Vesicouterine fistula (VUF) with cyclical hematuria, amenorrhea, and urinary continence is a rare condition referred to as Youssef's syndrome. It is most commonly observed after caesarean section (C/S) due to iatrogenic reasons. Open surgical management (transabdominal) has good results as it involves excision of the tract. We report a case of a VUF which developed after a repeat C/S and was successfully repaired with interposed vesico-peritoneal fold. Strict adherence to obstetric and surgical principles during Caesarean section can prevent formation of these fistulae.

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Acute appendicitis may mimic several acute abdominal conditions. In perforated peptic ulcer disease, the contents may track down the right iliac fossa to mimic the presentation of acute appendicitis. The objective of this study was to highlight the diagnostic dilemma encountered in differentiating perforated peptic ulcer (with gastric contents tracking into the right iliac fossa) and acute appendicitis. We present the case of a 45-year old man who had appendicectomy in a private medical center and later developed features of generalized peritonitis 10 days after surgery. Following a diagnosis of postoperative peritonitis, exploratory laparotomy was carried out, which revealed perforated gastric ulcer. The perforation was repaired and peritoneal lavage was done. He made an uneventful recovery and was discharged after 3 weeks on admission. Perforated peptic ulcer could mimic acute appendicitis. A high index of suspicion is vital in differentiating both conditions, to prevent the morbidity and mortality resulting from misdiagnosis.

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Congenital duodenal obstruction is one of the common causes of intestinal obstruction in neonates. They are usually due to duodenal atresia, malrotation of gut and annular pancreas. The combination of duodenal web with annular pancreas is very rare. We are presenting a case of congenital duodenal obstruction in a patient having both duodenal web and annular pancreas. A transverse incision on the duodenum was made and a duodenal web partially obstructing the lumen between its first and second part was confirmed. A longitudinal incision over the distal collapsed part of duodenum and Kimura's diamond-shaped duodeno-duodenostomy was done over a transgastric transanastomotic feeding jejunostomy. Baby did well postoperatively and was discharged in stable condition.

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Association between gallstone disease and iron deficiency anemia is not uncommon. The objective of this study was to assess correlation between gallstone formation and iron deficiency anemia in patients presenting with gallstone disease. Materials and Methods: A total of 60 patients' sonological evidence of gallstone were included in the study. Serum ferritin and serum iron levels were estimated. Gallstone patients were divided into anemic and non-anemic groups and compared with each other. Data were analyzed with descriptive statistical principles. Patients and Methods: Chi-square test or Fisher's exact test , Yates correction, independent t-test or Mann–Whitney U test. Results: There was significant association between serum iron and hemoglobin levels in patients with gallstone disease. This study suggests that iron deficiency leading to anemia plays a significant role in super saturation of bile, leading to stone formation in the gall bladder. Conclusions: Low serum iron and ferritin levels were found to be statistically significant in gallstone patients. Significant correlation found between iron deficiency and gallstone disease. Iron deficiency and low serum ferritin are probably independent risk factors operating for the causation of gallstones.

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Composite hemangioendothelioma (CHE) is a recently described new entity classified under the hemangioendothelioma group of vascular tumors. It is a rare vascular neoplasm of low malignancy that exhibits a composite of hemangioendothelioma variants which was first described in 2000 by Nayler et al. It is a complex heterogenous vascular tumor with infiltrative margins. We report a case of CHE of the scalp with spindle cell hemangioma-like areas comprising 10% of tumor, papillary intralymphatic angioendothelioma (Dabska) comprising 70% of tumor, and retiform hemangioendothelioma-like areas comprising 20% in a 9-year-old boy who presented with a 2 × 2 × 2 cm scalp mass on the parietal area with no regional lymph node metastasis. Immunohistochemical stain was positive for CD34 and vimentin in the all areas, and EMA was negative in all areas of tumor. Mitosis was less than 2 per 10 high-power fields.

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Sebaceous horn or cutaneous horn, a rare clinical entity, is a dense hyperkeratotic protrusion or growth composed of keratin that projects above the surface of the skin. We report a unique case of a giant sebaceous horn at left flank in a 64-year-old female developed on an old burn scar, which was successfully excised and reconstructed. Histopathological examination confirmed the presence of an underlying cutaneous horn in the setting of verruca vulgaris. Cutaneous horns mostly occur in sun-exposed areas and are typically found on the face and scalp, but may arise from any part of the body. They are thought to result from underlying benign, premalignant, or malignant pathology.

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Background: Transitional cell carcinoma (TCC) is the most prevalent, singly accounting for 90% of all bladder cancer cases. Various markers involved in cell cycle but none of them proven its capacity as a prognostic indicator. The discovery of new biological markers may lead to early clinical prediction and may help in individualization of therapeutic approach in management of bladder cancer patients. The human epidermal growth factor receptors (EGFRs) – HER2/neu play a role in neoplastic cell growth and its role proven in breast and ovarian cancer while its role in bladder cancer still not explored its potential. Bladder cancer incidence is higher in male as compared to female. This gender related difference is still not clear in humans while it is proven in animal studies. In this study, we investigated the potential role and association of HER2/neu and androgen receptors (ARs) in etiology and prognosis of TCC. Patients and Methods: The study included 20 histopathologically confirmed cases of TCC of urinary bladder attending the Department of General Surgery, KGMU, Lucknow and 20 healthy individuals were taken as control. Immunohistochemical analysis for AR and HER2/neu receptor was done using paraffin-embedded tissue blocks treated with monoclonal mouse anti-human antibodies against AR and HER2/neu receptor, respectively. Results: HER2/neu over expression was observed in 14 (73%) of which 12 were males and 2 were females. Among these 16.7%, 33.3%, and 37.5% cases were in Grade I, II, and III, respectively. The AR overexpression was observed in 4 (20%) of which all were males. About 16.7% and 27.3% cases were in Grade II and III, respectively. Peak incidence was observed in the age group of 50–70 years (75%). Conclusions: We conclude that HER2/neu and AR can be considered as bad prognostic factor in TCC. These results suggested that targeting AR and HER2/neu may provide novel chemopreventive and therapeutic approaches for the management of bladder cancer.

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Background: Published reports indicate that clinicopathologic profile of colorectal cancer (CRC) in Africa is different from that of the developed world. This study investigates microsatellite instability (MSI) status of CRC in relation to clinicopathologic profiles of our patients. Patients and Methods: This was a 2 year (2014-15) retrospective study of CRCs diagnosed at the pathology department of a tertiary hospital. Relevant bio-data of the CRC cases (age, sex and site) were obtained from records. Immunohistochemistry for MLH1 and MSH2 were done on corresponding archived CRC tissue blocks. The results were analyzed with SPSS software and presented in tabular form. Correlations between MSI tumours and clinicopathologic features were done using Fishers exact test (P < 0.05). Results: 53 cases of CRC comprised 37 (69.8%) males and 16 (30.2%) females with a M:F ratio of 2.3:1. The average age of patients was 45.0±15.3 years. Of the 53 cases, 28 (52.8%) exhibited MSI. M:F ratio for MSI CRCs was 3:1. Patients ≤50 years comprised 67.9% (19/28cases) of MSI CRCs (P > 0.05). MSI was detected in 80% of poorly differentiated and 60% of mucinous carcinoma. MSI tumours were mostly located in the left colon (23/28, 82.1%). However, correlation between sex, age, grade, site and MSI status was not statistically significant (P > 0.05) Conclusion: This study provides useful baseline data for future studies. Over half (53%) of CRCs in our study had MSI. Given the fact MSI CRCs are said to have better prognosis, this portends improved survival of our patients if diagnosis is made early.

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