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Objectives: The study was aimed to assess the epidemiological profile and patient characteristics, various morphological patterns of posterior reversible encephalopathy syndrome (PRES) on MRI and various pathophysiological mechanisms on MR perfusion. Methods: It was a prospective and observational study done over a total of 40 patients. Standard sequences included T1 and T2-weighted sequences, FLAIR, DWI, SWI and MR perfusion. Results: Females were affected predominantly with F:M ratio of 12:1. The commonest age group affected was between 20-40 years. The most common symptom was headache. The commonest etiology being pregnancy induced(37.5%).Hypertension was reported in 70%,out of which 37.5% included pregnancy induced hypertension. The commonest region involved was occipital lobe seen in 85% of patients. Atypical PRES was seen in 42.5% of patients in the form of involvement of atypical locations; basal ganglia 10%, thalami 2.5% and cerebellum 2.5%; diffusion restriction 12.5% and hemorrhage 22.5%, out of which 10% had subarachnoid hemorrhage,10% has intraparenchymal hematoma and 2.5% had minute focal hemorrhage. rCBV and rCBF was decreased in 82.5% of patients and unchanged in 12.5% of the total number of patients supporting the hypoperfusion theory. Conclusion: PRES predominantly involves female, hypertension is seen in most of the patients. The commonest lobes involved are the occipital and parietal lobes; however the incidence of atypical PRES is also seen in a significant number of patients. The basic pathophysiological mechanism is hypoperfusion.

Introduction: Renal Cell Carcinoma (RCC), a highly vascular tumor may present with rare metastasis at initial presentation. Synchronous breast metastasis from clear cell renal cell carcinoma is very rare and correlates with poor prognosis. In absence of any renal complaints, a breast lump can mimic a primary breast carcinoma or benign breast disease. A 55-year-old fema Case History: le, presented with a swelling in the right breast. Physical examination was suggestive of a benign swelling in view of well-dened margins, no lymphadenopathy, no skin changes. Fine needle aspiration cytology was done twice and was inconclusive. Tru-Cut biopsy revealed metastatic RCC. Mammography showed BIRADS-IV lesion and PET-CT revealed oligometastatic disease with breast and a small solitary lung metastasis. The patient underwent simultaneous right cytoreductive nephrectomy and lumpectomy. Early detection and surgical resecti Conclusion: on of limited metastatic disease is important, as the treatment instituted at an earlier stage when it is amenable to surgical resection improves the survival considerably

Background: Renal cell carcinoma with isolated metastasis to the parotid gland is extremely rare. Slow growth, low level of suspicion and negative Fine needle aspiration cytology (FNAC) often delay the diagnosis. A high level of suspicion of metastatic disease from a specic site is important, otherwise can be missed for a benign swelling leading to delayed treatment and poorer prognosis. A 59-year-old Case presentation: male presented with a swelling in the right preauricular area 5 years post right radical nephrectomy for right renal cell carcinoma (RCC). The examination was suggestive of a benign swelling. FNAC was done twice, which was inconclusive. A Tru-cut biopsy of the lesion revealed metastatic RCC. MRI revealed a dumbbell type of tumor extending deep into the gland and encasing vessels. PET-CT was negative for metastasis to the rest of the body. The patient received targeted therapy followed by radiation therapy with imaging showing non-progression of the disease. Conclusion: Metastatic disease should be considered whenever a parotid mass is detected in patients with an RCC history. Examination ndings can be misleading; hence dedicated imaging is critical. Small parotid metastasis can be cured with surgery. A combination of chemotherapy and radiation therapy can palliate the unresectable disease.

Introduction Laser therapy provides an alternative option for treating non-muscle-invasive bladder cancer. The clinical evidence for potassium-titanyl-phosphate (KTP) laser en bloc resection is still limited. Here, we evaluated the efficacy, safety profile, and outcomes of side-firing KTP laser enucleation with bipolar transurethral resection of bladder tumor (TURBT) in carefully selected patients with small bladder tumors in an office setting. Material and methods A total of 83 patients with small bladder tumors were treated with either side-firing KTP laser enucleation (Group A; n = 40) or bipolar TURBT (Group B; n = 43). Intraoperative and postoperative parameters of interest were recorded and analyzed as per the study so as to evaluate the efficacy, safety profile, and outcome of KTP laser enucleation. Results The mean enucleation time was 23 ±5.24 min in Group A and the mean operative time was 21.98 ±4.77 min in Group B (p = 0.207). Group A had a lower risk of obturator reflex (0 vs 8; p = 0.005) and lesser amount of irrigation used intraoperatively as compared to Group B (6.2 ±0.61 L vs 7.65 ±0.75 L; p

The major disadvantage of radical perineal prostatectomy (RPP) is the difficulty to perform pelvic lymphadenectomy via the same incision. Open retropubic, mini laparotomy, and transperitoneal laparoscopic pelvic lymphadenectomy as an adjunct to open RPP have been tried but need change in patient position and separate incision, thereby decreasing the acceptability of this procedure. Open RPP followed by a lap perineal pelvic lymphadenectomy via the same perineal incision is a hybrid technique that is aimed to decrease morbidity of lymphadenectomy.Patients of low and intermediate risk localized carcinoma prostate with a Partin score of5% were taken for this procedure. After completing prostatectomy part of RPP, lap perineal pelvic lymphadenectomy was performed via same incision using single incision laparoscopic surgery port.We performed this new hybrid technique in eight patients. Bilateral lymph node dissection required an additional mean time of 35 minutes. A total of 68 nodes were retrieved from eight patients with a median number of eight nodes (range: 6-12). None of our cases had any complications related to lymphadenectomy. Bilateral lymph node dissection was feasible in seven patients, and in one patient, it could be done on one side only.Sandwiching lap perineal pelvic lymphadenectomy between prostatectomy part of RPP and urethra-vesical anastomosis (by open approach) is a safe, reproducible, and feasible approach to pelvic lymphadenectomy compared to lymphadenectomy from other routes with simultaneous reduction in the operative time, patient morbidity, and discomfort. Ease of doing lymphadenectomy from same incision can increase the acceptability of this excellent procedure.