid bed recurrence 1.7%), and 21.2% patients died during follow-up. Overall survival (OS) rate at 10 years in both low-risk and high-risk groups of FTC (80 and 54%) was inferior to PTC (94 and 62%). Five-year OS for PDTC was 50%. Tumor multicentricity was a significant risk factor for OS in the low-risk group, whereas the presence of skeletal metastases and extrathyroidal invasion were significant factors for OS in the high-risk group., Conclusions: Advance stage at presentation and proportionately high rates of FTC and PDTC contribute to poor outcome of DTC in developing countries. Despite dismal outcome, total thyroidectomy seems to prevent thyroid bed recurrence in surviving patients.

Background: The aim of this study was to present our experience of dealing with patients with phyllodes tumours (PT) and to correlate the risk of local recurrence with different clinicopathological factors., Materials and Methods: This was a retrospective study of 25 women with PT, who were managed at our centre between 1991 and 2005. All the available clinical, operative and histological details were retrieved. The median follow-up period was 4 years (range, 1-9 years). Various clinicopathological features were compared between patients who suffered from recurrent tumours to those not experiencing any recurrence., Results: The mean age of the patients was 45 +/- 7 years and the mean duration of symptoms was 30 +/- 10 months. The mean tumour diameter was 10.5 +/- 5 cm. Preoperative diagnosis with fine needle aspiration cytology could be made in 72% of cases. Overall, 39 surgical procedures were performed (14 of which were performed for recurrences). The histology report was benign, borderline and malignant PT in 28%, 20% and 52% of cases respectively. Recurrent tumours were observed in 36% of patients and 16% experienced more than one recurrence. Two patients with malignant PT developed metastases in the follow-up period, and one of them died. Except for the extent of primary surgery, there were no significant differences in other clinicopathological factors between the recurrent and non-recurrent groups. Patients who had wide local excision (WLE) and procedures of greater magnitudes as primary procedures did not experience recurrence (p = 0.008). However, when WLE was performed for recurrent tumours, 50% of patients suffered from recurrence., Conclusion: WLE seems to be the initial procedure of choice for all PTs, and mastectomy for recurrent tumours. Further studies are needed to define the role of adjuvant therapies.

Background: The aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD., Methods: This prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared., Results: The mean age of the patients was 34 +/- 8 years, and the mean length of follow-up was 13.0 +/- 4.2 months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P = 0.001) or a lump (P = 0.01). In all, 39% of hypothyroid women had TSH concentrations >10 mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P = 0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P = 0.144)., Conclusions: All women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.

Background: The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India., Methods: This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis, Results: Mean age of the patients was 46 +/- 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n = 41), and remaining by CT scan (n = 10), and MRI (n = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%)., Conclusion: In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.

Introduction: Adrenal cysts are rare clinical entities. We report our institutional experience with adrenal cysts and also assess various management options., Material and Methods: Over the past 15 years the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, has had seven cases of adrenal cysts, of which two were functional: one patient had Cushing's syndrome and the other patient had pheochromocytoma. The other five cases were incidentally detected. Ultrasound scan and computerized tomography (CT) scan were the imaging modalities. Four patients had a single cyst, two patients had two cysts, and one patient had multiple unilateral cysts., Results: None of these cysts had foci of malignancy. Laparoscopic adrenalectomy was possible in three patients with no morbidity or mortality., Discussion: The reported incidence in clinical series has been 5.4%. Pseudocysts, endothelial cysts, epithelial cysts, and hemorrhagic cysts have been commonly described. The management can be conservative or surgical. It is generally agreed that a hormonal work-up is necessary in all cases of adrenal cysts to rule out a sub-clinical disease. Adrenal neoplasms, including adrenocortical carcinomas, can be associated with cysts that are benign in appearance. Percutaneous aspiration has been suggested as an alternative treatment option if the cyst is not hormonally active and if there is no suspicion of malignancy. However, surgical excision provides a definite histopathological diagnosis and also removes the fear of future complications such as hemorrhage into the cyst and local pressure effects due to the tumor., Conclusions: Given that the adrenals are a vascular gland and taking into consideration the possibilities of bleeding and complications in the cyst, our treatment of choice is the elective excision of adrenal cysts.