bluuebunny/crossref_metadata_2025 huggingface dataset:
Bariatric surgery between encouragement and inhibition: Sohag experience of first 50 cases with encouraging results
Authors: Abdelhameed Hosam F. , Abdelmageed Samir A. , Hassan AsemElsani M. A. , Radwan Alaa A.
Published: June 2019

Background: The advantages of bariatric surgery are improved co-morbidity, quality of life and survival in obese patients. Nowadays, many studies compare effectiveness of different bariatric surgery procedures. Our aim is to evaluate effectiveness of two laparoscopic bariatric surgery procedures performed in our centre (SG and OAGB) as regard outcome and post- operative complications.Methods: A retrospective study for our first 50 cases of bariatric surgery. Primary outcome was weight loss expressed as kilograms, body mass index (BMI) reduction and percentage excess weight loss % EWL. Secondary outcomes were remission or control of associated diabetes mellitus type2, hypertension and dyslipidaemia.Results: LSG was done in 38 cases and OAGB in 12 cases. Mean operating time for LSG was 75.6±10.5 min and for OAGB was 98.5±11.5 min. Mean length of hospitalization for LSG was 3.7±1.4 days and for OAGB was 5.2±1.6 days. Post-operative complication occurred in one patient (2.6%) with LSG and in two patients (16.6%) with OAGB. No significant statistical differences were found as regard short term complications or death. Mean EWL at 6 months was higher in patients receiving OAGB (59%) compared to those receiving LSG (47%). After 1 year it was (73% vs. 62%) and at 1.5 years (87% vs. 76%), respectively. At 6 months, associated comorbidities showed significant improvement in both groups but more with OAGB.Conclusions: For the short term, OAGB appears to achieve better %EWL and remission of obesity-associated comorbidities compared with the LSG.
Medial versus lateral approache in laparscopic right hemicolectomy
Authors: Elsisi Alla Abd-Elazim , Rageh Tarek Mohey , Elmeligy Mohamed Hammed , Ibrahm Saad Soliman
Published: June 2019

Background: Approach to right colon cancer is through open exploration but it has many complication, now laparoscopic right hemicolectomy is an advanced cancer surgery, laparoscopic right hemicolectomy can be done by medial or lateral or combined approach.Methods: This is prospective study carried out on 30 patients admitted to department of surgery in menufia university hospital from September 2016 to September 2018 and all cases have RT colon cancer;  The patients are divided into three groups, 1- group A (n=10): underwent medial  approach for laparscopic right hemicolectomy 2- group B (n=10): underwent lateral approach for laparscopic right hemicolectomy, 3- group C (n=10) : underwent combined laparscopic medial and lateral approach, Blood loss, operative time, operative and postoperative complication were assessed. The period of follow up is for 6 months.Results: Operative duration and blood loss were significantly lower in combined approach. Intra and post operative complications were low in combined and MA.Conclusions: Laparoscopic combined approach reduces the operative time and blood loss than MA and LA. Besides the oncologic advantages of an early vessel division and a "no-touch" dissection.
Thyroid autotransplantation following total thyroidectomy in benign thyroid disorders: a new technique to avoid postoperative hypothyroidism
Authors: Gamal Ahmed Mohamed , Elnaga Nagm Eldin Abu , Ayoub Mahmoud Thabet , Farghally Abdel Radi Abdel Salam
Published: June 2019

Background: Although total thyroidectomy has become the operation of choice in treatment of BMNG, it leads to permanent hypothyroidism which lead the patient to take a lifelong exogenous hormone replacement therapy, which involves daily administration of levothyroxine at a dose that must be in close follow-up in terms of thyroid hormone levels. In addition, reaching euthyroid status using hormone replacement therapy can be affected in  presence of other medical problems that interfere with absorption of the drug as mal-absorption syndrome. When all these are considered, there is a necessity of a novel method to avoid the occurrence of postoperative hypothyroidism.Methods: A case series prospective study carried out over 30 patients with benign thyroid disorders for whom total thyroidectomy is indicated to evaluate the capacity of auto-implanted thyroid tissue in achieving an euthyroid state without any need for life-long hormone replacement therapy. Postoperative Assessment consists of repeated thyroid function tests and thyroid scan with complementary SPECT/CT.Results: significant gradual increase in serum levels of T3 and T4 with corresponding decrease in TSH levels returning to normal levels 6-9 months postoperatively. Thyroid scan with complementary SPECT/CT was done for 15 patients to evaluate the functional capacity of the thyroid implant.  Among the 15 patients, 13 patients have functioning thyroid implant (success percent: 6.6%). whereas 2 patients show non functioning thyroid implant (failure percent: 13.3%).Conclusions: Thyroid Auto-transplantation following total thyroidectomy in benign thyroid disorders is an effective method to prevent postoperative hypothyroidism.
Full outline of unresponsiveness versus Glasgow coma scale in predicting mortality in paediatric trauma patients
Authors: Salah Rania , Fakhri Tamer , Gaber Ahmed
Published: June 2019

Background: Many scoring models have been proposed for evaluating level of consciousness in trauma patients. The aim of this study is to compare Glasgow coma scale (GCS) and full outline of unresponsiveness (FOUR) score in predicting the morbidity and mortality of trauma paediatric patients.Methods: In this diagnostic accuracy study trauma paediatric patients hospitalized in emergency room (ER) of Menoufia University hospital were evaluated. GCS and FOUR score of each patient were simultaneously calculated on admission as well as 6, 12 and 24 hours after that. The predictive values of the two scores and their area under the receiver operating characteristics (ROC) curve were compared.Results: 100 patients were included in the present study (mean age 7.6±5.1; 77% male). Comparing the area under the ROC curve of GCS and FOUR score showed that these values were not different at any of the evaluated times: on admission (p=0.68), and 6 hours (p=0.13), 12 hours (p=0.18). However, The values of FOUR score was high accuracy than GCS score in predicting mortality in paediatric patients with ROC; 0.97, 0.89 respectively.Conclusions: The results of our study showed that, GCS and FOUR score have the same value in predicting the mortality of trauma patients in first 24 hours. However, FOUR score has high accuracy than GCS score after 24 hours. Both tools had high predictive power in predicting the outcome at the time of discharge.
Observational study on carcinoma penis in Jharkhand
Authors: Alam M. Afsar , Ranjan Jitendra Kumar , Ahmed Aftab , Mundu M.
Published: June 2019

Background: Carcinoma of penis is relatively uncommon tumor. In India the incidence is relatively higher than western countries. It is the assumption that smegma is someway carcinogenic. Circumcision soon after birth confirm immunity against penile cancer. Many patients presents late either due to embarrassment or misdiagnosis. Surgery is the mainstay of treatment. Nodal involvement indicates a poor prognosis. Chemotherapy is relatively ineffective.Objective of the study to know the incidence, age group, avoidable risk factor and common presenting symptoms and 1st site of onset of growth of penile cancer in patients of Jharkhand.Methods: This is an observational study on carcinoma of penis in Jharkhand from 2012 to 2014. The patients were selected from the surgical outpatient and indoor patients, Department of General Surgery, RIMS, Ranchi, Jharkhand. The provisional diagnosis was based mainly on clinical examination and confirmed by biopsy.Results: Carcinoma of penis in Jharkhand commonly occurs in the 5th decade. This disease most commonly affects people of poor class with poor personal and sexual hygiene. The disease occurs commonly in uncircumcised Hindus particularly with phimosis and tobacco addiction appears to be a risk factor for penile cancer. Patients usually delay consultation with doctors until the disease is advanced.Conclusions: Penile cancer is associated with poor sexual hygiene, presence of phimosis and and consuming tobacco products is in important predisposing factor.
How to resolve zip injury of prepuce? Better way of manipulation
Authors: Thakkar Nimesh , Patel Pranav , Patel Nirav
Published: June 2019

Background: Entrapment of prepuce in a zipper is a common cause of prepuceal injury in children. It is seen in boys of age group 5-12 years who usually do not wear underpants. About 80% of these injuries occur accidentally while zipping up.Methods: We reported 20 cases with zipper injury during our study period, which were divided in two groups. In Group A, Patients were managed by conventional techniques while in Group B; we managed patients with our technique of manipulation. Final Outcomes were compared with need of circumcision.Results: All patients in this study were male patients. All were from pediatric age group, except one case in Group A was Adult. In Group A, 7 patients (70%) required Circumcision while in Group B study, only 1 patient (10%) required circumcision. Moreover we found this technique more Simple and Easy.Conclusions: We found this technique very easy, less time consuming, less trauma to prepuce and need of Circumcision is less with this manipulation.
Surgical outcome in patients with complicated appendicitis treated at a medical college hospital
Authors: T. Pramod , M. N. Prakashkumar
Published: June 2019

Background: Acute appendicitis is the most common surgical emergency requiring operative intervention. Most of the cases are simple; however complicated appendicitis with perforation, abscess and gangrene of appendix is seen in up to 1/4th of adults and 1/3rd of cases in children. It is associated with post operative complications with considerable morbidity. The aim is to study the clinical presentation of complicated appendicitis, the intra-operative findings, post-operative complications and the overall surgical outcome.Methods: It is a cross sectional study of 35 patients who had complicated appendicitis and who were treated with surgery.Results: 83% of patients with complicated appendicitis were younger than 40 years of age, with children constituting about 43% of total cases. All the patients had typical right iliac fossa pain, with tenderness and localized guarding in 37%. Ultrasound diagnosed appendicitis in 80% of cases. Leukocytosis was seen in 71% with neutrophil shift in 85% of patients. 60% of patients had perforation and abscess formation, gangrene in 45% and mass in 37%. Post operative complications were noted in 51% of the patients, commonly paralytic ileus (46%) and wound infection (20%). There was no mortality in our study and the general overall outcome of treatment was good.Conclusions: Complicated appendicitis with gangrene, perforation and abscess form a considerable proportion of cases. Early surgical intervention is the definitive treatment after initial resuscitation. Overall morbidity is considerable, but mortality is less than 1% and the general overall outcome is good with early surgical intervention.
Alternative laparoscopic techniques for stone extraction during laparoscopic CBD exploration: pros and cons
Authors: Abdelhameed Hosam Farouk , Abdelmageed Samir A. , Radwan Alaa A.
Published: June 2019

Background: A prospective work to study various laparoscopic techniques used for stone extraction during laparoscopic common bile duct exploration (LCBDE) with assessment of CBD clearance by each technique with discussion of its feasibility and difficulties.Methods: Patients with chronic calcular cholecystitis with CBD stone(s) were treated randomly by laparoscopic cholecystectomy plus choledocholithotomy. Various methods were used for stone extraction either through the scope technique, direct access technique, or irrigation/suction technique. Assurance of CBD clearance of stones was done later using intra-operative choledochoscopy, cholangiogram, or post operatively using sonography or MRCP.Results: Out of sixty seven patients, laparoscopic CBD stone extraction was done through scope control in 25 patients, direct access technique in 22 patients, while irrigation/suction technique was done in 20 cases. Choledochoscope method was the most effective method for CBD clearance with success rate (96%), it was effective in distal CBD stones of average size (0.5-1.0 cm), and number (1-5), but unfortunately missed stone is a relative risk (4%). Direct access technique is as effective blindly especially if associated with irrigation/suction with success rate (81.8%) specially in non-impacted single distal stone of average size (0.5-1.0 cm) well recognized by MRCP a night before operation. Irrigation / suction technique was the least effective with success rate (50%) only with the need to convert to other technique in 50% of cases.Conclusions: Choledocoscope guided stone extraction technique was the technique of choice for CBD clearance during LCBDE.
A clinical study involving anatomical distribution, pathological patterns and differentiation degrees in population with small bowel tumor
Authors: Akulwar Anil , Akulwar Akshay , Rao Siddarth , Narang Ravinder
Published: June 2019

Background: Occurrence of tumor of small bowel is very rare but the burden is in growing state in both more and less economically countries because of consumption of tobacco chewing by youngsters.Methods: The present studies include diagnosis and treatment of patients reported at tertiary care center of each districts of Vidarbha region and nearby districts for a schedule of six years.Results: Data refers to female predilection with male to female ratio of 0.75:1. The mean age of incidence for men and women recorded were 35±20.23 and 57±17.91 years respectively. Pain in abdomen was recorded as primary sign in 92.86% cases along with change in bowel habits in 85.71%. Anemia found was related to loss of weight and appetite. Melena and diarrhea were also significant in 65.29 and 14.95% of patients along with presence of mucus in stool in one patient. Pallor and palpable mass in abdomen was characteristic in 42.86% and 14.29% cases. Bowel wall thickening in 71.4% and bowel mass in 28.6% were examined by computer tomography. Intra-abdominal lymphadenopathy along with bowel wall thickening and bowel mass were noticed in one patient. Liver secondary were seen in 3 patients (21.43%). Ileum was most susceptible site of tumor with development of adenocarcinoma malignancy.Conclusions: Improvement in socioeconomic background, literacy and awareness regarding causative agents helps to control percentage of incidence.
Proportions and reasons for breast conservation surgery and modified radical mastectomy in early breast carcinoma
Authors: Sajikumar N. R. , Syamsunder S. , Pinheiro Carol
Published: June 2019

Background: Breast cancer is a common cancer among women in India and its incidence is increasing in an alarming rate. There is a paradigm shift in the management of early breast cancer with more emphasis given to breast conservation treatments. This study aimed to assess the proportion of patient underwent breast conservation surgery and reasons to choose breast conservation surgery or modified radical mastectomy in early breast cancer.Methods: Information of 41 patients with early breast carcinoma who attended the institute during the study period and who can choose either modified radical mastectomy or breast conservation surgery depending on their wish are included in the study group and the data thus obtained was entered in MS Excel data sheet and analysed using SPSS 16 software.Results: It was observed that the proportion of women selecting breast conserving therapy increased with improved literacy status. Similarly, menstrual status and location of tumor do have an influence in choosing breast conserving surgery with significant statistical correlation. However, unlike the previous studies we did not find any statistically significant association between age and surgical decision. Similarly, place of residence, and employment status of the patient does not influence the decision to undergo breast conservation surgery.Conclusions: We have to create awareness in the society about the safety of breast conservation treatment to popularize this modality of treatment there by more and more organs can be preserved.
Study on therapeutic effectiveness of laparoscopic drainage and image guided pigtail catheter drainage in the treatment of liver abscess: a randomised controlled trial
Authors: Chitrambalam Tharun Ganapathy , Pethuraj Manimaran , S. Jeyakumar , Anguraj Preetham
Published: June 2019

Background: Liver abscess is one of the major diseases of gastrointestinal system. A liver abscess is a suppurative cavity in the liver resulting from the invasion and multiplication of microorganisms, entering directly from an injury through the blood vessels or by the way of the biliary ductal system. Liver abscesses are most commonly due to pyogenic, amoebic or mixed infections.Methods: This is a randomised controlled trial to compare the outcomes of image guided pigtail catheter drainage and laparoscopic drainage in treatment of liver abscess. A total of 60 patients were recruited for the study and were divided into two groups between March 2017 to August 2018 with a follow up period of 6 months.Results: Mean average pain score were significantly higher in image guided pigtail drainage group than in laparoscopic drainage group on 2nd, 5th and 7th day. The time taken for more than 50% resolution and for total resolution of abscess cavity size in the laparoscopic drainage group is significantly less than the time taken by the pigtail drainage group (p value <0.001). The average duration of hospital stay with pigtail catheter drainage is significantly higher (14.5±2.03) than the average duration of hospital stays with laparoscopic drainage (8.07±0.78).Conclusions: We conclude that laparoscopic drainage of liver abscess is superior to image guided pigtail catheter drainage in terms of post-operative pain, hospital stay post procedure and resolution of abscess cavity.
Post-operative CT imaging of laparoscopic sleeve gastrectomy: our initial experience
Authors: Varaprasad Vemuri Naga , Venkatesh Manchikanti , Ravikanth Kongara
Published: June 2019

Background: Laparoscopic sleeve gastrectomy (LSG) is a restrictive type of bariatric surgery. It is safe and effective with its many advantages like relative simplicity of the procedure, lack of malabsorption component and anastomoses and retaining the anatomical gastrointestinal continuity. Obesity, a chronic disease, with the significant rise of its comorbidities and mortality is attributing to the major financial and health burden globally.  Methods: We conducted a prospective study of over 43 patients (male 32, female 11) over 5 years period i.e., from 2012 to 2017. These patients were assessed with contrast enhanced computerized tomography (CECT) for detection of post-operative complications.Results: The patients with the body mass index (BMI) >40 kg/m2 and or with a BMI >35 and <40 kg/m2 but with significant weight related comorbidities underwent Laparoscopic sleeve gastrectomy. Both intravenous (IV) and oral contrasts are used accordingly. With increasing number of surgeries and with associated co-morbidities complications following LSG are increasing, necessitating the need for a good understanding of clinical symptoms and post-operative complications of LSG. Post-operative imaging plays a crucial role in the early detection of complications resulting in reduced mortality rate.Conclusions: We suggest multidetector computed tomography (CT) with oral and IV contrast as an excellent tool for the patients having a nonspecific abdominal symptom post LSG.
Clinical, pathological and radiological correlative study of benign breast diseases in a tertiary care hospital
Authors: Samal Satyajit , Swain Phanindra Kumar , Pattanayak Siddharth
Published: June 2019

Background: Study of pattern of benign breast disease is a challenge due to variants in occurrence and presentation in different age groups and different geographical areas. The objective was to study the pattern of benign breast diseases and its clinical, pathological and radiological correlation.Methods: This is a prospective study of females with benign breast diseases presenting to surgery department. This work was done for studying the age distribution, to evaluate the different types of benign diseases of the breast, their mode of clinical presentation, pathology, to evaluate the accuracy of different modes of triple assessment and various modes of management for different types of Benign Breast Diseases. Patients with obvious malignancy and males were excluded from the study.Results: A total of 200 females were included in the study. Fibroadenoma (55%) was the commonest diseases with presenting mostly at 20-24years of age. Clinical examination had accuracy of 88%, USG had accuracy of 77.3%, FNAC had 93% and mammography had 83.33% accuracy foe diagnosing benign breast diseases.Conclusions: Benign breast diseases are common problems of 2nd and 3rd decade in females and raises considerable fear of malignancy. The patients of BBDs generally present with one or more of these complaints-breast lump, breast pain or nipple discharge. All the patients with discrete breast lumps should undergo a triple assessment to make an early diagnosis.
A study of treatment outcomes of liver abscess in a rural tertiary care centre
Authors: Reddy Pooja , K. Ashwin , Srinivasan N. , Halbhavi Manjush Ramesh
Published: June 2019

Background: Liver abscess is a cavity resulting from suppuration following invasion and multiplication of microorganisms. In tropical countries like India, pyogenic and amoebic liver abscesses are common clinical problems and an important cause of mortality and morbidity. Approach in management has changed with advances in radiological interventions. Image guided percutaneous drainage is nowadays increasingly used as treatment modality with high success rate. This study was undertaken to know the efficacy of various modalities of treatment (conservative and minimally invasive).Methods: This was a descriptive prospective observational study done at PES Institute of Medical Sciences and Research, Kuppam for a period of 2 years. A set of inclusion and exclusion criteria were defined and followed. Initial assessment, basic investigations with specific investigations (Ultrasonography-USG) were done. Relevant treatment modality was given and patients were followed up for a period of 1 month.Results: A total of 72 patients were included in this study. Majority of the patients were between the age groups of 31 to 50 years with male predominance. The most common presenting symptoms were fever and pain abdomen. Success rate was 83.3% with Percutaneous needle aspiration (PNA) and 90% with Percutaneous (pigtail) catheter drainage (PCD).Conclusions: Image guided modalities of treatment (PNA and PCD) have decreased the need for surgical procedures which are associated with higher rate of morbidity and mortality. These procedures have also decreased the complications of liver abscess like rupture, sepsis and are also cost-effective.
Prevalence of fistula-in-ano in patients attending tertiary care institute of Gujarat: a cross-sectional study
Authors: Sukhlecha Akhilesh G.
Published: June 2019

Background: Present research was done to study the evidence, etiology signs, symptoms, pathogenesis and management and follow up of the patient for a period of 6 months after surgery.Methods: This was a clinical study of fistula in ano done at medical institute for the period of 1 year. 50 cases, clinically diagnosed, fistula in ano were selected randomly utilizing the closed envelope method and studied. Clinical examination including per rectal and proctoscopic was done in required patients. Patients were treated with fistulectomy or fistulotomy for fistulae. Patients were followed up for a period of 3 months to 1 year.Results: In this present series, 44% of patients were in the age group of 31-40 years. 70% of patients were, discharging wound was the presenting the complaint. 20% of patients with pain and swelling around the anal region. In the study of 50 cases were randomly selected patients of fistula in ano, 84% of them had only one external opening, while 10% had 2 external opening and another 6% had more than 2 openings, hence fistula in ano with a single external opening is commonest in occurrence.Conclusions: On the basis of observations, we can conclude that early diagnosis and appropriate management is the key to success. It not only reduces the complications but also improve the quality of life among these patients.
Case series of 200 laparoscopic cholecystectomy, their intra-operative finding and post-operative complication
Authors: Ahirwar Sovat Lal
Published: June 2019

Background: In the current era of laparoscopic procedure, laparoscopic cholecystectomy are most commonly performed surgery all over the world. The biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. So adequate recognition and awareness of anatomical abnormalities of encounter during laparoscopic cholecystectomy can decrease the morbidity and mortality related to surgery.Methods: It is prospective study including 200 patients based on intra-operative finding and their postoperative complication in Bhopal Memorial Hospital and research centre Bhopal, during period of Jan 2017 to Jan 2019.Results: In 200 cases 154 were Female and 46 were male. Mucocele of gallbladder in 22 cases, pyocele of gall-bladder in 7 cases. Gallbladder wall thickened and fibrosis in 13 cases. Gallbladder with duodenal fistula in 1case, gall bladder with colon and gall bladder with stomach fistula both in 1 case, and gall bladder with stomach fistula in 1 case. In one case there is absent gall bladder but patient havingCBD stone. Cystic artery cant separated from cystic duct and clipped along with cystic duct in 16 cases. In 3 cases there were gall bladder malignancy two were suspected intra-operatively and procedure abandoned other one after post lap cholecystectomy, confirm with biopsy report. Two cases develop post op incisional hernia. In 8 cases lap cholecystectomy converted into open cholecystectomy.Conclusions: This case series of laparoscopic cholecystectomy will help surgeons to be aware of such intra-operative finding and complication, so as to prevent undesirable outcome.
Mixer grinder finger tip injuries and treatment outcome in a rural based tertiary center: a retrospective study
Authors: Hongaiah Deepak , . Abhilash , Kumar Dharmendra , Kumar S. Vijay
Published: June 2019

Background: Early morning mixer grinder fingertip injuries is encountered predominantly in females. Most of these injuries happened due to improper use of the grinder like keeping hands into the mixer when still the blades on run immediately after switching off the machine and sometimes during washing the jar. It can lead to injury of either single or multiple finger and either at single or multiple levels. Early wound debridement and reconstruction is essential for good functional outcome, prevention of the deformity and to achieve good cosmesis. The objective of the study was to classify the mixer grinder fingertip injuries and to asses treatment outcome of different type of mixer grinder fingertip injuries.Methods: This is a retrospective study involving 12 patients over a period of 2 years. Data was collected from the previous records and was analysed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions.Results: In the present study most common age group involved is between 26 and 30 years (66.7%) with female predominance and most common hand involved was right hand. D3 involved most frequently and at multiple levels. Most of them were treated under wrist block followed by digital block with very good short term and long term outcome.Conclusions: The treatment of the fingertip injuries should be aimed at preserving the length of the digit by giving adequate wound debridement and primary suturing/flap reconstruction when possible to provide soft-tissue coverage with protective sensation at a minimum.
Dynamic ultrasound in evaluating the spectrum of anterior abdominal wall lesions
Authors: Rana Priyanka , D’Souza John , Joshi Priscilla , Bandgar Amol , Mahajan Mangal , Kulthe Nikhil
Published: June 2019

Background: Lesions in anterior abdominal wall are evident early and their clinical detection is easy. Ultrasonography is the first investigation for the patient clinically suspected to have an anterior abdominal wall lesion. This study evaluated the anterior abdominal wall pathologies using Dynamic ultrasound (USG) and compared the findings with surgical operative findings.Methods: There were 100 consecutive patients of all age groups with clinically suspected anterior abdominal wall pathologies referred for USG of the abdomen were selected for this study.Results: Our study showed a higher incidence of anterior abdominal wall pathologies in male patients (77 %) with an incidence of 41 % in the age group of >60 years.  Hernias had an incidence of 93 % followed by undescended testis: 4 %, Divarication of recti: 2% and Rectus sheath hematoma: 1%. Inguinal hernia was the most common hernia with an incidence of 58%. The findings correlated with surgery and gave a sensitivity of 100 %.Conclusions: Ultrasonography including Dynamic USG is a safe, quick, cost-effective, accurate and non-invasive modality for assessing the anterior abdominal wall lesions with a high sensitivity. Dynamic USG also helped to accurately measure the diameter of the neck and content of the sac which aided the surgeon in managing the repair of the hernia.
Comparison between extra mucosal continuous prolene repair versus interrupted through and through silk repair in colonic anastomosis
Authors: Nayak Ashok Kumar , Nayak Malaya Krishna , Jha Dharbind Kumar , Kar Chinmaya , Maharana Debashree
Published: June 2019

Background: The traditional double layered colonic anastomosis incorporates large amount of ischemic tissue in the suture line causing luminal narrowing and fistula formations. Single layered anastomosis may be done through continuous extramucosal suturing or by interrupted through and through technique using nonabsorbable materials. The single layer of suture has shown to be safe and causes fewer complications.Methods: The study was conducted in the Department of surgery, VIMSAR, Burla during the period from October 2016 to September 2018. All the patients of colonic anastomosis were included in the study. One group consists of extra mucosal continuous prolene repair and other interrupted though and through silk repair. Both groups were followed up and were compared taking different variables.Results: 146 cases of colonic anastomosis were performed, 110 with interrupted through and through silk repair (75.34%) and 36 with continuous extra mucosal prolene repair (24.66%).The mean time taken for silk repair was more (25.67 min) than prolene  (15.5 min). The patients of prolene repair had shorter duration (9 days) of hospital stay than silk (12.4 days). The postoperative ileus was more in silk (16.36%) than prolene (5.56%). Anastomotic leak in prolene is less (2.78%) in comparison to silk (8.18%). The bowel movement appeared earlier with prolene (4.2 days) is less than ssilk (5.3 days).Conclusions: The present study shows single layer monofilament thin diameter prolene for different end to end colonic anastomosis has better prognostic panorama in relation to morbidity and mortality, and had an edge over conventional single or bilayere anastomosis.
Clinical and functional outcome comparison for platelet rich plasma with steroid injection in patients with isolated subacromial impingement syndrome
Authors: Mahajan Atul , Mehtani Anil
Published: June 2019

Background: To compare the 6-weeks, 3 and 6 months outcome in 80 patients who received an injection of platelet-rich plasma (PRP) or steroid for sub-acromial impingement syndrome (SIS).Methods: There were 42 males and 38 females received a single-dose injection of PRP (n=40) or steroid (n=40) for SIS that had not responded to conservative treatment for more than 6 months. Both groups were put on physiotherapy protocol followed in our institution. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks, 3 and 6 months after treatment using the constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder.Results: No local or systemic complication occurred. Improvement in the constant score and VAS for pain at week 6, 3 and month 6 was clinically better following steroid than PRP injection. However, this difference was statistically insignificant.  The 2 groups were comparable for improvement in ROM of the shoulder.Conclusions: PRP injection was not more effective than steroid injection for treatment of SIS in terms of at the end of 6 months. However, long term studies should be indicated to substantiate the findings.
Etiology, clinical presentation and management of pancreatic pseudocyst
Authors: Kulkarni Nikita , Saxena Divish , Wasnik Nitin , Akhtar Murtaza
Published: June 2019

Background: The clinical presentation of pseudocyst is varied among individuals and so does the spectrum of management ranging from resolution to open or minimal access/ endoscopic drainage procedures. This study aims to review the various etiological factors, mode of clinical presentation of pseudocyst in relation to age and sex, and to study various modalities of investigation & management of pseudocysts.Methods: In this prospective study, 31 diagnosed patients of pseudocyst of pancreas were included who underwent different biochemical and radiological investigations. The study duration was 2 years from November 2016 to October 2018 carried out at a tertiary care hospital and the management and outcome of these patients were studied.Results: Males (93.54%) were the predominating gender suffering from pseudocyst and alcohol consumption (70.96%) was the most common etiological factor. 67.74% of patients had pseudocyst formation after recurrent attacks of pancreatitis. 20 patients (64.51%) patients were managed conservatively with complete resolution of pseudocyst in 10 patients. In rest of the 11 patients, 7 patients underwent open internal drainage, 2 patients underwent endoscopic internal drainage and pancreatic duct stenting; in one patient, external drainage was performed and another patient distal pancreatic resection was done.Conclusions: Pseudocyst of pancreas is predominantly seen in males with alcohol consumption being the commonest etiological factor. Spontaneous resolution of pseudocyst occurs in most of the patients and symptomatic patients can be managed by intervention by open/endoscopic internal drainage with or without pancreatic stenting and external drainage should be reserved for infected pseudocysts.
Study of the Lichtenstein’s hernioplasty and its post-operative complications for different types of inguinal hernia
Authors: Nateson Anantha Kumar , Basavanayak Suresh Nayak , . Sudarsansrikanth
Published: June 2019

Background: Lichtenstein’s hernioplasty is the commonly done surgery for inguinal hernias. The present study is aimed to study the Lichtenstein’s hernioplasty and its postoperative complications for different types of inguinal hernia.Methods: This prospective study was conducted at Department of General Surgery, MVJ Medical College and Research Hospital, Hoskote, Bangalore Rural, Karnataka. A total of 90 patients were selected for this study. Subjects with the age of 21 to 75 years with inguinal hernia are included in the study. A pre-designed proforma was used to collect their details. All selected cases were studied up to discharge regarding the type of hernia and followed up in OPD for 1 year regarding post-operative complications.Results: Immediate post-op complications like seroma/hematoma was observed in 10 (11.1%), wound infection was in 5 (5.5%) and orchitis was in 2 (2.2%). Post-operative complications like stiffness in lower abdomen was observed in 21 (23.3%) patients. Long term complications like forein body sensation was experienced by 22 (24.4) patients post-operatively at 1 month follow up, 8 (8.8%) patients at 3 months follow up and 3 (3.3) patients at 1 year follow up.  Chronic pain was experienced by 17 (18.8%) patients at the end of 1 month follow up, at 3 month follow up, 13 (14.4%) patients and at the end of 1 year of follow up 4 (4.4%) patients at operated site. Recurrence was not observed in any of the patient.Conclusions: The study findings indicate that Lichtenstein’s hernioplasty was safe and reliable procedure for inguinal hernia repair.
Clinical profile and outcome of chest trauma: a four year retrospective analysis at a tertiary care centre
Authors: Khursheed Syed Quibtiya , Ashraf Waseem , Rather Ajaz Ahmad , . Shams-Ul-Bari
Published: June 2019

Background: Chest trauma comprises about 10-15% of all traumas and 25% of all deaths from traumatic injury. Chest injuries are cause by blunt mechanisms such as road traffic accidents or penetrating mechanisms such as stab and missile injuries. Traumatic chest injuries are the most common cause of preventive mortality and morbidity.Methods: A retrospective study of all patients with chest injury presenting to Emergency Department of SKIMS Medical College, Srinagar was done.  Records of all the patients were retrieved. A complete data regarding age, gender, mode/type of injury, extra thoracic injuries, mode of management and outcome was gathered.Results: A total number of 1429 trauma patients presented to AE of which 160 patients (11.2%) had chest trauma. Majority of the patients (51.87%, n=83) were of age group of 21-40 years. A male preponderance was observed. Road traffic accidents were major causes of blunt chest injury, while gunshot injury was the major causes of penetrating chest injuries. Head and neck injuries were the most common associated injuries. Tube thoracostomy was the commonest modality of management (65%) and (28%) patients were managed conservatively.  Severity of chest trauma and associated injuries coupled with prompt diagnosis and treatment were important factors in efficient management of chest injuries.Conclusions: Chest trauma resulting from road traffic accidents remains the major mechanism of injury. Preventive measures aimed at educating the common masses about traffic rules and strictly implementing them is indispensable to reduce the incidence of chest injuries.
Association of metabolic syndrome with complicated gall stone disease: our experience
Authors: Kumar Narender , Bansal Somendra , Gupta Shalu , Yadav Bhanwar Lal , Verma Pradeep , Choudhary Suresh
Published: June 2019

Background: Gall stone disease is the most common biliary pathology and frequently encountered in our daily practice. Patients with gall stone that experienced at least one attack of acute cholecystitis is defined as complicated gall stone disease (CGSD). Aim of this study was to find out the association between complicated gall stone disease and the metabolic syndrome.Methods: This prospective, observational study was done from 1st March 2017 to 30th November 2018 in department of general surgery, SMS hospital Jaipur. All patients with cholelithiasis admitted in general surgery department were included. Metabolic syndrome was defined by adult treatment panel III (ATP III) criteria. All patients were divided in two groups: complicated gall stone disease (CGSD) and uncomplicated gall stone disease (UGSD).Results: Mean age was 47.2 years in CGSD group and 46.7 year in UGSD group. Female to male ratio was 8.2:1 in CGSD group and 4:1 in UGSD. Metabolic syndrome was presented in 64 patients (58.2%) of CGSD group and 24 patients (21.8%) of UGSD patients, which was statistically significant (OR 4.986, CI 2.763-8.995, p value <0.001). Five components of metabolic syndrome were compared in both CGSD group and UGSD group. Lower serum HDL-C level and hyperglycemias was statistically significant in CGSD group as compared to UGSD group.Conclusions: Metabolic syndrome can be use to predict complicated gall stone disease. Hyperglycaemia and lower HDL-C associated with CGSD. One should be aware about possible metabolic syndrome background when dealing with gall stone disease patients.
Liver abscess: presentation and an assesment of the outcome with various treatment modalities
Authors: P. N. Sreeramulu , Swamy Srinivasan Dorai , N. Vikranth Suresh , S. Suma
Published: June 2019

Background: Liver abscess is a disease of frequent occurrence which is important in the differential diagnosis of upper abdominal and right lower respiratory tract diseases. Liver abscess are space occupying lesion in liver which has a higher incidence of mortality and morbidity. The aim is to study the clinical presentation and compare the outcomes of various treatment modalities.Methods: A Retrospective Study was conducted over a period of 3 years from November 2016 to October 2019, in tertiary care centre, R. L. Jalappa hospital, Tamaka, Kolar, Karnataka, India. 46 cases of liver abscesses were studied. Complete clinical details about the clinical presentation of the cases, investigative work up and treatment modalities adopted were collected. The associated morbidity and mortality of all patients were reviewed.Results: In our study, the mean age was 49.5 years which included male patients most commonly. Pyogenic liver abscess was more common than amoebic liver abscess. Right lobe of the liver was most commonly involved. The common treatment modality was continuous drainage of the abscess cavity by the percutaneous insertion of a pig tail catheter. Surgical intervention for the rupture was done in one patient.Conclusions: In our experience of managing liver abscess, pyogenic liver abscess involving right lobe of the liver was common with the presentation of upper abdominal pain, high grade fever with chills and tender hepatomegaly. Ultrasound abdomen is very useful investigative tool in diagnosis and also in intervention and in the follow up of the condition and to evaluate progression or resolution.
A comparative study of laying open of wound vs primary closure in low fistula in ano
Authors: Garag Sushila , Nagur Basavaraj
Published: June 2019

Background: Perianal fistulas remain a surgical treatment challenge in colorectal practice due to high recurrence rates and the risk of postoperative wound infection and incontinence. Anal fistula represents one of the most frequent anorectal diseases.Methods: This is a randomized comparative prospective study of 30 cases of fistula-in-ano presenting at the surgical OPD of Almeen Medical College and Research Institute from 1 September 2017 to 31 june 2018.Results: In our study the age of the patient varied from 25-60 years, patient’s wound healed in 3-4 weeks in those who underwent open fistulectomy, whereas in the primary closure method the wounds healed in 1-2 weeks. Recurrence of fistula occurred in 5 patients.Conclusions: The primary closure method of fistulectomy is a safe and feasible method and more effective in the management of fistula-in-ano.
Intraductal papillary neoplasm of bile ducts: report of a case and literature review
Authors: Colapkulu Nuray , Bas Gurhan , Buyuker Fatih , Beyazadam Damla , Ozemir Ibrahim A. , Alimoglu Orhan
Published: June 2019

A 67 year old male with right upper quadrant abdominal pain diagnosed with intraductal papillary neoplasm of bile ducts (IPNB) by endoscopic biopsy. The patient was treated surgically and disease free on first year follow-up. Intraductal papillary neoplasm of bile duct (IPNB) is a rare entity with malignant counterparts and recently classified by The World Health Organization. The aim of this study is to present a case of IPNB and review the literature. Pubmed/MEDLINE was searched and articles were extracted. Twenty four case reports and 17 retrospective case series were evaluated. From 41 studies, 824 cases were included. There was slight male predominancy among patients and almost all cases were from eastern countries. Even though the etiology remains unclear, hepatolithiasis was the most common potential etiological association. Most cases were treated with surgical intervention. More than half of the 577 resected specimens had invasive component. Incidence rate of histopathological subtypes were as fallowed: Intestinal (35%), pancreaticobiliary (32%), gastric (19%) and oncocytic (12%). Intraductal papillary neoplasm of bile duct has an increased malignancy rates at postoperative pathological diagnosis, consequently early surgical management is important.
Facts and fantasies about superior mesenteric artery syndrome: an unusual cause of intestinal obstruction
Authors: Kushwaha Swapnil Singh , Goja Shikha
Published: June 2019

Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowel sounds. We performed small bowel enteroclysis, upper gastrointestinal series, abdominal computer-tomography (CT) and ultrasonography to establish the diagnosis. Conservative treatment was tried for one month but failed. There was no relief of symptoms in the left lateral decubitus or prone position. Finally, the patient successfully underwent Roux-en-Y duodenojejunal anastomosis with a postoperative favourable outcome. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments.
Isolated renal pelvis injury in case of penetrating injury
Authors: Sarma Debanga , Ghanghoria Ashish , Barua Sasanka Kumar , Baruah Saumar Jyoti , P. Rajeev T. , Bagchi P. K. , Phukan Mandeep
Published: June 2019

Isolated renal pelvis injuries are uncommon in a case of penetrating injury. These injuries are associated with other solid or hollow viscous injuries or fractures of transverse process of the adjoining vertebrae. We report a case of a 41year old male involved in a homicidal stab injury. This patient presented with pain abdomen and protrusion of omentum at wound side while CECT whole abdomen revealed extravasation of contrast from left renal pelvis at L3 vertebral level into retroperitoneum with localized collection. He underwent exploratory laparotomy which revealed isolated (Grade III) injury in left renal pelvis with no associated renal parenchymal injury.
A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right
Authors: Karunadas C. P. , Mathew Cibu
Published: June 2019

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well.