Academia Journal of Surgery

A Clinical Study – Resection and Anastomosis of Bowel in Our Surgical Practice

2020-05-26T04:42:26+00:00

Background: Anastomotic leaks are among the most dreaded complications after bowel surgery. In the present era, even with better understanding of the impact of local and systemic factors on anastomotic healing, dehiscence and leakage remains frequent and serious problem associated with high morbidity and mortality. However, problems with definitions and the retrospective nature of previous analyses have been major limitations. Aim & Objective: We sought to use a prospective database to study the incidence of intestinal resection and anastomoses, to determine important factors and their significance in the healing of the anastomosis along with identifying the most ideal suture material for these techniques in our practice.Subjects and Methods:This study was carried out on 40 patients who underwent resection and anastomosis of bowel for various pathological causes in Kamineni Institute of Medical Sciences & Hospital Hyderabad during September 2018 to September 2019.Results:Out of the 40 patients who underwent resection and anastomosis of bowel, Anastomotic leaks were observed in 10 (25%) cases and all of them belonged to the group who were operated on emergency basis. Hypoproteinaemia, peritonitis and perioperative blood transfusions, hypovolemia were important attributable factors identified in the leak group. Minimal leaks were observed in the group of patients who were anastomosed with vicryl suture material alone. Mortality was observed in 3patients in the leak group. At 6 month follow up none of them developed anastomosis related complications like stenosis, diverticulum.Conclusion:The present study shows majority of the patients undergoing resection and anastomosis were dealt on an emergency basis. Multivariate analysis showed six predictive variables i.e., serum albumin less than 3 g/l, use of corticosteroids, bacterial peritonitis, malignancy, COPD, perioperative blood transfusions had a higher risk of developing anastomotic leaks. Vicryl when used alone being the suture material of choice.

Comparative Evaluation of Open and Laproscopic Method of Appendectomy in Acute Appendicitis

2020-05-26T04:45:38+00:00

Background: There is definitely added advantage of laparoscopic operations. Most of the surgeons now prefer these minimally invasive procedures. Laparoscopy has become the number one choice of educated and affording patients. Aim: The aim of the study was to compare and evaluate the open and laproscopic method of appendectomy in acute appendicitis.Subjects and Methods:The subjects undergoing appendectomy were evaluated for age, sex, episode number, duration of pain before presentation in hospital, operative time, conversion rate, wound infection, post-operative intra-abdominal abscess formation, and stay in hospital.Results:It was found that average operative time in open surgery was 67.5 minutes and 104 minutes in laparoscopic surgery, with a conversion to open in about 20% of the cases. Oral feeding in the open group was around the 5th day while it was around 2nd day in the laparoscopic group. Average hospital stay was also low in the laparoscopic group, being only around 5 days in laparoscopic group and around 8 days in the open group. Overall complications were also low in the laparoscopic surgery group.Conclusion:It was noted that though conversion to open operation was definitely high but there were other advantages of laparoscopic surgery as well. Stay in the hospital, beginning of oral feeds, requirement of analgesics, wound infection, intra-abdominal abscess; pulmonary complications were less in laparoscopy group.

A Study to Evaluate the Significance of Sherren’s Triangle Hyperaesthesia in a Treatment of Acute Appendicitis

2020-05-26T04:48:20+00:00

Background: Acute appendicitis is the most common surgical emergency. In spite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, Sherren`s triangle hyperaesthesia is very important sign with controversial efficacy about it in available literature. Aim: The aim of this study was to explore the significance of hyperaesthesia in Sherren’s triangle in a treatment of acute appendicitis.Subjects and Methods:This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy included in the study.Results:Sensitivity and specificity of hyperaesthesia in Sherren’s triangle were 47.7% and 42.9% respectively with positive and negative predictive values were 92.1% and 5.56%.Conclusion:Hence it indicates that hyperaesthesia in Sherren’s triangle is important sign to suspect to support diagnosis of acute appendicitis. It has minimal significance to rule out it. This sign plays very important role in a diagnosis of complicated appendicitis like obstructive appendicitis.

A Study to Evaluate the Size of Thyroid Nodules as an Indicator for Malignancy

2020-05-26T04:54:38+00:00

Background: Several authors have questioned the accuracy of fine- needle aspiration cytology (FNAC) in large thyroid nodules. It's the current practice to provide thyroidectomy to patient with thyroid nodules 4 cm or larger regardless of the FNAC results. Aim: The aim of the study is to answer two questions: is the size of nodule associated with higher risk of malignancy and is the size indication for surgery.Subjects and Methods:This study included 20 patients who underwent thyroidectomy. We compared all thyroid nodules with benign FNAC and their final histopathology reports. Patients were divided into two groups based on the size of the nodule (< 4cm or >4cm) and indication of surgery.Results:20 patients with thyroid nodule underwent thyroid surgery. 13 patients had nodule <4cm and 7 patients were ≥4 cm. For patients with nodules <4 cm, 3 patients had a malignancy, and for those with nodules ≥4 cm, 1 patients had a malignancy. For benign cases FNAC and histopathology reports are showing same results, (p<0.05).Conclusion:Thyroid nodules ≥4 cm are not risk factor of malignancy. Thyroid nodules ≥4 cm with benign FNAC should not undergo thyroidectomy as false negative rate is low. Therefore, the decision for surgery ought not to be taken based on the size of the nodule.

Evaluation of Potential Risk Factors Causing Abdominal Wound Dehiscence

2020-05-26T04:58:21+00:00

Background: Wound dehiscence/burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. Aim: The aim of this study was to highlight the risk factors for wound dehiscence and remedial measures to prevent or reduce the incidence of wound dehiscence. Subjects and Methods:This is a prospective and observational study involving all those who have developed abdomen wound dehiscence after initial surgery, an elaborative study of these cases with regard to date of admission, clinical history regarding the mode of presentation, significant risk factors, investigations, time of surgery and type of surgery postoperatively, study of diagnosis and day of diagnosis of wound dehiscence is done till the patient is discharged from the hospital. The collected data is analysed and statistics were made according to need.Results:The incidence of abdominal wound dehiscence is more common in male patients in 4th to 5th decade. Patients with peritonitis due to duodenal perforation, complicated appendicitis, pyoperitoneum and intestinal obstruction carried higher risk of abdominal wound dehiscence. Abdominal wound dehiscence was more common in patients operated in emergency. Patients with intra-abdominal infection, anaemia, hypoalbuminaemia, jaundice had higher incidence of wound dehiscence.Conclusion:Wound dehiscence can be prevented by improving nutritional status of patient, proper surgical technique, controlling infections and correcting co-morbid conditions.

A Randomized Prospective Study on Interlay Vs Underlay of Type I Tympanoplasty in Remote Tertiary Center

2020-05-26T05:01:35+00:00

Background: Type I tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as improve the hearing in inactive mucosal chronic otitis media. There are two main methods that are underlay and overlay in between both is interlay.Aims & Objectives: The present study is to analyse and compare the results of the two most commonly used type I tympanoplasty techniques, underlay and the interlay technique in chronic otitis media with mucosal disease in large central perforation, in terms of graft uptake and hearing improvement.Subjects and Methods:This is a randomized prospective study of 100 cases of inactive mucosal chronic otitis media with total or large anterior central perforation between October2017 to September 2019 in Anugarah Narayan Magadh Medical College & Hospital, Gaya. Half had gone through Interlay and half by Underlay technique of Type I Tympanoplasy surgery.Results:The graft uptake rate in this study was 96% and 90% for Interlay and Underlay technique respectively. Postoperatively mean air bone gap maximally reduced in the Interlay technique.Conclusion:The present study showed that Interlay method had better graft uptake rate as well as hearing improvement in total and large anterior central perforation of inactive mucosal chronic otitis media than the Underlay technique.

Retrospective Clinical Study on Epistaxis

2020-05-26T05:04:25+00:00

Background: Epistaxis is bleeding through nose.It is most common emergency situation in ENT that is disastrous to the patient and troublesome to treat for doctors.It is seen that 60% population experiences epistaxis in their life time and only 6% went to take consultation. Aims & Objectives: Evaluate incidence, etiology, provoking factors and cost effective management.Subjects and Methods:A 3years retrospective study between September2015 to August 2018 carried out in Anugarah Narayan Magadh Medical college& Hospital,Gaya on 98 admitted epistaxis patients.Results:Total11,667 patients came in ENT department among them2,723 patients with nasal complain.Incidence was0.84% among all cases and 3.6% among nasal problems.No obvious cause seen in 34 cases(34.23%)then cardiovascular cause in32 cases(32.65%) then infection in19.32% and lastly by trauma in 5.68%.Maximum patients in40-50 years age group 36% and minimum in70-80 years 1%.Most patients belong to urban76 cases(77.27%) and middle age 36 cases(36.36%).Males are more prone 57 cases(57.95%)with ratio 1.39:1.Mostly inJanuary-March months 45cases (46.59%).Most patients came with unilateral epistaxis 86cases(87.5%).About 26cases (26.14%)came with single episode whom urgent treatment required.Well managed with Nonsurgical method to 85 patients(86.73%) by anterior nasal packing(ANP) in43 cases(43.87%) and chemical cauterization to 19 cases(19.30%) while surgical treatment given to 13 patients(13.26%).Some required electrocauterization 16 cases(16.32%) with bipolar.Mean hospital stay length 3.2 days.Blood transfusion required in 7cases (7.14%).Conclusion:Costeffectively anterior nasal packing is best conservative indirect method and electrocauterization is very effective direct method.

Prevalence and the Risk Factors of Haemorrhoids among the Patients Attending Tertiary Care Hospital of Bhuj, Kutch: A Cross-Sectional Study

2020-05-26T05:08:30+00:00

Background: Haemorrhoids are abnormal engorgement of arteriovenous plexus in anal cushions lining the anal canal. As per the theory of sliding anal canal lining, weakening of supporting tissues of anal cushions lead to blood vessel descent. Present study was carried out to study the surgical profile of patients with hemorrhoidectomy so that we can throw a light on the etiopathogenesis of the patients with hemorrhoidectomy.Subjects and Methods:Present cross-sectional study was carried out at a tertiary care hospital of Bhuj in the department of general surgery among 200 patients who presented with symptoms suggestive of hemorrhoids. Information on socio demographic variables, types and degrees of haemorrhoids, age at diagnosis, risk factors, clinical manifestations, associated co-morbidities, methods used for diagnosis, management practices, and outcome of management was noted down by the investigators. Dietary history was taken they were classified as having vegetarian diet or mixed diet based on the answers given by them.Results:The incidence of hemorrhoids was more in upper class compared to the lower class where only 46% were found to be affected. But statistically the difference might not be significant. Incidence of hemorrhoids was less i.e. 24% among those who took only vegetarian diet compared to 76% among those who took mixed diet. Bleeding was present in the majority i.e. 95% of the patients followed by constipation in 90% of the cases which was followed by pain in the anal region in 86% of the cases and prolapse was seen in 84% of the cases.Conclusion:Haemerrhoids are one of the common diseases observed in patients below 40 years of age, especially if they are under stress. Proper diet, which is inclusive of adequate quantities of fibre as well as with less spice, is essential to prevent this disease.

Association of Serum Iron and Ferritin Levels in Patients of Cholelithiasis: A Cross-Sectional Study

2020-05-26T05:11:32+00:00

Background: Cholelithiasis is a common abdominal disorder resulting in increasing hospital admissions. About 10-12% of adults develop gallstones. Aim of this study was to find out any association of serum iron and ferritin levels in patients of cholelithiasis.Subjects and Methods:Present study was conducted at the department of surgery, tertiary care institute of for the period 1 year. For the study purpose 70 gall stone cases and 70 normal healthy matched controls were taken as study participants. After explaining about the study to the subjects, an informed consent will be obtained, followed by a detailed history with clinical examination with more emphasis on the parameters given below in outcome variable (ultrasonography finding, serum iron level, serum ferritin level, serum cholesterol).Results:The mean age in the case group (gallstones present) is 43.12 years, as compared to the control group the mean age is 41.05 years, The study shows in the case group 64% of patient was female and 36% was male and in the control group 76% of patient was female and 24% was male. In this study 46 (65.7%) patients with gallstones have the value of serum iron less than normal (normal value: >40 μg/dl). Our study shows, there are 35 female patients with gallstone disease who have serum iron levels below the normal value Most of the patients with gallstone disease whose serum iron levels are subnormal are females. Our study shows that the mean serum iron between cases and control was statistically significant p≤0.05. There is no effect of anemia on serum cholesterol. In this study the mean serum cholesterol between cases and control was statistical insignificant (p>0.7)) In the case group, 20 of male and 36 of female patients have normal serum ferritin levels. The number of females having normal serum ferritin levels (in both case and control groups) is more.Conclusion:Gallstones are more prevalent in female population than males. Serum ferritin association is insignificant as it increases other condition with inflammation also. Low serum iron level associated with high risk of cholelithiasis as this may lead to super saturation of bile.

Prevalence of Chest Trauma at Tertiary Care Institute: A Cross Sectional Study

2020-05-26T05:15:26+00:00

Background: Trauma is the leading cause of mortality and disability, especially during the productive age, and is the third most common cause of death. Present study carried out to assess the general spectrum of chest injury patients at tertiary care institute of Gujarat.Subjects and Methods:A total number of 500 patients were admitted with chest were included in the study. Details of all these patients were entered in the study from their records with specific reference to age, sex, mode of injury, severity of injury, number of ribs fractured, treatment employed and final outcome.Results:Out of a total of 500 patients, the maximum was in the age group of 20-29 years and the next common decade was the 4 th one. There were 380 male and 120 female patients. Blunt trauma was responsible for the injury in 405 patients and 95 patients sustained chest injury after penetrating trauma. Regarding treatment profile, no active treatment was required in 135 cases with either one or two rib fractures on x-rays without any haemopneumothorax. Intercostal drainage was required in 330 patients and thoracotomy was essential in 35 patients.Conclusion:Early recognition and management of associated injuries and complications is of paramount importance in reducing the morbidity and mortality. The majority of these patients can be managed by simple intervention i.e., intercostal drainage and only less than 10% require thoracotomy. For ICD, results of negative suction pleural drainage are better as compared to simple underwater seal drainage.

Role of Hyperbilirubinemia as a Diagnostic Tool to Predict Gangrenous/Perforated Appendicitis: An Observational Study

2020-05-26T10:08:02+00:00

Background: Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis.Subjects and Methods:This was a prospective observational study, which was conducted at the Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Patients were clinically evaluated by detailed history, routine examination on initial contact with patients and the routine investigations as per surgery and anesthesia requirements with inclusion of serum total bilirubin. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene).Results:Out of 100 patients, 20 were managed conservatively (mass formation) and was called for interval appendectomy after 6 weeks. In acute catarrhal appendicitis group 47 patients showed normal total bilirubin levels, whereas 8 patients showed increase in levels of total bilirubin. In gangrenous appendicitis group all 10 patients showed elevated serum total bilirubin levels In perforated appendicitis group consisted of 15, 11 patients showed elevated serum bilirubin levels and 4 patients showed normal total bilirubin levels.Conclusion:Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations.

Evaluation of the Viscus injury in Abdominal Trauma

2020-05-26T10:11:39+00:00

Background: The diagnosis of hollow viscus injury with advanced diagnostic tools and management of trauma by conservative and surgically by laparotomy and correction of anatomy. Hence such injuries are frequently overlooked leading to increased morbidity and mortality. Thus, this study is intended to throw light upon the prompt diagnosis and management of hollow viscus injuries in trauma. Hence the aim of the present research was to study the diagnosis and management of hollow viscus injuries.Subjects and Methods:A total of 100 cases were included in the study. All the patients were above the age of 11 years and maximum age of 80 years. Most of the patients included were male with ration of 4:1. After recording of history clinical examination followed by radiological, serological and operative findings were recorded. Data was analyse to study the male: female ratio, etiologies of viscous injury, investigation done and possible management for the treatment.Results:On analysis of the data, most common reason for the abdominal trauma was found to be road traffic accident followed by stab injury. The maximum of the patients belong to the age group of 2 to 30 years. Most common reason for the abdominal trauma was found to be road traffic accident followed by stab injury.Conclusion:It is mostly seen in the age group of 21-30 years which form the young and reproductive group. These patients’ measures should be taken to prevent these accidents and care of victims at the accident site. Well established trauma care centers should be established at least at every taluk hospital. Measures for early transport of the patients from the accident site to the trauma care centres to be undertaken.

A Comparative Study of Efficacy of Outcome of Lateral Internal Sphincterotomy versus Subcutaneous Fissurectomy in Chronic Fissure in Ano

2020-05-26T10:17:45+00:00

Background: Fissure-in-ano is a very common problem across the world which causes considerable morbidity and affects the patient’s quality of life to a greater extent. Anal fissure is a common painful condition affecting the anal canal. The main aim of study was to compare the efficacy of outcome of subcutaneous fissurectomy versus lateral internal sphincterotomy in chronic fissure in Ano.Subjects and Methods:The study was a prospective, parallel group, comparative trial. The study was conducted at Department of General Surgery, Chalmeda AnandRao Institute of Medical Sciences, Karimnagar. The number of patients included in the study was 50. Patients were divided into lateral internal sphincterotomy groups and subcutaneous fissurectomy groups. Patients were followed up regularly for relief of symptoms i.e., pain in the anal region and bleeding from anal region and for complications like incontinence; duration of sitz baths and number of work days lost.Results:The mean age group in the present study was 38.24 ± 9.96 for subcutaneous fissurectomy and 39.2 ± 10.4 for lateral internal sphincterotomy; there was no significant difference in the mean age in either of the groups with P value > 0.05.Conclusion:The current study shows results in favor of subcutaneous fissurectomy with a healing rate of 100% with faster pain-relief and minimal or no complications if performed by the hands of an experienced surgeon.

Serum C-reactive protein and Pro-Calcitonin as an Indicator in Post-Operative Infection after Hepatobiliary Surgery

2020-05-26T10:21:50+00:00

Background: Major hepato-biliary surgeries carry a high risk for post-operative sepsis. Recent therapeutic advances both medical and surgical have improved early post-operative outcome. Considering the difficulties in diagnosis of infection in critically ill patients an early sensitive and specific marker for sepsis would be of interest. Studies have shown that C - reactive protein(CRP) and pro calcitonin (PCT) are acute phase reactants and good independent early markers of post-operative sepsis, severe or septic shock. This aspect has not been evaluated in the hepatobiliary surgeries. More over there is no data available from the Indian sub-continent in this aspect. This study aims to evaluate the efficacy of serum CRP and PCT levels after hepatobiliary surgery for diagnosis of postoperative complication. Subjects and Methods:This is a cross-sectional diagnostic study has conducted in 42 patients who all are satisfying the inclusion criteria. Study duration was From August 2017 to July 2019, conducted on patients between 18-80yrs of age undergoing hepato-biliary surgery, in surgical wards of PK Das Institute of Medical Sciences. Study variables include age, sex, pre-operative serum albumin level, pre and post-operative S.CRP AND S.PCT levels. On post-operative day 4 and day 7 S.CRP and S.PCT are monitored and its predictability also measured. . Descriptive statistical analysis will be carried out using SPSS (IBM). The p-value of less than 0.05 will be taken as significant. Results: out of 42 patients studied, 30 patients developed post-operative complications. Pre-operative serum C - reactive protein and serum procalcitonin measured compared with pre-operative serum albumin was significant identifying post-operative complications (P-value 0.02). On post-operative day 4 and 7value was significant in post-operative patients with P-value of 0.04 vs. 0.046 respectively. Similarly serum procalcitonin values also were significant on postoperative day (POD) 4 and 7 with P-value of 0.02 and 0.03. Sensitivity and specificity of S.PCT was more compared to S.CRP (92 vs 90% in sensitivity and 100% vs 80% in specificity respectively. This study shows those who were clinically septic post operatively have statistically elevated levels of serum CRP and Procalcitonin. Conclusion: S.PCT is more sensitive and specific as a marker of post operative infection following hepato biliary surgery. Early identification of patients with insidious septic illness allows early therapeutic intervention which may favorably influence outcome.

Clinical Study on Patients with Duodenal Perforation

2020-05-26T10:27:36+00:00

Background: Perforations of peptic ulcer are third in frequencies, acute appendicitis and acute intestinal obstruction being more common. Prompt recognition of the condition is very important and only by early diagnosis and treatment it is possible to reduce the still relatively high mortality. The aim of this study was to review and study the factors influencing, the outcome of the duodenal perforations.Subjects and Methods:A clinical study was conducted in 50 cases of diagnosed duodenal ulcer perforation that was established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confined at operation. This study comprises of 50 cases of duodenal ulcer perforation admitted in period from January 2017 to January 2020.Results:In present study, out of total 50 patients with duodenal ulcer 46(92%) males and 5(8%) females, with male predominance. Highest incidence was found between 41-50 years followed by 21-29 years. Most of the patients admitted by 12-24 hours, common site of ulcer is prepyloric in presentation. Duodenal ulcer perforations were single perforation, while two cases of ileal perforations were multiple. Smoking is main predisposing cause of ulcer. ARDS were 14% (7 patients) and it was observed that 32 percent (16 patients) having wound complication, 2 percent (`1 patient) having mortality and 46% (23 patients) have no complications. In this present study, 60% of patients had h/o Peptic ulcer. On X- ray, 90% of patients had finding of air under diaphragm.Conclusion:The mortality in perforated duodenal ulcer has been reduced owing to early approach to hospital, diagnosis, prompt surgical treatment and appropriate and adequate antibiotics. Smoking and alcohol consumption and life style modification may reduce morbidity and mortality in patients with duodenal perforation.

A prospective Comparative Clinical Study on Bladder Urine, Pelvic Urine and Renal Stone Culture & Sensitivity in Predicting Urosepsis Following Percutaneous Nephrolithotomy

2020-05-26T10:30:45+00:00

Background: Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome.UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock.It is estimated that the mortality rate due to urosepsis ranges from 30 to 40 p.c respectively. Urosepsis may also cause multiple organ dysfunction, hypoperfusion or hypotension.Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection.Aim & Objectives:To compare bladder urine (culture & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy.Subjects and Methods:A hospital-based,analytical prospective clinical study was conducted among thirty cases who were present during the study period and had undergone percutaneous nephrolithotomy (PCNL). Cases were included irrespective of gender with renal calculi in whom percutaneous nephrolithotomy was about to be done at Narayana Medical College & Hospital, Chintareddypalem, Nellore, Andhra Pradesh during 1^st February 2014 to 31^st January 2015. Data collected was divided into three main groups Midstream urine (C&S); Pelvic urine (C&S); and Stone (C&S) respectively.Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant.Results:Bladder urine (C&S) was positive in 3/30(10.00 %) patients,Pelvic urine(C&S) in 5/30 (16.66 %) patients and Stone (C&S) in 8/30 (26.66 %) patients.Most of the infected specimens grew Escherichia coli followed by pseudomonas, klebsiella, enterococcus.Systemic Inflammatory Response Syndrome (SIRS) was reported among26.7 p.c (8) of the patients. In one patient (3.33%) septic shock developed but no deaths were reported.Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S).

Tamsulosin and Tadalafil in Relieving Benign Prostatic Hyperplasia Related Symptoms- A Comparative Study

2020-05-26T10:33:38+00:00

Background: Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting men and constitutes a major factor impacting the health of the male. The present study compared tamsulosin and tadalafil in relieving benign prostatic hyperplasia related symptoms in patients.Subjects and Methods:The present study was conducted at NRI Medical College & Hospital, Chinakakani, Mangalagiri Mandal, Andhra Pradesh from April 2007 to March 2008 on 82 men of >45 years of age with LUTS secondary to benign prostatic hyperplasia (BPH) with an IPSS >8. All patients were divided into 2 weeks. In group I, Tadalafil 10 mg once daily with an intervening 4-week period of placebo (P4) wash out followed by Tamsulosin 0.4 mg once daily were administered for a period of 6 weeks and in group II, reverse of it was administered. IPSS scores, Uroflowmetry parameters and International Index of Erectile Function-5 scores were recorded in both groups.Results:Age group 45- 55 years had 12, 55-65 years had 28 and >65 years had 42 patients. The difference was significant (P< 0.05). Comorbidities such as diabetes mellitus was present in 4 in group I and 5 in group II, bronchial asthma 5 in group I and 3 in group II, Hypertension was present in 7 in group I and 9 in group II and both hypertension and diabetes mellitus was present in 10 in group I and 12 in group II. The difference was significant (P< 0.05). Mean IPSS total score, IPSS voiding score, IPSS storage score and IPSS QOL score at baseline, 2 weeks and 8 weeks in group I and group II was non- significant (P> 0.05).Conclusion:Authors found that both Tadalafil and Tamsulosin improved LUTS and benign prostrate hyperplasia symptoms.

Antegrade Percutaneous Versus Retrograde Ureteroscopic Lithotripsy in Upper Ureteric Cases

2020-05-26T10:36:28+00:00

Background: The technical advancements in urology have profoundly changed the management of upper ureteric calculus. The present study compared antegrade percutaneous versus retrograde ureteroscopic lithotripsy in upper ureteric cases.Subjects and Methods:The present study was conducted at NRI Medical College & Hospital, Chinakakani, Mangalagiri Mandal, Andhra Pradesh from May 2013 to April 2014 on 60 patients with upper ureteric stones of both genders. Patients were divided into 2 groups. Group I patients were treated with antegrade percutaneous and group II with retrograde ureterolithotripsy. Outcome in both groups was recorded and compared.Results:The mean anesthetic time in group I was 82.4 minutes and in group II was 73.1 minutes, operative time was 45.2 minutes in group I and 58.4 minutes in group II, post- operative stay in group I was 2.6 days and in group II was 1.7 days, stone clearance was seen in 26 patients in group I and 22 in group II. Mean stone size in group I was 1.89 cm and in group II was 1.49 cm. Follow ups days were 71.2 in group I and 83.4 in group II. Clavien-Dindo categorization grade 0 was seen in 16 in group I and 13 in group II, grade 1 in 10 in group I and 12 in group II and grade 2 in 4 in group I and 5 in group II. The difference was significant (P< 0.05). There were 4 and 5 patients in group I and group II with post- operative complications (P< 0.05).Conclusion:Authors found that antegrade percutaneous has better stone clearance rates as compared to retrograde ureterolithotripsy for an upper ureteric calculus.

Retrograde Intrarenal surgery- Our experience

2020-05-26T10:44:56+00:00

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

A Study of Predictive Factors in the Outcome of Necrotizing Fasciitis in Patients of Sepsis

2020-05-27T09:48:19+00:00

Background: Necrotizing fasciitis is an infection occurring in the deep fascial layers. It is a progressive infection. The diagnosis of necrotizing fasciitis is usually clinical and is important to find it early as it is a fast spreading infection. Necrotizing fasciitis occurs as a result of necrosis of skin and subcutaneous layer. Objective: To assess factors which will help in clinching the diagnosis of Necrotizing Fasciitis and to identify factors responsible for morbidity and mortality. Design: This was hospital based observational study. Duration: 2 years from May 2017- June 2019. Setting: Department of general surgery, Osmania General Hospital. Participants: 30 patients with necrotizing fasciitis.Subjects and Methods:Clinical and anatomical findings rendered initial diagnosis. The patient's details have been noted. Detailed patient interview on history and other comorbid conditions was conducted. Bacteriological culture is done. Following initial debridement, the wound was inspected regularly and subsequent debridement was done periodically whenever necessary.Results:Majority of the patients were males, 80% and the rest 20% were females. In 56.66% of the patients the site of NF was perineum and in the rest 43.33% of the patients it was in the extremities. The type of bacterial culture done was polyculture in majority 90% of the patients and monoculture was done in the rest 10% of the patients. 30% of the patients tested positive for NF and rest 70% were found to be negative with NF. The mortality rate was 30% and morbidity rate was 10%.Conclusion:Effective and vigorous surgical debridement, often in multiple sessions, supplemented by adequate antibiotics and supportive treatment, is the key to a successful result with necrotizing fasciitis.

P53 and the Carcinoma of the Breast: A Review

2020-05-27T10:14:51+00:00

Background: TP53 is a gene and p53 is its product protein. Since its discovery many studies have looked into its function and its role in cancer. It is not only involved in the induction of apoptosis but is also, a key player, in cell cycle regulation, development, differentiation, gene amplification, DNA recombination, chromosomal segregation and cellular senescence and so, it is called “the guardian of genome”. The human TP53 gene spans 20kb on chromosome band 17p13.1. The biological functions of p53 are apoptosis, senescence and cell migration. The evolution of a normal cell towards a cancerous one is a complex process. Tumorogenesis is considered to endow, the evolving tumor with, self-sufficiency of growth signals, insensitivity to antigrowth signals, evasion from programmed cell death, unlimited replicative potentials and finally the ability to invade and metastasize. TP53 may be considered as the “ultimate tumor suppressor gene”. Its oncogenic activity is attributed to loss of function, dominant negative (DN) oncogenic properties and activities of mutant p53. In breast cancer its oncogenic function is due to p53 mutation, changes in- upstream regulatory pathways, in p53 transcriptional target genes, in p53 co-activators, and/or involvement of other family members of p53 family like p63 and p73. The p53 mutation is present in only in about 20% of breast cancers, but when present, they entail the worst prognosis. This interesting paper is a review and discussion about role of p53 in carcinoma breast.

Management Strategies and Clinicopathological Evaluation of Liver Abscess in the Tribal Area: A Cross Sectional Study

2020-05-27T10:16:54+00:00

Background: Liver abscess continues to be disease with considerable mortality in our country especially in Tribal Area. Locally made alcoholic drinks like neera, arrack may be the routes of faeco-oral transmission of amoebic cysts. Hence the aim of the study was to study the influence of alcohol, diabetics & immunocompromised diseases leading to increased incidence of Liver abscess and to evaluate efficacy associated with most effective treatment.Subjects and Methods:The present study included 50 patients diagnosed with liver abscess. All the patients were under the treatment for the period of years. All cases of liver abscess diagnosed clinically and/or ultrasonographically, all cases of bacterial and parasitic liver abscess and the cases in evolving, liquefied & ruptured stage with or without peritonitis were included in the study.Results:When the management part of the liver abscess was analysed 14 patients had abscess that was less than 200 cc or had multiple small abscess involving both lobes that were managed conservatively. Total of 36 patients who had abscess > 200 cc or left lobe abscess were subjected to intervention, of which 24 patients were treated with percutaneous aspiration with antibiotic coverage, 6 patients were treated with laparotomy procedure and 4 patients treated with drainage with laparoscope and 2 patients underwent ICD insertion.Conclusion:Liver abscess is a common condition in tribal area of India. It is still, a disease associated with considerable morbidity. Intraperitoneal rupture, pleural rupture, septicemia are the conditions that can occur. Multiple small liver abscess and solitary liver abscess < 200 cc or size < 5cms can be successfully managed with conservative line of management with antimicrobials / antiamoebic drugs, but recurrences were noted. Percutaneous needle aspiration as well as Pigtail Catheter insertion is safe and highly effective method of managing liver abscess cases. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

Evaluation of the Management of Urolithiasis with Clinical Study

2020-05-27T10:19:11+00:00

Background: Urolithiasis encompasses both renal and ureteric stones. It is estimated that up to 5% of the world population is affected by this disease and the lifetime risk of getting urinary stone is 8-15%. The aim of this study is to look for epidemiological patterns in the disease distribution, understand the causative factors of the disease and assess the existing surgical modalities of treatment of this disease.Subjects and Methods:In the present study 68 cases of Urolithiasis fulfilling the study parameters were admitted and subsequently operated in Medical College and Research Hospital.Results:65% of the patients were between age group 18-40. The most common site of urinary calculus was lower 1/3ureter followed by lower pole kidney. Diet, fluid intake, diabetes and obesity were significant predisposing factors for urolithiasis. PCNL was the treatment of choice for renal calculus while ECSWL was treatment of choice in upper ureteric calculi and ureteroscopy for lower ureteric calculi.Conclusion:For renal calculi, PCNL is the best treatment modality as of now, but it is associated with greater post-operative morbidity. For stone less than 1cm size, ECSWL is a good alternative to PCNL, but has poor clearance rate and thus greater need for auxiliary procedure. For ureteric calculi, both ECSWL and ureteroscopy have given good results but ECSWL is better tolerated by the patients.