bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACTO DE LOS TRATADOS DE LIBRE COMERCIO (TLC) EN LA ECONOMÍA COLOMBIANA
Authors: Salazar Araújo Eduardo
Published: April 2017

El presente artículo de investigación se realizó con el objetivo de determinar los impactos que los TLCs han producido en la economía colombiana. En su desarrollo, se han identificado aspectos positivos, negativos y las acciones que se deben llevar a cabo a fin de que cumplan con los propósitos para los cuales fueron firmados. Se utilizo el método analítico y la técnica de revisión documental, que permitió la evaluación de los resultados de la política de libre comercio emprendida por el país durante la última década. Los resultados muestran que algunos tratados han sido beneficiosos para el país, como el caso del tratado con Chile, y el TNC. Otros, aunque no han sido muy beneficiosos fueron necesarios, como ocurre con los suscritos con México y Estados Unidos, pues son socios comerciales muy importantes; mientras que algunos no han surtido efecto como EFTA, Canadá o han quedado obsoletos como el de la Comunidad Andina de Naciones (CAN). La conclusión general es que el país no se encuentra preparado para aprovechar plenamente estos tratados, por lo cual conviene estudiar con mayor detalle la conveniencia de firmar nuevos acuerdos con otros países. ABSTRACTThis research article , look for determining the effects that have produced the AFT in the Colombian economy, identifying the positives , negatives and actions to be carried out, in order that the country to achieve economic level to fulfill the purposes for which the agreements were signed. The methodology used is the document review, based on the general theory of international trade and statistical data analysis, to describe and evaluate the result of the free trade policy undertaken by the country in the course of the last decade. This research focus on a quantitative paradigm.The results show that some trade agreements have been beneficial for the country, as the case of the AFT with Chile, and the TNC, others have been very beneficial, but were necessary, as the case of Mexico and the United States, because they are important trading partners, even some have not worked or have become obsolete as EFTA, Canada and CAN. The general conclusion is that the country is not prepared to take full advantage of these treaties, so the country should study in detail the advisability of signing new agreements with other countries.
PRINCIPIOS DEL SECTOR COOPERATIVO EN EL MUNICIPIO DE EL ESPINAL (COLOMBIA)
Authors: Hernández Sánchez Jairo , Cruz Ramírez César Augusto
Published: April 2017

El presente artículo es producto de una investigación desarrollada en el sector cooperativo adscrito al municipio de El Espinal, departamento del Tolima (Colombia). El objetivo del estudio consistió en determinar si las entidades del sector cooperativo cumplen efectivamente con la aplicación de los principios del cooperativismo. El tipo de estudio fue exploratorio y descriptivo; en tanto que el método de investigación utilizado fue cuanti-cualitativo, la técnica de investigación fue la encuesta, que se aplicó a los asociados de las diferentes cooperativas. Los resultados mostraron que pocos asociados reciben formación respecto a los principios del cooperativismo y a la gestión cooperativa, situación que dificulta su aplicación eficiente. En conclusión, el sector cooperativo de El Espinal-Tolima requiere fomentar la cultura de formación y apropiación de los principios cooperativos de sus asociados para que sean aprovechados en el quehacer diario. Esto exige a los directivos generar estrategias de divulgación oportunas, que fortalezcan la interiorización y aplicación de la filosofía y principios cooperativos, de manera que se produzca un crecimiento económico y social al interior de la empresa. ABSTRACTThe present article is the result of a research developed in the cooperative sector in the municipality of “El Espinal”, department of Tolima (Colombia). The aim of this study consisted of determining if the entities of the cooperative sector comply with the implementation of cooperative principles. The type of study was exploratory and descriptive; while the research method used was the quantitative-qualitative one; a survey was the research technique applied to the associates of the different co-operatives. The results showed that few associates receive formation with regard toco-operative principles and the co-operative management; this situation makes their application difficult. In conclusion, the co-operative sector in ”El Espinal”, Tolima, needs to promote the culture of formation and appropriation of co-operative principles of its associates for them to be used in everyday life. This demands managers to generate appropriate dissemination strategies, which strengthen the internalization and application of Philosophy and co-operative principles, so that an economic and social growth takes place within the company.
CT imaging and staging of carcinoma oesophagus
Authors: Chandna Parveen , B. Siddesh M. , U. Jeevika M. , Kochar Praveen Kumar T.
Published: April 2017

Background: Over the past decades, computerized tomography (CT) technology has led to an early detection of cancers and thereby decreasing mortality rate. The objective was to demonstrate usefulness of Toshiba Activion 16 slice multi detector computerized tomography (MDCT) scan in staging of oesophageal cancer.Methods: The study was carried out in the Department of Radio diagnosis, Bapuji Hospital and Chigateri Government Hospital attached to Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India over a period of 24 months. After taking a properly informed written consent, complete history and thorough clinical examination was done and these patients were subjected to CT scan.Results: The total numbers of patients studied in present study were 25. Out of which 10 were males and 15 were females. There were 6 patients upto the age of 54 years and 8 patients equal to or greater than 65 years of age, there were 11 patients between 55-64 years of age. Dysphagia was the most common symptom in patients and was present in all the 25 patients of present study. Other common symptoms were weight loss followed by pain in throat. Two different types of wall thickenings of the involved portion have been reported. The most common asymmetrical wall thickening was observed in maximum number of patients 18 (72%) and circumferential wall thickening was observed only in 7 number (28%) of patients out of 25 total patients showing heterogeneous/homogeneous enhancement. Lower third (40%) and middle third (40%) of the esophagus was the most common site of involvement with regards to location of oesophageal cancer followed by upper third (20%) of the esophagus. Homogeneous wall attenuation was observed in most of the cases accounting for (64%). The other type of wall attenuation noted were heterogeneous (36%).Conclusions: By performing endoscopy uncertainty lies in discrimination of muscular layer from serosal layer in most parts of esophagus. However, by employing MDCT technique separation of 2 layers of esophagus can be better judged.  Therefore, MDCT has been found to be the most valuable and preferential technique for planning operational strategy.
Comparison of clinical and CSF profiles in 62 Adults with tuberculous and pyogenic meningitis
Authors: Kumar Munish , Kumar Durgesh , Sahu Alok Onkar , Rastogi Manoj Kumar
Published: April 2017

Background: Many a times differentiating tuberculous meningitis from pyogenic meningitis becomes very difficult. The diagnosis depends upon clinical manifestation and cytochemical analysis of cerebrospinal fluid (CSF). Many researchers found that the CSF glucose: protein ratio less than 0.5 and Adenosine deaminase levels (ADA) in cerebrospinal fluid are useful to differentiate tubercular disease from non-tubercular meningitis.Methods: Sixty-two patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and divided into two groups: tubercular (n=39) and pyogenic (n= 23), depending upon the accepted criteria. Clinical features and CSF parameters noted in each patient. Cut off value of ADA kept at or above 10 IU/L for tubercular meningitis.Results: The mean age of patients with tubercular meningitis was 39.07±16.67 years and that of pyogenic meningitis 34.35±16.73 years. Clinically fever was present in 60 (96.77%), headache in 49 (79.03%), and vomiting in 44 (70.96%) patients. Meningeal signs – neck rigidity in 46 (74.2%), Kernig’s sign in 37 (59.68%) and Brudzinski’s sign in 18 (29.03%) patients. On CSF cytological and biochemical analysis the mean total white blood cell count was 256.74±184.03 /cmm, mean protein 182.22±113.12 mg/dl and mean sugar 52.85±19.3mg/dl in TBM whereas in pyogenic meningitis 106.17±185.18 / cmm, 88.78±114.35 mg/ dl, and 63.47±19.48 mg/dl respectively. Out of 39 tuberculous patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L while only one among pyogenic meningitis. On comparison between two groups, the CSF ADA level found to be statistically highly significant (P < 0.001) with overall accuracy of the test was 85.5 %.Conclusions: We found that the duration of illness, estimation of cerebrospinal fluid ADA with a cut off value of 10 IU/L and CSF glucose: protein ratio of 0.5 may useful in differentiating tuberculous from pyogenic meningitis. posterior cranial fossa surgeries. This work will also be useful to anthropologists, forensic science experts for determination of sex of the skull along with other parameters.
Correlation of intra-abdominal pressure with the outcome of perforation peritonitis
Authors: Agrawal Saurabh , Chaudhary Tarun , Sahu Shantanu Kumar
Published: April 2017

Background: A progressive increase in intra-abdominal pressure (IAP) may cause abdominal compartment syndrome (ACS) with organ dysfunction. Studies have documented the impact of Intra-abdominal hypertension (IAH) on virtually every organ. However, it remains strangely underdiagnosed. Present study was aimed to correlate Intra- abdominal pressure with the outcome in perforation peritonitis patients.Methods: This study was done on 50 patients with perforation peritonitis and patients undergoing intervention in the form of either emergency laparotomy or drain placement. The abdominal pressures were indirectly determined by measuring urinary bladder pressure with a Foley's catheter. Pearson correlation was used to see relation between intra-abdominal pressure and outcome of peritonitis.Results: Mean intra-abdominal pressure during time of presentation to the hospital was 26.7±3.2cm H2O. Among various morbidities following operation, surgical site infection was most common (38%) followed by wound dehiscence (24%). There was weak linear correlation between intra-abdominal pressure and factors determining morbidity such as surgical site infection, wound dehiscence, burst abdomen, prolonged ileus, ARDS and ARF. However, this was not statistically significant.Conclusions: There is weak correlation of various co morbidities with increased intra-abdominal pressure in patients with perforation peritonitis which was not significant statistically.
A comparison of left ventricular function in patients undergoing beating heart bypass surgery using mixed versus pure venous conduits
Authors: Chaudhary Tarun , Nautiyal Hemant Kumar , Nahak Aratatran , Sahu Shantanu
Published: April 2017

Background: The pathophysiology of coronary artery disease was established in 1876 by Adam Hammer when he postulated that angina is caused by interruption of coronary blood supply and that myocardial infarction occurred after the occlusion of at least one coronary artery. Aims of the study were to compare the left ventricular function in patients who have undergone beating heart bypass surgery using mixed (internal mammary artery and venous conduits) versus pure Venous conduits, and to compare the incidence of postoperative complications.Methods: It was an observational, analytical study. All patients admitted with triple vessel disease requiring CABG (n=50), with ejection fraction >30%, were subjected to either left internal mammary artery and venous conduits (group A, n=25) or only venous conduits (group B, n=25). Patient who had undergone prior surgical myocardial revascularization, preexisting valvular disease, any evidence of raised pulmonary arterial pressure more than 40/15 mmHg, operated using cardiopulmonary bypass machine, pre-operative use of Intra-Aortic Balloon Pump, any history of neurological dysfunction/Transient ischemic attack, left atrium size more than 5.5 cm were excluded from the studyResults: Improvement in left ventricular function after coronary artery bypass grafting was objectively demonstrated in both the groups. There was a statistically significant increase in mean LVEF in group B (56.16±4.13) compared to group A (51.96±5.30) at 3 months of follow up (p=0.009). The most common complication in both the groups were atrial fibrillation group A=36% (n=9), group= B 16 % (n=4), renal failure group A=12% and group B=8% and sternal wound infection. The post-operative bleeding (Drain output) in first 24 hours was similar in both the groups, 295.56 ml in group A and 265.20ml in group B (p=) with similar hospital stay (group A=9days, group B=8.5days).Conclusions: Patients with venous conduits have better postoperative LVEF as compared to Mixed conduit with similar rate of post-operative complications.
Acute urinary retention in children
Authors: Agarwal Brijesh Kumar , Agarwal Namita
Published: April 2017

Background: Acute urinary retention is relatively infrequent in children. There are a variety of causes that are poorly defined in the literature and they differ from those seen in adult.Methods: We review our experience with pediatric patients presenting with urinary retention at Sri Ram Murti Smarak- Institute of Medical Sciences, Bareilly. Children were reviewed from January 2012 to December 2015 from the record section of our institution. We selected 38 children for this study, of which 24 were boys and 14 girls.Results: The most common cause in our study was mechanical obstruction in 18 children (47%). Infections were documented in 8 children (20%). Neurological causes were identified on X-rays and urodynamic studies in 5 children (13%). We could not find any cause in 3 (9%) cases (idiopathic or behavorial). 2 (5.5%) children had fecal impaction as a cause. 2 (5.5%) girls had a Gynaecological cause. 20 patients out of 38 underwent surgical procedures. 5 children under went clean intermittent catheterization programme. 13 patients were kept on medical treatment. Our study is similar to previous studies in terms of aetiology but quite different in incidence of different aetiologies. This difference in incidence might be due to different population studied in various studies.Conclusions: Urinary retention in children is relatively rare. Urinary retention in children has various etiologies. Timely diagnosis and prompt treatment is needed because it is often associated with severe underlying disorders.
A comparative study to evaluate the efficacy of the USG and USG guided FNAC of axillary lymph node of carcinoma breast in clinically node negative cases
Authors: H. Ramesh , N. Praveen K. , Gokak Akshay V. , H. Abhijit D.
Published: April 2017

Background: Breast cancer remains the most common malignancy among women and accounts for 32% of all cancers in women. The average age of developing cancer is shifted from 50-70 years to 30-50 years. Cancers in young tend to be more aggressive. In the absence of distant metastasis, assessment of axillary status is the important part of initial staging process because of its subsequent importance in management. And the absence of presence or absence of axillary metastasis is the strongest prognostic indicator available for breast carcinoma. The objectives were to assess the accuracy USG and USG guided FNAC of axillary lymph nodes of carcinoma breasts in clinically node negative cases and to determine USG guided FNAC can be used to detect axillary lymph nodes metastasis.Methods: This was a comparative study conducted at KIMS Hospital from November 2013 to November 2015. All the patients with clinically node negative carcinoma breasts were evaluated with USG Axilla and those found to be having lymph nodes were subjected to USG guided FNAC and these were correlated with the HPR report.Results: A total 12 patients who satisfied the inclusion criteria were included in study. The most common age group involved in this study was 30-40 years. Upper outer quadrant was the most common location of the group. The sensitivity of the USG in detecting axillary lymph node was 50%, specificity 75%, positive predictor value 805, negative predictor value 42.8% and accuracy of 58.3%. Sensitivity of USG guided FNAC was 50%, specificity 100%, positive predictor value 100%, negative predictor value 50% and accuracy of 66.6%.Conclusions: In conclusion USG-FNAC of axillary lymph node is a simple, minimally invasive and reliable technique for the initial determination of ALN status in patients with breast carcinoma. In present study, the PPV of 100% and NPV of 50% indicate that the predictor power of a positive result is excellent but as expected a negative result is less helpful.
Comparison between laparoscopic and open appendectomy in pregnant women
Authors: Dova Subba Rao , Pagoti Sankara Rao , Mannem Manoj Kumar
Published: April 2017

Background: Acute appendicitis is the most common indication for surgical emergency in normal patients and also in pregnant women. The objective of this study was to study the clinical significance of a laparoscopic over an open approach to appendicectomy pregnant population.Methods: Total 46 cases patients with acute appendicitis confirmed the diagnosis by clinical examination and ultrasonography. The patients were divided into two groups laparoscopic appendectomy (group 1) n=21 and Open appendectomy (group 2) n=25. We retrospectively analyzed the medical records to compare the 2 groups.Results: All the demographic details are not significant when compared with each other. Laparoscopic appendectomy is significantly i.e. <p-value <0.05 less time for operation, length of stay in hospital and complication when compared with open procedure. Time to first flatus, leucocyte and neutrophil ratio are not significantly when compared laparoscopic appendectomy and open appendectomy. Preterm delivery, birth weight, APGAR score, gestational age at delivery, delivery type, fetal loss and maternal death were not significant when compared laparoscopic appendectomy and open appendectomy.Conclusions: Laparoscopic procedure is safe and effective technique for the treatment of appendicitis during pregnancy with nearly similar rates of complications compared to open procedure. Laparoscopic appendectomy associated with shorter hospital stay, faster return to daily activities and shorter time to first flatus.
Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial
Authors: Philipose Atul , Akhtar Murtaza , Saxena Divish , Keswani Siddharth
Published: April 2017

Background: Haemorrhoidal disease is one of the most frequently encountered anorectal condition in the clinical practice of a surgeon. Haemorrhoidectomy is the treatment of choice for grade III and IV haemorrhoids but is associated with significant postoperative pain and complications. Harmonic dissection causes less lateral tissue injury and thus less intra-operative bleeding and post-operative complications. The present study compares Harmonic Haemorrhoidectomy with conventional Haemorrhoidectomy.Methods: In a randomized controlled trial, patients with grade III and IV haemorrhoids satisfying inclusion and exclusion criteria were allocated to Harmonic scalpel haemorrhoidectomy or conventional Milligan Morgan open haemorrhoidectomy by block randomisation of 4. The outcome factors were intra operative blood loss, postoperative pain on VAS scale, urinary retention and anal stenosis after one month of follow up.Results: Total of 40 cases were enrolled. Of them, 22 were allocated to Harmonic haemorrhoidectomy, the rest 18 patients underwent conventional haemorrhoidectomy. The mean age of patients was 47.03 years with a Male to Female ratio of 1.35:1. Intraoperative blood loss measured by number of soaked gauze pieces and pain score measured on visual analogue scale at 12, 24 and 48hours was seen to be statistically significant (p<0.001) lesser in patients who underwent Harmonic scalpel haemorrhoidectomy. There was no statistically significant difference in operative time urinary retention or anal stenosis.Conclusions: Harmonic scalpel haemorrhoidectomy appears to be a better procedure for symptomatic grade III and grade IV haemorrhoids with ease of operating due to less bleeding, good postoperative recovery and patient acceptance.
Clinical profile and surgical management of primary vaginal hydrocele: our experience in a rural India
Authors: Ahmed Mohd Hamid Shafique , S. Bankar S. , S. Gosavi V. , B. Dalavi S. , D. Gurav P.
Published: April 2017

Background: Hydrocele is one of the commonest diseases occurring worldwide. Since olden days surgical procedures have been described for the treatment of hydrocele. Aim of the study was to analyse the clinical profile, diagnosis and surgical management of primary vaginal hydrocele in adults (>12 years)Methods: A prospective study of 60 male patients of age range of more than 12 years with a history of scrotal swellings were studied for their clinical profiles, diagnosis and management. The study was carried out in Government Medical College, Miraj, Maharashtra, India from November 2010 to November 2012. In the present study Jaboulay's Procedure was performed on 48 patients and Lord's Procedure was performed on 12 patients.Results: The data was collected and results were analysed. Post-operatively about 1.6% of patients developed hematoma, 5% developed wound infection, 21.66% of the patients developed skin oedema and only 1 patient i.e 1.6 % had recurrence over a period of 2 years of follow up. Out of the total 60 patients,12 patients who underwent Lord's plication 8.33%,0%,0% developed skin oedema, hematoma and wound infection respectively as compared to 25%,2.08%,6.25% in the remaining 48 patients who underwent Jaboulay's procedure, respectively.Conclusions: These two surgical procedures were very safe, easy to perform and economical and associated with minimal recurrence. Lord's procedure has lesser incidence of post-operative complications as compared to Jaboulay's procedure.
Clinical study and management of incisional hernias: a prospective monocenter experience
Authors: Deshmukh Santoshkumar N. , Varudkar Anagha S. , Chopde Anant V.
Published: April 2017

Background: Incisional hernia is the most frequent postoperative complication following abdominal surgery. Several studies have shown that incisional hernias have different etiologies which are related to the patient, the surgical technique, the suture material, and experience of the surgeon. Aim of present study was to assess the magnitude of problem, analyse various factors leading to development of this condition, different modalities of treatment practiced, postoperative complications, various factors affecting surgical outcome in these patients.Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Solapur, Maharashtra, India from January 2014 to December 2016.  All the patients, regardless of age and gender, admitted with diagnosis of incisional hernia were included in the study. Depending upon the size of defect treatment was carried out. Postoperatively patients were followed up for detection of possible complications and their treatment.Results: Total 50 patients of incisional hernia were studied. Mean age was 46 years with male to female ratio 4.5:1 wound infection in the post-operative period was the commonest etiology noted followed by obesity.Conclusions: Wound infection following previous surgery was the most important risk factor associated with incisional hernia. The other risk factors were obesity and COPD. Polypropylene mesh repair is superior to anatomical repair as it has less recurrence.
A study of VP shunt in management of hydrocephalus
Authors: Pal Sudhir Singh , Dubey Saurabh
Published: April 2017

Background: Hydrocephalus a neurological disorder common in both children and adults. VP shunt placement is considered the mainstay of management. The aim was to study complications of VP Shunt and factors influencing shunt malfunction and prognosis.Methods: This study was conducted in the Department of Surgery, Gandhi Medical College Bhopal, Madhya Pradesh, India between January 2013 to August 2016 and included all patients of hydrocephalus who underwent VP shunt surgery. We performed a retrospective and prospective data review which was subjected to statistical analysis, frequency determination, determination of mean and standard deviation, Pearson’s Chi-square test for studying associations between variables.Results: A total of 198 patients were studied. The predominant etiologies being congenital hydrocephalus, aqueduct stenosis, spina bifida/MMC, intracranial space occupying lesions and tuberculous meningitis. The incidence of overall shunt complications was 28.8%, incidence of shunt revision was 21.2%, shunt blockade 7.6%), shunt migration 5.05%, shunt infection 4.5%, and shunt malfunction due to other causes 8.6%. The mortality rate was 20.2%.  Factors associated with increased shunt complications included infective etiology of the hydrocephalus and CSF culture positivity in preoperative period.Conclusions: Infective and traumatic causes of hydrocephalus are more likely to be associated with complications like infection and obstruction. Shunt migration is seen in paediatric patients.
Clinical study of diabetic foot with different treatment modalities at Medical College Hospital Bikaner, Rajasthan, India
Authors: Thurwal Kartik , Dawn Manohar Lal , Parmar Ashok
Published: April 2017

Background: Diabetes is a chronic disease. Diabetes the global epidemic is rapidly increasing at an alarming rate. Developing countries like India will harbour majority of diabetic people by the year 2030. Diabetic foot are complex, chronic wounds, which have a major long-term impact on the morbidity, mortality and quality of patients’ lives.Methods: Hospital based prospective study. From August 2015 to July 2016. 50 patients reporting to the General Surgery department within study duration and eligible as per inclusion criteria will be included in the study.Results: In present study, maximum 52% patients belonged to age group was 51-70 years followed by 13 (26%) in 31-50 age group. In present study most common complication of diabetes was cellulitis (32%) and least common complication was abscess (18%). In this study, most common lesion was right dorsum of foot 11 (22%) followed by left toe 7 (14%). Maximum 30% patients were treated through debridement of diabetic foot whereas 20% patients received slough excision, dressing and skin graft and toe amputation as treatment modality. 18% patients were treated by I and D. Amputation was the least used treatment modality.Conclusions: Diabetes mellitus is a lifelong disease and diabetic foot complications can be life threatening, physically incapacitating, costly to treat and result in extensive morbidity.
Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula
Authors: Patil Rajashekhar T. , Prakash Advait
Published: April 2017

Background: There have been major advances in the surgery for esophageal atresia (EA) and tracheo-esophageal fistula (TEF) with survival now exceeding 90%. The standard open approach to EA and distal TEF has been well described and essentially unchanged in last 60 years. Improved survival in recent decades is most attributable to advances in neonatal surgical techniques, anaesthesia and perioperative care. In a prospective randomized trial, we analysed the effect of pleural flap wrap around the anastomosis and post-operative elective ventilation support for 48 hours as main strategies towards improving the outcome in such patients.Methods: Twenty five neonates who were diagnosed as a case on tracheo-esophageal fistula (TEF) on clinical and radiological basis were selected for the study. All babies were more than 2kg weight and were operated within first two days of life after optimization. There was no evidence of any congenital heart disease or any other associated anomaly. In all patients primary esophageal anastomosis was possible which was subsequently covered by pleural flap wrap. All the patients were put post-operatively on ventilator electively for 48 hours. Contrast study was done on post-operative day five and feeding was started subsequently.Results: Postoperative surgical outcome was very good. Out of twenty five cases, 24 patients survived and only one baby died secondary to anastomotic leak and sepsis. Twenty three babies were discharged on post-operative day 8. One baby was on ventilator for 6 days and discharged on postoperative day 15. All patients are on regular follow up.Conclusions: Surgical outcome in patients with esophageal atresia and tracheo-esophageal fistula in neonates can be improved with use of pleural flap wrap and elective post-operative ventilation.
Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications
Authors: Mir Farooq A. , Aara Shaugfta , Jan Masrat , Wani Nisar A.
Published: April 2017

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6)   (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=<0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation.
Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma
Authors: Rudiman Reno , Saragih Nova , Purnama Andriana
Published: April 2017

Background: Occult ongoing bleeding has become the second highest cause of death in blunt abdominal trauma. Undetected abdominal injury has caused morbidity and mortality in patients at the early phases of trauma. Non-operative Management (NOM) in solid organ trauma is safe and effective, and this strategy has become widely used. Lactate clearance (LC) has important clinical benefits in patients with acute trauma that is superior to initial lactate examination.  Methods: This study was a prospective cohort study of patients with history of hemorrhagic shock caused by blunt abdominal trauma that came to emergency room of Hasan Sadikin Hospital Bandung from August 2015 to July 2016. The tests were including initial blood lactate, 2 hours, and 4 hours post-resuscitation and then calculation of LC. Analysis using SPSS with chi square for the significance of relationships and Spearman correlation to determine the strength of the relationship between variables. Comparison test between LC2 and LC4 were calculated using Mann-Whitney tests.Results: During one year period, from August 2015 to July 2016, there were 34 patients. Age was in the range of 15-65 years, with a range of 15-25 years were 19 (55.8%), 25-50 years were 11 (32.4%), and >50 years as many as four (11.8%). By sex, there were 28 (82.4%) male gender and 6 (17.6%) women. Based on the type of trauma, there were 11 (32.4%) single trauma patients and 23 (67.6%) multiple trauma patients. Based on the results of statistical analysis with chi square, there was a significant correlation between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) with the success of NOM (p <0.001) with the Odds Ratio (OR) are 3.750 and 6.500 respectively. Based on non-parametric test (Mann Whitney) showed that there were no significant differences between the LC2 and LC4 in determining the successful of NOM (p>0.05).Conclusions: There was a significant relationship between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) in determining the success of non-operative management (NOM) in patients with history of hemorrhagic shock caused by blunt abdominal trauma. In addition, there are no significant differences between the LC2 and LC4 in determining the success of the NOM, so that either LC2 or LC4 may be used in predicting the success of NOM, as LC4 is the first preference. The low level of lactate clearance may be used as one of indicators to terminate non-operative management and proceed with surgery right before all symptoms of hemorrhagic shock arise.
Factors predicting difficult laparoscopic cholecystectomy: a single institution experience
Authors: Bunkar Shiv K. , Yadav Sushil , Singh Amit , Agarwal Kalpana , Singh Preeti , Sharma Amar C.
Published: April 2017

Background: Laparoscopic cholecystectomy is one of the most common operations performed by general surgeon. This study was performed to evaluate pre-operative factors predicting difficult laparoscopic cholecystectomy.Methods: A prospective study was carried out at Jawaharlal Nehru Medical College Hospital, Ajmer, a tertiary care centre in Middle East Rajasthan, India. In present study we included 100 patients diagnosed with symptomatic gallstones disease on the basis of history, clinical examinations and USG findings and underwent laparoscopic cholecystectomy in our hospital by a single surgeon during the period of July 2014 to July 2016. These all patients were evaluated for a group of risk factors and preoperatively these risk factors were given a score between 0-5 labeled as easy, 5-10 as difficult and 11-15 as very difficult. Statistical analysis was done by Fischer’s test and chi square test.Results: BMI >30, previous medical disease like DM, palpable gall bladder, prior hospitalization pericholecystic collection and impacted stone are significant risk factors to predict difficult laparoscopic cholecystectomy.Conclusions: The studied scoring system had a positive prediction value for easy prediction of 94% and for difficult prediction of 100%.
Rheumatic mitral valve surgery: about 1025 cases
Authors: Amellal M. , Mermad L. , Moughil S. , Bjijou Y. , Bouchikhi El
Published: April 2017

Background: Rheumatic mitral valvulopathy is often associated with other valvulopathies. It remains endemic in developing countries where it is the leading cause of heart failure and cardiovascular death.Methods: This study provides a retrospective analysis of 1025 cases involving patients who underwent mitral valve surgery at Ibn Sina Hospital in Rabat, Morocco between the dates of January 2, 2001 and April 5, 2012. Preoperatively a clinical and paraclinical assessment has been established.Results: The predominant valvular defects are mitral stenosis, functional tricuspid insufficiency. The gesture was a first intervention in 93% of the cases, with mitral valve replacement in 90% of cases and plasty in 10% of the cases.Conclusions: These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries.
Primary closure versus T-tube drainage after laparoscopic choledocholithotomy: a prospective randomized study
Authors: Shakya Jugendra Pal Singh , Agrawal Neelabh , Kumar Arun , Agrawal Archana , Singh Akash , Singh Kunwar Vishal , Yadav Charu
Published: April 2017

Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.
The role of ultrasonography in acute appendicitis
Authors: Lamture Yashwant R. , Gajbhiye Varsha P. , Shahapurkar Vinay V.
Published: April 2017

Background:Acute appendicitis is the most common surgical emergency. Inspite of new investigations, mainstay of diagnosis depends on clinical sign and symptoms, laboratory and USG (ultrasonography) of abdomen. Out all these investigations USG is having a crucial role in a diagnosis of it. Hence this study was undertaken to prove its efficacy.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by Stata statistic software. Before surgery patients were subjected for necessary investigations including USG.Results:The mean age was 18.8 (range 8-83) years. Normal appendix found in 22 cases, hence negative appendicectomy rate was 6.6%.  Chronic appendicitis was found in 28 patients. Different pathology was found in 1 in the form of carcinoid of appendix (0.24%) but treated by appendicectomy. USG abdomen in present study showed sensitivity of 88.6% and specificity 92% with PPV and NPV was 98% and 52.3%, frequency reports were s/o acute appendicitis in 337 patients and normal in 82 subjects.Conclusions:It conclude that USG is very important tool to diagnose and rule out appendicitis and its complications like perforation or peritonitis. Its liberal use by expert radiologist can help to reduce negative appendicectomy rate.
Clinical study and management of hollow viscus perforation of abdomen
Authors: Velappan Dhanapal Pattanam , Kaveri Selvam
Published: April 2017

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Surgery plays an important role in the management of perforation. Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality.Methods: 100 cases of hollow viscus perforation of the abdomen have been studied prospectively in detail during the period from May 2010 to July 2012. Cases were selected randomly from admissions in Government Mohankumaramangalam Medical College Hospital, Salem, Tamil Nadu, India. Clinical diagnosis of hollow viscus perforation confirmed by investigations or by laparotomy performed.Results: The results obtained in the present study were analysed: Among hollow viscus perforation duodenal ulcer perforation was common (52 out of 100 cases). Next being appendicular perforation. Age group of 20-40 years were affected mainly. Males are affected more than females. Signs and symptoms of acute abdomen like acute abdominal pain vomiting fever may present tachycardia, hypotension, abdominal tenderness guarding\rigidity with obliteration of liver dullness and absence of bowel sounds and absolute constipation were predominant signs.Conclusions: GI hollow viscus perforations cause significant morbidity and sometimes mortality. Hollow viscus perforation is the common cause of acute abdomen needing immediate effective surgical attention. A proper early diagnosis and adequate treatment can prevent complications. Surgical approach depends on the site, size, age of perforation and number of perforations.
Laparoscopic management of renal and hepatic hydatidosis in a child: a case report and review of literature
Authors: Patil Rajashekhar T. , Parelkar Sandesh V. , Sanghvi Beejal
Published: April 2017

Hydatidosis is an endemic disease caused by Echinococcus granulosus. Humans are accidental intermediate hosts. In children, it affects the lung in 64% of cases and the liver in 28%. Renal involvement is uncommon (2-4%). We operated 7 years old girl with renal and hepatic hydatidosis laparoscopically. Hydatid cyst should be kept as one of differential diagnosis while managing cystic disease of any organ in the body. To the best of our knowledge this is the first case of renal hydatidosis with hepatic hydatidosis that has been managed laparoscopically. Laparoscopic surgery is safe and efficacious in managing multiorgan hydatid disease in children.
Ruptured amoebic liver abscess with empyema thoracis - a case report
Authors: C. Danny Darlington , Anitha G. Fatima Shirly
Published: April 2017

Amoebiasis is one of the leading causes of deaths in the world. Though the most common manifestation is colitis, liver and lung involvement can occur. High index of suspicion is warranted to diagnose this condition. Apart from surgery and drainage, medical treatment is also important. We present a five year old boy with ruptured amoebic liver abscess with right empyema thoracis and right sided psoas abscess. The boy recovered well after timely percutaneous drainage and antibiotics. This case highlights the importance of serology and imaging in the diagnosis of this rare manifestation of a common etiology.
Acute mesenteric ischemia with tuberculous mesenteric lymphadenitis in a young female
Authors: Shreshtha Suruchi , Sekhose Ashu K. , S. Sujitha
Published: April 2017

We present the case of an 18 year old female with tuberculous mesenteric lymphadenopathy who came to hospital with peritonitis and acute mesenteric ischemia. An emergency exploratory laparotomy with resection of gangrenous small bowel and right colon with end-to-end anastomosis was performed. Subsequent evaluation for etiology of bowel gangrene was essentially normal. By exclusion, the most likely cause of acute mesenteric ischemia in this patient was of unknown etiology which is indeed rare. However, tuberculosis as a cause of mesenteric vasculitis and bowel gangrene needs to be explored.
Valentino’s syndrome: the simulation of an appendicitis
Authors: González Chávez Alberto Manuel , García Vázquez Alain Arturo , Gómez López José Manuel , Pavón Nicolás Leyva , Lemus Gómez José Luis , Álvarez Hernández Diego Abelardo , Durón Mauricio Valdez
Published: April 2017

Acute abdominal pain is still the domain of the surgeon. Among the many differential diagnosis that should be considered, acute appendicitis must be one of the main options for the clinician. Even though we have excellent diagnostic tools nowadays, accomplishing an accurate diagnosis is not that easy. We all know that is better to perform surgery on a normal appendix than not operating an appendix that will result in complications; we also know that the diagnostic challenge will be higher in a female patient.  But, what if right lower quadrant pain is produced by a pathology that doesn’t involve that anatomical region? We present two cases that clearly explain this situation.
Lymphoepithelial cyst of submandibular gland, a clinical dilemma- case report
Authors: Cheereth Robin , Paulose Dheeraj Eldho , Ninan George Abraham
Published: April 2017

Swellings of the head and neck region present great difficulty in accurate diagnosis as well as proper management. Swelling associated with the maxilla and mandible has a tendency to be provisionally diagnosed as orofacial space infections, which is the most common cause for acute swelling in this region. Fine needle aspiration cytology (FNAC), ultrasonogram and computed tomography can be used in supporting diagnosis. It usually occurs due to the process of lymphocyte-induced cystic ductular dilatation and the confirmatory diagnosis is always made postoperatively by histopathological examination. The mainstay in the treatment of a lymphoepithelial cyst remains the surgical approach, which includes complete enucleation of the cyst along with total excision of the involved salivary gland. Here we present an interesting case of swelling in the right submandibular region which was provisionally diagnosed as submandibular space infection, but later proven histopathologically as a lymphoepithelial cyst of the submandibular gland.
Isolated intraperitoneal rupture of the urinary bladder following blunt trauma abdomen
Authors: Arumugam Praveen Kumar
Published: April 2017

Bladder injuries occur due to blunt, penetrating or iatrogenic trauma. The ones that occur following blunt trauma are commonly associated with pelvic fractures and can range from contusions to bladder rupture. Extraperitoneal ruptures occur more commonly than intraperitoneal ruptures. Here we present an uncommon case of intraperitoneal bladder rupture without any bony or solid organ injury. Following a fall from his motorbike a 42-year-old gentleman presented to us with abdominal pain, inability to pass urine with features of peritonism. CT cystography showed contrast leak into the peritoneal cavity. No other injuries were detected. The patient was taken up for emergency laparotomy and a full thickness rent in the bladder dome, 7 cm in length was found which was repaired in two layers with a supra pubic catheter. The patient improved post operatively and was discharged on the 3rd post-operative day. Intraperitoneal bladder ruptures are possible even without pelvic fractures and can be missed on routine imaging of the abdomen. A high degree of suspicion with appropriate imaging (CT cystography) is necessary in all such cases to ensure timely diagnosis and intervention.