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   Table of Contents - Current issue
July-December 2022
Volume 9 | Issue 2
Page Nos. 85-163

Online since Thursday, December 29, 2022

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Perception and practices of COVID appropriate behavior: A cross-sectional study among adult populations in rural and urban West Bengal Highly accessed article p. 85
Archita Bhattacharya, Manisha Das, Santanu Ghosh, Amrita Samanta
Introduction: Recent COVID-19 pandemic is an unprecedented public health problem worldwide. Knowledge about the disease and adoption of COVID Appropriate Behavior (CAB) are of utmost importance in combating the pandemic. The study was conducted to assess and compare the knowledge, attitude, and practice and to determine different misconceptions and wrong practices related to the disease among urban and rural populations. Materials and Methods: A community-based analytical study with cross-sectional design was conducted from January 2021 to March 2021 among 144 adult residents from urban and rural West Bengal. Multistage sampling was adopted and a predesigned, pretested, semistructured schedule was used for interviewing study subjects. Results: Urban people were significantly more knowledgeable and more appropriate in attitude and practice than rural people (P < 0.05). The mean knowledge and attitude scores of urban population were significantly higher than the rural population across age groups, gender, occupation, and education (P < 0.05), whereas mean practice score was significantly higher across gender and occupation in the urban population compared to the rural population (P < 0.05). Many cultural and indigenous practices such as drinking warm water, using mouth wash, using home remedies were more common in urban areas and consumption of homeopathy medicines, lighting candles, making sound with utensils, blowing conch shells, and worshipping corona were observed more in rural areas. Conclusions: Wide gap exists in knowledge, attitude, and practice between urban and rural population and there were many wrong perceptions and practices surrounding COVID-19 among both urban and rural population. Appropriate policy for improving knowledge, attitude, and CAB is the need of the hour.
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Workplace violence as a predictor of work-related stress among doctors Highly accessed article p. 93
Adwitiya Das, Mousumi Datta, Shibasish Banerjee, Soumitra Mondal
Introduction: Workplace violence (WPV) toward health-care workers is increasing. The present study aims to estimate the proportion of resident doctors and interns of a tertiary care hospital who experienced WPV, to find out the perpetrators of WPV, and to ascertain any association between WPV and work-related stress. Materials and Methods: This observational, institution-based, cross-sectional study included resident doctors and interns working in six different departments of a tertiary care hospital. Data collection was done using a predesigned, pretested semi-structured self-administered questionnaire adapted and validated from the "WPV in the health sector survey questionnaire" from WHO along with "Perceived occupational stress scale." Results: Out of 323 participants, 247 (76.47%) experienced some form of WPV, 138 (42.72%) experienced physical violence and 203 (62.85%) experienced psychological violence. Patient relatives were reported as the only perpetrators of physical violence, while seniors of the study subjects were reported as main perpetrators of psychological violence. One hundred and thirty-four (42%) individuals reported work-related stress. On multivariate analysis, psychological violence was significantly associated with work-related stress. Conclusion: WPV was experienced by a high proportion of study subjects. Psychological violence was more frequently experienced, and senior colleagues were deemed responsible in most cases. WPV may be associated with work-related stress.
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Histopathological spectrum of myxoid soft-tissue neoplasms in a tertiary care center with a special focus on vascular patterns: A 13-year compilation p. 99
Thotadamane Nagaraja Chandrashekhar, Priyadharshini Bargunam, Kusumanjali Boya
Introduction: Myxoid soft-tissue tumors are a diverse group of tumors which have similar histomorphology but have varied genetic sequence and clinical outcome, hence differentiating and diagnosing them is a challenge for any pathologist. This study describes the various histomorphological spectrum and vascular pattern of various myxoid soft-tissue tumors. Materials and Methods: This was a retrospective and prospective observational study of myxoid soft-tissue tumors over a period of 13 years. A total of 224 cases with myxoid morphology were included and were examined morphologically with a special focus on the vascular pattern. SPSS v 24 was used for statistical analysis. Results: The predominant lesions were benign in 164 (73.21%) cases, followed by malignant lesions in 43 (19.19%) cases and intermediate lesions 17 (7.58%) cases. Both benign and malignant lesions showed a male preponderance and were seen to arise predominantly from the extremities. The most common benign myxoid lesions in this study were of neural origin with myxoid neurofibroma constituting 65 (29. 01%) cases, followed by schwannoma 38 (16.9%) cases. Myxoid dermatofibrosarcoma protuberans was the most common intermediate lesion. Tumors with adipocytic differentiation were the predominant lesions among the malignant group, i.e myxoid liposarcoma seen in 17 (7.5%) cases. Conclusions: Vascular pattern in the myxoid lesions are subtle yet crucial in arriving at a histo-morphological diagnosis. Further studies correlating the vascular pattern with the genetic profile of these tumours can help arriving at a histo-morphological diagnosis of myxoid lesions.
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Practical anatomy online learning among COVID-19 pandemic era: perceptions of 1st-year MBBS students p. 104
Shalom Elsy Philip, Ranjna Janagal, Rohin Garg, Simmi Mehra
Introduction: With the rise of the COVID-19 pandemic, digital learning has been implemented in medical colleges across India to continue the ongoing medical education. Anatomy is the basis of medical science and is best learned through offline classes that allow students to experience the texture of structures and handling of specimens. During this pandemic period, cadaveric dissection was not used to study anatomy. The aim of this study was to learn about students' attitudes regarding virtual teaching and learning in anatomy, as well as the problems they may confront. Materials and Methods: A descriptive cross-sectional study was conducted in the department of anatomy among the 50 1st-year MBBS students of All India Institute of Medical Sciences, Rajkot in April 2021. Google Forms were used to obtain informed consent from students. Prevalidated questionnaires were given online to the students and responses were noted and descriptive statistical data was derived from the analysis. Results: About 37 (74%) respondents found traditional classes are better than online teaching. Majority preferred to attend anatomy practicals offline with safety precautions. About 17 (34%) showed interest in prerecorded videos. About 35 (60%) students faced social isolation as an impact of online learning. Technical issues and distractions were the key problems faced while learning anatomy online. Conclusion: Prerecorded videos of the practicals are helpful in teaching anatomy practicals, and can be used in future to ensure an unbroken, continuous, and effective delivery of medical education.
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Challenges for primary caregivers during the COVID-19 pandemic in accessing health care of children with chronic diseases under periodic follow-up at a tertiary care hospital in South India p. 108
Ramya Rajamanickam, Rajesh Jayanandan, Aparna Jayaraman, Shobhana Sivathanu
Introduction: Challenges faced by the primary caregivers during the COVID-19 pandemic help to identify their needs and health seeking behavior during pandemic. Objectives: (1) To describe the factors associated with periodic follow-up at the hospital which posed as difficulties to their primary caregivers during the COVID-19 pandemic. (2) To identify the measures adopted by these primary caregivers to overcome those difficulties. Materials and Methods: This hospital-based cross-sectional observational study was conducted from May to August 2021 among 57 primary caregivers of children with chronic diseases registered before March 1, 2020, who were under periodic follow-up in our pediatrics department. Data were collected by direct or telephonic interview using a predesigned semi-structured questionnaire and analyzed using descriptive and inferential statistics like mean, standard deviation, proportions and paired "t"-test using Epi info and IBM SPSS trial version 28.0. Results: Frequency of hospital visits of 14 (24.6%) subjects were reduced during the COVID pandemic compared to the prepandemic period. During the COVID pandemic, 42 (73.7%) subjects had faced transportation difficulties, 23 (40.3%) had faced financial difficulties, 22 (38.6%) had skipped their scheduled follow-up visits and around 31.6% of them have feared of contracting COVID. None had availed telemedicine consultation for their children either before or during the pandemic. Conclusions: Difficulties faced in transportation, fear of contracting COVID, financial difficulties, and lack of awareness of teleconsultation services were identified as their major obstacles.
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A prospective cross-sectional study to analyze the effect of transnasal sphenopalatine ganglion block in carcinoma buccal mucosa patients p. 115
Nipun Lamba, Shikha Dhal, Ruchika Makkar, Sumit Goyal, Sudha Sarna
Introduction: Cancer pain is known to be one of the Most severe pain anyone in life and is the primary reason for discontinuation of treatment. Sphenopalatine ganglion block (SPGB) can be useful in alleviating pain of carcinoma buccal mucosa. The study aims to analyze the effect of transnasal SPGB in pain management of patients suffering from carcinoma buccal mucosa. Materials and Methods: It was a hospital-based study done on 150 patients with carcinoma buccal mucosa using a prospective cross-sectional study design. To do statistical analysis, paired t-test was used having SPSS software. Results: On visual analogue scale, intensity of pain was found to be notably reduced from 7.42±2.02 to 3.45±1.21 (P < 0.0001), after first sitting. Preprocedure and postprocedure morphine requirement were 90.24 ± 30.24 and 60.42 ± 0.93 mg/day (P > 0.05) At the conclusion of study, the results were found to be statistically significant. Conclusion: Transnasal SPGB is beneficial in improving patient compliance and reducing pain scores and morphine requirement in patients suffering from carcinoma buccal mucosa.
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Prognostic factors in lung adenocarcinoma with brain metastasis p. 118
Elanur Karaman, Sema Yilmaz Rakici
Introduction: Brain metastasis (BM) is significantly seen in lung adenocarcinoma and adversely affects survival. We aimed to evaluate the factors affecting the prognosis in patients with BM diagnosed with lung adenocarcinoma. Materials and Methods: Patients with BM between 2012 and 2022 were reviewed retrospectively. Demographic characteristics of the patients, primary tumor characteristics, presence of mutation, BM number, localization, size, development time, and treatment characteristics were evaluated. Inflammatory indices at the time of BM were examined. The overall survival time was calculated. Results: About 92.9% of 113 patients were male, the median age was 62 years (54.5–68.5), and follow-up was 8 months (3–18). BM was detected at the time of diagnosis in 62 (54.9%) of the patients, whereas BM developed later in 51 (45.1%) patients. Systemic treatment was applied to 72.5% of the patients. Survival was lower in patients with BM at diagnosis (4 vs. 14 months, P < 0.001). Primary tumor maximum standardized uptake value level was higher on fluorodeoxyglucose-positron emission tomography-computed tomography at diagnosis in patients with late BM (P = 0.004). The development time of BM was 9 months (4–16), and the median survival was 8 months (6.2–9.8). There was no difference between tumor localization or inflammatory indices and the development of BM and prognosis. The presence of BM at diagnosis and lack of systemic treatment were found to be factors that independently reduced survival (P < 0.001, P = 0.007). Conclusion: The presence of BM at diagnosis significantly reduces survival. It has been observed that systemic treatments applied in addition to local treatments have a positive effect on the prognosis.
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A comparative study to analyze the effect of gabapentin with amitriptyline versus pregabalin with amitriptyline in neuropathic pain in cancer patients undergoing palliative care p. 124
Nipun Lamba, Anukriti Pareek, Shikha Dhal, Sumit Goyal, Ruchika Makkar, Sudha Sarna
Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low-dose amitriptyline and gabapentin with low-dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoing palliative care treatment in our institute. It was a hospital-based, randomized, tertiary cancer center-based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t-test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P > 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.
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Mucormycosis in COVID-19 patients: A tertiary care experience p. 127
Sarandeep Singh Puri, Jyoti Mishra, Monal Trisal, Ashish Kumar Mandal, Suparna Dubey
Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material and Methods: Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Results: A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion: It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.
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Morphometric analysis of laminae of C3–C6 vertebrae of cervical spine in the population of north west India p. 132
Vivek Singh Malik, Amanpreet Singh Sidhu, Neeru Ghalawat, Vipin Garsa
Introduction: The knowledge of morphometric parameters of laminae of cervical vertebrae is indispensable in surgical procedures and developing instrumentation for surgical processes. Literature reports ethnic and geographical variations reported in these dimensions. Materials and Methods: This cross-sectional study included analysis of laminae of 212 cervical vertebrae (C3–C6). The length of superior border of lamina and inferior border of lamina was measured on the right and left sides using vernier caliper. Descriptive and inferential statistical analysis was done with the help of Microsoft Excel version 2021. Results: The length of the superior border of lamina on both sides increases from C3 to C5. The length of the inferior border of the lamina on both sides decreases from C3 to C4, then on the right side, it increases from C4 to C5 and then decreases from C5 to C6, and on the left side, it increases from C4 to C6. At C4, the length of superior border of lamina on the right side differed statistically from the length of superior border of lamina on the left side (P = 0.042). A significant difference between lengths of the inferior border of laminae on the right and left sides was also found at the C5 vertebra (P = 0.001) and C6 vertebra (P = 0.012). No significant difference in thickness and height of lamina was observed between right and left sides. Conclusion: The present study indicates morphometric parameters of laminae of typical cervical vertebrae in the North West Indian population differ from the same parameters in Brazilian as well as South Indian populations. The length of superior border as well as inferior border of lamina has significant differences between right and left sides. However, there is no significant difference in height and thickness of laminae between right and left sides.
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Incidence of metopic suture in adult human crania in Uttar Pradesh p. 137
Neha Gupta, Durgesh Singh, Anuj Malik, Mohd Arshad, Vinay Kumar, Mirza R U. Beg, Shashi Prabha Singh
Introduction: Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle. Materials and Methods: The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls. Results: This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% "V" shape metopic suture. Conclusion: The morphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area.
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Guided imagery intervention for the treatment of tension-type headache associated with state-trait anxiety p. 141
Introduction: Guided imagery (GI) is a mind–body intervention, in which individuals generate mental images of pleasant objects or events in their minds. These mental images produce positivity and alter the perception of headaches and other pain disorders. A review of literature suggests that GI is an effective psychological treatment for tension-type headache (TTH) and state-trait anxiety. Hence, the present study aimed to assess the efficacy of GI on TTH associated with state-trait anxiety and to compare its efficacy with treatment as usual (TAU). Materials and Methods: Forty treatment-naïve patients diagnosed with TTH were selected from the psychiatry outpatient department through purposive sampling method. The Henry Ford Hospital Headache Disability Inventory and the State-Trait Anxiety Inventory for Adults were administered on all the patients for baseline data. Experimental group (n = 20) were given eight sessions of GI along with TAU for 2 months, whereas waitlist group (n = 20) were given only TAU. Results: A Significant positive association was obtained between emotional and functional disability of headache and state-trait anxiety at baseline. Postassessment findings demonstrated a significant reduction in severity and frequency of TTH, emotional and functional disability, and state-trait anxiety in the experimental group receiving GI as compared to the waitlist group. Conclusion: Patients living with TTH more commonly suffer from state-trait anxiety. Those patients who were given GI along with TAU for 2 months improved on severity and frequency of TTH, emotional and functional disability of TTH, and state-trait anxiety more effectively than those patients receiving only TAU. Consequently, it can be said that GI is an effective treatment for TTH and state-trait anxiety as compared to TAU.
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Histomorphological analysis of gestational trophoblastic disease spectrum with clinicopathological correlation at a teaching hospital p. 147
BM Soumya, D Rajalakshmi, Sriharsha Kulkarni, Rajkumari Jayshree Devi, Vardendra G Kulkarni
Introduction: Clinically, all trophoblastic lesions are frequently combined under a broad spectrum of gestational trophoblastic diseases (GTDs) without the use of specific pathological terms. However, studies now demonstrate that various forms of GTDs demonstrate differences in etiology, histogenesis, morphology, and clinical behavior. Thus, the need for diagnostic histopathology of these lesions to distinguish gestational trophoblastic neoplasms from nonneoplastic lesions and molar pregnancies and also for early anticipation for early anticipation, risk category stratification, prognostication, management, and prediction of persistent GTD. Our study aimed to study the histomorphological patterns of various types of GTD with light microscopy and the pattern of occurrence of GTDs in relation to age, parity, and gestation. Materials and Methods: The present study was conducted in the department of pathology, from January 2020 to April 2022. All GTDs confirmed by histopathological examination by hematoxylin- and eosin-stained slides were included. Results: The spectrum of GTDs found in this study was seventy cases of hydatidiform mole (92.10%), three cases of exaggerated placental site (EPS) reaction (3.94%), and two cases of choriocarcinoma (2.63%) and one case (1.31%) of placental site trophoblastic tumor (PSTT). The most common presenting symptom was vaginal bleeding (93.42%). Conclusion: Hydatidiform mole forms the most common type of GTD with an incidence of complete moles more than partial moles. Histomorphological examination and analysis are helpful for confirmatory diagnosis. The most common clinical presentation of GTD was vaginal bleeding followed by amenorrhea. Emphasis on detailed descriptive morphological assessment can help in the histological distinction of benign lesions such as EPS reaction and placental site nodule and avert such cases from being erroneously diagnosed as neoplastic. The Ki-67 proliferation index helped in distinguishing the EPS reaction from neoplastic lesions such as PSTT which requires surgical intervention and chemotherapy.
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A comparative study on comprehension of informed consent before emergency and elective surgical operative procedures p. 153
Soumitra Mondal, Saikat Bhattacharya, Pulak Kumar Jana, Kaushik Mitra
introduction: A health-care beneficiary should comprehend different aspects of medical and surgical interventions before giving consent to perform those. There is no defined way to find out adequate patient comprehension as part of the decision-making procedure to give consent. This study was conducted to find out the disparity of comprehensiveness between emergency and elective surgical operative procedures both in terms of knowledge dissemination and knowledge comprehension. Materials and Methods: A cross-sectional comparative study was conducted at the General Surgery Department of Medical College, Kolkata, during September and October 2021. An interviewer-administered questionnaire was used on patients undergoing emergency and elective surgical procedures. The comprehension level of informed consent (IC) form was scored as 1, 2, and 3 and compared between two groups using an unpaired t-test and Mann–Whitney U-test. Result: Data collection was done from 39 patients for emergency operative procedures and 52 for elective surgical procedures. A composite comprehension score was calculated after adjusting for questions not asked while taking IC. The mean comprehension score for emergency procedures was 18.86 and for planned surgery, it was 20.14. Unpaired t-test showed significantly high mean comprehension for planned procedures than the emergency procedures (P = 0.007). Comprehension is significantly poorer in emergency conditions even after controlling for age and literacy denoting difficulty in decision-making in emergency scenarios. Conclusion: It is suggested that the procedure of consent taking should be more structured and interactive so that even in stressful conditions participant understand better about the procedures and take their own decision instead of relying blindly on doctors.
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Histomorphological analysis of nephrectomy specimens: Experience at a tertiary care institute p. 159
BM Soumya, Rajkumari Jayshree Devi, Sriharsha Kulkarni, Vardendra G Kulkarni
Introduction: For a range of kidney abnormalities, including both neoplastic and nonneoplastic disorders, nephrectomy is a popular surgical treatment. We conducted this study to examine the range of lesions found in the nephrectomy specimens obtained and to ascertain the distribution of these lesions by age and sex. Materials and Methods: This study was conducted in the department of pathology, from 2017 to 2022. All nephrectomy specimens received during 5 years were included. Results: The spectrum of renal lesions observed in the study included both neoplastic (43.75%) and nonneoplastic (56.25%) conditions. Nineteen patients were males (59.37%) and 13 were females (40.62%) (M: F = 1.4:1). The most common entity in the nonneoplastic category was chronic pyelonephritis (n = 9, 28.12%). In our study, we documented two unusual cases of renal replacement lipomatosis (RRL), a type of pseudotumor related to nonfunctioning kidneys. Fourteen patients underwent nephrectomy for neoplastic conditions such as Wilm's tumor and renal cell carcinoma (RCC). Conclusion: Nephrectomy for the nonneoplastic condition was performed more frequently in our series. Histopathological evaluation of nonneoplastic nephrectomy specimens must be thoroughly considered, particularly in unusual circumstances such as RRL, where a preoperative erroneous initial impression of a malignant lesion such as angiomyolipoma or liposarcoma is possible.
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