Abstract Overview Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD.

ABSTRACT Langerhans cell histiocytosis (LCH), a disorder of antigen-presenting cells, is the commonest disorder of the mononuclear phagocytic system. Diagnosis is always challenging due to heterogeneous clinical presentation. However, with the evolution and better understanding of its biology, many of these children are being diagnosed early and offered appropriate therapy. Despite these advances, in developing countries, an early diagnosis is still challenging due to resource constraints for specialized tests. As a result, many patients succumb to their disease. Autopsy data on LCH is notably lacking in the literature. We sought to analyze the clinical (including mutational) and morphologic features at autopsy in six proven cases of LCH. This study includes a detailed clinico-pathological and mutational analysis of 6 proven cases of LCH. Presence of BRAF V600E mutation was assessed by both Real Time PCR and Sanger sequencing. A varied spectrum of organ involvement was noted with some rare and novel morphological findings, like nodular bronchiolocentric infiltration of LCH cells, lymphovascular emboli of LCH cells, and paucity of eosinophils within the infiltrate; these features have not been described earlier. Surprisingly, all cases were negative for BRAF V600E mutation on both RQ-PCR and Sanger sequencing. The present study is perhaps the first autopsy series on LCH. This extensive autopsy analysis represents a correlation of pathological features with clinical symptoms which provides clues for a timely diagnosis and appropriate therapeutic intervention. Also, our findings hint at the low frequency of BRAF V600E mutation in our LCH patients.

RESUMO CONTEXTO: A pancreatite aguda é uma desordem comum na prática médica. Nos últimos tempos, sua gestão mudou drasticamente com a maioria das decisões tomadas baseadas na gravidade da doença, como administração de antibióticos intravenosos, sucção negativa com o tubo de Ryle ou intervenções cirúrgicas como necrosectomia, etc. Há diferentes escores em uso para avaliar a gravidade da doença, mas a eficácia relativa manteve-se um assunto discutível. OBJETIVO: O presente estudo foi assim realizado para investigar a acurácia preditiva de diferentes sistemas de pontuação na pancreatite aguda. MÉTODOS: Foram selecionados 50 pacientes com pancreatite aguda admitidos na enfermaria de medicina de Pt. B.D. Sharma PGIMS, Rohtak, Índia, e foram considerados para estudo após o cumprimento dos critérios de elegibilidade. Estes pacientes foram investigados na admissão e seguidos prospectivamente. A severidade da pancreatitie foi classificada para cada um destes pacientes pelo sistema de classificação Atlanta revisado. Os sistemas de pontuação comumente usados pertencentes à pancreatite aguda, ou seja, BISAP, Ranson, APACHE II e CTSI modificado foram calculados. Posteriormente, esses escores foram correlacionados com a severidade, presença de falência de órgãos, ocorrência de complicações locais e desfecho final dos pacientes. RESULTADOS: Dos 50 pacientes, a ingestão crônica de álcool foi a etiologia em todos, exceto em um com pancreatite idiopática. A média de idade da população estudada foi de 42,6±13,27 anos. Destes pacientes, 32% apresentavam necrose pancreática, 40% apresentavam coleções peripancreáticas, 56% apresentavam pancreatite aguda leve, 24% apresentavam pancreatite aguda moderadamente grave, enquanto 20% apresentavam pancreatite aguda grave. O APACHE II teve maior precisão em prever a severidade, a falha do órgão e resultados fatais. No que diz respeito a esses parâmetros, os valores preditivos negativos do escore BISAP também foram consideráveis. A contagem modificada de CTSI foi exata em prever complicações locais, mas teve a exatidão limitada em outras predições. CONCLUSÃO: O APACHE II emergiu como o sistema de pontuação mais confiável seguido por BISAP e Ranson na gestão dos pacientes com pancreatite aguda. Mas em condicionantes do tempo e dos recursos, mesmo a Pontuação do BISAP com seus valores preditivos negativos significativos, serviu como uma ferramenta valiosa para avaliar e administrar esses pacientes.

ABSTRACT BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle’s tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.