Child with hepatic hydatid cyst: A diagnostic uncertainty

Many parts of India are endemic for hydatid cyst, and hence, the most common diagnosis of a hepatic cyst in such regions is hydatid cyst. Undifferentiated embryonal sarcoma of the liver (UESL) is a rare differential diagnosis for hepatic hydatid cyst as the clinical and radiological features of hydatid cysts and UESL overlap. Here, we report a 4-year-old boy with hepatic cyst, who was initially diagnosed as hepatic hydatid cyst, which was later confirmed as UESL. The child was successfully treated with chemotherapy. This case report highlights the need to spread awareness about UESL, as prompt diagnosis and treatment improves prognosis of the same

Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia

Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation

Managing floods in Chennai City as part of situation understanding and improvement project

Transdisciplinary approaches in water are important to ensure water security to everyone around the world. Recently, Young Water Professionals (YWPs) training was carried out to impart learning in transdisciplinary approaches. Besides online workshops and lectures, the training program included the Situation Understanding and Improvement Project (SUIP). Through SUIP, YWPs were able to implement the transdisciplinary approaches learnt during lectures and workshops. The SUIP selected by one of the groups of YWPs was related to the flooding experienced by the residents of Chennai, India. Flooding is a very common phenomenon having its occurrence across the world with varying severity and magnitude because of changes to the use of river floodplains, changing the land use pattern, encroachment of waterbodies, and the impact of climate change on water resources. Chennai City in Tamil Nadu, India, with a population of about 6.5 million is facing frequent flooding because of extreme rainfall events and the presence of three rivers within the city and is also facing an acute shortage of water which also needs to be addressed for its sustainable development. This study used transdisciplinary approach to understand 2015 flooding in Chennai and made several recommendations to improve the flood management in Chennai including an early warning system. The YWP training and the concept of SUIP significantly enhanced the outcomes from this study

ALPPS in neuroendocrine liver metastases not amenable for conventional resection – lessons learned from an interim analysis of the international ALPPS registry

BACKGROUND: Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM. METHODS: The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM. RESULTS: From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Registry. Of them, 24 (2.5%) were performed for NELM. Twenty-one patients entered the final analysis. Overall grade ≥3b morbidity was 9% after stage 1 and 27% after stage 2. Ninety-day mortality was 5%. R0 resection was achieved in 19 cases (90%) at stage 2. Median follow-up was 28 (19-48) months. Median disease free survival (DFS) was 17.3 (95% CI: 7.1-27.4) months, 1-year and 2-year DFS was 73.2% and 41.8%, respectively. Median overall survival (OS) was not reached. One-year and 2-year OS was 95.2% and 95.2%, respectively. CONCLUSIONS: ALPPS appears to be a suitable strategy for inclusion in the multimodal armamentarium of well-selected patients with neuroendocrine liver metastases. In light of the morbidity in this initial series and a high rate of disease-recurrence, the procedure should be taken with caution