bluuebunny/crossref_metadata_2025 huggingface dataset:
CALCULATION OF INSTANT-RIGID HINGED-ROD SYSTEMS WITH MISSING LINKS
Authors: AKHMEDOV Akramdzhon D.
Published: October 2018

The problem of determination of forces and displacements in a spatial hinged-rod system with missing (up to geometrically unchangeable) links under static loading is considered. Equilibrium equations and geometric relations are writt en in a matrix form. The calculated equations are not linear. To solve the equations we propose a general technique that is not related to assumptions about the structure of the system or the nature of the load based on the fact that the displacements obtained by solving a linear part of the equations can be substantially refi ned by interpreting the nonlinear terms as a load under the action of which the system can be regarded as linear.
ON THE INFLUENCE OF SOLAR ACTIVITY ON THE HYDROCHEMICAL COMPOSITION OF THE WATER OF THE SAMARA RIVER
Authors: SHABANOV Vsevolod A. , KHRYANINA Anastasia A.
Published: October 2018

A brief description of the water in the Samara River is given. The data on hydrochemical parameters of the river water for the period 2005-2015 are given. Indicators are marked out, sharply changing their values in the period under review. For such studies the indicator-the oxygen concentration-was selected. It was revealed with the help of statistical methods that the series of observations under consideration is divided into two samples with diff erent sample averages. It is graphically proved that the sharp jump in oxygen concentration was due to the infl uence of solar activity. The dependence of the sulfate content in the Samara River on solar activity for the period from 2005 to 2015 was studied. Calculations have been made that prove the hypothesis of the infl uence of solar activity on the hydrochemical composition of the water of the Samara River.
JEAN-NICOLAS-LOUIS DURAND: MACHINE OF ARCHITECTURE
Authors: DANILOVA Elina V.
Published: October 2018

The article deals with the design methodology invented by the French architect Jean-Nicolas-Louis Durand as a machine of mass production of architecture. The author describes the historical and temporal background which determined the requirements for the design and construction of a large number of public buildings. The historical parallel between diff erent epochs when urban expansion became the reason for the invention of methods of high-speed and simple design of various objects is studied. Duran’s methodology is described based on the analysis of two theoretical works. The positive and negative aspects of the project approach based on such methodology are investigated. The role of Duran’s work in the process of creating architecture for the modern city is established.
ARCHITECTURAL AND PLANNING FORMATION OF INDUSTRIAL AREA OF KUYBYSHEV - BEZYMYANKA, IN THE 1930s-1950s
Authors: SAMOGOROV Vitaly A.
Published: October 2018

The process of forming the architectural and planning structure of the industrial area of the city of Kuibyshev in the mainstream of the theoretical concept of the 1930s. - a socialist city - is considered. The specifi cs of the process of designing and building the largest in the USSR industrial hub of the aviation industry and the residential area serving it in the conditions of the transitional stage of the prewar, military and post-war period are revealed. The existing building of the district is analyzed on three hierarchical levels of the organization - industrial-residential area, residential quarters, residential buildings. The architectural and compositional features of the existing urban environment are determined.
PRINCIPLES OF THE CONTEXTUAL APPROACH AND THE CONCEPT OF RESIDENTIAL BUILDINGS DESIGNING IN THE HISTORIC QUARTERS OF THE CITY
Authors: VOLOGDINA Natalya N. , YARUKOV Viktor N.
Published: October 2018

The problems of residential buildings designing in the historic quarters of the city are considered. A judgment is given about the origins of contextualism. Att ention is drawn to various positions in creating a full-fl edged environment, taking into account a wide range of issues of its comprehension and development. On the basis of the adopted concept of the contextual approach the principles demonstrated with the help of three-dimensional models are formulated. As a research area and priority intervention a specifi c area of urban fabric with regular planning is selected. Contextual design techniques are off ered which can be used as a tool in professional activity. The importance and value of the approach returning to the city its historical memory is emphasized.
PERFECTION OF THE FORM AND TECHNOLOGY OF THE REINFORCED CONCRETE PILES DESIGN FOR LOW-RISE CONSTRUCTION
Authors: ISAEV Veniamin I. , MALTSEV Andrey V. , KARPOV Andrey A.
Published: October 2018

The results of a computational and analytical study of the carrying capacity of various variants of short piles used in low-rise construction are presented. The relevance of the topic of work is determined by the current situation in the fi eld of individual housing construction. The most common pile foundations in this direction of construction are considered. Two alternative designs and technologies for piling are proposed. A comparative analysis of the bearing capacity of the piles proposed by the authors with the most common variants is made. The materials of the publication refl ect the eff ectiveness of the proposed designs and suggest continuation of research in this direction.
INVESTIGATION OF THE INFLUENCE OF ALUMINA ADDITIVE ON SINTERING OF LOW-MELTING CLAY BY THE DTA DIAGRAM SECTION
Authors: KRASHENINNIKOV Maxim V.
Published: October 2018

A variant of using low-melting clays for the production of clinker products is considered. In this case it is customary to modify the charge with additives, refractory and refractory clays. A promising approach is to use a relatively small amount of additive with correction of the fi ring regime. The composition of clinker mass with a complex alumina additive based on industrial waste products is optimized and developed. The W-SID method including preliminary discrete fi ring, diff erential thermal analysis and compression strength test provides diagrams that give a complete picture of the relationship between the amount of the complex additive in the charge and the fi ring regime.
Remnant gall bladder and cystic duct stump stone after cholecystectomy: tertiary multicenter experience
Authors: Mageed Samir A. A. , Omar Mohammed A. , Redwan Alaa A.
Published: October 2018

Background: There is no doubt that cholecystectomy relieves pre-surgical symptoms of gallbladder (GB) disease. The persistence of symptoms mainly biliary pain was recorded in 10 - 20% of cases, with variety of causes. Residual GB/cystic duct stump stone is one of the most important un-expected cause. The present study was conducted to study and evaluate those patients, with their surgical treatment.Methods: This retrospective study was conducted on 27 cases with residual GB/cystic duct stump stone. The diagnosis was guided by ultrasound and magnetic resonance cholangio-pancreatography. All cases were managed by using completion cholecystectomy - either open or laparoscopic. All preoperative, operative, and postoperative data were collected.Results: Preoperative endoscopic retrograde cholangio-pancreatography and papillotomy were required in 13 patients whom were presented with obstructive jaundice. Open completion cholecystectomy techniques were done in the majority of cases (21 patients) while laparoscopic approach was feasible in only 6 cases with one conversion (1/6). The mean operative time was (89.57 ± 12.05 and 118.16 ± 12.6 min), and the mean blood loss was (195.5 ± 19.22 and 187.5 ± 23.61 ml) respectively. Intra-operative minor biliary injury occurred in two cases and repaired instantaneously. The mean hospital stay was (4.76 ± 2.81 and 2.33 ± 1.32 days) respectively. All patients were reported to be symptom-free at the follow-up after surgical treatment.Conclusions: Residual GB/cystic duct stump stone is a preventable and correctable cause of post-cholecystectomy complaint. Completion cholecystectomy is a proven treatment of choice to relieve symptoms and avoid complications; furthermore, it can be carried out laparoscopically with experienced team and facilities in spite of difficulties.
Gastro intestinal perforations: an audit from a tertiary care teaching hospital, Mysore, India
Authors: H. B. Shashikumar , B. S. Madhu , S. Shyama
Published: October 2018

Background: Peritonitis secondary to hollow viscus perforation is one of the most frequently encountered surgical emergencies in India. The objective of this study was to study the demographic and clinical profile of gastro intestinal perforations and surgical procedures done for the same in a tertiary care teaching hospital.Methods: This study was performed on 46 cases of hollow viscus perforation admitted in K. R. Hospital from January to June 2018. The presenting symptoms, age and sex profile, risk factors, site of perforation, the surgical procedure they underwent, post-operative complications were assessed and analyzed.Results: The most common age group affected was 21-30 years out of which 89.1 % were males. Gastric perforations were the most common type (56.5%) and jejunal perforations were the least common (6.5%). Abdominal pain was the main presenting symptom in all the cases. Fever was found to be a significant history in cases of ileal perforation (p=0.001) as was history of trauma in cases of jejunal perforation (p=0.001). Guarding, rigidity and air under the diaphragm were seen consistently in most cases. Graham’s patch repair was the most common surgical procedure performed. Ileostomy was the most common surgery done for ileal perforations. Wound infections were the most common post-operative complication observed and death occurred in 13% of cases mostly due to sepsis and cardio pulmonary complications.Conclusions: This study showed an increased incidence of perforation in younger age group which is alarming. The rise in the frequency of gastric perforations points towards an unhealthy lifestyle and dietary habits.
Tarsal tunnel decompression: an effective method for prevention of foot complications in diabetic patients with compressive neuropathy at tarsal tunnel
Authors: S. Viswanathan M. , S. Lakshmanan , Anbazhagan R.
Published: October 2018

Background: Diabetic foot is one of the most devastating complications of diabetes with 15% lifetime risk of developing ulcer foot. About 80% of diabetic foot is neuropathic in origin, revealing the importance of sensory sensation in preventing the development of diabetic ulcer. This study is aimed to identify the efficiency of tarsal tunnel decompression surgery in diabetic patients in ulcer healing and in the prevention of development of new diabetic related foot complications.Methods: About 70 diabetic patients with ulcer in one foot, acting as test limb and contralateral foot having no ulcer, acting as control limb was included in the study. Tarsal tunnel decompression surgery was done in the test limb and the status of ulcer in the test limb, in terms of diameter/ progress of ulcer healing was observed. In both the study limb and the control limb foot was examined for onset of any new diabetes related foot changes/complications during the follow up period for 18 months.Results: Postoperatively, at 6 weeks, 20 patients (28.6%) had their ulcers fully healed. At 3rd month postoperative follow up 90.48% of ulcers in the test limb showed complete healing following decompression surgery and 9.52% of ulcers showed partial healing. Following decompression surgery in the test limb, only 2 patients (3.28%) developed new diabetes related foot changes/complications as compared to control limb, where 15 patients (24.59%) developed new diabetes related foot changes/complications.Conclusions: Present study firmly proves that following tarsal tunnel decompression surgery, there is improvement in healing of the ulcer with conservative measures and there is a definitive role of tarsal tunnel decompression in prevention of development of new diabetes related foot changes/complications in patients.
Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis
Authors: T. Kemparaj , K. N. Narasimhamurthy , Muralidhar Archit
Published: October 2018

Background: Acute pancreatitis is an acute inflammatory process of the pancreas. The Ranson and the modified Glasgow scores require 48 hours of data collection to asses’ severity. Hypocalcaemia is one of the components of Ranson's scoring system done to assess the severity of pancreatitis. Albumin-corrected calcium (ACC) has also been associated with severity, but no study has evaluated it as a prognostic severity factor within the first 24 h of the patient’s hospital admission. This study tries to evaluate total calcium and albumin corrected calcium as prognostic severity markers in acute pancreatitis within first 24 hour of admission.Methods: This prospective study was conducted in Bowring and Lady Curzon hospital, a tertiary care centre from June 2016 to May 2018. Inclusion criteria included all patients above 18 years of age, who presented within 72 hours of onset of epigastric pain. The clinical and demographic data with respect to gender, age, previous history of pancreatitis, total calcium taken 24 h after admission. In order to evaluate total calcium and albumin corrected calcium as prognostic factors of severity, the lowest total calcium values were collected within the first 24 h of hospital admission. These values were then corrected according to the serum albumin level.Results: A total of ninety-four patients were included in the study. There was no significant difference in the age of patients in each severity grade (p value: 0.242). No difference was observed in gender distribution of three groups. (P >0.05). As compared to total calcium, mean values of albumin corrected calcium were 8.03, 7.18 and 6.28 for mild, moderate and severe acute pancreatitis respectively, which were also significant at 0.05.Conclusions: Total calcium and albumin-corrected calcium obtained within the first 24 hours of hospital admission are useful predictors of severity in acute pancreatitis.
A comparative study of single incision laparoscopic cholecystectomy with conventional laparoscopic instruments versus multiple port laparoscopic cholecystectomy
Authors: Malladad Nagaraj S. , Kulkarni Ashwin
Published: October 2018

Background: Treatment of gall stones have evolved markedly since open cholecystectomy was first described by Lange Buch in 1881. Management has progressed through eras of nonsurgical management, laparotomy, minilaparotomy and now laparoscopic cholecystectomy which is the gold standard for the treatment of gall stone disease today. Laparoscopic surgery is the procedure of choice for most benign gall bladder diseases unless obvious contraindication exists. There has been a trend toward minimizing the required number and size of ports to reduce postoperative pain with better cosmetic results.Methods: Comparative randomized study was conducted in Department of Surgery, SDM College of Medical Sciences and Hospital between February 2017 to July 2018. 60 patients who fit into the inclusion criteria were included in the study. 30 patients were included in the multiport cholecystectomy and 30 in the SILC. Random allocation of patients presenting with symptoms suggestive of gall bladder disease with confirmatory USG study. Group1: single incision laparoscopic cholecystectomy, Group2: multiple port laparoscopic cholecystectomy.Results: Majority of presenting patients were in age group 41-50 years. No significant difference in the mean age of patients, surgical complication, conversion rates and SSI operated by the two techniques. Median time required to complete cholecystectomy by SILC technique was not significantly higher than that required for multiport cholecystectomy. Statistically significant lower postoperative pain score was seen in patients with SILC compared to Multiport laparoscopic cholecystectomy. Patients operated by SILC technique had a postoperative hospital stay of mean 4.04 days, almost same as for patients operated by multiport technique.Conclusions: Difference of Conversion rates and time required for SILC is not significantly higher than that required for multiport cholecystectomy. No rise in intra and post-operative complications occurred in the single port surgery. Postoperative pain is significantly lower in patients undergoing SILC Length of postoperative hospital stay and incidence of SSI for single port cholecystectomy is almost as same as for multiport cholecystectomy.
Evaluation of brain CT-scan results and indications before lumbar puncture in children suspected of meningitis hospitalized in Ardabil city hospital
Authors: Vafaie Majid , Mirzarahimi Mehrdad , Enteshari-Moghaddam-moghaddam Afsaneh , Mousavi Sahar
Published: October 2018

Background: Multiple use of CT scan is associated with an increased risk of cancer in the future especially in children due to cellular growth and mutation. The aim of this study was to evaluate the result and indications of brain CT scan before lumber puncture in children with suspected of meningitis.Methods: In this retrospective cross-sectional study, information of brain CT Scans on all meningitis suspected children under 12 years old hospitalized in Ardabil city hospital at 2016 who were candidates of CT Scan before Lumbar Puncture were extracted and the results were analyzed by statistical methods in SPSS version 22.Results: In this study, a total number of 67 patients were studied and CT scan changes were seen in 13 cases (19.4%) that of them 6 (46.2%) were male and rest of them were female. The mean age of the cases that had CT scan changes was 36.9±2.14 months and in other patients were 38.8±3.56 months. Of all patients, 13 patients experienced decrease in consciousness level that CT scan changes were observed in 8 cases (61.5%). Of the 13 patients (19.4%) had CT scan changes, 5 (38.4%) ha brain structural lesions.Conclusions: The prevalence rate of CT-scan changes was 19.4% and the most commonly detections in patients by CT scan, were structural disorder of the brain and subdural effusion.
Evaluation of combined use of modified Alvarado score and Ultrasound in predicting acute appendicitis: a prospective study
Authors: Kansakar Nirajan , Agarwal P. N. , Singh Rajdeep , Mishra Anurag , Kumar Jyoti , Hadke N. S. , Sheth Srushti
Published: October 2018

Background: Appendicitis is notorious in its ability to simulate other conditions and accurate diagnosis is imperative for preventing complications of appendicitis on one hand and avoiding negative appendectomy on other. Despite extraordinary advances in modern radiography imaging and diagnostic laboratory investigations, the accurate diagnosis of acute appendicitis remains an enigmatic challenge.Methods: We evaluated 32 patients with features suggestive of acute appendicitis between September 2013 to March 2015. It was a cross-sectional observational study that included modified Alvarado score (MAS) and ultrasound (USG) in predicting appendicitis and correlated both these individually as well as combined, with histopathological findings. Statistical analysis was done by Chi-square test with Yates correction, Fischer’s exact test and unpaired Students’ t test.Results: Ultrasound was found to be more sensitive (74.19%) and accurate (75.0%) as compared to MAS (41.94% and 43.75% respectively). The specificity and positive predictive value (PPV) were similar in both the parameters (100% each). Also, when both the MAS and Ultrasound were combined in predicting acute appendicitis, the sensitivity, negative predictive value and accuracy increased to 80.64%, 14.29% and 81.25% respectively with specificity and PPV being the same as when MAS and USG were considered individually.Conclusions: It is advised that both modified Alvarado score and ultrasound whenever available should be used to predict acute appendicitis to increase the number of positive cases and reduce negative appendectomy and hence reduce the morbidity and mortality.
Incidence of peripheral arterial disease in eastern part of Uttar Pradesh, India in a tertiary hospital and its management
Authors: Singh Sanjay , Singh Mayurika , Kola Anish
Published: October 2018

Background: Peripheral artery diseases, group of some pathological conditions affecting limbs are chronic and gradually progressing causing limitation in blood flow. to assess the incidence, related factors and treatment comparison of peripheral arterial diseases in eastern part of Uttar Pradesh.Methods: All the patients come to OPD with suspected peripheral arterial disease are evaluated with proper history taking, investigation and diagnosed the specific pathology and treated accordingly. From these 40 patients conclusions have been made.Results: Majority of the patients were suffered from thromboangitis obliterans (42.55%). Arteriosclerosis obliterans constitute only 12.55% of peripheral arterial disorders.25%were congregation of miscellaneous arterial disorders viz. Rheumatoid arthritis (3 cases), infective gangrene and non-healing ulcers (5 cases) and 2 cases of arteriovenous fistula.Conclusions: Most common peripheral arterial disease is thromboangitis obliterans. Males are commonly affected by peripheral arterial diseases. But incidence of Buerger’s disease increase in females because of increasing habits of smoking and tobacco addiction in any form. Most of patients of T.A.O were villagers while A.S.O, diabetic arteriopathy, vasospastic disease and rheumatoid arthritis commonly affected urban population. Sympathectomies yields good results in early stages of thromboangitis obliterans and vasospastic disease.
Prevalence of diabetic complications and risk factors among diabetic foot ulcer patients: a retrospective hospital-based study
Authors: P. Shanmuga Raju , N. Venkata Ramana , V. Surya Narayana Reddy , S. Bhagya Seela , G. Sachin
Published: October 2018

Background: Diabetic foot ulcer is a painful, demands increased health care utilization, and increases healthcare costs for the patients as well as the health care system. The purpose of this study was to analysis the prevalence of diabetic foot complications and risk factors among diabetic patients at tertiary care Hospital, Karimnagar.Methods: Total 60 sample sizes were included in the study. The study was conducted at General Surgery ward, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from July 2017 to June 2018. Demographic, complications and risk factors were recorded, and outcomes were analyzed using SPSS statistics version 21.0.Results: The Mean age of the study group is 50.31±14.26 years. The male to female distribution is 47 (78.3%) and 13 (21.7%) respectively. The mean duration of illness in days is 96.68±289.21, while mean HbA1C is 9.44±9.02. The mean fasting blood sugar and postprandial blood sugar is 159.78±70.01 and 157.78±86.28 which shown no significance difference (p = 0.87). Odds ratio with 95% confidence interval was computed to the level of significant.Conclusions: There was no significant outcome was found in diabetic foot ulcer. Patient with high risk complications need as early detection, foot care education, moderate physical, exercise, fitted foot wear and diabetic diet should be decrease the risk of diabetic foot ulcers.
Study of epidemiology and outcome of chest trauma at an apex tertiary care trauma centre
Authors: Iyer Sandhya , Singh Mansha , Jathen Vinay
Published: October 2018

Background: Trauma accounts for 12% of the world’s burden of disease. Chest trauma is present in about 50% of trauma victims and is the cause of death in about 25%. Present study focuses on the epidemiology and outcome associated with both, blunt and penetrating chest trauma, over a period of one year in our high-volume tertiary level trauma centre in Mumbai.Methods: A prospective study including all patients between the ages of 18-60 years who suffered from chest trauma and were admitted to trauma ICU over a period of one year. Master chart was maintained of all data collected and Revised trauma Score and Apache II Score was calculated.Results: Using Stepwise Logistic Regression Analysis it was found that factors significantly affecting mortality were Age, Revised Trauma Score <7, Apache II score >18 and infective complications.Conclusions: Mortality from chest trauma can be significantly reduced by development of better trauma care systems, prevention of shock and hypoxia and adherence to strict aseptic precautions to prevent infective complications.
Comparative analysis of closed reduction and percutaneous pinning versus conventional closed reduction with casting in extra-articular fractures of distal end radius
Authors: Singh Gaurav , Rastogi Prateek , Kodi Harish , Vishwakarma Rakesh , Singh Ajit
Published: October 2018

Background: Distal radius fractures are very common. Closed reduction and casting are the conventional non-operative treatment option available while plate fixation, external fixation and closed reduction with percutaneous pinning are a few surgical options available to the surgeon.Methods: A prospective comparative study of one year was conducted in the Department of Orthopaedic Surgery. A total of 40 patients of distal radial fracture fulfilling the inclusion criteria and giving their consent for inclusion in the study were randomly allocated to either closed reduction (n = 20) or closed reduction with percutaneous K-wire (20). Patients were followed up to 6 months and radiological and functional outcome was compared between two groups.Results: On global assessment using Gartland and Werley criteria, median score of K-wire group was 7.5 which indicated that majority of patients had score <8, thus indicating a good outcome whereas in closed reduction cast group, median score was 13.50, thus indicating that majority of patients had scores in the fair to poor grade. None of the patients in K-wire group had score above 18, thus indicating that all the patients in this group had shown a fair treatment response. Statistically, the difference between two groups was significant too.Conclusions: The present study thus establishes that the immediate post-operative morphological/anatomical and 6 month functional and morphological outcome of closed reduction with K-wire is better as compared to closed reduction with cast.
Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair
Authors: Dhanaraju S. , Kannan N.
Published: October 2018

Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor.
Clinical study of fistula in ano in patients attending surgical OPDs of a tertiary care teaching hospital, Central India
Authors: Qureshi Irfan Parvez , Sahani Indra Singh , Qureshi Saima , Modi Vimal
Published: October 2018

Background: A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening.Methods: All cases of clinically diagnosed fistulae-in-ano admitted in various surgical units in Index Medical College Hospital, Indore during the study period January 1, 2015 to December 31, 2017. A Preformed set of questionnaires will be prepared and tested and the same proforma will be used for the study of selected clinically diagnosed cases of Fistula-in-ano. Clinical history was obtained in all the patients. Clinical examination including per rectal and proctoscopic was done in required patients.Results: Total 44 cases of fistula in ano were selected randomly using closed envelope method and studied in detail the following results were obtained. In this present series, 56.81% of patients were in the age group of 31-60 years followed by 34.09% of patients were in the age group of 11-30 years. Only 9.09% of patients were in the age group above 60 years. About major clinical features were noted perianal discharge, pain, swelling and peri anal irritation were 75%, 65.91%, 43.18% and 11.36% respectively.Conclusions: Early diagnosis and appropriate management is the key to success. Fistula-in-ano forms a good majority of treatable benign lesions of rectum and anal canal. 90%or so of these cases are end results of cryptoglandular infections.
Single-incision laparoscopic surgery versus conventional laparoscopic appendectomy
Authors: K. Jawahar , R. Sharanya , Prakash Sanjay
Published: October 2018

Background: Single Incision Laparoscopic Surgery (SILS) is a new technique of minimally invasive surgery using a single incision to minimize all ports to one site, hence a single scar that can be strategically placed in the umbilicus for a perceived scar less abdomen.Methods: We report this study evaluating the possible advantages of SILS versus conventional laparoscopic appendectomy through a randomized controlled trial. The study population includes patients diagnosed as acute appendicitis. A total of 50 patients underwent appendectomy, patients were randomly assigned to either SILS appendectomy or conventional appendectomy in 1:1 ratio. Primary end points were operative time, complication rate, postoperative pain, post-operative hospital stay and patient satisfaction.Results: The pain scores measured at 48 hours were significantly lower in SILS group than conventional Lap appendectomy group. Patients had significant satisfaction score and lower pain score in SILS group than Lap appendectomy group measured at 6 weeks after appendectomy. However, the post-operative stay was similar in both the groups. There was no conversion to open appendectomy in both the groups. Patient satisfaction score in SILA was found to be higher than CLA. Operating times were similar and post-operative stay was apparently lower.Conclusions: SIL appendectomy is as safe and effective as conventional lap appendectomy.
Oncological outcomes of obstructed locally advanced rectal cancer in the era of multi-modal therapy
Authors: Franklyn Joshua , Varghese Gigi , Rghunath Rajat , Sebastian Tunny , Jesudason Mark Ranjan
Published: October 2018

Background: The management of locally advanced rectal cancer is multi-modal. In India, a number of patients present with features of intestinal obstruction and are diverted prior to initiation of chemo-radiation therapy. The purpose of this paper is to study the demographics and oncological outcomes of obstructed locally advanced rectal cancer (OLARC) requiring pre-therapy diversion colostomy in comparison with patients who did not need pre-treatment diversion (non-obstructed group).Methods: This is a retrospective analysis of a prospective data-base. Patients diagnosed with non-metastatic locally advanced adenocarcinoma of the rectum in a colorectal unit of a tertiary care teaching hospital between August 2012 and December 2014 were analyzed. Data was collected from hospital records and telephonic interviews.Results: Two hundred and thirteen patients were diagnosed to have locally advanced rectal cancer.  One hundred and fifty patients (70.4%) did not have features of intestinal obstruction and received NACRT upfront and 63 (29.6%) required pre-therapy diversion colostomy. Thirty-nine patients (61.9%) completed therapy (neo-adjuvant chemo-radiotherapy followed by Surgery and adjuvant chemotherapy) in the obstructed group, compared to 127(84.7%) in the non-obstructed group (0<0.05) who completed all components of cancer directed therapy.  The 3-year overall survival (OS) of the obstructed and non-obstructed groups was 59% vs 90% (p<.001) and the disease-free survival (DFS) was 51% and 76% (p<0.01) respectively.Conclusions: In the era of multi-modal therapy, patients with obstructed locally advanced rectal cancer have worse oncological outcomes with respect to overall and disease-free survival.
Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality
Authors: Ekka Nishith M. Paul , Mishra Gaurav , Kumar Vinod , Tiwary Arun Kumar , Kar Tanushree , Tiwary Ashutosh
Published: October 2018

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.
Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India
Authors: Qadri Arshid Iqbal , Ahmad Younis , Bhat Gowhar Aziz , Khan Aamir A. , Bashir Khalid
Published: October 2018

Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.
Laparoscopic inguinal hernia repairs: comparison between TAPP and TEP at a tertiary center of Nepal
Authors: Gurung Komal B. , Banepali Niroj , Sthapit Rakesh R. , Adhikari Baikuntha
Published: October 2018

Background: Laparoscopic inguinal hernia repair has been proven to be a safe and effective procedure for groin hernias. In recent years, many of the tertiary centers in Nepal have started performing laparoscopic hernia repair. With the availability of resources and the facilities, the laparoscopic repairs for inguinal hernias are going to be more accessible in near future in Nepal. The aim of this study was to compare the intraoperative events and postoperative complications of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repairs.Methods: Out of 56 patients, 30 underwent TAPP and 26 TEP repairs for primary unilateral inguinal hernias and were prospectively analyzed. Patient demographics, past medical and surgical history, intraoperative, and postoperative events were recorded. Patients were followed-up for two years.Results: Demographic parameters were comparable in both the groups. The difference in mean operating time was statistically significant (longer in the TAPP group). Intraoperative events such as port-site bleeding and peritoneal tear were comparable in both groups. The immediate postoperative complications like skin ecchymosis, cord hematoma, and scrotal edema were comparable in both repairs.  Immediate postoperative pain was significantly lesser in TEP repair whereas the hospital stays and time to return to the normal physical activity were comparable in both groups.Conclusions: Both TAPP and TEP laparoscopic techniques are safe and effective for inguinal hernia repair. However, there are few advantages of TEP repair such as shorter duration of surgery and less postoperative pain.
Safety and efficacy of laparoscopic versus open surgery in management of common bile duct stones: experience at the Sohag University Hospital, Egypt
Authors: Helmy Mena Z. , Ahmed Ahmed E.
Published: October 2018

Background: Management of common bile duct (CBD) stones includes removal of the gallbladder and clearance of the ductal system which can be achieved through different approaches; endoscopic, laparoscopic or surgical.  Objective of this study is to assess the safety, efficacy, technical feasibility and surgical outcomes of laparoscopic common bile duct exploration (LCBDE) versus open surgery in the treatment of patients with cholidocholithiasis.Methods: From June 2015 to December 2017, 120 patients with CBD stones were prospectively treated at Sohag University Hospital, Upper Egypt. Patients were divided into two groups: the first one treated by LCBDE (60 patients), while the other group treated by open surgery (60 patients).Results: The ages of our patients were ranged from 20 to 80 (mean = 40) years, with a female predominance (female/male = 74/46). Patients in the first group were treated by laparoscopic approaches: transcystic approaches in four patients and transcholedochotomy approaches in 56 patients. Choledochoscop was routinely used to detect, extract the stones, in addition to assessment of CBD clearance. The conversion rate was done in two cases. The operative time was 120 (90-220) min, the clearance of CBD stones was achieved in 98.4% of cases (one case of missed stones). Hospital stay was 3 (2-4) days, with no mortality, morbidity rate was 5% including bile leak, and missed stone. The operative time in the second group was 100 (80-180) min, the clearance of CBD stones was achieved in 96.6% of cases (two cases of missed stones). Hospital stay was 8 (5-12) days, with no mortality; the morbidity rate was 15% in the form of wound infection, bile leak, missed stone and ileus.Conclusions: Management of cholidocholithiasis by laparoscopic approach is feasible, effective and safe procedure with good outcome and high success rate.
Caroli’s disease: a diagnostic challenge
Authors: Yadav Padmini , Adhikari Shailesh , Pandit Narendra , Awale Lalijen , Vasan Keerthi , Khadka Sarada
Published: October 2018

Caroli’s disease is a rare congenital hepatobiliary disease characterized by multifocal segmental dilatation of intrahepatic bile ducts affecting all or parts of the liver. It predisposes to biliary stasis and consequent lithiasis, cholangitis, abscesses, and septicemia. Sometimes it is difficult to diagnose and differentiate it from other similar disease conditions. 60-year-old female presented with features of recurrent cholangitis with hepatolithiasis and multiple cyst in liver, cholelithiasis was planned for cholecystectomy and drainage procedure. Patient underwent open cholecystectomy with common bile duct (CBD) exploration with T-tube placement due to intraoperative instability. Post-operative T tube cholangiogram was done. Post-operative T tube cholangiogram showed bilobar major duct cystic dilatation with predominant left lobe involvement, with few cysts containing calculi. Patient was planned for left hepatectomy with bile duct excision but patient refused to undergo aforementioned surgery. Therefore ERCP and sphincterotomy was done in view of poor performance status.Caroli’s disease being a rare disease is sometimes difficult to diagnose and treat in an old age patient with bilobar involvement and poor general conditions.
Gastric volvulus post sleeve gastrectomy converted to gastric bypass in pregnancy: a case report
Authors: Ferris Baillie W. C.
Published: October 2018

Complications arising from revision bariatric surgery can be complex due to altered anatomy. This is especially the case in a bariatric patient who becomes pregnant. I present an interesting case of a female patient who suffered a gastric volvulus during pregnancy after having had revision gastric bypass surgery 3 years prior, secondary to an internal hernia. This case highlights that revision bariatric surgery attracts a higher rate of complication, both preoperatively and long term, as well as highlighting the need for a high degree of suspicion for rare causes of abdominal pain in patients post bariatric surgery. Pregnancy is also an added risk factor for these patients.
Appendicitis presenting as LUQ pain in an anatomically normal patient: a case study
Authors: Ferris Baillie W. C.
Published: October 2018

Appendicitis typically presents with right sided pain, but some patients present with left sided symptoms. This is most commonly due to anatomical abnormalities such as intestinal malrotation or Situs Inversus. In this case study I present a case where an anatomically normal patient presented with Left Upper Quadrant (LUQ) pain. I hypothesize that the reason for this is incorrect interpretation of visceral nociceptive afferents by the Central Nervous System (CNS). I review the literature in regard to the “visceral homunculus.” I also review the literature with regards to left sided ab-domical pain and Appendicitis. This case highlights the importance of considering Appendicitis in LUQ pain.
Anorectal malformation with apple peel atresia: case report of a rare association
Authors: Kamble Archana M. , Saoji Rajendra
Published: October 2018

Anorectal malformations (ARM) are common congenital malformations. They are mostly associated with other congenital anomalies including but not limited to vertebral anomalies, cardiac malformations, Tracheoesophageal fistula, esophageal atresia, Renal anomalies, limb anomalies and aneuploidy (Trisomy 21). Apple-peel atresia or ‘Christmas-tree deformity’ consists of a high jejunal atresia with discontinuity of the small bowel and a wide gap in the mesentery. Association of Apple peel atresia with ARM has been reported by many authors in past and in any neonate presenting with ARM proximal atresia needs to be ruled out before surgical intervention is undertaken and newborns with ARM and presenting with drooling of saliva, bilious or non-bilious vomiting in presence of non-distended abdomen must give rise to a suspicion of associated atresia. We are reporting this case of high anal atresia with apple peel atresia of terminal ileum who was treated by double barrel ileostom to emphasize the importance of knowing this association.
Global surgery volunteerism with operation hernia: a trainee surgeon’s experience
Authors: Abdalla Sala , Oppong Chris
Published: October 2018

Access to adequate health services is a universal right for individuals and lack of it can have adverse consequences. The elective hernia repair rate in Ghana remains low and a considerable number of inguinal hernias still present as emergencies. Operation hernia is a charitable, UK-based organization that supports the healthcare infrastructure in Ghana through the provision of elective hernia repairs to prevent complications. Mesh repairs are carried out using sterilized, affordable mesh which is made of polyester and is a cheaper alternative to the expensive, commercial mesh. In November 2017 Operation hernia sent two teams of Surgeons and scrub nurses to work in two hospitals in Ghana. This was a successful mission that resulted in more than 150 successful hernia repairs. This article is written by a full-time general surgical ST6 Registrar detailing her first experience as a volunteer surgeon in Volta Regional Hospital in the town of Ho and the rewards reaped from this global surgical volunteerism experience.
Amit Jain’s new models for diabetic foot
Authors: Jain Amit Kumar C.
Published: October 2018

Diabetes mellitus and its complications are growing worldwide. Diabetic foot is one such devastating complication often associated with amputation and mortality if not prevented. Various different specialists are involved in management of diabetic foot in form of multidisciplinary approach in view of lack of diabetic foot surgeons. The author proposes various new models for diabetic foot that are novel, visionary, practical and applicable in Asian countries like India where the education pattern is different from the west. These new concepts are addition to author’s Amit Jain’s system of practice for diabetic foot, which now is considered a modern diabetic foot surgery.