Academia Journal of Surgery

Renal Stones and Tuberous Sclerosis: A Rare Co-Existence

2019-04-02T02:41:29+00:00

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome first described by Bourneville in 1880. It is a rare genetic disorder characterized by a triad of seizures, mental retardation and cutaneous lesions due to mutations in two genes, TSC1 and TSC2. We report a case of 46-years old male with generalised weakness and seizures. Patient was investigated and diagnosed after examination and investigation with tuberous sclerosis involving central nervous system i.e. sub-ependymal nodules and cortical tubers, skin manifestation adenoma sebaceum and ash leaf spots, lungs with cysts i.e. lymhangioleiomyomatosis, kidneys with angiomyolipomas and cysts . Patient also had right partial staghorn stone which was challenge for management. The patient was managed with right extended pyelolithotomy and discharged only to be re-admitted with vesical calculus after 18 months. This case report emphasizes the rare co-existence of renal stone formation with tuberous sclerosis.

Various Modalities of Scalp Reconstruction: A Review of Literature and Case Series

2019-04-02T02:41:30+00:00

Background: The human scalp has various functions from protecting the skull bone to providing an aesthetic look. Various condition of the scalp that can cause full or partial thickness scalp loss are trauma (gunshot, RTA, avulsion injuries), acute and post burn injuries, post tumour excision defects and scalp infection etc.Subjects and Methods:This retrospective observational study was conducted over a period of 3 years in a tertiary care centre and the different etiologies of scalp injuries along with the various techniques of scalp reconstruction were discussed.Results:A total of 50 patients of both sexes and any age with full or partial thickness scalp defects were admitted. The most common age of presentation was 20-40 years age (40%) with trauma (56%) being the most common etiology followed by burns in 30% patients. 40 % of the patients were reconstructed with skin grafts while in 30% patients local flaps and in 10% patients tissue expanders were used.Conclusion: An aesthetically pleasing scalp reconstruction requires a precise preoperative planning with detailed knowledge of scalp anatomy and blood supply. The wide armamentarium of techniques for reconstruction allows the plastic surgeon to give a much pleasing final result.

Steinstrasseafter Extracorporeal Shockwave Lithotripsy: Aetiologyand Management

2019-04-02T02:41:30+00:00

Background: Renal stone is the most common disease managed by an urologist. Extracorporeal shock wave lithotripsy (ESWL) is one of main modality of management of renal stone. Steinstrasse one of complication of ESWL is not an uncommon event. Steinstrasse may be managed with conservative management, ESWL or ureteroscopy (URS) or open surgery. We describe our experience of management of steinstrasse patients in IGMC Shimla.Subjects and Methods:Extracorporeal shockwave lithotripsy (ESWL) is given to patients presenting with renal and upper ureteric stones. This study included diagnosis and management of 7 patients developing steinstrasse after ESWL.Results:All steinstrasse developed in patients of renal stone and size more than 2cm. Four patients had pain after ESWL and 3 patients were asymptomatic. Four patients had pre-ESWL DJ stenting in view of large stone, 2 patients did not require DJ stenting and one patient required DJ stenting after persistent pain. Five patients required URS at 3 weeks after an incomplete response to conservative treatment. One patient received ESWL for fragments in ureters, and 1 patient didn't require intervention.Conclusion: Stone size and site were the significant factors predicting steinstrasse formation. URS and ESWL are very effective interventions for patients not responding to conservative management

An Analytical Study on Non-Traumatic Surgical Emergencies in Rural Medical Colleges

2019-04-02T02:41:30+00:00

Background: Surgical emergencies are very common in surgical practise. Non-traumatic surgical emergencies include peritonitis, perforated appendix, strangulated hernias, urological conditions and some malignant conditions. These conditions are slowly increasing world-wide and especially in developing countries. And it is associated with high mortality and mobility because of non-availability of emergency surgical care. World-wide the mortality rate is ranges from 21.75% to 36.50%. Aim: To analyse the non-traumatic surgical emergencies and their outcome in rural India. Subjects and Methods:We have conducted this study in 1 year and we have examined 270 emergency case which were admitted in our hospital. The emergency care which were admitted in our hospital. The emergency cases which were due to traumatic haemorrhage and stab injuries were excluded from this study.Results:Out of total emergency cases 430, non-traumatic emergencies are 270. Age ranged between 20 year and 80 year. Out of 270 males were 155 and females were 115. The most common age group is 40-50 year.Conclusion: Facilities are inadequate in most of the part of the world and especially in developing countries like Africa, South Asian countries and in rural part of India. So there is need to improve rural and suburban health centres to reduce the morbidity and mortality in emergency surgical conditions.

Assessment of Patients with Blunt Abdominal Trauma Admitted to Emergency Department

2019-04-20T04:23:20+00:00

Background: Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. Hence;
under the light of above mentioned data, we planned the present study to assess the profile of the patients admitted to the emergency
department with blunt abdominal trauma (BAT). Subjects and Methods: The present study consisted of a total of 200 patients who were
admitted to the emergency department with history of blunt abdominal trauma. Complete haematological profile of all the patients was
obtained. We also obtained detailed demographic and clinical profile of all the patients. Radiographic imaging was done in all the patients for
evaluating the extent of involvement of abdominal organs. Mortality rate was also calculated. Results: Majority of the patients belonged to the
age group of 21 to 40 years. Abdominal distension was present in 80 percent of the patients while it was absent in 40 percent of the patients.
Haematuria was found to be present in 12 percent of the patients, while it was absent in 88 percent of the patients. Mortality occurred in 12
percent of the patients. Conclusion: Patients with blunt abdominal trauma presents with a varied clinical presentation. Therefore radiographic
diagnostic techniques should be carried out as soon as possible for assessing the extent of injuries so that prognosis could be improved.