JMS SKIMS

Preventive Oncology: A Public Health Priority

2026-09-18T11:42:09+0530

Cancer remains one of the foremost causes of morbidity and mortality worldwide, with an estimated 20.6 million new cases diagnosed in 2024 and projections indicating a rise to nearly 35 million cases annually by 2050. Approximately 37% of new cancer cases globally are attributable to modifiable or preventable risk factors, underscoring the substantial potential of evidence-based prevention strategies to reduce the future cancer burden. This review synthesizes current evidence on the global burden of cancer, the modifiable and non-modifiable determinants of cancer risk, and the structured framework of primary, secondary, and tertiary preventive oncology. It further examines systemic barriers to implementation and presents population-level evidence from England, Finland, Australia, and the Indian states of Sikkim and Tamil Nadu, demonstrating that organized, evidence-based preventive interventions can produce measurable reductions in cancer incidence and mortality. The review concludes that strengthening preventive oncology, supported by political commitment, health-system capacity, and equitable financing, is essential to complement advances in cancer diagnosis and treatment.

Teaching Unilateral Cleft Lip Repair Using a Standardized Geometric Landmark-Based Method: A 10-Year Educational Cohort Study

2026-09-18T11:39:43+0530

Background: Accurate marking is a fundamental component of unilateral cleft lip repair. The Tennison–Randall technique uses predetermined anatomical landmarks and geometric relationships to design a triangular flap and restore lip height. Although the geometric nature of the technique provides a structured framework for operative planning, there is limited literature describing standardised methods for teaching this technique to plastic surgery residents.

We describe a 10-year educational experience using a standardised, landmark- and measurement-based method to teach unilateral cleft lip marking and repair to plastic surgery residents.

Methods: This retrospective educational cohort study included plastic surgery residents who received direct instruction in the Tennison–Randall technique at King Fahad Medical City Riyadh, Kingdom of Saudi Arabia, and during resident rotations over 10 years. The teaching method used a sequential series of fixed anatomical landmarks, bilateral measurements, measurement transfer, and geometric construction to reproduce the cleft-side Cupid’s bow and construct the Randall–Tennison triangular flap.

Residents were required to perform the marking themselves and subsequently perform unilateral cleft lip repairs under direct faculty supervision. Approximately 40 residents underwent training and collectively participated in approximately 400 unilateral cleft lip repairs involving complete and incomplete unilateral clefts.

Immediately following training, residents completed a three-item assessment addressing ease of cleft lip marking, understanding of the marking and operative procedure, and ability to demonstrate the technique to others. Each item was rated on a 5-point scale.

Results: Forty residents received training during the study period. All residents were able to demonstrate the standardised marking technique under direct faculty supervision and subsequently participated in operative repair under supervision.

Approximately 400 unilateral cleft lip repairs were performed by trained residents during the study period.

Thirty-six of the 40 residents completed the post-training assessment, giving a response rate of 90%. All respondents (36/36, 100%) rated each of the three educational domains 5/5.

Conclusions: A standardised landmark- and measurement-based approach provided a reproducible framework for teaching the geometric principles of the Tennison–Randall unilateral cleft lip repair. In this 10-year educational experience, 40 residents acquired the marking technique sufficiently to demonstrate it under supervision, and all questionnaire respondents reported the highest level of perceived learning across three educational domains. Prospective studies using objective technical-skill assessments are warranted to determine whether this approach reduces the learning curve for unilateral cleft lip repair.

Superior Mesenteric Artery Doppler Ultrasound as a Non-Invasive Tool for Monitoring Disease Activity in Crohn's Disease: Validation Against Quantitative Magnetic Resonance Imaging-Based Reference Standards

2026-09-18T12:18:10+0530

Background: Crohn's disease activity monitoring is expensive in low-resource settings. Superior mesenteric artery (SMA) Doppler measuring flow rate, pulsatility index (PI) and resistive index (RI) can detect splanchnic hyperaemia of active intestinal inflammation. We validated SMA Doppler indices against quantitative MR enterography (MRE) indices, the simplified Magnetic Resonance Index of Activity (sMaRIA) and London score.

Methods: Cross-sectional diagnostic accuracy study in 50 Crohn's disease patients. Activity was classified by sMaRIA (active, score of 1 or more; inactive, score of 0) and London score (active, 4.1 or more). Receiver operating characteristic curve analysis assessed diagnostic accuracy; Spearman's correlation examined Doppler-MRE associations.

Results: Fifteen patients (30%) had active and 35 (70%) had inactive disease. Active disease showed higher SMA flow rate (712 vs 322 ml/min), lower PI (1.66 vs 2.68) and lower RI (0.70 vs 0.83; all p<0.001). Flow rate achieved the highest accuracy (area under the curve 0.992; 95% CI 0.971–1.000); at a cut-off of 514 ml/min or more, sensitivity was 100%, specificity 97.1%, positive predictive value 93.8% and negative predictive value 100%. PI of 1.88 or less gave 97.1% specificity. Flow rate correlated strongly with sMaRIA (rho +0.770) and moderately with London score (rho +0.662; both p<0.001).

Conclusion: SMA Doppler reliably tracks Crohn's disease activity against quantitative MRE reference standards. A two-step strategy, flow rate 514 ml/min or more confirmed by PI 1.88 or less, identifies active disease without radiation, supporting SMA Doppler as a low-cost surrogate for serial monitoring in resource-limited settings.

Role of Transrectal Ultrasonography in Male Infertility

2026-09-18T15:31:34+0530

Background: Male infertility accounts for nearly 50% of all infertility cases. The evaluation of male infertility is complex, with anatomical abnormalities playing a significant role. This study aimed to assess the role of TRUS in diagnosing anatomical abnormalities contributing to infertility in north Indian region.

Methods: This descriptive observational study was conducted over two years in the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), and its associated hospitals. Sixty male patients aged ≥23 years with complaints of infertility and two samples showing oligospermia/azoospermia underwent TRUS examination. TRUS was performed using a 5.5-7.5 Hz transrectal probe, evaluating the prostate, seminal vesicles, ejaculatory ducts, and vas deferens.

Results: The mean age of patients was 32.5 years, with a mean infertility duration of 6.2 years. TRUS detected abnormalities in 93% of patients, including correctable causes such as ejaculatory duct obstruction (25%), seminal vesicle cysts (40%), and prostatic cysts (30%). Irreversible conditions included congenital bilateral absence of the vas deferens (5%) and seminal vesicle hypoplasia (3%). Life-threatening conditions as prostatic abscesses were identified in 3% of cases.

Conclusions: TRUS is a valuable tool for evaluating male infertility, capable of detecting both correctable and irreversible abnormalities, as well as potentially life-threatening conditions. Its routine use in infertility workup is recommended.

Primary Splenic Hydatidosis: An Institutional Case Series and Review of the Literature

2026-09-18T11:12:31+0530

Background: Primary splenic hydatidosis is an uncommon manifestation of cystic echinococcosis. Because of its rarity, most available evidence consists of small retrospective series, and the optimal extent of surgery remains debated.

Methods: We retrospectively reviewed 15 consecutive patients with primary splenic hydatidosis who underwent surgical treatment at our institution between 2010 and 2026. Demographic, clinical, radiological, operative, postoperative and follow-up data were collected. A focused review of published case series and contemporary literature was undertaken to place the institutional experience in context.

Results: Fifteen patients were included, with a median age of 38 years; 9 (60.0%) were women. Three patients (20.0%) were diagnosed incidentally. Thirteen patients (86.7%) had solitary cysts and the median maximum cyst diameter was 7.9 cm. Spleen-preserving surgery was performed in 11 patients (73.3%), while 4 (26.7%) underwent total splenectomy. Six patients (40.0%) developed a postoperative complication, predominantly atelectasis and postoperative collections. Two patients (13.3%) developed recurrence during follow-up; both had initially undergone spleen-preserving cystectomy/enucleation with omentopexy.

Conclusion: Our experience reflects the contemporary shift toward spleen-preserving surgery in selected patients with primary splenic hydatidosis. Although recurrence and postoperative collections were observed in the spleen-preserving cystectomy group, the small, retrospective nature of the series precludes comparison of procedures or causal inference.

Adult Colonic Lymphangioma presenting as Intussuseption

2026-09-18T11:29:51+0530

Background: Lymphangiomas are rare benign neoplasms of lymphatic origin mostly occurring in the neck and axillary region. Gastrointestinal involvement is uncommon, with colonic localisation representing an exceptionally rare occurrence, particularly in adults.

Case Presentation: We report the case of a 78-year-old female presenting with abdominal pain for two days. Ultrasound (USG) abdomen revealed a large ileocolic intussusception in the infraumbilical region. Contrast-enhanced computed tomography (CECT)-Abdomen revealed an intramural, low-density, multilocular mass with a low-contrast-enhanced wall and internal septations located in the ascending colon. Right hemicolectomy was performed which revealed ileocolic intussusception along with a large grey-brown polypoidal mass in the ascending colon and cecum measuring 5 x 4.5 cm. Cut section through the mass was grey-brown with areas of haemorrhage. Histopathology revealed thin-walled lymphatic channels lined by flattened benign endothelial cells and containing eosinophilic proteinaceous fluid and occasional lymphocytes, consistent with submucosal lymphangioma.

Conclusion: Colonic lymphangiomas are rare benign lesions with nonspecific clinical manifestations. Imaging techniques can assist in identifying the lesions, but microscopic evaluation is necessary for confirmation. Complete surgical excision is curative and associated with excellent prognosis.

Hormonal Mimics: Early Detection of Bilateral Testicular Adrenal Rest Tumors in Congenital Adrenal Hyperplasia. A Case report

2026-09-19T12:11:41+0530

Testicular adrenal rest tumors (TART) are benign ectopic adrenal tissue proliferations commonly associated with congenital adrenal hyperplasia (CAH). Early recognition is crucial to prevent misdiagnosis as testicular neoplasm and avoid unnecessary surgical intervention. We report a case of 11-year-old male who is a follow up case of CAH with salt wasting and GnRH dependent precocious puberty, in whom scrotal ultrasonography and magnetic resonance imaging demonstrated characteristic features of bilateral TART

A case of Chromoblastomycosis

2026-09-17T15:27:55+0530

A 45-year-old Kashmiri flute player presented with a 5-year history of a progressively enlarging lesion on the right thigh. The lesion developed following minor soil-contaminated trauma sustained in Punjab and gradually increased in size, eventually forming a cauliflower-like verrucous growth (a). Direct microscopy of a biopsy specimen following 10% potassium hydroxide (KOH) preparation demonstrated characteristic sclerotic (Medlar) bodies, confirming the diagnosis of chromoblastomycosis (b).

Ruptured Intracranial Dermoid Cyst

2026-09-19T12:04:43+0530

Background: Intracranial dermoid cysts are rare congenital inclusion cysts accounting for less than 1% of all intracranial tumors. Spontaneous rupture releases lipid droplets into the subarachnoid and ventricular spaces, producing chemical meningitis and acute neurological symptoms.
Clinical presentation
A young male in his 30s presented to the Emergency Department of SKIMS with sudden severe headache preceded by nausea. He had a history of chronic intermittent headache and low mood. Neurological examination was otherwise unremarkable.