bluuebunny/crossref_metadata_2025 huggingface dataset:
"Los ojos de la noche" de Paloma Pedrero = "Los ojos de la noche", by Paloma Pedrero
Authors: Rebollo Calzada Mar
Published: December 2016

Paloma Pedrero ha sido reconocida como la dramaturga más representada en lo que llevamos de siglo. Los orígenes de su escritura se remontan al último cuarto del siglo XX, cuando aparece en España una nueva generación de dramaturgos que empiezan a escribir en la Democracia. Este artículo aborda un análisis de Los ojos de la noche, pieza emblemática de teatro breve de la dramaturga donde conecta con la sociedad de su tiempo desde una mirada femenina. Se abordan los temas recurrentes de la autora como la soledad, el amor, la ceguera y el triunfo. Y es que la pieza se centra en una mujer madura que supuestamente ha triunfado en el ámbito familiar y profesional como no podría haber soñado ninguna de las dramaturgas del s. XIX, a las que recordamos al principio, pero que evidencia los conflictos y contradicciones entre los valores tradicionales y los nuevos tiempos.

Paloma Pedrero has been recognized as the playwright more represented in so far this century. The origins of his writing can be traced back to the last quarter of the twentieth century, when displayed in Spain a new generation of playwrights who begin to write in democracy.
This article discusses an analysis of Los ojos de la noche emblematic site in teatro breve of the playwright where it connects with the society of his time from a female perspective. Addresses the recurrent themes of the author as the loneliness, the love, the blind nessand the triumph.
And that is that the piece focuses on a mature woman who supposedly has triumphed in the family and professional as could not have dreamed of none of the dramaturgas of s. XIX, which we recall at the beginning, but that evidence the conflicts and contradictions between traditional values and the new times.
R. Chacel. La sinrazón. Editorial Comba, 2015
Authors: Fernández Martínez Sergio
Published: December 2016

R. Chacel, La sinrazón, Barcelona, Editorial Comba, 2015, 705 pp.
Presentación
Authors: Conde Guerri María José
Published: December 2016

Presentación al Monográfico
Tularemia: A review of pathogenesis, clinical presentations and current diagnostic and treatment approaches
Authors: Snowden Jessica , Aldrich Aileen , Shaw Morgan
Published: December 2016

Tularemia is a highly infectious pathogen, important for both its role as a cause of acute febrile zoonotic infection and its potential role as a bioweapon. It can present with multiple possible clinical syndromes, requiring a high index of clinical suspicion on the part of health care providers. This review discusses the pathogenesis and clinical syndromes associated with tularemia infection, as well as reviewing current diagnostic, treatment and prevention strategies. Further study is on-going to design more effective treatment and prevention strategies for both endemic and potentially weaponized tularemia infections. Additionally, continuing education of clinicians in endemic areas will be needed to raise awareness of the variety of clinical phenotypes associated with this infection, as well as update providers on new treatment and diagnostic options as they become available.
Influence of Gender on pain: In Temporomandibular Disorders
Authors: Shaefer Jeffry Rowland , Bavia Paula Furlan , Khawaja Shehryar N.
Published: December 2016

Most patients with TMD disorders will respond to non-operative therapy involving; control of parafunctional behaviors, exercises to restore good jaw function, and use of analgesics and muscle relaxers during episodes of acute pain and dysfunction. But up to 20% of TMD patients will not respond to these conventional treatments and multiple factors influenced by gender can be responsible for this poor response.Prolonged nociception in such patients can lead to the peripheral and central nervous system sensitization, as evidenced by low pain thresholds and temporal summation, routinely encountered in patients with chronic TMD symptoms, but also female patients in general. Tailoring treatment to address these gender –based contributing factors is the challenge that providers must meet for successful management of chronic TMD patients. This chapter evaluates gender as an initiating, predisposing, or  perpetuating factor for TMD via the role of sex hormones, muscle activity and parafunctional behaviors, pain perception, and genetics.

 

 
The treatment to make home life peaceful
Authors: Isobe Tetsuya
Published: December 2016

Background: Studies have reported that acupuncture using the specific pattern of needle placement is effective in treating the mental symptoms of Premenstrual syndrome (PMS).

Methods: Subjects were 45 patients who received acupuncture using the specific pattern of needle placement. Acupuncture was performed by placing needles at certain combinations of acupuncture points. Needles were inserted only slightly by gently tapping the handle protruding from the guide tube. Patients underwent 6 acupuncture sessions in total, with 1 session taking place each week. Patients’ mental state before menses was assessed using the Stress Response Scale-18 (SRS-18). The SRS-18 was administered before and after treatments. The percentage of subjects whose total score on the SRS-18 decreased to 0.5 points or lower served as the rate of improvement. The percent decrease in a subject’s total score on the SRS-18 after treatment served as the extent of improvement.

Results: The rate of improvement and the extent of improvement in total score on the SRS-18 were 77.8% (35/45), 0.37. The rate of effectiveness and the rate of satisfaction were respectively 91.1% (41/45), 75.6% (34/45). When asked “Is your home life peaceful?”, 51.1% (23/45) answered “ Yes “.

Conclusions: The efficacy for mental symptom of PMS in shallow acupuncture using the specific pattern of needle placement was excellent, and this treatment made home life peaceful.
Role of sentinel lymph node biopsy in assessing the cancer spread to axilla in early breast cancer
Authors: Gumber Ashutosh , Mudgal Manish
Published: December 2016

Background:Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to axillary lymph node dissection as a way to stage breast cancer in clinically node-negative patients. Objective of the study was to determine the safety and reliability of sentinel lymph node biopsy without axillary lymph node dissection (ALND) in early breast cancer patients.Methods: This prospective study was conducted in patients with operable breast cancer in a single surgical unit of our hospital. Patients with T1-T3 breast cancer with clinically negative axilla and patients with previous lumpectomy were included. All the patients had undergone complete axillary lymph node dissection after sentinel lymph node biopsy. All the specimens were sent separately for paraffin section histopathology.Results:Mean age of 35 female patients included was 54 years. SLN was identified in 94.29% cases and it could not be identified in 2 cases. SLN (96.97%) was most commonly identified at level I. Mean numbers of sentinel node and axillary node were 1.52 and 16.11 respectively. Study of SLN biopsy with methylene blue dye for staging the axilla was done with 81.25% sensitivity and 100% specificity. Positive predictive value was 100% and was able to negatively predict the axilla in 86.36% with an overall accuracy of staging of 96.97% and false negative rate of 18.75%.Conclusions:Sentinel lymph node biopsy without axillary lymph node dissection in sentinel lymph node negative breast cancers appears to be a safe and reliable procedure for determining the nodal status and ensuring the loco-regional control.
Role of preoperative nutrition in gastro-intestinal cancer patients: a prospective study
Authors: Shukla Samir , Songra M. C. , Patbamniya Naveen Kumar , Damor M. , Tyagi Vijay
Published: December 2016

Background:This prospective study was carried out to compare outcome and postoperative complication in patients with gastro-intestinal malignancy who received preoperative total parentral nutrition with those whom doesn’t.Methods: The study was a prospective single-centre, two-arm, conducted in department of general surgery, Gandhi Medical College and Associated Hamidia Hospital, Bhopal, Madhya Pradesh, India of one year duration, a total of 60 patients with G. I. malignancy, with or without sign of malnutrition, were included in the study. Patients were randomized and 30 patients were placed in each arm (interventional and control group) patients in the control group were asked to continue their normal feeding while interventional arm were given TPN in addition to their normal diet, for 7 to 10 days before surgery.Results:Infectious complications were more in control group, while one case each of pneumonia and sepsis was observed in patients receiving supplementation. Complications related to nutritional status of the patient like wound infection and anastomotic leak were observed only in patients without supplementation. There was no death observed in interventional group but two deaths occurred in control group.Conclusions:Preoperative nutritional support is beneficial and should be routinely used in abdominal and gastrointestinal cancer patient with or without clinical signs of malnutrition.
Study of clinical profile and outcome of gall bladder perforations at a tertiary care centre from central India
Authors: Jain Suraj , Kolla Venkatesh , Datey Sanjay , Vasistha Rishikant
Published: December 2016

Background:Amongst the diseases of gall bladder calculous cholecystitis is the most common. Acute cholecystitis can worsen and result in various complications. Gall bladder perforation leading to generalised peritonitis is a lethal complication.Methods: In this retrospective observational study we have reviewed 550 cases of acute cholecystitis who were admitted to our institution in 8 years i.e. from 2008 to 2015. Perforations due to other causes (trauma, iatrogenic causes, and carcinoma) were excluded. Niemeier classification was used to identify the patients. Direct-abdominal X-ray series, abdominal ultrasound scanning (US), abdominal contrast-enhanced computerized tomography (CECT), routine blood cell count, and blood chemistry tests were performed.Results:Fourteen cases (2.5%) were found to have gall bladder perforations during the course of investigations and intraoperatively. Ten (71.42%) were females out of the total fourteen patients. Mean age was 65 years and presenting features on admission were nausea, vomiting, abdominal pain, fever and variable general condition. Aetiopathology of gall bladder perforation remains obscure till date. This clinical condition still remains a diagnostic as well as therapeutic challenge to surgeons. On detailed review of literature, we could not get few references, as the condition is uncommon.Conclusions:We have done this study to analyse the variable clinical presentation, correlation of non-invasive investigations and intraoperative findings and outcome in cases of gall bladder perforations so as to improve our further management of such cases.
Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute
Authors: Gohel Jayesh B. , Patel Kalpesh H.
Published: December 2016

Background:Benign prostatic hyperplasia (BPH) is the most common disease occurring in men as the age advances. There are various treatment modalities available, amongst which trans-urethral resection of prostate (TURP) is widely used but role of open Freyer's prostatectomy and medical management can't be ignored at the same time. This study was done to compare different modalities of treatment, to evaluate the individual modality in view of its efficacy, complications and patient satisfaction, to compare the different modalities in their efficacy for management of BPH and their complication profile, to suggest the best form of therapy that can be offered to patients.Methods: A retrospective comparative study was conducted including 90 patients having benign prostatic hyperplasia (BPH) were enrolled for the study and randomly divided into three groups of 30 patients each. Group I consists of patients undergoing for Freyer's prostatectomy, Group II consists of patients undergoing TURP and in Group III patients were managed conservatively with medical management. Results:Temporary Incontinence of urine was the most common complication occurred found in 6 cases (20%) in Freyer’s prostatectomy group I and in 3 cases (10%) in TURP group II; per-urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer’s prostatectomy it was kept up to average 10 days (8-18); All 30 cases (100%) of in Group II where TURP done were discharged within 6 days of surgery whereas in Group I where Freyer's prostatectomy done, most of the cases 21 (70%) were discharged between 11-15 days post-operatively. In Group III, patients were managed by medical management patients, 11 cases (36.67%) presented with acute urinary retention (AUR)     and 19 (63.33%) patients presented with lower urinary tract symptoms (LUTS) without retention.Conclusions:TURP is having definite advantage over Freyer's prostatectomy, because Length of hospitalization, postoperative complications are less frequent. Transurethral resection is the method of choice in the treatment of benign prostatic hyperplasia especially in patients with mild to moderate prostatic enlargement and in the elderly patients with co-existing medical disease. Endoscopic instruments, training and more experience is required for TURP. Medical management can delay immediate surgery but later on surgical management is usually required.
Role of proximal drainage in obstruction in the urinary tract: an observational study
Authors: Das Subrata Kumar , Panda Anshuman , Gupta Tapas Ranjan , Chowdhury Arunava , Kesari Gouri Shankar , Sen Sukanta
Published: December 2016

Background:Urinary tract obstruction may occur due to various causes at various levels. Proximal drainage implies drainage of the urinary tract proximal to the site of obstruction. This may be unilateral or bilateral and may be classified as follows: Renal- nephrostomy, pelvic-pyelostomy, ureteral-ureterostomy, vesical-cystostomy and urethral- urethrostomy. The aim of the present work would be to analyse the cases needed such drainage procedure in six months period in a tertiary care teaching hospital, Kolkata, India.Methods: Proximal drainage operations done in series of 35 cases were standard nephrostomy, U-tube nephrostomy, percutaneous needle nephrostomy, end cutaneous ureterostomy, T-tube ureterostomy and suprapubic cystostomy. In 4 cases the drainage operations were done as emergency and lifesaving procedure. Seven drainage operations were done for permanent diversion of urine, 22 as preparatory to subsequent corrective or palliative surgery and 8 as adjuvant with corrective surgery. Clinical findings, post-operative complaints and results of investigations were noted and both pre and post-operative findings were compared to assess the ultimate results of the surgical treatment.Results:Out of 9 cases of nephrostomy, 4 cases (44.44%) showed good result, 4 cases (44.44%) showed fair result and 1 case (11.11%) showed bad result. In 21 cases of T-tube ureterostomy, 15 cases (71.42%) showed good result, 3 cases (14.28%) showed fair result and 3 cases (14.28%) showed bad result. Out of the 6 cases of cutaneous ureterostomy, 4 cases (66.66%) showed good result, 1 cases (16.66%) showed fair result and 1 case (16.66%) showed bad result. The case had bad result (case no. 3) was a case of urinary tuberculosis with ureteric stricture at the lower third with hydroureteronephrosis and poorly functioning kidney on the other side. Out of the 3 cases of suprapubic cystostomy, 1 case showed good result and 2 cases showed fair result.  Conclusions:Drainage operation was done as preparatory to subsequent corrective or palliative surgery in majority of the cases. Proximal drainage helps controlling infection, normalizing blood biochemistry, regression of back pressure changes, in a word improving renal function. Proximal drainage of urine should be done before irreversible damage to the renal parenchyma occurs.
Non-operative treatment of splenic injury in patients with blunt abdominal trauma
Authors: Wani Munir Ahmad , Shah Mudassar , Malik Ajaz Ahmad
Published: December 2016

Background: Few decades back splenectomy was the sole treatment for splenic injury. But with the recognition of OPSI and mortality related to it, attempts have been made to preserve the spleen whenever possible. Patients with blunt abdominal trauma and splenic injury can be treated non-operatively in selected cases.Methods: One hundred (100) patients of blunt abdominal trauma with splenic injuries were treated non-operatively between 2013 and 2015. Patients were between 18 and 60 years of age and 95 were males. Patients having signs of peritonism or free intraperitoneal fluid on FAST were subjected to contrast CT abdomen. Patients having life threatening extra-abdominal injuries were excluded from the study. Similarly, patients having Grade V splenic injury, pneumoperitoneum or contrast extravasation were operated and hence excluded from study. The patients were monitored, transfused blood when necessary and discharged when stable enough.Results: We had 20 Grade I, 26 Grade II, 44 Grade III and 10 Grade IV splenic injuries.  Associated thoracic injuries were seen in 20 patients, orthopaedic injuries in 13 patients, head/maxillofacial injuries in 4 patients and other abdominal injuries in 22 patients. The hospital stay was between 5 and 20 days. 23 patients needed blood transfusion. There was no operative intervention and no mortality in 100 patients.Conclusions: Patients with splenic injury who are haemodynamically stable can be effectively managed non-operatively under meticulous monitoring and ever readiness for operative intervention if need arises. Saving spleen saves the patient from laparotomy and some life threatening infections.
A clinical study of inguinal hernia with special reference to laparoscopic trans-abdominal pre peritoneal repair
Authors: Singh Suraj , Prakash Rajkumar , Singh Vasundhara
Published: December 2016

Background:Hernia may be generally defined as the protrusion of an abdominal viscus outside the abdominal cavity through a natural or acquired defect. Latin meaning of the word “hernia” is tear or rupture. A Clinical study on inguinal hernia is undertaken to assess the incidence of inguinal hernia in relation to age, gender and occupation, the different types and modes of clinical presentation of patients, the management of patients with special consideration to laparoscopic (TAPP) repair, to evaluate the operating time, pre-operative and post-operative complications, duration of hospital stay, time taken for recovery, recurrence rate and limitations with respect to laparoscopic TAPP repair.Methods: This is a prospective study of 54 cases of inguinal hernia admitted and underwent surgery for inguinal hernia in Department of General Surgery in Guwahati Medical College and Hospital during the study period of August 2014 to July 2015.Results:The highest number of cases presenting with inguinal hernia were over 45 years and it was more common in males which constituted 96.3 percent of cases. It is more common on right side and indirect hernia is more common than direct hernia. The major possible risk factors are smoking and strenuous work. The commonest presenting mode was swelling followed by swelling with pain. The mean time taken for TAPP was 91.85±15.85 minutes and the median time was 87.50 minutes. There were no intra operative (neurovascular, visceral) complications in any of the patient and there was no conversion to open surgery. There was no mortality in present study and none of the patient had any testicular complication.Conclusions:Laparoscopic hernia repair is associated with steep learning curve for surgeons and is more costly both to patients and health care system in the present scenario. Laparoscopic TAPP hernia repair is found to have encouraging results which is a safe and viable option for repair of inguinal hernia with less postoperative pain and discomfort, improved cosmesis, less post-operative complications and early return to work.
Managing bilateral inguinal hernia laparoscopically: is it gold standard?
Authors: Patel Kalpesh H. , Gohel Jayesh B. , Patel Bhumika J.
Published: December 2016

Background:Even after many studies done in recent years, no consensus has been achieved on the surgical technique of inguinal hernia repair. It was believed that in bilateral inguinal hernia cases laparoscopic surgery is very much advantageous as it can be done through same incisions as unilateral laparoscopic inguinal hernia repair (no additional incision required), whereas in open surgery for bilateral case separate groin incision for each side required. Aim of this study is to evaluate and compare results of bilateral inguinal hernia patients operated by laparoscopic (transabdominal preperitoneal) or open (lichenstein) repair.Methods: A prospective comparative study was conducted in a tertiary care teaching hospital over the period of two years. 60 patients with bilateral inguinal hernia were taken up and randomly divided into two groups. Group I (study group) includes patients operated by bilateral laparoscopic hernia repair (TAPP) and Group II (control group) includes patients operated by open hernia repair (lichenstein tension free hernioplasty). All patients were followed up for 18 months post-operatively. All patients of both groups were monitored for operative time, conversion rate, length hospital stay, post-operative complications and recurrence, time to return to work.Results:Statistically there was significant difference between both groups in terms of length of hospital stay and time to return to work. Group I patients where TAPP surgery performed, 22 patients (73.33%) were discharged within 36 hours of surgery, whereas in Group II patients - control group where open surgery performed, only 4 patients (13.33%) discharged within 36 hours. All 30 patients (100%) in group I had joined their routine work within 10 days of surgery; whereas in Group II patients only 4 cases (13.33%) joined duties on or before 10 days and most of the patients 26 (86.67%) had taken more than 10 days to resume their duties. But there was no significant difference between operative time, complication rates and recurrence rates. All cases in group I were completed laparoscopically (no conversion to open repair).Conclusions:Simultaneous bilateral inguinal hernia repair laparoscopically does not increase the risk for the patient and has an equal morbidity compared with unilateral repair, length of hospital stay, and return to normal work and over all recovery after laparoscopic repair is faster than after open bilateral simultaneous repair. Laparoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.
Palliative surgery in management of advanced carcinoma stomach and its outcome
Authors: Pattanayak Sibaprashad , Saha Debabrata , Bara Bipin Kishore , Nayak Sanjit Kumar
Published: December 2016

Background:Gastric cancer is the second leading cause of death from malignant disease World-wide and most frequently discovered in advanced stages. The incidence of gastric cancer in India is low compared to developed countries. But in India southern and northeast area more number of cases was diagnosed. More cases of cancer stomach are diagnosed in the early stages in Japan due to effective screening programme. Lack of such screening programme, ignorance about the disease and lack of awareness of warning signs of cancer lead to the detection of many cases in the advanced stage of gastric cancer. Where palliation is the mainstay of treatment. We discussed the different methods of palliative surgery and its outcome in this paper.   Methods: This is a prospective study over 5 years February 2011 - 2016 January including 6 months follow up. 104 advanced carcinoma stomach patients were included in this study. To evaluate role of palliative surgery in advanced gastric cancer we analyse the data in the basis of presentation of disease, sex distribution, type of palliative surgery, relive of symptoms, preventions of complications, post-operative mortality morbidity, and overall survival.Results:In our study mean age of presentation is 58 years. Most common affected are male. Stage III disease are more common. Immediate post-operative mortality is 4 patients 7.14% comparable to the non-resection group 1 patients (2.63%). Symptoms relived 46 patients in resection group (82.14%), in non-resection group it is 16 (42.1%).  Overall survival is (6 moths - 1 years) 19 (33.9%) patients, and in non-resection group it is only 2 (5.26%) patients. Median survival rate is 10 months.Conclusions:Palliative resection should be carried out for betterment of quality of life where it is possible. Relief from symptoms and complications can be achieved by resection of tumour mass in advanced carcinoma stomach.
Prospective comparison of high resolution ultrasonography with technetium sestamibi scintigraphy and operative findings in detection of abnormally hyper functioning parathyroid gland/glands in primary hyperparathyroidism
Authors: Din Dar Parvez Mohi Ud , Wani Munir Ahmad , Wani Khureed Alam , Masoodi Shariq Rashid , Misgar Riaz Ahmad , Wani Sajid Mohammad , Wani Afshan Anjum , Malik Liaqat Ahmad
Published: December 2016

Background:Ultrasonography is cheap, easily available and convenient modality of diagnosis.Methods: We prospectively studied 61 patients with PHPT. Patients preoperatively underwent USG neck and MIBI scan, results were interpreted independently and compaired with intra operative findings.Results:61 patients who underwent parathyroidectomy for PHPT were studied. Ultrasonography neck showed correct side in 46/51 (90%) and correct site in 32/51 (63%) patients with single parathyroid adenomas. MIBI scan showed correct side and site of parathyroid adenoma in 46/50 (92%) and 43/50 (86%) patients respectively. Patients with double adenomas USG neck showed positive results in all 5 patient with 100% sensitivity where as MIBI scan showed positive results in four out of five patients (80%). 1 patient with four gland hyperplasia USG picked three out of four enlarged glands while as MIBI scan not picked any of the enlarged glands. Operative findings revealed that right lower parathyroid gland was the most common gland involved (54%) followed by left lower (29%), right upper (6.6%), left upper (0%) and multiple / bilateral (9.6%).Conclusions:USG is an affordable, conventional and useful tool in detecting enlarged parathyroid glands in most of the patients with PHPT, but operator dependant. However, when USG can’t detect enlarged parathyroid gland 99mTc-MIBI Scan is complimentary to it.
Negative laparotomy rates in acute abdomen: a declining trend
Authors: Sabhnani Geeta , Tomar Shreya
Published: December 2016

Background:A prospective observational study of 105 operated cases of non-traumatic acute abdomen in emergency setting in tertiary government hospital was carried out. The correlation between preoperative diagnostic, radiological and clinical assessment and operative findings was noted. The clinical and radiological diagnostic accuracy rates were calculated using descriptive statistical analysis. Negative laparotomy rates were calculated and compared to the previous studies.Methods: The most common finding was acute appendicitis and the most frequently involved age group was 21-40.The absence of correlation between preoperative diagnosis and operative findings was noted in 7 cases of which 2 cases of appendicitis had been missed on ultrasound and 2 cases of appendicular mass were reported as acute appendicitis where appendectomy could not be done on account of adhesions.2 cases of x-ray diagnosed obstruction with clinical features of vomiting ,constipation had no gross bowel pathology on laparotomy while one case diagnosed preoperatively as appendicitis turned out to be a case of renal colic with hydroureter.Results:The diagnostic accuracy rate of x-ray and ultrasound for obstruction/perforation and acute appendicitis were found to be 89.79% and 94.64% respectively.Conclusions:The negative laparotomy rates were low around 2.85%.
The role of laparoscopy in diagnosis of patients with chronic abdominal pain
Authors: Saxena Pradeep
Published: December 2016

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Results:Laparoscopy was performed in 142 patients of chronic abdominal pain with unsettled diagnosis. A conclusive diagnosis could be made in 136 of these patients. The common causes of chronic abdominal pain were abdominal tuberculosis, adhesions, bands, small intestinal strictures, chronic appendicitis, abdominal malignancy and various gynecological diseases. Gynecological problems causing chronic abdominal pain were pelvic inflammatory disease, ovarian cyst, tubo-ovarian mass, hydrosalpinx, fibroid uterus, bulky uterus, endometriosis. Thus laparoscopy provided positive diagnosis of in 136 (95.77%) patients based on laparoscopic findings, histological reports, ascitic fluid analysis and cytology.Conclusions:In patients suspected to have abdominal pathology early laparoscopy may be useful to establish a conclusive diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.
Nonsurgical separation and topical Clobetasol therapy for phimosis
Authors: Arora Bhavinder K. , Arora Rachit , Arora Akshit
Published: December 2016

Background:Phimosis is non-retractile foreskin or prepuce over the glans. This is due flimsy adhesions between glans and prepuce. The two types of phimosis, physiological and pathological must be differentiated. The phimosis can be treated by conservative methods by application of topical steroid cream. The objective of this study was to evaluate the efficacy of nonsurgical separation and topical clobetasol propionate 0.05% cream therapy in treatment of phimosis.Methods: This study was done on 62 patients presenting with symptoms of phimosis were included in the study. The clinical examination prepuce and penis was done. The patients were classified according to Kirkiros classification. In this classification of phimosis, 5 grades have been ascribed according to the retractibility of prepuce.Results:Out of total 62 patients, the complete response was obtained in 55 (80.71%), partial response in 5 (8.06%) and no response in 2 (3.23%) patients. In patients with partial response the topical clobetasol therapy, the treatment was repeated for another 4 weeks. The phimotic ring disappeared in all the patients after 4 or 8 weeks of topical clobetasol propionate 0.05% cream application. The surgical therapy either circumcision or preputioplasty should be done only in selected cases.Conclusions:This study concludes that nonsurgical separation and topical clobetasol cream therapy is quite effective for treatment of phimosis.
Neutrophil to lymphocyte ratio in diagnosing acute cholecystitis: a retrospective cohort study in a tertiary rural hospital
Authors: Karthik Hareen T. V. K. , Bhaskaran A. , Jaswanthi A. R.
Published: December 2016

Background:Acute cholecystitis accounts for most of the hospital admissions related to gastrointestinal diseases. In approximately 90% of patients, inflammation develops due to obstruction of the cystic duct by one or more gall-tones. Delayed management can lead to increased morbidity, due to progression to severe cholecystitis, such as gangrenous change, abscess formation, and gallbladder perforation. The neutrophil to lymphocyte ratio is derived from the counts of circulating neutrophils and lymphocytes, both of which are major leukocyte subpopulations. The inflammation triggered release of arachidonic acid metabolites and platelet-activating factors results in neutrophilia, and cortisol induced stress results in relative lymphopenia, and thus, the neutrophil to lymphocyte ratio accurately represents the underlying inflammatory process. The objective of this study was to evaluate the utility of the neutrophil to lymphocyte ratio (NLR) as a prognostic indicator in patients with cholecystitis. And to identify a relevant NLR value that discriminates between simple and severe cholecystitis.Methods: A retrospective analysis of patient data compiled by assessment of operative findings documented and patient follow up recorded over the period encompassing three years (2015-2012) at RL Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India.Results:Our study population comprised of 250 patients with simple cholecystitis (69.63%) and 109 patients with severe cholecystitis (30.36%). The NLR of 3.0 could predict severe cholecystitis with 70.5% sensitivity and 70.0% specificity. A higher NLR (≥3.0) was significantly associated with older age (p = 0.001), male gender (p = 0.001), admission via the emergency department (p <0.001), longer operation time (p <0.001), higher incidence of postoperative complications (p = 0.056), and prolonged length of hospital stay (LOS) (p <0.001).Conclusions:NLR ≥3.0 was significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.
Comparative study of laproscopic versus open appendicectomy
Authors: Patil Mahadeo R. , Patil Sandhyarani M.
Published: December 2016

Background:Open appendicectomy (OA) has been the treatment of choice for acute appendicitis since its introduction in 1884. Since its initial description in 1983, laproscopic appendicectomy (LA) has struggled to prove its superiority over the open technique. This is in contrast to laproscopic cholecystectomy over open cholecystectomy. Some early studies showed equivocal results about benefits of LA. Recent studies showed overall benefits in favour of LA. So we have done comparative study with the aim to compare the safety and benefits of LA over OA.Methods: We have studied data of 753 appendicectomies done in Dr. D.Y. Patil Medical College Kolhapur from July 2011 to June 2016 for a period of 5 years.Results:We found mean operation time 32±5.7 minute and 36±7.4 minute in LA and OA. Duration of postoperative stay was 1.2 days shorter in LA group. LA required 1.1 less shots of analgesics. Oral feeding was resumed 21 hours earlier in LA as compared to OA.Conclusions:Our study found that LA is effective and safe procedure irrespective of age, sex and BMI of the patient. It requires less operative time, has minimal complications, less hospital stay, less narcotic analgesics requirements, early return of bowel movement and the advantage of diagnosing the concomitant pathologies.
Clinical study of peripheral arterial occlusive disease of lower extremities
Authors: Clement H. Suresh , Kumar M. Arun , Ramchander S.
Published: December 2016

Background:Diagnosing PAD is important in order to implement appropriate therapies for preventing cardiovascular morbidity and mortality, improving functional impairment, and preventing further functional decline. The objective was to study the pattern of clinical presentation and etiology of peripheral arterial occlusive disease.Methods: This was a cross sectional observational study of 50 cases diagnosed with peripheral arterial disease of the lower extremities. History was taken as soon as the patient was admitted. A thorough clinical examination was carried out personally to find out and establish clinically first, the presence of vascular obstruction. Detailed vascular system examination was done as per the proforma provided.Results:TAO and atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. All the cases of PAD presented with ischemic claudication and rest pain as common symptoms, while gangrene (80% of cases) and ischemic ulcer (20% of cases) were the other predominant symptoms. Doppler findings correlated with the disease presentation, TAO having a more infra-popliteal obstruction and atherosclerosis showing more proximal obstruction. All the cases were managed with some form of surgery and majority of them had limb loss. The level of amputation was below knee in 42% and above knee in 58% cases. Improvement of rest pain noted in 62.5% of cases, healing of ulcer in 50% of cases and improvement in claudication pain in 37.5% of patients who underwent lumbar sympathectomy.Conclusions:Post operatively most of the patients recovered uneventfully and some patients required secondary suturing of the surgical site. Three patients required a revision amputation at a higher level. At first month follow-up, many patients were ambulatory with the use of crutches.
Splenic abscess in an immune competent individual: case report and review of the literature
Authors: Elsiddig Kamal Elzaki , Abd Elrahim Walid Elhaj , Gasim Khalil Eltahir Awad
Published: December 2016

Splenic abscess is a rarity in immune competent individuals. Salmonella, Pasteurella multocida, M. tuberculosis and actinomycosis have been implicated. A 63-year old immune competent female with an arab descent presented with fever, nausea and vomiting. Polymorph leucocytosis, high ESR and markedly high C-reactive protein (CRP) were reported. Chest x-ray and CT scan pointed to the diagnosis. She was managed uneventfully by splenectomy. Enterobacter Spp was grown from operative samples. The patient was well and asymptomatic when seen six months post-operatively. Splenic abscess should be considered even in the absence of co- morbidities in individuals with fever, non-specific abdominal symptoms, polymorphs leucocytosis and high CRP.
Right-sided omental torsion with inguinal hernia
Authors: Deng Liming , Xiong Guozuo , Yan Yaping , Dai Xianpeng , Xin Shen , Bi Guoshan , Chen Jie , Hu Bingbing , Wu Wengao , Li Linpeng
Published: December 2016

A 38 year old man was admitted to our hospital with abdominal pain. He had an untreated right inguinal hernia and the hernia presented as a swelling ball of 4.0×3.0 cm in size. CT showed a large mass of fat density below the Sigmoid colon and incarcerated fat within the right inguinal hernia. Emergent laparotomy revealed four-circle twisted and infarcted greater omentum and a little bloody ascites within the right inguinal hernia. Pathological examination showed hemorrhagic infarction of the greater omentum. Although omental torsion is a rare cause of acute abdominal pain, it should be taken into consideration in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.
Lift procedure for long complex ano-scrotal fistula and review of literature
Authors: Kumar T. Siva , Naresh G. , Akther Md. Jawed
Published: December 2016

Ano-rectal sepsis can be complicated by anal fistula during the acute phase of sepsis or within 6 months thereafter. An anal fistula is characterised by chronic purulent drainage or cyclical pain associated with abscess formation, followed by intermittent spontaneous decompression. A fistula-in-ano can be "simple" or "complex". The goal of surgical management is to effectively eradicate current and recurrent septic foci, associated epithelialized tracts and preserve continence. Study present a case of 22 year old male with long recurrent complex ano-scrotal fistula which was treated by ligation of the intersphincteric fistula tract (LIFT) procedure, preserving the anal continence without leaving any residual septic foci that may lead to recurrence.
Internal hernia - a rare cause of small bowel obstruction: a case report
Authors: Rambhia Samir U. , Madhukar Premjeet
Published: December 2016

Internal hernia means a protrusion into pouches or openings in the peritoneum or mesentry in contrast to the hernias through defects in the retaining walls of the abdomen. Internal hernias are of many varieties with different classifications and can be congenital or acquired post-surgery. We present a case of a 55 year old female who presented with symptoms of acute small bowel obstruction with previous history of exploratory laparotomy 20 years back for reasons not known to her. Routine blood investigations, chest and abdomen skiagram and a CECT abdomen were performed (which gave no significant clue to diagnosis) and after a failed conservative trial patient was taken for exploration. Intra operatively a gangrenous loop of small bowel was found herniating through a band between the small bowel mesentry and the sigmoid mesocolon, forming a closed loop obstruction. Resection anastomosis of the gangrenous segment along with band transection was performed. The post-operative course was uneventful. Internal herniation as a cause of bowel obstruction should always be kept in mind as a differential.
Low grade fibromyxoid sarcoma of the perineum: a surgical challenge
Authors: Anees Afzal , Singh Kaushal D. , Khan Shehtaj
Published: December 2016

Low-grade fibromyxoid sarcoma is a rare, slow growing and deceptively benign-appearing neoplasm. It is presently diagnosed on the basis of histopathology (typical fibro-myxoid appearance), immunohistochemistry (vimentin staining) and cytogenetics [chimeric FUS/CREB3L2 gene produced by t (7;16), (q33;p11)]. This tumour should be differentiated from other resembling tumours like myxofibrosarcoma, sclerosing epitheloid fibrosarcoma, desmoid fibromatosis and others. It has the potential for local recurrence and late metastasis, if not treated adequately. Although surgical excision is the only hope for treatment, reporting of details of surgical management have often been neglected for this primarily pathological entity. We report a case of a 30-year female who had a perineal mass which was managed by wide surgical excision. It was diagnosed as low-grade fibromyxoid sarcoma on the basis of histopathology and immunohistochemistry. This extremely rare presentation is, thus, discussed in context of challenging nature of its surgical excision. Patient is in follow-up and has no recurrence even after 5 years.
Aggressive angiomyxoma of vulva in a young female: a rare entity with an unusual presentation
Authors: Jaiman Richa , Agrawal Neelabh , Kumar Dipt , Kumar Chandrodaya , Pathak Abhishek , Dundy Garima
Published: December 2016

Aggressive angiomyxoma is a rare benign neoplasm usually involving the pelvic region. It is six times more common in females than males. It occurs almost exclusively in adult females. The term aggressive signifies the neoplastic character of the blood vessels, its locally invasive nature, and the high risk of local recurrence. Here we report a rare case of an eighteen year old female, who had a vulvar swelling for over two years, which turned out to be aggressive angiomyxoma after wide local excision on histopathological examination.
Insulinoma: is it still a diagnosis of exclusion? A case report
Authors: Kumar Vipan , Sharma Vikrant , Sharma Ankur , Rattan Amit
Published: December 2016

Few cases of hypoglycaemic peripheral neuropathy due to insulinoma have been reported in literature. We are reporting a case of insulinoma manifesting with chronic progressive encephalopathy, intractable seizures, and neuropathy-a triad of neurological features in insulinoma. The diagnosis was delayed as the repeated investigations including dual phase CECT abdomen was normal. This case report highlights the importance of evaluation of patients for insulinoma with high resolution CECT abdomen and FDG PET scan. A keen suspicion and investigation with appropriate modality can prevent the irreversible neuroglycopenic damage, as reported in this case.
La jerarquía de los tratados internacionales en la Constitución Política de 1998
Authors: Chiriboga V. Federico
Published: December 2016

El derecho internacional expresado en los tratados forma parte del ordenamiento jurídico interno y prevalece sobre las leyes y otras normas de menor jerarquía. En caso de conflicto entre una ley y un tratado prevalece éste y la ley posterior no modifica al tratado y si lo hace queda comprometida la responsabilidad internacional del Estado ecuatoriano.
Suma cero, la tradición contenciosa y las teorías contemporáneas de resolución de conflictos
Authors: Zalles Santivanez Jorje Hugo
Published: December 2016

Este artículo examina algunas de las implicaciones, en especial para el manejo y la resolución de conflictos, de dos distintos esquemas relacionados a los posibles desenlaces de las relaciones entre personas y/o grupos humanos, el denominado “esquema suma cero” y el que propongo denominar “esquema suma positiva”. En las siguientes secciones del artículo, examino la naturaleza, las implicaciones más importantes, los orígenes y la validez de cada esquema, y la relación entre ellos y la transición del uno al otro.
El comercio electrónico en Ecuador: régimen jurídico y comentarios
Authors: Romero Rosales Margarita , Ribadeneira Molestina Teodomiro
Published: December 2016

Las transacciones electrónicas necesitan un ordenamiento jurídico claro. El comercio por esta vía se desarrolla a pasos agigantados y la legislación se ha quedado atrás. El comercio electrónico es un tema desconocido en el Ecuador. A pesar de que últimamente hemos descubierto las grandes ventajas del correo electrónico, la navegación en el Internet -con toda la información que podemos encontrar al alcance de la mano- así como la oferta de productos y servicios a través de portales o páginas en la red (marketing virtual). Sin embargo, ésta es apenas la primera fase de un círculo que sólo estará completo cuando, además de acceder virtualmente a todas las tiendas del mundo, adquiramos artículos de todo tipo, variedad y uso, eventualmente paguemos nuestros impuestos y cuentas de teléfono y luz en la red, por ejemplo.