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Mumbai, India

Laish I.,Beilinson Hospital | Benjaminov O.,Diagnostic Imaging | Morgenstern S.,Histopathology | Greif F.,Surgery A | And 2 more authors.
Transplant Infectious Disease

Infections in transplant recipients are associated with high morbidity and mortality, making their early recognition and treatment particularly important. Abdominal actinomycosis is a rare clinical entity and difficult to diagnose because of its various and nonspecific features. We describe a 57-year-old patient who presented with abdominal actinomycosis simulating colon cancer 6 years after liver transplantation. The main symptom was abdominal pain. Abdominal computed tomography and colonoscopy revealed an intraluminal 4.5 cm mass in the right colon, raising suspicions of a colonic malignancy and leading to surgical intervention. The postoperative pathologic study showed sulfur granules in the resected specimen compatible with abdominal actinomycosis. No signs of recurrence were seen throughout the 6-month follow-up. The literature on actinomycosis infections in immune-compromised hosts is reviewed. This presentation of actinomycosis in a liver transplant recipient has not been described previously, to our knowledge. © 2011 John Wiley & Sons A/S. Source

Cohen P.,Histopathology
Annals of the Royal College of Surgeons of England

This study specifically examined right colonic cancer resection a common operation for colorectal surgeons starting laparoscopic resection to assess the impact of commencing laparoscope A total of 56 patients undergoing open (n = 34) and attempted laparoscopic (n = 22} elective right hemicolectomy for colorectal cancer between November 2003 and March 2007 were compared. Postoperative stay was the primary outcome, Secondary outcomes included analgesic requirements, bowel recovery, morbidity and mortality, Frequency of laparoscopic versus open surgery over time was also examined. Resections attempted laparoseopieally increased from 9.1% to 75% in the first and last quarters of the study period, respectively (P = 0,0002). Uptake of 'enhanced recovery' was mainly in the laparoscopic group. Conversion was required in two of 22 patients, Attempted laparoscopic cases had a shorter median postoperative stay (6 vs 10 days; P < 0.0001), duration of parenteral or epidural analgesia (48 vs 72 h; P< 0.0001} and time to first bowel action (3 vs 4 days; P = 0.001} compared with open cases. Demography, tumour characteristics, morbidity and mortality were comparable between groups. Multivariate analysis identified decreased age, attempted laparoscopic surgery, use of enhanced recovery and absence of complications as independently shortening postoperative stay, Advantages of laparoscopic surgery and enhanced recovery, even early in a surgeon's experience, suggest this is the preferred mode for elective right colon cancer resection. Source

Longcroft-Wheaton G.,Endoscopy | Brown J.,University of Portsmouth | Cowlishaw D.,Histopathology | Higgins B.,University of Portsmouth | Bhandari P.,Endoscopy

Background and study aims: The resolution of endoscopes has increased in recent years. Modern Fujinon colonoscopes have a charge-coupled device (CCD) pixel density of 650000 pixels compared with the 410000 pixel CCD in standard-definition scopes. Acquiring high-definition scopes represents a significant capital investment and their clinical value remains uncertain. The aim of the current study was to investigate the impact of high-definition endoscopes on the in vivo histology prediction of colonic polyps. Patients and methods: Colonoscopy procedures were performed using Fujinon colonoscopes and EPX-4400 processor. Procedures were randomized to be performed using either a standard-definition EC-530 colonoscope or high-definition EC-530 and EC-590 colonoscopes. Polyps of<10mm were assessed using both white light imaging (WLI) and flexible spectral imaging color enhancement (FICE), and the predicted diagnosis was recorded. Polyps were removed and sent for histological analysis by a pathologist who was blinded to the endoscopic diagnosis. The predicted diagnosis was compared with the histology to calculate the accuracy, sensitivity, and specificity of in vivo assessment using either standard- or high-definition scopes. Results: A total of 293 polyps of<10mm were examined-150 polyps using the standard-definition colonoscope and 143 polyps using high-definition colonoscopes. There was no difference in sensitivity, specificity or accuracy between the two scopes when WLI was used (standard vs. high: accuracy 70% [95%CI 62-77] vs. 73% [95%CI 65-80]; P=0.61). When FICE was used, high-definition colonoscopes showed a sensitivity of 93% compared with 83% for standard-definition colonoscopes (P=0.048); specificity was 81% and 82%, respectively. Conclusions: There was no difference between high- and standard-definition colonoscopes when white light was used, but FICE significantly improved the in vivo diagnosis of small polyps when high-definition scopes were used compared with standard definition. © Georg Thieme Verlag KG Stuttgart · New York. Source

Singh V.P.,Surgical Oncology | Mir R.,Surgical Oncology | Kaul S.,Histopathology
Annals of Thoracic Surgery

Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion of the bone characterized by the presence of spongy or multi-loculated cystic tissue filled with blood. It accounts for 2.5% of all bone tumors. An ABC may involve almost any bone, but the most frequent sites are long tubular bones and vertebrae. The sternum is a rare location for an ABC. Here we present a case with sternal ABC, discuss the clinical manifestations and treatment, and review the literature. Radical wide resection of primary sternal tumors and reconstruction with appropriately rigid prosthetic material are necessary to avoid chest wall instability and minimize local recurrence. © 2010 The Society of Thoracic Surgeons. Source

Pillay N.,University College London | Plagnol V.,University College London | Tarpey P.S.,Wellcome Trust Sanger Institute | Lobo S.B.,Histopathology | And 13 more authors.
Nature Genetics

Chordoma is a rare malignant bone tumor that expresses the transcription factor T. We conducted an association study of 40 individuals with chordoma and 358 ancestry-matched controls, with replication in an independent cohort. Whole-exome and Sanger sequencing of T exons showed strong association of the common nonsynonymous SNP rs2305089 with chordoma risk (allelic odds ratio (OR) = 6.1, 95% confidence interval (CI) = 3.1-12.1; P = 4.4 × 10-9), a finding that is exceptional in cancers with a non-Mendelian mode of inheritance. © 2012 Nature America, Inc. All rights reserved. Source

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