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· WEEKLY BULLETIN OF SURGERY AND ALLIED SPECIALITIES· ISSUE XII
SMART KNIFE SNIFFS OUT CANCER CELLS THE TRIVIA Breast cancer is the commonest cancer in women, with the fifth highest THEATRE mortality rates worldwide. Breast conserving surgery (BCS) is the most commonly performed surgical technique for the treatment of women with early-stage breast cancer. Over a fifth of patients undergoing BCS require re- operation for inadequate margins. Positive resection margin following BCS UNBELIEVABLE STORY BEHIND more than doubles the chance of ipsilateral breast tumor regional recurrence THE INVENTION OF CARDIAC (IBTR). CATHETERIZATION Re-operative intervention is associated with greater patient anxiety, impaired cosmesis, a higher incidence of post-operative wound complications, delay Imagine a cardiologist considering receipt of adjuvant therapies and increases healthcare costs. Intraoperative ureteric catheter to perform cardiac margin assessment (IMA) techniques like frozen section and cytology, catheterization. Unbelievable, specimen radiology (SR) and intraoperative ultrasound (IOUS) aim to provide impossible! However, it took all the courage and determination of a the surgeon with actionable information about margin status in the midst of young surgery resident to try this to the index procedure to reduce the need for re-operation. However, the achieve one of clinical cardiology’s limitations of pathological techniques, including slow turnaround times, greatest advances. The name of that manpower requirements, and the potential for false positive interpretation, resident was Werner Forssmann and have limited international adoption & compared to pathological techniques he did it in 1929. Specimen radiology and IOUS have inferior accuracy.
Rapid evaporative ionization mass spectrometry (REIMS) is an ambient ionization technique that utilizes the aerosol by-product of electrosurgical Werner Forssmann saw a picture in a book showing how a tube was (Bovie) tools. The electrosurgical process of cutting or coagulating tissue inserted into the heart of a horse causes heat to dissipate inside the tissue resulting in release of cellular content through a vein. A balloon at the to the gas phase. Aspiration of the aerosol allows for rapid mass spectrometric other end of the tube showed chemical analysis and computational algorithms can “learn” (cf. ‘machine- changes in pressure. He was learning’) to recognize the chemical differences between tissue types. The convinced that a similar experiment technology can identify tissue characteristics within a few seconds of could be carried out on people and electrosurgical activation. was determined to prove his hypothesis that Cardiac The REIMS system or intelligent knife (iKnife), capable of providing intuitive Catheterization wasn’t as lethal as feedback on real-time tissue characterization at the point of dissection, offers everyone thought it was. a potential solution. One day, he persuaded a nurse to unlock the medical supply room for Dept of General Surgery, AFMC, Pune. him, and asked her to assist him with April 09,2021 Pg. 1
SURPRISING MACULOPATHY: AN an experiment. Unaware of his plans, the nurse agreed. She laid down on a UNEXPECTED PRESENTATION OF COVID bed in the supply room — and then A 42-year-old male presented with decreased vision in both eyes for six days. He had a Forssmann surprised her, he tied her history of fever with sore throat 12 days ago and was diagnosed positive for COVID-19, to it. Forssmann pulled out a treated in hospital for the next 10 days with supportive therapy, and was discharged Catheter and inserted the tube into after RT-PCR tested negative. On ocular examination, best-corrected visual acuity was his own arm. With the tube still in his RE: 6/18 and LE: 6/24. Fundus examination revealed multiple, yellowish, refractile veins, Forssmann rushed out from deposits in the foveal centre of both eyes (RE>LE), with absence of any superficial or the supply room and climbed up one deep retinal hemorrhages at the macula or outside retinal vascular arcades. floor, to a room with an X ray machine. He took X ray images of Spectral domain optical coherence tomography (SD-OCT) showed increased hypo- himself, and used the images to reflectivity and highly refractile deposits at the foveal centre with normal foveal guide the catheter through his veins contour, consistent with foveolitis. Posterior segmental involvement is usually seen 1– right up to his heart, a distance of 4 weeks following the onset of fever in majority of viral diseases, as also seen in around two feet. present case, this points towards immune-mediated pathogenesis for foveolitis. Fundus fluorescein angiography (FFA) revealed no leakage or any hyper fluorescence in both eyes. Hence, diagnosis of maculopathy secondary to COVID-19 infection was made. Systemic workups for vasculitis as well as ischemic causes of maculopathy were unremarkable. In view of a probable immune-mediated etiology and corticosteroid being the mainstay of the treatment, the patient was prescribed oral steroids on weekly tapering dosages. The best-corrected visual acuity improved to RE: 6/9 and LE: 6/12 at four weeks.
Multiple ophthalmic complications of COVID-19 have been reported, with This experiment paved the way for conjunctivitis being most commonly seen. Despite the emergence of new data and an invasive study of cardiac anatomy ongoing increase in understanding of the disease, there are several ocular features and and function. related complications of COVID-19 disease that remain unknown. Clinicians need to be vigilant for the presence of such potential ocular manifestations as the likely presentation of COVID-19 disease.
Dept. of Ophthalmology, AFMC Pune
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unusual case of dermoid cyst Q-RIOSITY 1.Hyperacusis in Bell’s palsy is due to invading in to the uterus paralysis of following muscle: a) Tensor tympani A 29 years old lady, P1L1A3, a known case of dermoid cyst under evaluation for last 7 b) Levator palatini months, presented with complaints of passing tooth-like structures per vaginally during c) Tensor veli palatini her menses. There was no history of pain abdomen, vomiting or fever. General d) Stapedius examination revealed pallor and no abnormalities were detected on abdominal examination. 2.A 17 yrs. Old male presented with swelling in the cheek with recurrent CECT abdomen and pelvis showed that the anterior part of the cyst was invading the epistaxis. Most likely diagnosis is: posterior wall of the bladder, while the posterior part of the cyst was invading the a) Angiofibroma myometrium at the fundus and cervico-uterine junction, thus indicating the presence of b) Carcinoma nasopharynx a fistulous communication. This was subsequently confirmed by hysteroscopy and the c) Rhabdomyosarcoma uterus was found to be filled with hair and teeth. d) Ethmoid polyp
3.A 10 yrs. old child presented with history of chronic sinusitis and multiple nasal polypi. He also suffers from recurrent chest infections and malabsorption syndrome. Which one of the following tests would be useful for diagnosis: a) Total IgE estimation b) ESR c) Level of angiotensin converting enzyme d) Sweat chloride test
4.Horner’s syndrome consist of all of the following features except: a) Ptosis Hysteroscopy showing tooth and hair Tooth passed during menses b) Dilated pupil
C) Anhidrosis d) Endophthalmos The patient underwent exploratory laparotomy, followed by left salpingo- hhair 5.Spontaneous perforation of the oophorectomy and hysterotomy. Cyst was esophagus as a result of severe sent for frozen section and was negative barotrauma while a person vomits for malignancy. There was no fistulous against closed glottis is known as: connection with urinary bladder on check a) Mallory- Weiss syndrome cystoscopy. Subsequent HPE report b) Plummer- Wilson syndrome confirmed the absence of malignancy. She c) Kartagener syndrome recovered after a stormy post-operative d) Boerhaave syndrome period.
Answers can be emailed to [email protected]. Names A dermoid cyst is a teratoma of cystic of the top 3 people who answer nature that contains an array of correctly will be published in the developmentally mature, solid tissues. It next issue along with the answer key. CECT showing dermoid cyst (red arrow) frequently consists of skin, hair follicles, and tooth inside uterus (yellow arrow) and sweat glands, while other commonly Winners of the previous quiz: found components include clumps of long hair, pockets of sebum, blood, fat, bone, 1. Maj R B Yadav (Gd Spl Surgery) nail, teeth, eyes, cartilage, and thyroid tissue. Dermoid cysts may occur anywhere in 2. SLC Apphia Saphir (OBG resident) the body, but most predominant site is ovary. The present case is an unusual 3. Dr. Pahaul Sekhon (ENT resident) presentation of dermoid cyst in the form of a fistula and invading in to the uterus leading to passing out of tooth like structures per vaginally during menstruation. Answer key: 1. b 2. b 3. b 4. a 5. a Dept of Obstetrics and Gynecology, AFMC, Pune.
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