bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study of papanicolaou smear and colposcopy in the evaluation of cervical lesions
Authors: Mohan Priyanka , M. Lakshmidevi , Venkatesh Shreedhar
Published: May 2019

Background: Cervical cancer is the third most common type of cancer among females. Study aims to critically evaluate the sensitivity and specificity of colposcopy versus papanicolaou (Pap) smear in the early detection of dysplasias. Its secondary objective to correlate the findings in the evaluation of unhealthy cervix by cytology, colposcopy and colposcopy guided biopsy.Methods: This was a tertiary care teaching hospital based, prospective, cross sectional study done in Department of Obstetrics and Gynaecology, at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, conducted on 200 women attending Gynaecology OPD.Results: PAP smear was taken for all 200 patients. 73% of smear was found to be normal, 11% showed inflammatory atypia, 9% showed low grade squamous intraepithelial lesion (LSIL), 3.5% showed atypical squamous cells of undetermined significance (ASCUS) and 3.5% showed High Grade Squamous Intraepithelial Lesion (HSIL). Among the 200 cases studied, 38% (76/200) were diagnosed as colposcopically abnormal. Among the abnormal cases, AW areas were diagnosed in 4%. Punctate pattern of vessels was seen in 5% of women. Normal findings was present in 62%, Erosion cervix in 6%, inflammatory changes were seen in 6% and polyps were diagnosed in 7.5%, leucoplakia was found in 2% and unsatisfactory colposcopy finding was seen in 4% and underwent endocervical curettage. 32 cases out of 200 women were positive on Pap smear. 66 out of 200 women were positive on Biopsy. Pap smear was positive in 22 out of 66 biopsy proven positive cases.Conclusions: The commonest presenting complaint was vaginal discharge (182/200; 91% of the patients. the PAP smear  is found to have sensitivity of 33.33%  and specificity of 92.54%. colposcopy is found to have sensitivity of 81.82%  and specificity of 82.84%.
Hysteroscopy: a boon in abnormal uterine bleeding
Authors: Kulkarni Grishma , Shinde Kunaal K. , Thosar Mayur
Published: May 2019

Background: Aim of the study was to analyze retrospectively the efficacy of hysteroscopy in the diagnosis of abnormal uterine bleeding (AUB).Methods: Eighty-six women in the reproductive and perimenopausal age group (20-50 years) visiting the gynaecology OPD from March 2018 to February 2019 with the complaints of abnormal uterine bleeding were enrolled in the study. All the patients who underwent hysteroscopic examination were subjected to endometrial curettage; which was sent for histopathological examination (HPE). The hysteroscopic findings were then corelated and compared with HPE.Results: Mean age of the patients was 37.2 years. Around 60.46% patients presented within six months of complaints. Clinically, 54.65% were diagnosed as menorrhagia, 37.2% as polymenorrhoea and 8.13% as intermenstrual bleeding. On hysteroscopy, 44.1% showed abnormal pathology. The positive findings including polyps (8.13%), calcification (3.48%), submucous myoma (12.79%), necrotic mass and forgotten IUCD (2.32%) and adhesions in one case. On the other hand, the findings of histopathology; 56 patients (65.11%) had normal / proliferative / atrophic endometrium, 17 (19.76%) had hyperplasia, 10 (11.62%) had polyps and 3 (3.48%) had calcified endometrium. There was no significant difference between two modalities for normal / proliferative / atrophic endometrium. The HPE diagnosed slightly higher patients of hyperplasia as compared to hysteroscopy. Hysteroscopy diagnosed a higher number of patients with submucous myoma and necrotic mass.Conclusions: Hysteroscopy provided additional visual information for some pathologies which otherwise would remain undiagnosed by HPE.
Comparing the degree of pelvic pain with the macroscopic features of endometriosis
Authors: Sonwani Tarini , Biswas Ratna
Published: May 2019

Background: Endometriosis is considered as the chronic benign gynecologic disease which can cause chronic pelvic pain (CPP) and infertility. Endometriosis has affected almost 10% of the women of reproductive age.Methods: Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously.Results: Mean age of women with endometriosis was 30±5.75 years. Majority had superficial implants (30%), 6.66% had deep implants and 6.66% had combination of superficial and deep implants. There was no significant difference between implants and severity of pain (p=0.069). There was a significant association between severity of pain with obliteration of POD. Significant association was seen between deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration and severity of pain.Conclusions: Severity of pain was significantly associated with deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration. However, no association was obtained between severities of pain with superficial implants.
The study of thyroid profile in abnormal uterine bleeding at tertiary care center, Rajasthan, India
Authors: Gurjar Dinesh , Pachori Purnima , Chaudhary Sandhya , Singh Dharmendra
Published: May 2019

Background: Hypothyroidism and Hyperthyroidism leads to menstrual irregularities. Females with thyroid gland abnormality have chances of reproductive abnormalities ranging from abnormal sexual development, menstrual irregularities, infertility and premature menopause. The objectives were to study the association between thyroid dysfunction and AUB in the reproductive age group (18-45 years), To study the thyroid abnormalities in different types of AUB in the reproductive age group, to establish if screening for thyroid abnormalities is justified using T3, T4 and TSH.Methods: This cross-sectional study conducted among 250 women with ‘abnormal uterine bleeding’ (AUB). Inclusion criteria for participants were females in the age group of 18-45 years, females presenting with abnormal uterine bleeding, with thyroid dysfunction, females who do not have signs of demonstrable pelvic pathologyincluding PID.Results: Majority of the patients belonged to the age group of 24 - 32 years i.e.56.8%, 9.2% cases were nullipara, 44.0% cases have menorrhagia, 32.2% have oliogomennorrhea, 19.6% have amenorrhea. Around 3.6% had Thyromegaly, 12.4% have weight gain in hypothyroidism, 28.4% have fatigue in hyperthyroidism, 6.8% cases have higher T4 level, 18.0% cases have higher TSH level.Conclusions: The risk of progression to overt hypothyroidism (about 5% per year) in patients with subclinical disease and the cost-benefit ratio also emphasises the need for selective screening. Early detection of subclinical disease by selective screening facilitates appropriate therapy early in the course of the disease.
Evaluation of amniotic fluid volume and its relation to perinatal outcome
Authors: Dwivedi Richa , Depan Anju , Yadav Kanti , Samariya Meenakshi
Published: May 2019

Background: In pregnancy amniotic fluid surrounds the foetus and plays an important role in the development of fetus. From the very beginning of the formation of the extracoelomic cavity amniotic fluid can be detected. To evaluate the predictive value of amniotic fluid index (AFI) (<5) for adverse perinatal outcome in terms of cesarean section for fetal distress, birth weight, meconium staining, Apgar scores, and NICU admission at birth.Methods: This was a prospective study of 100 antenatal women visited RMC, Ajmer, Rajasthan, India during the year 2018 with gestational age >34 weeks. The women’s history, clinical examination recorded, and AFI were measured and the perinatal outcome was compared between two groups, i.e., AFI <5 and >5.Results: The cesarean section rate for fetal distress, low birth weight babies, <2.5 kg and meconium staining was higher in patients with oligohydramnios (p=0.012, 0.001, 0.00015 respectively). There was no significant difference in Apgar score at 5 min <7 (p=0.087) and NICU at birth between the two groups.Conclusions: Oligohydramnios has a significant correlation with cesarean section for fetal distress, low birth weight babies and NICU admission.
Association of occupational exposure on semen density in male industrial workers undergoing infertility treatment at tertiary care hospital
Authors: Wadhwa Leena , Fauzdar Ashish , Wadhwa Sanjana N. , Singh Lata , Chakravarti Sumit , Kaur Onkar
Published: May 2019

Background: Working with particular substances or under certain working situations may cause some workers to experience abnormalities in their sexual or reproductive health. Occupational exposures can lead to infertility, but the workers may not be aware of such problems. The purpose of the study was to determine the association between male infertility and occupation of industrial workers in organized sector.Methods: Prospective case-controlled study that included 136 industrial workers working in organized sector and attending infertility clinic for treatment. This study included male partners aged between 21-46 years with primary or secondary infertility and undertaking same occupation for at least last three months. Complete infertility workup of all male partners attending infertility clinic was done that included detailed history and information related to occupation. Routine semen parameters were evaluated according to the 2010 World Health Organization (WHO) criteria.Results: In the present study, significant semen abnormalities were observed in male partners with age more than 31 years and undertaking arduous jobs for more than 5 years (p <0.05) in study group (n=136) as compared to control group (n=62). The abnormal semen count were observed in 114 (83.2%) workers in the study group that included 43 (31.6%) with total sperm concentration (TSC) less than 10 million/ml and azoospermia in 44 (32.3%). Reduced motility (asthenozoo-spermia) was observed in majority 125 (91.9%) of male partners. The findings were significant (p <0.05) as compared to control group.Conclusions: Preventive measures in the workplace need to be established to reduce the effect of occupational hazards and its influence in the semen parameters ultimately leading to infertility.
Comparative study of intra and post-operative complications between total abdominal hysterectomy and laparoscopic assisted vaginal hysterectomy
Authors: Priya S. Nithya , Priya S. Senthil , Allirathnam S. , Nithya S. , Shankar R.
Published: May 2019

Background: Vaginal hysterectomy is preferable due to faster recovery, decreased morbidity and absence of an abdominal incision. The aim was to compare the risks and complications of laparoscopy assisted vaginal hysterectomy and total abdominal hysterectomy in terms of intra-operative and post-operative complications.Methods: A retrospective observational study was conducted in the Gynaecology ward at Vinakaya Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India. The data for the past 1-year record was taken for analysis. A total of 80 subjects were included in the study and were divided into two groups with 40 patients under TAH (total abdominal hysterectomy) group and 40 under LAVH (Laproscopic assisted vaginal hysterectomy) group. The primary outcome of the present analysis was incidence of perioperative complications like blood loss and the secondary outcomes were operating time, blood loss, urinary tract injury, rate of conversion to laparotomy, postoperative pain, and length of postoperative stay.Results: The mean intra-operative blood loss was measured among both the groups and it was found to be very high among TAH group (201 ml) compared to LAVH group (149.8 ml) and the difference was found to be statistically significant (p <0.05). Similarly, the duration of operative procedure was found to be less in LAVH group (57.9 mins) compared to TAH group (72.6 mins) and the difference was found to be statistically significant (p <0.05). Post-operative wound infection (14 vs 0) was found to be more among the patients in TAH group than that of the LAVH group and the difference was found to be statistically significant (p <0.05).Conclusions: LAVH is a safe and effective surgical treatment for benign gynaecological diseases and should be offered whenever possible, taking into account the low rate of complications and cost-effectiveness.
Mammary lipofiling seen to the hospital complex of Dax
Authors: Aimé Rainibarijaona Lanto Nirina , Martial Rakotonirina Andriamaro , Kamary Rakotoarivony Valerie , Lova Andriamihajason , Ibrahim Housni , Rousseau Eric , Andrianampanalinarivo Hery Rakotovao
Published: May 2019

Background: Taken care therapeutics of breast cancer is in constant evolution. She links, according to the stadium of illness, a specific treatment of the cancer and mammary reconstruction which makes integral part of the treatment of breast cancer today. The lipofilling or lipostructure is one of the techniques used in mammary reconstruction.Methods: A descriptive retrospective study on lipofilling accomplished in Hospital complex of Dax, France from January 1st, 2016 till October 31st, 2017 was accomplished, to assess the rate of aesthetic and psychological satisfaction of the patients on the basis of breast Q, then to assess its effectiveness and its security. The statistical analysis was made with the software Excel of Microsoft Office 2007.Results: Authors could record 52 lipofillings at 40 patients among 1212 gynecological surgical operations is 4.29% surgical activities. 47 cases (90.38%) of lipofilling were accomplished at 35 patients after a surgery for breast cancer accomplishing a frequency of 3.87% of surgical activity. The women from 49 to 54 years old are the most concerned the median age of which was of 52 years (37 and 73 years) and the patients are still sexually active in 26 cases (74.29%). The mastectomy was practiced in 32 cases (91.45%). An immediate reconstruction was accomplished at 29 (82.86%) patients. The back big rag autologous was used in 22 cases (62.85%). In 33 cases (94.27%), the lipofilling was accomplished to supplement the reconstruction among which by the back big rag at 22 patients (62.5%) and by mammary prosthesis at 11 patients (31.42%). One took a sample in 32 cases of a volume from 400 to 700 ml of grease average of which was 456.38 ml (200-800 ml). A volume from 200 to 300 ml was injected at 17 patients (36.17%) with an average of 264.14 ml (100-600 ml). No repetition of the cancer was recorded during this study. A score of more than 60 was recorded in every domain for the valuation of satisfaction in more than 90% cases.Conclusions: With the evolution of the taking care of the cancers of breast, mammary reconstruction by lipofilling is a technology which goes know a big development. It is a new way of natural reconstruction at the mastectomy patients who wish, more and more a less aggressive surgical gesture with good result.
A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination
Authors: Verma Ashok , Sharma Shivani , Verma Suresh , Sharma Pankaj , Tenga Tenzin Tsamo , Chauhan Indu
Published: May 2019

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle.  Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.
Condom catheter: a simple and efficacious alternative of hysterectomy in postpartum haemorrhage
Authors: Natu Neeta , Singh Vandna
Published: May 2019

Background: The aim of this study was to evaluate the effectiveness of the condom catheter in treating postpartum hemorrhage refractory to medical treatment.Methods: This prospective study included 21 women with postpartum hemorrhage treated with a condom catheter as a conservative therapeutic option.Results: The condom catheter was successful in controlling hemorrhage in 90.4% of the women. It was effective in all women with vaginal delivery (11 of 12) and highly effective in women with uterine atony who did not respond to medical uterotonic treatment (6 of 7 women).Conclusions: Its ease of use and high effectiveness make the condom catheter a useful approach for the conservative management of acute postpartum hemorrhage. This device reduces bleeding, shortens the hospital stay and avoids the need for surgical management.
Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge
Authors: Bhat Dharitri M. , Mahajan Vrushali A. , Kumbhalkar Dinkar T. , Raut Waman K.
Published: May 2019

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.
Study of thyroid dysfunction in perimenopausal women with abnormal uterine bleeding
Authors: Sree Velicheti Satya , E. Gomathy
Published: May 2019

Background: AUB is a common but complicated clinical presentation and occurs in 15-20% of women between menarche to menopause and significantly affects the women’s health. Women with thyroid dysfunction often have menstrual irregularities, infertility and increased morbidity during pregnancy. The objective of present study is to find the correlation between thyroid disorders and AUB in perimenopausal women attending gynecology OPD.Methods: In the present study, Ninety patients with AUB were included and were evaluated for the cause including thyroid abnormality. Thyroid function tests were done in all patients.Results: Among 90 patients, 22 patients were diagnosed as hypothyroidism and 9 as hyperthyroidism, women with AUB 59 (65.4%) were euthyroid. Among 31 women with thyroid abnormality, heavy menstrual bleeding was seen in 14 (45.1%) women, 11 (35.4%) had Polymenorrhagia, 6 (19.3%) had oligomenorrhea. The frequent menstrual abnormality in women with hypothyroidism (22 women) was heavy menstrual bleeding in 9 (40.9%) women, 5 (22.7%) had oligomenorrhea, 8 (36.3%) had Polymenorrhagia. Out of 9 women with hyperthyroidism, 3 (33.3%) had oligomenorrhoea, 4 (44.4%) had heavy menstrual bleeding, 2 (22.2%) had Polymenorrhagia.Conclusions: AUB might be because of structural or non-structural causes. Thyroid abnormalities may present in perimenopausal women with abnormal uterine bleeding, therefore proper identification of the cause of AUB is needed to give appropriate treatment to the patient. And to avoid unnecessary surgical intervention.
Uterine Lipoleiomyoma: a rare variant of benign uterine neoplasm
Authors: Jagtap Sunil V. , Phalke Abhijit , Kshirsagar Nitin S. , Jagtap Shubham S. , Nasre Nitesh
Published: May 2019

The lipomatous tumors are very rare benign neoplasms of the uterus. Lipoleiomyoma is a benign tumor which is variant of leiomyoma. It has similar clinical course and presentation like uterine leiomyoma and is typically found in postmenopausal women. Authors report a case of 45 years female presented with a complaint of increased frequency of menstrual cycles and generalized weakness since 5- 6 months. On ultrasonography abdomen - pelvis a single large lobulated hyperechoic mass was noted in the fundal myometrium measuring 5 x 4.6 cm. The finding was suggestive of fibroid uterus. On histopathological examination showed variable proportions of lobules of mature adipocytes and interlacing bundles of benign smooth muscle cells which was diagnostic of lipoleiomyoma. Authors are presenting this case for its rarity, clinical presentation, imaging and histopathological finding with differential diagnosis.
Post mastectomy pain control using bupivacaine installation via wound drains
Authors: Alhussini Mahmoud A. , Awad Ahmed T. , Girgis Akram M. , El Fayomi Tarek A. , Agameya H. M.
Published: May 2019

Background: This study is a controlled prospective randomized blinded study. Our aim was to evaluate the effect of wound installation with bupivacanie through surgical drains to control postoperative pain and decrease the use of systemic analgesics after mastectomy.Methods: This study was conducted on 168 female patients candidates for modified radical mastectomy admitted to the Surgical Oncology Unit, Faculty of Medicine, University of Alexandria. Patients were randomly divided into two equal groups. Group A Bupivacaine was installed through axillary and chest wall drains by the end of surgery. While, group B was installed by equal amount of normal saline as placebo. We assessed the visual analogue score (VAS), need and timing for systemic analgesics during the first 24 hours.Results: The mean values for VAS were always lower in group A. This was reflected on the timing and need for additional analgesia.Conclusions: We concluded from this study that using bupivacaine instillation through surgical drains is an effective and easy method to control post mastectomy pain and enhance patients' recovery in the first 24 hours postoperative.
Feasibility of axillary nodal staging through same incision of round block technique in breast cancer cases
Authors: Alhussini Mahmoud A.
Published: May 2019

Background: Round block technique was originally described as a mastopexy technique that is currently widely used as an oncoplastic technique for managing breast cancer. The aim of the study is to assess the feasibility of axillary dissection via same circumareolar incision of lumpectomy.Methods: A prospective randomized controlled study including 100 patients distributed among 2 equal groups. In which group A had axillary dissection performed via same lumpectomy incision by the aid of lighted retractors; while on the other hand group B had axillary dissection performed via separate axillary incision.Results: The technique was feasible in all cases without the need for extra incisions. However, the time of surgery was longer and rate of complications was higher.Conclusions: Axillary staging can be accomplished via same incision of round block. The surgery is demanding especially in large breast cup size and fatty breasts.
Study of outcome of a new method of darning for repair of large and recurrent hernias
Authors: Das Dibyendu , Yadav Neelam , Jhariya Kamlesh , Minz Reena
Published: May 2019

Background: Incisional hernia is the result of a failure of fascial tissues to heal and close following laparotomy. Laparoscopic Meshplasty is a standard method of repair but not usually done in large incisional and recurrent hernias.  Recurrence after repair is common in incisional hernia and poses a significant challenge for the plastic surgeons. We describe here a technique of anatomical repair of the large incisional, and recurrent hernia by darning without using mesh, which is effective in midline, paramedian as well as transverse incisional hernias. Aims and objectives to study the outcome and efficacy of our technique of Darning in cases of large and recurrent incisional hernias without using mesh.Methods: It is a prospective non randomized study of 5 year duration in which we have studied 20 cases of either large or recurrent incisional hernia admitted in our hospital. We operated these cases by darning of the rectus sheath without tension by mattress suture by prolene no.1.Results: 20 patients underwent this repair with few minor complications and there was no recurrence for minimum period of follow of 2 years.  Approximation of inner margin and separately mattress pattern darning of outer rectus sheath by prolene no.1 strengthens the repair, but do not cause complication associated with meshplasty like infection, adhesion and fistula formatioṇ.Conclusions: Our technique of darning is an extraperitoneal method of hernia repair which do not incorporate mesh and is an effective method of hernioplasty with manageable early postoperative complication. We have not seen any recurrences in follow up period.
An analysis of post traumatic leg and foot defects
Authors: G. Gopalan , S. Dhanaraju
Published: May 2019

Background: Management of lower extremity trauma with bone and soft tissue injury is a challenging task with the aim of giving early recovery and durable good quality skin cover according to the skin defect and analyze various reconstructive options at various levels of injury. Our aim of the study is to analyze various reconstructive options for traumatic skin loss involving lower limbs especially knee and below knee, and analyze the incidence of age, sex and etiology of traumatic defects.Methods: Prospective study in our plastic surgery department in the period of 24 months, with all the cases of traumatic defects of leg and foot where included. All age and sex patients were included.Results: Most common cause for traumatic leg and foot defects are road traffic accidents followed by accidental fall and others, most commonly in males amounting 73%, children 10% and  females 17%, among the skin and soft tissue  defects upper and lower 1/3 leg defects are predominant. Among the soft tissue coverage split thickness skin graft dominating about 60% of cases, flaps 30% of cases, among the flaps 70% are fasciocutaneous flaps predominantly inferiorly based  and 30% are muscle and musculocutaneous flaps, among the muscle predominantly soleus muscle flap was used to cover the defect.Conclusions:Road traffic accidents dominating the cause for leg and foot defects , males are more commonly affected  and upper one third leg defects are predominant for soft tissue coverage split thickness skin graft are commonest procedures followed that cutaneous and muscle flaps.
A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment
Authors: Jain Mohit , Sharma Yogesh Kumar
Published: May 2019

Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females.
A study on the clinical and sonological correlation in the diagnosis and management of acute appendicitis in a tertiary care centre
Authors: Mudavath Keerthi , K. Thinagaran
Published: May 2019

Background: Acute appendicitis is the most common acute surgical condition of the abdomen requiring early intervention. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. Alvarado score for diagnosis of acute appendicitis is easy and additional tools like sonography results in accurate diagnosis. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological findings and histopathological examination for the diagnosis of acute appendicitis.Methods: 100 cases of acute abdomen admitted in PES institute of medical sciences and research, Kuppam from December 2016 to June 2018 were included. Clinical examination was done and all patients were subjected to ultrasound abdomen examination and other relevant blood and imaging investigations.Results: Out of 100 patients 62 were males and 38 were Females. Most common symptom was pain in the right iliac fossa and patients with Alvarado Score 7 or > 7 subjected to USG followed by emergency appendectomy showed positive operative findings and histopathological findings. The overall specificity of abdominal USG in the diagnosis of acute appendicitis was 88.09% and sensitivity was 95.37%.Conclusions:The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and less expensive useful, reliable and non invasive way of confirming acute appendicitis thus helps in reducing negative appendectomy rate. The overall accuracy of diagnosis of acute appendicitis goes up to 90% with positive histopathological findings.
Peptic perforations: comparative study of its closure (omentopexy versus figure of 8 closure)
Authors: Changole Sanjay , Soni Maheshkumar , Thakare Dattatray
Published: May 2019

Background: Peptic ulcer perforation is one the most common and catastrophic maladies that affect mankind. The aim of this study was to compare the surgical techniques of peptic ulcer perforation closure namely omentopexy and figure of 8 stitch with reference to recovery time and complications rate.Methods: Of 80 selected patients, figure of 8 method for closure of peptic perforation was used in 40 patients and 40 by using omentopexy method. Outcomes were compared in view of postoperative recovery time and postoperative complications such as wound complications, respiratory complications, burst abdomen, septicaemia, hospital stay, death.Results: In our study it was noted that age of presentation was in elderly males with risk factors like alcohol, smoking, tobacco chewing, and NSAIDS use in decreasing order. Late presentation was associated with higher complication including one death. In figure of 8 group it was found that RT Removal was early, early oral resumption loss hospital stay in figure of 8 group than in omentopexy group. Complications such as wound complication, burst abdomen , leak, and septicaemia  were more in omentopexy group than figure of 8 group. Only one death occurred in study that was in omentopexy group.Conclusions: We came to conclusion that peptic perforation is more common in males around 50 years with risk factors of smoking and alcohol. Outcomes of surgery with figure of 8 stitch were better than omentopexy with respect to oral resumptions, early discharge, less complications such as wound complications, burst abdomen leak septicaemia and death.
Comparative study on surgical outcomes of needle port assisted two port laparoscopic appendicectomy verses conventional three-port laparoscopic appendicectomy
Authors: Sonarkar Rajiv , Ghuge Ashutosh , Akhtar Murtaza
Published: May 2019

Background: Conventional three port laparoscopic appendicectomy is fast becoming a procedure of choice for appendicitis. Needle port assisted two port laparoscopic appendicectomy is the procedure with similar technique as conventional procedure but has its distinctive advantages. The present study aims to compare the results of needle port assisted two port and conventional three port laparoscopic appendicectomy.Methods: In comparative non-randomized study patients with acute appendicitis, recurrent appendicitis and patients posted for interval appendicectomy of age >18 years, both gender without co-morbidity were enrolled as subjects. Non-consenting patients were excluded. The study factor was needle port assisted two port and conventional three port laparoscopic appendicectomy procedure. The allocation to each procedure was done at random. The outcome factors were compared between both groups.Results: A total of 91 patients with a mean age of 29.77 years and F:M ratio of 1.67:1 were enrolled, of them 31 underwent needle port assisted two port laparoscopic appendicectomy. The mean operative time for two port was 53.38±7.97 min as compared to conventional three port was 44.65±5.86 min which was statistically significant but cosmetic outcome was better as well as statistically significant with two port procedure. The post-operative pain, intra-operative and post-operative complications were compared between these groups but were statistically not significant.Conclusions: Needle port assisted two port laparoscopic appendicectomy appears to give better cosmetic results and can be a good surgical alternative modality for uncomplicated appendicitis.
Study of use of saphenoperitoneal shunts in intractable ascites
Authors: Yadav Rajeshwar , Verma Satyajeet , Rai Sujeet
Published: May 2019

Background: Ascites is a common complication in patients with chronic liver disease. Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. Describe the experience with this procedure with some changes in the technique.Methods: A prospective study was performed on 8 patients with intractable ascites admitted to the surgical ward of Maharani Laxmi Bai Medical College during the period from November 1999 to April 2001. Eight patients with chronic liver disease and diuretic-resistant ascites underwent this procedure. The patients were classified by severity of liver disease as estimated from serum bilirubin and albumin values. Observations were present in tables, number and percentage using Microsoft excel.Results: Procedure performed in 8 patients and was successful 6 patients. Effective doses of diuretics required were decreased to one eighth of the preoperative dose over a median 3 months post- operative period. No patient with successful shunt needed postoperative paracentesis or re-hospitalization in a median follow-up of 8 month. No other complication was found except ascitic leakage.Conclusions: All patients, who had a successful shunt had symptomatic relief from ascites. Therefore the saphenoperitoneal shunt potentially offers all the benefits of peritoneovenous shunting without the disadvantage of using prosthetic material.
Do we need more than one mediastinal drain in cardiac surgery?
Authors: Bansal Dhananjay , Guha Soumya , Sharma Ashish , Gupta Anubhav , Jhajhria Narender Singh , Aiyer Palash , Grover Vijay , Gupta Vijay Kumar
Published: May 2019

Background: Placement of mediastinal drains after cardiac surgery is standard of care. However, there is no consensus over the number of drains to be placed. Is there any advantage of multiple drains over a single drain? This question formed the premise of this study.Methods: All consecutive patients operated between 2014 and 2015 were included. Those with pleural drains were excluded. Patients had either a single drain in the pericardial cavity or had two drains, one in the pericardial and the other in retrostenal area. A total of 244 patients were included in the study group.Results: Out of 244 patients, 122 had single drain and 122 had 2 mediastinal drains. The mean age was 24.38±17.08 (Age range 6 months to 66 years) and male: female ratio was 1.5:1. There was no statistically significant difference in single drain vs double drain group in terms of the number of days of drainage (1.65 vs 1.55, p 0.325), time to mobilize (36.57 vs 35.23 hours, p=0.684), ICU stay (2.62 vs 2.63 days, p=0.96)and re-exploration (5.7%, vs 9.8%, p=0.34). However, patients with two mediastinal drains had higher requirement of analgesia (p=0.004).Conclusions: The use of two mediastinal drains does not confer any advantage over a single mediastinal drain after cardiac surgery in assessing or controlling bleed or recovery. However, the post-operative pain is significantly higher with use of two mediastinal drains.
Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures
Authors: Mushtaque Majid , Bacha Umar Q. , Rashid Arshad , Malik Tajamul N. , Khanday Samina A.
Published: May 2019

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy (LIS) which is usually performed at a single location. This randomized study compares bilateral to unilateral lateral internal sphincterotomy.Methods: Patients were randomized into two equal groups (64 each) to undergo either bilateral (Group A) or unilateral (Group B) open lateral internal sphincterotomy (LIS). Comparative study was done in terms of symptomatic relief of pain, incontinence, complete healing of fissure, and recurrence. Chi-square test was used as a test of significance.Results: Both groups had comparable demographic and clinical characteristics. Mean operative time for was longer for bilateral LIS (P-value <0.05). Mean pain score (VAS) in bilateral LIS group was lower in early post-operative period (P-value <0.05). At the end of 4th week 65.6% of patients in bilateral LIS group and 56.25% of patients in unilateral LIS group had completely healed fissures (P-value <0.05). Mean Wexner score for incontinence was comparable, while significant decrease in resting anal pressure was noted at 1 month in BLIS group. There was one recurrence in unilateral LIS group.Conclusions: Bilateral LIS resulted in better outcome in terms of early pain relief, early reduction of anal pressures, complete healing rate in 4 weeks with no recurrence. It does not increase the risk of incontinence and has better patients’ satisfaction as compared to unilateral LIS.
Safety and feasibility of video assisted thoracoscopic thymectomy for myasthenia gravis: a single centre experience
Authors: Gajbhiye Raj N. , Bhanarkar Hemant , Akulwar Vikrant V. , Tirpude Bhupesh , Jambhulkar Niketan , Deshpande Gayatri
Published: May 2019

Background: Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is a mainstay in the treatment for myasthenia gravis with or without thymoma. For many years transsternal and transcervical thymectomy had been the most common approaches used, video assisted thoracoscopic thymectomy is still not accepted as approach of choice. We intend to study the role of Video assisted thoracoscopic thymectomy for myasthenia gravis in central Indian population.Methods: Study was conducted in single tertiary care institute from January 2015 to November 2018. It is a prospective study. Aims of the study were to evaluate the safety and feasibility of video assisted thoracoscopic thymectomy for patients of myasthenia gravis. All patients of myasthenia gravis who underwent underwent video assisted thoracoscopic thymectomy (VATS) were included in the study. Intraoperative and postoperative details were studied to assess the safety and feasibility of VATS for treatment of myasthenia gravis.Results: 16 patients including 7 men and 9 women with the mean age of 35.5 years were investigated. All patients had myasthenia gravis, 12 pts had thymoma while remaining 4 pts had normal thymus. Mean operating time was 104 mins, Mean intraoperative blood loss was 45 ml (range 20 to 60 ml). There was no major intraoperative or postoperative complication or mortality. Mean ICU stay and hospital stay was 33 hrs and 4.25 days respectively.Conclusions: VATS thymectomy is safe and effective approach for the treatment of MG with or without thymoma. MG treated by VATS resulted in comparable neurological outcomes to those associated with the transsternal approach.
A comparative study of skin staples and conventional sutures for abdominal skin wound closures
Authors: Kathare Sagar S. , Shinde Nandkishor D.
Published: May 2019

Background: The objectives of the study were to study the operative time, the effect on wound healing, cosmetic results, patients acceptance and total cost with the use of sutures and staples.Methods: The study was conducted on 100 patients who were undergoing elective surgery from January 2016 to July 2017 in our institute. The patients were randomly selected to receive either suture or staple.Results: The study group included 50 patients who underwent wound closure by staplers and 50 patients underwent suturing. The commonest region of the surgical wounds was Mc Burneys site. The time taken for wound closure using staplers showed statistically significance difference over closure with suture, it took the stapler 4 times less duration to perform wound closure. The average cost of using stapler was higher than suturing. The appearance of the scar among the staple group was good in 90% of those who returned for follow-up at 1 month, 10% had average scar. The patients acceptance was better in staple group with less pain during removal as compared to suture group. P-value calculated using students unpaired T-test. P<0.0001 which was highly significant.Conclusions: Staples did not cause excess wound pain and allows saving in time with better cosmetic results.
In vitro comparison of ultrasonic shear versus ligating clip application in closure of cystic duct in cholecystectomy
Authors: Yadav Pritesh , Shah Dharmendra , Sutaria Akshay , Bhabhor Vishal
Published: May 2019

Background: Cholecystectomy is one of the most commonly performed surgery overall. One of the most important steps in the operation of cholecystectomy whether open or laparoscopic, is the closure of cystic duct which if not done properly can lead to disastrous postoperative outcome. This study was conducted with an aim to do in vitro comparison of ultrasonic shear and standard titanium ligating clips in closure of cystic duct with respect to their ability to withstand the pressure generated inside the gall bladder by pneumatic tourniquet device.Methods: A total 148 patients underwent open or laparoscopic cholecystectomy Between August 2016 to October 2017 at Sir Sayajirao Gaekwad Hospital, Baroda, were eligible for this prospective randomized study. A total of 16 cases were excluded from the study and specimens from 132 patients were included in the study. The eligible patients were randomized into two groups using sealed envelopes. The two groups were as follows: A) ligating titanium clips, and B) ultrasonic shear. Independent assessors were assigned to obtain cystic duct bursting pressure.Results: A comparison of the mean cystic duct bursting pressure between both the groups indicated the superiority of ultrasonic shear group over ligating titanium clip group.Conclusions: The mean cystic duct bursting pressure was higher in the ultrasonic shears group than in ligating clips group, higher than the maximum cystic duct bursting pressure (195 mmHg). The ultrasonic shear provides safe alternative to standard titanium ligating clip for cystic duct closure.
Head and neck non-metastatic cancer associated hypercalcemia
Authors: Lazutkin Anna , Eliashar Ron , Weinberger Jeffrey M. , Hirshoren Nir
Published: May 2019

Cancer associated hypercalemia (CAH) is a relatively common paraneoplastic syndrome and may be associated with head and neck cancer patients. As the hypercalcemia may be life-threatening, recognition is paramount. Herein we investigate the prevalence and outcome metrics of CAH and create a proposed clinical guideline for advanced stage head and neck malignancies.  We describe our experience with non-metastatic, asymptomatic persistent head and neck CAH, which resolved after surgical ablation. We have performed a literature search in the PubMed database between the years 1998-2018 using the key words "head neck", "squamous cell carcinoma", "hypercalcemia", "cancer associated hypercalcemia" and "paraneoplastic.  Non-metastatic head and neck CAH generally presents in patients with advanced stage disease and is associated with poor prognosis (median survival time range 28-64 days). It may portend imminent distant spread. Most patients continue to suffer from persistent high calcium levels despite treatment. We present a patient with nodal recurrence of advanced stage IV oral cavity squamous cell carcinoma and CAH. Regional neck metastases were surgically excised, resulting in normalization of blood calcium levels. Hypercalcemia should be ruled out in all advanced head and neck cancers. Treating physicians should be aware and promptly treat severe hypercalcemia. CAH may herald advanced disease, thereby modifying treatment decisions. However, in cases where surgical ablation is feasible, it is the preferred management for achieving calcium normalization.
Hobnail variety of papillary cell carcinoma thyroid mimicking a thyroglossal cyst: a rare presentation
Authors: Ravishankar K. S. , Subramanian Atreya M.
Published: May 2019

The hobnail variant of papillary thyroid carcinoma (HVPTC) is a newly described aggressive variant relative to that of the classical PTC. There have been genetic markers like the BRAF V600E mutation associated with more aggressiveness and a higher rate of recurrence and mortality. Here we discuss a case of thyroid swelling which clinically resembled a thyroglossal cyst due to movement of the swelling with tongue protrusion. Imaging indicated a multilobulated cystic swelling arising from the thyroid gland. FNAC was suggestive of colloid goitre. Total thyroidectomy was done and histopathology revealed HVPTC.HVPTC is an aggresive variant and if diagnosed preoperatively may warrant more extensive surgery. One must also have a high index of suspicion for thyroid swellings that are large with variable clinical presentations (including mutiple septations) as they may appear benign on FNAC but may prove to be malignant on histopathology.