bluuebunny/crossref_metadata_2025 huggingface dataset:
ALPPS readdresses the management of advanced liver tumors
Authors: Huang Fa-guang , Xiao Jiang-Hua , Kong Jun , Gong Jian Ping
Published: February 2017

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been developed to induce rapid liver hypertrophy of the future liver remnant (FLR) prior to hepatectomy in primarily non-resectable or marginally resectable liver tumors. In recent years, this novel strategy has aroused interests of many liver surgeons. Its indications have been broadened gradually with more and more reported cases. Modified ALPPS is also developed to reduce morbidity and mortality. The authors searched Medline and PubMed to identify related articles published in English, using terms: “ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, in situ split, in situ splitting, liver partition”. The authors summarized and analysed the superiority, indications, modifications, safety, mechanisms of regeneration of ALPPS. ALPPS was more effective than traditional portal vein embolization (PVE) or portal vein ligation (PVL). ALPPS obtained 80% volume increase of future liver remnant (FLR ) within 7 days in contrast to 10%-46% within 2 to 8 weeks by PVE or PVL. ALPPS opens a chapter in the history of liver surgery and readdresses the management of advanced primary and metastatic liver tumors. The high morbidity and mortality associated with ALPPS could be decreased remarkably if we carefully select patients and carry out the operation with experienced surgeons. In addition, the safety, mechanisms and oncological outcome of ALPPS are still not clear, which need further research and randomized controlled trials.
Mechanism of Kupffer cells in hepatitis infected by hepatitis B and C virus
Authors: Tan Yi-qing , Zhu Xi-wen , Lai Xing , Gong Jian-ping , Yin Qing-gang
Published: February 2017

The infection of hepatitis B virus or hepatitis C virus (HBV / HCV) is the most common cause of the chronic liver disease. Kupffer cells (KCs), the largest number of viscera macrophages, are located in the sinusoid of the hepar and play an extremely significant role in hepatic chronic inflammation after HBV / HCV infection. KCs could affect the secretion of cytokines and the interaction among cells via a variety of signalling pathways and they could regulate the inflammatory response and immune activities as well. The activation of KCs could balance inflammation and anti-inflammation, maintaining the stability of internal environment in vivo. Studies of KCs have the significance of the understanding of pathogenic mechanisms and the access to the treatment of HBV/HCV infection. Meanwhile, such studies might help to delay the development of fibrosis, cirrhosis and even carcinoma of liver after HBV / HCV infection.
Below knee long stump guillotine amputation for mine blast injury foot: a safe need to do primary management in war zone: an experience in 18 cases over 10 months
Authors: Ray M. S. , Deepak B. S.
Published: February 2017

Background:Somewhere in western sector, high intensity conflict zone, we had to manage a large number of battle causalities, especially gunshot wound abdomen, and mine blast injury foot. In our collective experience of working in battle strife- zone, we realized that the best and the least a surgical team can do is to execute an old fashioned ‘long stump’ below knee (BK) guillotine amputation, achieve perfect hemostasis, immobilize the limb and rapidly transport the patient to higher surgical centre. This increase in the magnitude of mine blast injuries prompted us to highlight the problem and its management.Methods: We analyzed 18 cases of anti- personnel mine blast injury foot over a 10 months period 2000 to 2001. We have managed 18 mine blast feet in “staged- manner. Stage I- “on battle-field” long stump BK guillotine amputation, perfect hemostasis, wound toileting and stump immobilization. Stage II - at a higher surgical centre elsewhere, the patient underwent a planned BK, prosthetic compatible, posterior myo-cutaneous flap covered stump construction and stage III - On recovery the patient with healed BK stump was transferred to limb prosthesis centre where tailor made BK prosthesis was provided and patient rehabilitated.Results:Various body regions were involved in the mine blast injuries, but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 18 patients underwent below knee (BK) amputation while 01patient required bilateral BK amputations. The initial aggressive BK Guillotine amputation saved the limb and life of all patients. Few had stump related self-limiting complications. Some had post-traumatic stress disorder (PTSD). Almost all of them had high degree of BK prosthesis acceptance.Conclusions:Mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. In our experience on 18 cases this “safe-need-to-do” staged management of mine blast injury foot, in high conflict area, was found to be least time consuming, less precious resource draining and hardly manpower straining strategy.
Study of laparoscopic appendectomy: advantages, disadvantages and reasons for conversion of laparoscopic to open appendectomy
Authors: Agrawal Sujan Narayan , Meshram Sunita , Dhruv Kamlesh
Published: February 2017

Background:Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. Objective was to study the efficacy of laparoscopic appendectomy.Methods: A Hospital based cross sectional study was carried out among of 302 patients. The study duration was from June 2004 to December 2006. Institutional Ethics Committee permission was obtained. Informed individual consent was taken. Out of 302 subjects, 236 underwent open appendectomy and 66 underwent laparoscopic appendectomy.Results:It was observed that in both the groups majority patients had retrocecal position of the appendix. The amount of blood loss, adjacent organ injury and duration of surgery were similar in both the groups. The difference in the incidence of wound infection in both groups was not found to be statistically significant. But the antibiotic use was significantly less in the LA group compared to OA group. It was found that time to resumptions of oral fees, duration of hospital stay and time to return to normal duties were significantly lesser in LA group compared to OA group. (p < 0.001). As per the cosmetic end result, majorities were satisfied in LA group and rated the surgery as excellent as compared to patients in OA group.Conclusions:Laparoscopic appendectomy was better than open appendectomy with respect to wound infection, tackling co-existing pathology, duration of hospital stay, earlier return to normal activity, excellent cosmetic end result, lesser use of antibiotics and earlier resumption of oral feeds.
A study on clinical profile and management of lump in breast at tertiary rural hospital, Wardha, Maharashtra, India
Authors: Chandak S. R. , Tabrez Md. Omar
Published: February 2017

Background: Breast lumps diseases are one of the most common diseases in India which include congenital, traumatic, inflammatory, hormonal mastopathy, benign and malignant neoplastic conditions. Around 200,000 cases of breast diseases are diagnosed annually. In India, as there is no study of breast disease conducted separately in rural India hence studies are required to evaluate the incidence and prevalence of breast lump diseases so that interventions can be done to educate and guide people about the risk factors, importance of screening and management strategies.Methods: We have conducted our study on 50 cases of lump in breast with the objective to know their incidence, clinical, pathological and radiological features of various breast swellings and different investigative approach different treatment modalities and their outcome presenting in rural India.Results: The present study of lump in the breast was based on 50 cases admitted in AVBRH, Wardha, Maharashtra, India. During this period maximum patient were of benign breast lump as compared to malignant. All patients were females with age variation from 15 years to 55 years. Majority of patients had lumps varying from 2 months to more than 12 months.Conclusions: Most of the patients from benign lump were managed with excision of lump and all patient of malignant lump underwent mastectomy.
Clinical profile in cases of intestinal perforation
Authors: Utaal Maneshwar Singh , Bali Sharadendu , Batra Pooja , Garg Navdeep
Published: February 2017

Background: Intestinal perforation is a surgical emergency with a wide variety of clinical features and causes. Regional variations are common with regards to the cause of intestinal perforation, and need to be evaluated in local settings. The study was conducted to determine the clinical profile of patients with intestinal perforation, with regard to clinical presentation,  investigative results, pathological features, surgical findings, complications and outcome.Methods: Detailed information was recorded on 40 cases of intestinal perforation with regard to clinical features, investigative results, surgical findings, post-operative course and outcome. The data was analysed with appropriate statistical methods.Results: The site of perforation was gastric 27.5%, duodenum 20%, jejunum 5%, ileum 35%, appendix 10% and colon 2.5%. Main causes included peptic ulcer 42.5%, typhoid 25% and few cases of trauma, tuberculosis, appendicitis and malignancy. Peritonitis was universal. Primary repair, resection with anastomosis, appendectomy and stoma were the operative procedures. Morbidity rate was 60.0% and mortality rate was 12.5%.Conclusions: Commonest site of perforation was gastro-duodenal while commonest cause was peptic ulcer disease. Morbidity and mortality was comparable with other studies.
Prognostic predictors in polytraumatized children and their impact on outcome
Authors: Essa Ahmed Abdelhady , El-Shaboury Islam M. , Ibrahim Mohammed A. , Abdelgwad Emadeldien A. , Gadelrab Mohammed A.
Published: February 2017

Background: Trauma is the leading cause of death and disability in children ≥ 1 year of age. More than 80% of injuries are caused by blunt trauma. Most seriously injured children have multiple injuries. Injury scoring systems are designed to accurately assess injury severity, appropriately triage the injured, and develop and refine trauma patient care. The pediatric trauma scoring (PTS) was devised specifically for the triage of pediatric trauma patients. The pediatric trauma scoring (PTS) was devised specifically for the triage of pediatric trauma patients. The PTS is calculated as the sum of individual scores from six clinical variables. The variables include weight, airway, systolic blood pressure (SBP), central nervous system (CNS) status (level of consciousness), presence of an open wound, and skeletal injuries. Other predicting factors for morbidity and mortality in polytraumatised children include age and gender of the patients, trauma type, arrival interval time, Glasgow Coma Scale (GCS), respiratory rate, heart rate, hematocrit value at admission. These factors can further help to prevent mortality. The objectives of this study were to assess the prognosis of polytraumatised pediatric patients by evaluation of pediatric trauma scoring system and clinical predictors of morbidity and mortality as prognostic predictors of trauma in pediatric patients.Methods: This was adescriptive study, included 60 polytraumatised pediatric patients who were attended emergency department in Suez Canal University Hospital, Ismailia, Egypt.Results: This study showed that the mean of the pediatric trauma scoring system was 10±2. According to the nature of the most severe injury, this study showed that 43 % of injuries among patients were of extremities and pelvis nature. According to length of resuscitation time among patients, this study showed that the mean time of resuscitation was 35.5±8.23 minutes. According to the type of treatment done for the patients, this study showed that 72% of the patients didn't need surgical intervention. This study showed that regarding the final outcome of the patients, 68% of the patients were admitted to inpatient.Conclusions: This study showed that both heart rate and respiratory rate had good sensitivity while both of them had lower specificity. This study showed that GCS good specificity and fair sensitivity. Regarding the PTS, this study showed that PTS had the highest specificity and the highest sensitivity among all the predictors.
Bacteriological profile of burn patients and antimicrobial susceptibility pattern of burn wound isolates
Authors: Sharma Latika , Srivastava Harshit , Pipal Dharmendra Kumar , Dhawan Rohit , Purohit Poojan M. , Bhargava Anupam
Published: February 2017

Background: Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.Methods: A retrospective study was conducted at Mahatma Gandhi Hospital Burn Unit Associated with Dr. S. N. Medical College, Jodhpur, Rajasthan. Fifty burn patients were investigated for bacterial profile of burn wound infections. Specimens were collected on 3rd and 7th day of burns in the form of wound swabs. The organisms were isolated and identified by standard microbiological methods. Antimicrobial susceptibility test was done by Kirby -Bauer disc diffusion method.Results: Gram negative organisms were found to be more prevalent. The most common isolate was Pseudomonas aeruginosa (P. aeruginosa) -38%, followed by Staphylococcus aureus (S. aureus) -35%, Klebsiella spp.-8%, Acinetobacter spp -5%, Staphylococcus epidermidis - 5%, Proteus spp. -3% and Escherichia coli -1%.Conclusions: Pseudomonas was the commonest cause of infection in fire burn patients in our setting followed by S. aureus. About 82% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.
Conservative management of early uncomplicated appendicitis in children
Authors: Maini Sunil Kumar , Jain Neeraj Kumar , Jain Manjari Goel , Khobragade Vicky
Published: February 2017

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.
Access loop Roux-en-Y hepaticojejunostomy: revisited a study of twenty two cases over 15 years (2001-2015)
Authors: Ray M. S. , Deepak B. S.
Published: February 2017

Background: Access-loop Roux-en-Y hepaticojejunostomy (HJ), an interesting and an unique surgical technique described in the past seems to have resurfaced amidst commendation and condemnation.Methods: The technique involves the incorporation of a cutaneous access stoma in the Roux-en-Y loop of jejunum used for the anastomosis. This stoma provides permanent access to the bilio-enteric anastomosis and thus to the hepatobiliary tree for non-operative management of chronic and recurrent biliary tract problems. Here we are presenting our experience in 22 cases managed by us with “access-loop Roux-en-Y hepaticojejunostomy (HJ)” over a period of 15 years (2001 to 2016).Results: 22 cases were managed successfully. The maximum follow-up was for 05 years with no recurrence or stricture only 01 patient had a small Incisional hernia.Conclusions: The objective of this work is to, describe an optional technique (although less known and practiced) during the accomplishment of a "roux-en-Y" hepaticojejunostomy that, allows future endoscopic and interventional radiology access to the bilio-enteric anastomosis.
A clinical study on the management of sigmoid volvulus
Authors: Durai M. Ramula , Kumar J. Kiran , Vijayanand .
Published: February 2017

Background: Sigmoid volvulus is a surgical emergency and significant cause of large bowel obstruction with high mortality and morbidity. The disease is more prevalent in India, especially rural population. It constitutes 15% of total bowel obstructions. This study analyzes various management options in our institute which caters mainly to patients from the surrounding rural areas.Methods: The present work is study of 36 cases, carried out as regards to the etiological factors which predispose to the sigmoid volvulus, the clinical features, modes of treatment and the outcome. Particular stress has been laid on the various treatments. The duration study was 2 years between November 2014 and October 2016 at Government Chengalpattu medical college, Tamil Nadu, India.Results: The mean age of sigmoid volvulus was 49 years (range 19-75) and male to female ratio was 2:1. Comparatively less frequent in less than 20 years and above 70 years. Distention of abdomen (100%), followed by constipation in 88% were common mode of presentation. Sigmoidopexy done in 22% patients with nil mortality and, for primary resection and anastomosis, it was 17%. Common post-operative complication found to be wound infections.Conclusions: Primary resection anastamosis is found to be definitive safe procedure if the colon is viable. Hartman’s procedure is suitable only if the bowel is gangrenous. Absence of co morbid conditions a notable feature. Pre operative X-RAY helpful in diagnosis. Mortality found to be 17.5% in our study.
Management of benign oesophageal strictures: our experience at tertiary care centre
Authors: Varudkar Anagha S. , Deshmukh Santoshkumar N. , Vitekar Dyanesh D.
Published: February 2017

Background: Oesophageal stricture is a common problem in general surgical practice. It can be benign or malignant, simple or complex. Benign oesophageal strictures include peptic, corrosive, post-surgical anastomotic strictures, post radiotherapy and drug induced strictures. The aetiology of this condition varies in developed and developing countries. Aim of present study was to determine the aetiology of benign oesophageal stricture, to evaluate the role of endoscopic dilatation of stricture and final outcome in these patients in our region.Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Aurangabad from December 2009 to November 2013.  All the patients, regardless of age and gender, admitted with diagnosis of benign oesophageal stricture were included in the study. Depending upon the type of stricture treatment was carried out. Postoperatively patients were followed up for detection of possible complications and their treatment.Results: Total 50 patients of oesophageal stricture were studied. Mean age was 33.65 years with male to female ratio 2.8:1. Ingestion of corrosive substance was the commonest etiology noted followed by peptic strictures.Conclusions: Corrosive ingestion was the commonest cause of benign oesophageal stricture in our region followed by peptic strictures. Endoscopic dilatation is safe and effective in treating benign oesophageal strictures.
Management of necrotizing pancreatitis and its outcome in a secondary healthcare institution
Authors: Karim Tanweer , Kumar Vinod , Katiyar Vivek Kumar , K. Subhash
Published: February 2017

Background: Surgical debridement is the “gold standard” for infected pancreatic necrosis. Advances in imaging methods and minimal access techniques have changed the management of many surgical conditions and even infected pancreatic necrosis has successfully been treated in selected patients. However, technical advances don’t obviate sound clinical judgment. Aim was to consider recent advances in minimal access surgery, this article retrospectively analyses the role of open surgery and laparoscopic techniques in the management of necrotizing pancreatitis.Methods: A retrospective study of 30 cases of pancreatic necrosectomy admitted and managed during 2012-2016 was carried out and compared with results available in the existing literature.Results: Out of 30 cases, 20 were men and 10 were women. Patients' age ranged from 23 to 70 years (mean age - 49.8 years). The mean operating time was 103.8 min (range, 60-120 min). Timing of necrosectomy was 21-32 days (average - 25.5 days). The average duration of hospital stay after the procedure was 17.4 days (range, 10-21 days).Conclusions: Comparative analysis of results of different surgical techniques reveals that there is no significant difference in terms of mortality. However, overall rate of complications and failure (inadequate debridement and drainage) are still higher with minimally invasive techniques.
Closed versus open lateral internal anal sphincterotomy in a chronic anal fissure
Authors: B. N. Anandaravi , B. Ramaswami
Published: February 2017

Background: Anal fissure is a common proctological problem, which presents with pain in the anal region during and after defecation. The aim of the study was to determine the best technique for surgical treatment of chronic anal fissure patients.Methods: The study was designed as a prospective randomized study. The study was conducted in surgical unit, K.R. Hospital, MMCRI, Mysore, India from January 2015 to June 2016. A total of 100 patients undergoing surgery were divided into two groups. In group A there were 50 patients who were treated by closed lateral internal anal sphincterotomy, and in group B there were 50 patients who were managed by open lateral internal anal sphincterotomy method. Patients were followed up for 6 months following surgery to observe for pain, bleeding, infection, incontinence, and recurrence. The exclusion criteria were patients who had in addition haemorrhoids or any other anorectal diseases.Results: There was acceptable difference in postoperative acute complications between the two methods of internal anal sphincterotomy. However, in group A, three patients (6%) versus 10 (20%) were complicated with incontinence postoperatively, whereas the recurrence rate was 4 versus 4% in group A versus group B, respectively (P = 0.015).Conclusions: There was significant difference between closed and open methods of lateral internal sphincterotomy in recurrence rate, healing rate, and other complications. Closed lateral internal sphincterotomy is treatment of choice for chronic anal fissure and can be done effectively and safely with acceptable rate of complications. Our recommendations are that closed technique should be adopted by experienced surgeons and Trainee should be initially trained by open technique then be shifted to closed technique.
A study of use of bipolar cautery in thyroidectomy
Authors: R. Vasuki , N. B. Thanmaran , V. Malathi , Kujur Lizrose
Published: February 2017

Background: Thyroidectomy is one of the most commonly performed surgeries throughout the world which has an extremely low morbidity rate. Nowadays with the advent of newer techniques the duration of surgery and complications have decreased. Conventionally Thyroidectomy was done by suture knot tying technique which needs large number of surgical ties and also time consuming. It decreases healing as well as increases wound infection, injury to neighboring structures and foreign body reaction.Methods: In this study, I selected 50 patients with thyroid swelling attending the surgery outpatient department from February 2015 to August 2015. Thyroid surgery was done using bipolar cautery. The results were analyzed.Results: This study shows most of the patients belong to 30-40 years followed by 40-50 years. The male: female ratio is 1:25. Time duration varies from 50 minutes to 135 minutes. The longer duration of surgery compared to other studies is attributed to learning curve. We started using bipolar diathermy since 2013. The blood loss ranges from 25-50 ml. Complication rates are also less with bipolar thyroidectomy, 2% had postoperative hemorrhage, 2% developed temporary RLN palsy, 2% developed minor degree of wound infection, and 6% developed signs and symptoms of hypocalcemia. The mean duration of hospital stay was 4 days.Conclusions: Thyroidectomy using bipolar cautery is safe and effective method and also less time consuming. The cost of the bipolar cautery is less compared to harmonic scalpel and LigaSure. Bipolar cautery is available in our government hospital. Blood loss using Bipolar Cautery is less compared to conventional Knot–tying technique. The post-operative complications are less with bipolar cautery.
Appendicitis inflammatory response score: a novel scoring system for acute appendicitis
Authors: Patil Suresh , Harwal Rahul , Harwal Sharanabasappa , Kamthane Sangamesh
Published: February 2017

Background: Acute appendicitis is one of the most common surgical emergencies encountered by doctors on call with emergency appendicectomy being a very common outcome of emergency laparotomies. There's been a marked decline in mortality over the past 50 years, but the rates of perforation and negative laparotomy have not changed much as they're influenced by factors untouched by technological advances.Methods: A prospective comparative study to compare appendicitis inflammatory response score (AIR) and Alvarado scoring systems in evaluating suspected cases of acute appendicitis. 100 patients presenting with pain in the right lower quadrant of abdomen at the surgical clinics at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, India, who after clinical examination and relevant investigations were provisionally diagnosed to have acute appendicitis and warranted surgery for the same were evaluated using the scoring systems - Alvarado Score and Appendicitis Inflammatory Response Score. The scores were tallied and compared with final histopathology report. The study was conducted for a period of one and a half year.Results: The results revealed that AIR (at score >4) demonstrated a higher sensitivity and specificity compared to Alvarado score (89.9 versus 78.6%) and (63.6 versus 54.5) respectively. Alvarado showed a slightly better sensitivity at score>8 (21.3 versus 12.3%).Conclusions: The Appendicitis Inflammatory Response Score outperformed the Alvarado score. It holds promise to be incorporated into the clinician's daily inventory in efficiently diagnosing Appendicitis.
The clinical study and management of lateral neck masses
Authors: Deshpande Amol Vasantrao , Pothare Amit Narayan
Published: February 2017

Background: Tumors of neck are especially interesting to surgeons because of complex neck anatomy and difficult differential diagnosis. The aim is to study different type of lateral neck masses excluding thyroid and salivary swellings, there relation with age and se, there clinical features, presentation, and complications, diagnostic modalities and treatment according to the diagnosis and miscellaneous and rare lumps in the neck.Methods: The study was conducted at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India from January 2012 to December 2015. In cases of tubercular lympahdenopathy, patients are treated with antitubercular chemotherapy regime DOT’s. In cases of malignant secondaries in neck, patients were offered radical neck dissection, radical radiotherapy or neoadjuvant chemotherapy followed by neck dissection.Results: Total 228 patients are studied. 74.56% were benign and 25.44% were malignant. Most common age group affected was 11-20 years. Malignant lesions were more common after 50 years. Male female ratio was nearly equal. Most common lesion overall was tubercular lymphadenopathy followed by malignant lymph nodes.Conclusions: Lymphadenopathy predominated lateral neck swellings of which tubercular lymphadenopathy found to be commonest followed by malignant secondries. Tubercular infections are common during 1st and 2nd decade, while malignant lesions after 5th decade. FNAC was most common and most effective investigation. Treatment varies according to the cause of lateral neck mass.
Serum albumin as predictor of post-operative morbidity and mortality
Authors: Sharma Latika , Purohit Poojan M. , Pipal Dharmendra , Kothari Saurabh , Srivastava Harshit , Soni Amit
Published: February 2017

Background: Protein energy malnutrition affects every organ system. So correct assessment of nutritional status is important as malnourishment is a risk factor for morbidity and morality in surgical patients. In our study, serum albumin has been taken as parameter for nutritional assessment.Methods: Study is conducted on 50 patients admitted in Department of General Surgery, Dr. Sampurnanand Medical College and associated Hospital, Jodhpur, Rajasthan, India for surgeries during January 2014-December 2015. Data was analyzed using Z-test and Fischer exact t-test and p value was calculated. P value <0.05 is considered statistically significant.Results: Patients with serum albumin <3gm/dl had more complications with maximum number of complications in age group of 41-60 year group. This finding was statistically significant.Conclusions: Low serum albumin patients has more post-operative complication than those with normal level and so is a good indicator of post-operative morbidity and mortality.
A case of papillary thyroid carcinoma in toxic adenoma: are hyperfunctioning nodules truly innocent all the times?
Authors: Yurekli Banu Sarer , Ozisik Hatice , Kutbay Nilufer Ozdemir , Makay Ozer , Ozgen Gokhan , Akgun Aysegul
Published: February 2017

Thyroid nodule is seen commonly in clinical practice. Thyroid scintigraphy should be performed for the evaluation of thyroid nodules in case of suppressed TSH. We would like to present a case of toxic adenoma with the diagnosis of papillary thyroid carcinoma. Forty-four-year-old female patient had applied to the hospital with the diagnosis of thyroid nodule. Thyroid fine needle aspiration biopsy (FNAB) was performed for the evaluation of thyroid nodule measured as 47x12 mm. This nodule was in mixed solid form bearing cystic components. FNAB revealed that the thyroid nodule was benign. Our ultrasonographic evaluation was consistent with a thyroid nodule located at right lobe with a diameter of 43x18x28 mm. The patient underwent right thyroid lobectomy. Pathology report revealed macrofollicular variant of papillary thyroid carcinoma. The tumor was 3.5 cm in diameter with regular margin and 0.2 cm away from the surgical border. The tumor didn’t spread out of the thyroid capsule. Second thyroid surgery was performed due to remaining thyroid tissue. After that ablative radioactive iodine therapy was applied. Guidelines in Endocrine literature report that hyperfunctioning nodules are almost always benign. However, the risk of malignancy was reported as a weighted rate of 3.1%. As follicular lesions are seen in high percentage in hot nodules, surgery should be recommended in case of the cytological results of a follicular neoplasm of a hyperfunctioning nodule. So, hyperfunctioning thyroid nodules warrants careful evaluation and appropriate therapy. We wanted to draw attention of the clinicians for this rare issue.
Giant gastrointestinal stromal tumor of ileum: the gist of GIST: a case report
Authors: Ray M. S. , Deepak B. S.
Published: February 2017

Gastrointestinal stromal tumors (GIST) are relatively rare pathology as compared with other mitotic lesions of GIT. However, GIST is the most common mesenchymal neoplasms of the gastrointestinal tract. Biopsy of the lesion and Immuno-Histo-Chemistry (IHC) for CD117 confirms the diagnosis. Surgery remains the standard of care and only potentially curative therapy for patients with primary, resectable, localized gastrointestinal stromal tumor. However, chemotherapy with Imatinib is added in neoadjuvant or adjuvant form according to clinical situation, and histopathological status of the lesion.
Non-functioning neuroendocrine tumors of the common hepatic duct: a case report and literature review
Authors: Abou-Jaoude Maroun , Nasser Haydar A.
Published: February 2017

Extra-hepatic biliary tree neuroendocrine tumors are not common, accounting for about 0.1 % of all carcinoid tumors. Those affecting the common hepatic duct are very rare and their diagnosis is usually made post-operatively. Poorly differentiated tumors or neuroendocrine carcinomas are commonly seen in elderly, whereas well differentiated tumors, tend to occur in young patients, for whom surgery will lead to good long term results. About 100 cases have been reported in the English medical literature, showing good long term results after surgery for well differentiated (Grades 1 and 2) tumors. Herein, we report a case of an 18-year-old female, complaining from a dull epigastric pain related to a nodule compressing the common hepatic duct. After complete investigation, a laparotomy has been performed and showed a nodular tumor located in the common hepatic duct just above the insertion of the cystic duct with close contact with the pancreatic head distally. En bloc cholecystectomy with bile duct resection was performed and followed by a Roux-en-Y hepatico-jejunostomy. The pathology of the nodule came back to be a neuroendocrine tumor grade 2.
Oil cyst of breast: a rare mammographic finding
Authors: Sattibabu Vundavalli , Dalal Satish , Nara Nityasha , Bhatia Chisel
Published: February 2017

Oil cysts of breast are rare benign breast disorders resulting from fat necrosis.  Oil cysts are rare mammographic findings encountered. Here, we describe a case of 35 years female with history of breast trauma who presented with a small breast lump which was later diagnosed as oil cyst.
A rare case of non-Hodgkins lymphoma of testis: case study and review of literature
Authors: P. N. Sreeramulu , T. V. K. Karthik Hareen , N. Rakesh , V. Prajith Reddy
Published: February 2017

Primary testicular lymphoma is a rare non-Hodgkin’s lymphoma, usually seen in people around 50 years. It accounts for 1% of all non-Hodgkin’s lymphoma. It usually involves bilateral testes. Orchidectomy followed by chemotherapy is the treatment modality. Central nervous system is the common site for extra nodal site followed by skin, lung, and pleura. A 70 years old male patient presented with complaint of painless swelling of the left testes since 1 year. On examination left testes enlarged in size measuring around 8x5x4 cm. Ultrasound showed features suggestive of malignancy? Seminoma left testes. Orchidectomy was done and sent for histopathological examination. Histopathological report showed features of non-hodgkin’s lymphoma. Patient was started with systemic chemotherapy. 3 cycles of CHOP regimen was given to the patient at 21 days interval. Primary testicular tumour being a rare condition, early diagnosis and treatment with orchidectomy followed by chemotherapy is the first choice. Prognosis is poor. Secondary spread to CNS advocates the use of intrathecal chemotherapy.
Mammary metaplastic carcinoma: a very rare case with review of literature
Authors: Tabrez Md. Omar , Aziz Md. Tabrez
Published: February 2017

Metaplastic carcinoma of breast is a rare neoplasm. Although it is a tumor of ductal type, the predominant component may have an appearance other than the glandular pattern and usually runs an aggressive course. We report the case of a 36-year-old female patient with a left breast lump. Neither imaging nor fine needle aspiration biopsy was crucial in achieving a diagnosis. The patient underwent MRM with axillary clearance. In consideration of the lymph node status, the patient was subjected to radiotherapy and adjuvant chemotherapy. The patient has been disease free for 2 years now. Literature review has suggested metaplastic carcinoma of breast is rare neoplasm and diagnosis is difficult to make, hence should be managed aggressively with surgery followed by radiotherapy and adjuvant chemotherapy.
Rectal foreign body: a case report
Authors: Cheereth Robin George , Ninan George Abraham
Published: February 2017

Colorectal foreign bodies are infrequently encounteredand present a dilemma for management. The diagnosis may be confirmedby plain abdominal radiographs and rectal examination, butabdominal computerized tomography with 3-D reconstruction can be decisive in thefurther management and must be advised without reconsideration. Transanal removal is only possible for very low-lying objects, while patients with high-lying foreign bodiesusually require anoperative intervention. An early decision of laparotomy should only be madeafter subjecting the patient to suitable investigations to determineexactly the localization of the object, in order toavoid any inadvertent damage to the adjoining vasculatureas well as anal incontinence. We report the case of a youngadult male who presented in the emergency department with a Hand Held Bidet Shower inserted per rectum. Transanal removal was unsuccessful and Emergent laparotomy with colotomy and primary repair was necessary for safe removal of the same.
Laparoscopic adrenalectomy for large adrenal pheochromocytoma: a case report and discussion
Authors: Prakash Shwetank , Thakare Vaibhav , Goel Anubhav , Mohan Atiharsh
Published: February 2017

A 40-year-old patient who presented hypertension and hyperglyemia, on CECT showing 7x6.2x5 cm sized retroperitoneal mass lesion in left para-aortic region extending to suprarenal region, diagnosed as pheochromocytoma. Patients BP monitored hourly, started antihypertensive and insulin. After adequate control of blood pressure and blood sugar patient planned for laparoscopic adrenalectomy by lateral transperitoneal approach. GA and combined epidural spinal anesthesia given. The patient was placed in the right-lateral decubitus position with the left side up. The surgeon and assistant stand on the right side of the table. and 4 trocars were inserted. The first port is situated 2 cm below the costal margin at the midclavicular line. The lateral port is placed under direct visualization at the anterior axillary line. The remaining port was placed between the two port. Adrenal Vein bluntly dissected, the vein is carefully doubly ligated with hemlock clips and transacted between clips. The adrenal gland was retracted in a superolateral direction and the harmonic scalpel was used to continue dissection laterally. The specimen was retrieved via a small, 4 cm incision on lateral costal margin. Histopathology of tumor specimen confirmed diagnosis as pheochromocytoma. Laparoscopy offers a better anatomical exposure, shorter length of stay, a decrease in postoperative pain, faster return to preoperative activity level, improved cosmesis, and reduced blood loss, early to resumption of oral feeding.
A rare presentation of genital self-mutilation in a patient of schizophrenia
Authors: Tabrez Md. Omar , Aziz Md. Tabrez
Published: February 2017

Genital self-mutilation (GSM) is an uncommon self-inflicted injury. GSM is not a single clinical entity, and it can occur in any psychiatric state or condition. The instruments that are used for self-mutilation can vary, and treatment of these injuries requires a detailed clinical evaluation and multi-disciplinary approach. We report here a case report of a 28-year-old psychotic man who came to our emergency with complaint of self-hammered nails in his both scrotum with fear of not able to reproduce child after marriage. He underwent surgical removal of nail under local anaesthesia and was promptly reviewed by the psychiatrists who managed appropriately. To our knowledge this is the first case reported in literature and the rarest type of injury presented as a bilateral scrotal self-mutilation as should be managed wisely.
Superior mesenteric artery syndrome
Authors: Bhagvat Vikrant Mohan , Aher Juily Vishwanath , Shah Nimesh
Published: February 2017

Superior mesenteric artery syndrome (SMAS) is a rare condition caused by compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and the aorta, causing symptoms of duodenal outflow obstruction. We report a case of superior mesenteric artery syndrome in a 25-year-old female associated with rapid loss of weight and intermittent vomiting and resulting in severe duodenal compression that necessitated surgical treatment.
An innovative method of electro-cauterization to control bleeding
Authors: Echchaoui Abdelmoughit , Amellal Mina , Jaiteh Lamin , Boulaadas Malik
Published: February 2017

The authors describe a simple and innovative method of managing bleeding by monopolar electrocautery in some critical circumstances such as: the lack of bipolar electrocauter, and the surgeon alone without his assistant, or with one who is inexperienced in surgery.
Zika virus infection: a public health emergency!
Authors: Qureshi Muhammad Salman Haider , Qureshi Bakhtawar Wajeeha , Khan Ramsha
Published: February 2017

Zika virus belongs to the family of Flaviviridae. The Flaviviridae family also includes other human pathogens like West Nile virus (WNV), Yellow fever virus (YFV), mosquito transmitted Dengue virus (DENV), Tick borne encephalitic virus (TBEV) and Japanese encephalitis virus (JEV). Zika virus is a mosquito-borne disease and is transmitted by Aedes aegypti mosquito. 
The effect of statins on carotid intima-media thickness in patients with acute coronary syndrome
Authors: Zamani Bijan , Sharghi Afshan , Hoseini Zahra
Published: February 2017

Background: Statins have been established by definitive primary and secondary cardiovascular prevention trials as the cornerstone of pharmacy prevention of atherosclerotic vascular disease. Carotid arterial intima-media thickness is used as a noninvasive surrogate end point in epidemiologic studies and clinical trials to gauge progression and regression of atherosclerosis. In this trial, we compared the effects of a high-potency statin with different dose (atorvastatin 20 mg/d and atorvastatin 40 mg/d) on carotid intima-media thickness (CIMT).

Methods: This was a randomized, single blinded clinical trial that performed on 100 patients with ACS diagnosis from April 2014 to September 2015. The effects of atorvastatin (20 mg/d; n=50) and atorvastatin (40 mg/d; n=50) on CIMT were compared using serial assessment of the thickness of common carotid artery.  

Results: The mean patient age was 52 years and 74% were male. Baseline CIMT and other characteristics were similar between study groups. CIMT was stable in the both study groups after 6 months and there were no meaningful statistical differences observed between study groups (change in CIMT, 0.044±0.169 and -0.006±0.168 mm; p=0.14).

Conclusions: This comparative trial shows that the use of atorvastatin 20 mg/d and 40 mg/d in short term have similar effects on carotid intima-media thickness. However, intensive statin therapy may have been shown to yield improvement in atherosclerosis with measurement of the carotid intima-media thickness. 
Communication skills (verbal, listening, feedback) among Ardabil Azad university medical students and related factors
Authors: Masoumi Rahim , Zakeri Anahita , Ojaghi Habib , Farzaneh Esmaeil
Published: February 2017

Background: The aim of this study was to investigate the level of communication skills (verbal, listening, feedback) among Ardabil Azad university medical students and related factors.

Methods: In this descriptive-cross sectional study, 150 medical university students selected randomly from September 2014 to September 2015. The necessary data collected by a standardized questionnaire named Interpersonal communication skills test containing 34 items having five points scale and its score ranged 34-170. Data were analyzed by descriptive and analytical statistical methods in SPSS.16.  

Results: 71.3% of participants were female. The mean score of student’s communication skills (CS) level was 100.8±13.6 and in girls was 110.1±13.7 and in boys was 102.5±13.1 which hasn’t significant differences between two genders in CS scores. There wasn’t significant relation between CS in students with age, student’s grade, residence place, term and participated in the CS workshop.

Conclusions: Results showed that level of CS in students was in moderate level which doing interventional studies in future for raising their CS level is necessary. 
Knowledge and practice on over-the-counter drugs among adults of age group 20 and above residing in Chapapani-12, Pokhara, Kaski, Nepal
Authors: Sharma Dibya , Gurung Durga , Kafle Ramchandra , Singh Sakun
Published: February 2017

Background: The incidence of usage of over-the-counter drugs is drastically increasing day by day. Over-the-counter (OTC) drugs are medicines sold directly to consumer without a prescription from health care personnel. In many countries, OTC drugs are selected by a regulatory agency to ensure that they are safe and effective when used without physician’s care. Taking OTC medicines still has risk. Some interact with other medicines, supplements, food and drinks and some causes problem for people with certain medical conditions.

Methods: A descriptive cross sectional was conducted from 1st February - 15th August 2016 among 110 among adults of age group 20 and above residing in Chapapani-12, Pokhara. A pre-tested structured questionnaire were used and data were analyzed using Statistical Package for Social Science (SPSS) for windows version 18.0. Frequency, percentage, chi-square and correlation were performed.  

Results: Nearly 1/3rd of the respondents (33.6%) were of age group 20-29 years and more than half (60.9%) were female. More than half of the respondents (54%) had good knowledge and less than half (47%) had good practice of OTC. There was significant association of knowledge with age, marital status, education and monthly family income. There was significant association of practice with education of respondents. There was weak positive correlation between knowledge and practice (r =0.211).
Conclusions: This showed that the knowledge hadn’t been fully practiced into action by the community people and still they are lacking the concept of over-the-counter drugs and its safe use in daily living.