Hepatoblastoma

Introduction:
The liver is a large, very important organ situated in the right upper quadrant of abdomen. The normal functions of the liver in the body are: 

To help store nutrients from food
To break down and remove harmful chemicals from the body
To build chemicals that the body needs to stay healthy.

Hepatoblastoma: The most common type of liver cancer in children is Hepatoblastoma. it occurs most frequently in infants or very young children between 2 months and 2 year.

Symptoms:

• Lump in the abdomen (most common)
• Reduced appetite
• lethargy
• nausea / vomiting
• Pain in abdomen
• Jaundice

Investigations:The following minimal investigations are proposed to diagnose hepatoblastoma

• Tumor markers- serum AFP
• CT scan of abdomen with Ct guided FNAC or Biopsy
• X-ray ches/CT Chest
• Complete blood count
• Biochem profile

Treatment: 

Surgery & chemotherapy are two treatment options

Surgery: Liver resection according to the location & extent of the tumor. It will be either

• Rt hepatectomy
• Lt hepatectomy
• Extended Rt or Lt hepatectomy
• Bi or trisegmentectomy

If liver resection is not possible because of multicentric disease then liver transplant is the only treatment of option.

Chemotherapy:
Chemotherapy is given before or after surgery. Surgery is done either as a sandwich surgery (in between cycles of chemotherapy) or it is done at the start & then chemotherapy is given.

The drugs used in chemotherapy are

• Cisplatin
• Doxorubicin
• Vincristine
• 5-Fluorouracil

Ksharsutra for fistula in ano

Ksharsutra is barbouslinen No.20 coated with latex of ‘EUPHORBIA NERIFOLYA’ ash of
‘ACHYRANTHUS ASPERA’and dried powder of ‘TURMERIC’.

It has antibacterial, antifungal, anti-inflammatory, antioxidant, anticoagulant properties.

How it is used-

Under general anesthesia fistula site is probed

Tract delineated by methylene blue and hydrogen peroxide

Internal opening is identified

Ksharsutra passed through the probe

Knot tied and kept

Re application of Ksharsutra is done after 10 days

Ksharsutra cut through the fistula over a span of 3 weeks

Wound healed well with secondary intention

Ksharsutra performs chemical cauterization

Complications are less

It can avoid incontinence, stricture and bleeding

High cure rate

Early ambulation and early discharge

Average cutting time 0.78 to 1 cms/week

Palatal abscesses

Hard palate is the partition between the nose and floor of the mouth. Embryologically, hard palate is formed by the palatine process of maxilla and the horizontal plate of the palatine bone. Anterior portion of the hard palate contains irregular ridges which help during feeding. Hard palate continues posteriorly in a soft portion called soft palate.

Abscesses of hard palate are known. The etiology may be trauma, ulceration, secondarily infected nasopalatine cyst or infected tooth. The line of treatment will be antibiotics and anti-inflammatory followed by incision and drainage.