CARE Hospitals is a chain of multi-specialty healthcare hospitals with 14 hospitals in 6 cities across 5 states of India .
Awake coronary artery bypass grafting (CABG) is increasingly becoming recognized as a feasible alternative for high-risk cardiac patients, with a potential to reduce perioperative morbidity. In light of this, high thoracic epidural anesthesia (HTEA) has been used for cardiac surgery over the past two decades, providing excellent analgesia and sympathetic blockade. In this case report, a 71-year-old patient with interstitial lung disease (ILD) on home oxygen treatment had successful awake CABG at our institute, using a combined mid-thoracic and lumbar epidural approach. This method offered effective segmental anesthesia and analgesia, ensuring patient comfort and hemodynamic stability throughout the surgery. In comparison to HTEA, the mid-thoracic epidural approach provided better control of anesthesia and analgesia, minimized the risk of high sympathetic blockade, and facilitated early postoperative recovery with minimum opioid usage and early mobilization without any intraoperative or postoperative complications. This case emphasizes the feasibility and potential advantages of combined mid-thoracic and lumbar epidural anesthesia over high thoracic epidural in selected high-risk patients undergoing awake CABG.
Ventral hernia repair (VHR) is a common general surgical procedure. While robotic VHR (RVHR) has shown advantages in large, complex hernias, comparative evidence with laparoscopic VHR (LVHR) for smaller defects is limited. We conducted a prospective, real-world evidence study across 12 centers in India. Adults aged 18–65 years undergoing primary or incisional VHR with a defect ≤ 5 cm requiring mesh placement were included. Primary outcomes were postoperative pain and analgesic use within 14 days; secondary outcomes included quality of life (QoL), hospital stay, and perioperative complications. A total of 200 patients (101 RVHR, 99 LVHR) were analyzed, with comparable baseline characteristics. Defect size was larger in the RVHR group (p < 0.001). Median operative time was longer in RVHR (p < 0.001), while post-anesthesia care unit stay was shorter (p = 0.0026). RVHR was associated with faster recovery, including earlier return to daily activities (median 5 vs. 7 days, p < 0.001), fewer analgesic doses (2.55 ± 0.97 vs. 3.25 ± 1.55, p < 0.001), and shorter work restrictions (14 vs. 30 days, p = 0.0042). Pain outcomes favored RVHR, with consistently lower Numeric Rating Scale (NRS) scores, greater improvement in PROMIS pain intensity scores at day 14 (p = 0.0072), and more patients reporting low pain intensity (51.5
INTRODUCTION:Male breast cancer (MBC) accounts for <1% of breast malignancies yet often presents at advanced stages, particularly in low- and middle-income countries where awareness is limited. This study sought to define the clinicopathological spectrum, biomarker profile, and treatment outcomes of MBC in a South Indian tertiary cancer center. OBJECTIVES:To analyze the demographic features, clinical presentation, pathological characteristics, biomarker distribution, treatment modalities, and outcomes of MBC cases managed at our center between 2019 and 2025. MATERIALS AND METHODS:We retrospectively analyzed all male patients with histologically confirmed breast carcinoma managed between 2019 and 2025 at ESIC Medical College and Hospital, Hyderabad. Demographic, clinical, pathological, biomarker, and treatment data were retrieved from hospital records and supplemented by follow-up contact. RESULTS:A total of 15 patients (mean age 60 years, range 31-74) were identified. Median delay from symptom onset to diagnosis was 6 months. All presented with a retroareolar mass, frequently accompanied by nipple retraction or skin changes. Most patients had advanced disease: Stage III (n = 9, 60.0%) and Stage IV (n = 4, 26.7%). Invasive ductal carcinoma was universal. Hormone receptor positivity was seen in 80%, HER2 positivity in 40%, and a triple-positive phenotype in 26.7%. Treatment strategies were stage- and biomarker-driven: 86.7% underwent surgery, endocrine therapy was prescribed for all HR+ cases, HER2-directed therapy was delivered when feasible, and CDK4/6 inhibitors were used in selected advanced HR+ tumors. At last follow-up, 9 patients (60%) remained alive with disease control, while 2 succumbed to progression. CONCLUSION:MBC in this cohort was characterized by delayed diagnosis, advanced presentation, and a high prevalence of HER2-positive tumors. Multimodality, biomarker-guided therapy achieved durable control in many patients, underscoring the urgent need for awareness initiatives, earlier detection, and equitable access to targeted therapies in India.
Primary hyperparathyroidism is caused by either adenoma or hyperplasia involving the chief cells of parathyroid glands. Primary hyperparathyroidism is third most common endocrine disease affecting women 2-3 times more often than men. The incidence of Primary Hyperparathyroidism (PHPT) is increasing with rate of 42:100,000 per year. Both parathyroid adenoma or hyperplasia is surgically curable, but the real twist lies in pre-operative localization. The usual pre-operative localization of PHPT is done by two modalities namely cervical ultrasound and SestaMIBI scan. Cervical ultrasound is cheap and easily available and can simultaneously detect any thyroid pathology if present. The radionuclide imaging is particularly useful in identification of ectopic glands as well as easier recognition of posteriorly located upper glands. When both modalities are used together it increases the sensitivity of pre-operative localization of the glands. Primary hyperparathyroidism due to ectopic parathyroid adenoma is seen in 16-23% of cases. We report a case of a 55-year-old female who presented with elevated calcium levels on routine investigations. She had bilateral renal calculi with a serum calcium level of 11.8 mg/dL and an iPTH level of 98.1 pg/mL. Ultrasound of the neck revealed a hyperechoic nodule in the inferior pole of the left lobe of the thyroid, suspicious for a parathyroid adenoma and sestamibi confirmed the lesion on right side. She underwent a right inferior parathyroidectomy, but her iPTH levels were persistently elevated postoperatively. She was further evaluated for hyperparathyroidism with an 18-F fluorocholine Positron Emission Tomography (PET) scan, which revealed a right retropharyngeal parathyroid adenoma. She underwent re-exploration of the neck and removal of the parathyroid adenoma. Intra-op iPTH dropped to normal levels. The histopathological findings were consistent with parathyroid adenoma. Patient is in follow-up with normal calcium and iPTH levels.
Abstract The purpose of this study was to describe the technique for midline biportal endoscopic decompression (MBED) for lumbar canal stenosis by a new “under the cave” decompression technique: a paradigm shift in biportal endoscopic decompression. Laminectomy with/without fusion and facet-preserving microforaminotomy has been performed as conventional surgical treatments for lumbar canal stenosis (LCS). Recently, endoscopic spinal surgery has been introduced as a minimally invasive therapeutic modality of LCS by several authors. Here, we describe the surgical steps and technical pearls of MBED with “under the cave” decompression technique in LCS, successfully treated with a modification to the novel unilateral biportal endoscopic (UBE) spine surgery technique, that is, by using a more midline approach using primary two portals. The authors included patients who presented with chronic onset of back pain and neurogenic claudication symptoms. They were diagnosed with LCS from magnetic resonance imaging and computed tomography preoperatively. The surgery was performed via unilateral approach to achieve bilateral compression without additional skin incisions by “under the cave” decompression technique and primary two portals. This technique ensures complete decompression of the spinal canal as compared to the microscopic, tubular, and traditional UBE. Midline modification of the conventional BED done through the “under the cave” technique permits clear visualization of ipsilateral and contralateral sublaminar and foraminal areas. Owing to this enhanced exploratory capability it gives us a good outcome in terms of complete decompression of the ipsilateral and contralateral exiting roots while avoiding fusion in the elderly. The authors suggest that the new MBED, which is minimally invasive, is a good alternative treatment option for degenerative LCS.
