Port-site metastasis (PSM) is often encountered during laparoscopic surgery in patients with malignancy. We report a 45-year-old woman who presented with a single PSM from papillary adenocarcinoma after undergoing laparoscopic cholecystectomy for calculus cholecystitis. Post cholecystectomy, a diagnosis of chronic cholecystitis was confirmed on histopathology. The patient presented with a mass at the site of epigastric port 28 months after surgery. PSM was suspected on clinical examination, which was supported by findings on computed tomography and further confirmed by fine-needle aspiration cytology of the lump. The patient underwent surgical clearance of the mass, and histopathological examination proved the lesion to be papillary adenocarcinoma. The site of the primary tumour was not detected even after thorough examination. Based on the histopathology report following local surgical clearance, the patient was started on chemotherapy. This case is unusual because of the long delay prior to the presentation of PSM and the unknown primary malignancy.
Adenocarcinoma ; diagnosis ; surgery ; Biopsy, Fine-Needle ; Cholecystectomy, Laparoscopic ; adverse effects ; Cholecystitis ; surgery ; Female ; Gastrointestinal Neoplasms ; diagnosis ; surgery ; Humans ; Laparoscopy ; adverse effects ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Unknown Primary ; diagnosis ; surgery ; Tomography, X-Ray Computed

Background: This study aimed to determine: (1) the perspectives of the patient cohort that underwent telehealth consultation and shoulderrehabilitation during coronavirus disease 2019 (COVID-19) and the differences in the patients’ perspectives with the two different telehealth video applications (apps) used in the study. Methods: This is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patientsfrom the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom orWhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtualconsultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained fromthe TUQ were the primary outcome measure. Results: The study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20–77 years). The patientswho contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in thestudy. The average TUQ score was 13.6 (median, 14.5; range, 6–21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than theWhatsApp app (median, 8.5; average, 9.6) (p=0.004). Conclusions Patients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth apps with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.

Background: This study aimed to determine: (1) the perspectives of the patient cohort that underwent telehealth consultation and shoulderrehabilitation during coronavirus disease 2019 (COVID-19) and the differences in the patients’ perspectives with the two different telehealth video applications (apps) used in the study. Methods: This is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patientsfrom the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom orWhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtualconsultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained fromthe TUQ were the primary outcome measure. Results: The study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20–77 years). The patientswho contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in thestudy. The average TUQ score was 13.6 (median, 14.5; range, 6–21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than theWhatsApp app (median, 8.5; average, 9.6) (p=0.004). Conclusions Patients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth apps with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.

An improved high performance liquid chromatography–tandem mass spectrometry (LC–MS/MS) method has been developed for sensitive and rapid determination of albendazole (ABZ) and its active metabolite, albendazole sulfoxide (ABZSO), in the positive ionization mode. The method utilized solid phase ex-traction (SPE) for sample preparation of the analytes and their deuterated internal standards (ISs) from 100 mL human plasma. The chromatography was carried out on Hypurity C18 column using acetonitrile-2.0 mM ammonium acetate, pH 5.0 (80:20, v/v) as the mobile phase. The assay exhibited a linear re-sponse over the concentration range of 0.200–50.0 ng/mL for ABZ and 3.00–600 ng/mL for ABZSO. The recoveries of the analytes and ISs ranged from 86.03%–89.66% and 89.85%–98.94%, respectively. Matrix effect, expressed as IS-normalized matrix factors, ranged from 0.985 to 1.042 for the both analytes. The method was successfully applied for two separate studies in healthy subjects using single dose of 400 mg conventional tablets and 400 mg chewable ABZ tablets, respectively.

The present study describes a simple, reliable and reproducible liquid chromatography–tandem mass spectro-metry method (LC–MS/MS) for the simultaneous determination of allopurinol and its active metabolite, oxypurinol in human plasma for a pharmacokinetic/bioequivalence study. After protein precipitation (PPT) of 100 μL plasma sample with 1.0%formic acid in acetonitrile, the recovery of the analytes and allopurinol-d2 as an internal standard ranged from 85.36% to 91.20%. The analytes were separated on Hypersil Gold (150 mm×4.6 mm, 5 μm) column using 0.1% formic acid-acetonitrile (98:2, v/v) as the mobile phase. Quantification was done using electrospray ionization in the positive mode. The calibration concentration range was established from 60.0 to 6000 ng/mL for allopurinol and 80.0–8000 ng/mL for oxypurinol. Matrix effect in human plasma, expressed as IS-normalized matrix factors ranged from 1.003 to 1.030 for both the analytes. The developed method was found suitable for a clinical study with 300 mg allopurinol tablet formulation in healthy subjects.

A highly sensitive and selective high performance liquid chromatography–tandem mass spectrometry method was developed and validated for the quantification of alverine (ALV) and its active metabolite, para hydroxy alverine (PHA), in human plasma. For sample preparation, solid phase extraction of analytes was performed on Phenomenex Strata-X cartridges using alverine-d5 as the internal standard. The analytes were separated on Symmetry Shield RP18 (150 mm×3.9 mm, 5 μm) column with a mobile phase consisting of acetonitrile and 10 mM ammonium formate (65:35, v/v). Detection and quantitation was done by electrospray ionization mass spectrometry in the positive mode using multiple reaction monitoring. The assay method was fully validated over the concentration range of 15.0–15,000 pg/mL for ALV and 30.0–15,000 pg/mL for PHA. The intra-day and inter-day accuracy and precision (%CV) ranged from 94.00%to 96.00%and 0.48%to 4.15%for both the analytes. The mean recovery obtained for ALV and PHA was 80.59% and 81.26%, respectively. Matrix effect, expressed as IS-normalized matrix factor ranged from 0.982 to 1.009 for both the analytes. The application of the method was demonstrated for the specific analysis of ALV and PHA for a bioequivalence study in 52 healthy subjects using 120 mg ALV capsules. The assay reproducibility was also verified by reanalysis of 175 incurred subject samples.

This study aimed to systematically review the effectiveness of methylene blue (MB) photosensitizers in the management of symptomatic oral lichen planus (OLP). Electronic online databases and manual searches were performed for randomized controlled trials (RCTs) published in English between January 2010 and February 2022. RCTs comparing photodynamic therapy (PDT) and corticosteroid therapy at baseline and follow-up period were identified. The Cochrane risk of bias tool was used to assess the quality of the included studies. A meta-analysis was performed regarding visual analog scale (VAS) scores, Thongprasom sign scores, lesion size, response to treatment, and exacerbation of lesions after therapy. The clinical severity was analyzed qualitatively. Five RCTs consisting of 180 samples fulfilled the inclusion and exclusion criteria. All parameters of VAS score, Thongprasom sign score, lesion size, and response to treatment were statistically non-significant. Our results indicate that both MB-PDT and corticosteroid therapy are effective for the management of OLP. Moreover, MB-PDT is an effective alternative treatment option for OLP when corticosteroids are contraindicated. However, conclusive evidence cannot be ascertained owing to the heterogeneity among the studies.

Primary lymphoma of the breast is a rare occurrence because of the paucity of lymphoid tissue in the breast and is an even rarer entity in the male breast. Imaging, along with tissue diagnosis goes a long way in diagnosing breast lymphoma which has a significantly different management scheme than other breast neoplasms with respect to radio-chemotherapy rather than surgical resection. We present a case of primary male breast lymphoma which was evaluated with magnetic resonance imaging as well as other conventional imaging modalities and was treated by chemotherapy with a 7-month follow-up.
Breast ; Breast Neoplasms ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Lymphoma ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male

It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures.
Anesthesia ; Atlanto-Axial Joint ; Dislocations* ; Follow-Up Studies ; Humans ; Odontoid Process ; Spinal Cord Diseases ; Traction