bluuebunny/crossref_metadata_2025 huggingface dataset:
Is it possible to alleviate thoracic surgery? chest tube removal before the extubation
Authors: Hazem Zribi , Ahmed Ben Ayed , Amina Abdelkbir , Sarra Maazaoui , Mahdi Abdennadher , Taher Mestiri , Adel Marghli
Published: November 2017

Background: The ambulatory surgery (AS), is an operative management that does not require an overnight hospital stay. But, the application of AS still limited in the thoracic surgery due to the necessity of air leaking management. The aim of this study is to review our AS institutional experience by a chest drain removal before the extubation, in thoracic sympathectomy surgery.Methods: We have carried out a retrospective analysis of patients who underwent thoracic sympathectomy between November 2012 and July 2016 in the Thoracic Surgery Department of Abderrahmen MAMI University Hospital.Results: During the study period, 17 patients underwent thoracic bilateral sympathectomy. Twelve (12) females were operated versus 5 males. The mean age was 24.47 (range:17-33) years. There is no chest X-ray disorder detected during all frame times. No patient had developed a respiratory distress during the postoperative period. In addition to that, no postoperative morbidities had been detected during the follow up. All patients were satisfied about the procedure at the end of the follow up.Conclusions: The ambulatory thoracic surgery procedures can safely, and efficiency be applied if the patient is well selected. The progression on operative mini invasive techniques will increase the number of patients who can profit from an "alleviated thoracic surgery".
To compare the efficacy of topical negative pressure dressing with that of conventional moist wound dressings, in healing of wounds
Authors: Hebsur Narayanchandra I. , Pandey Kalyan , Puttannavar Girish
Published: November 2017

Background: Wounds and their management are fundamental to the practice of surgery. In the past 15 years there have been significant advances in complex acute and chronic wound management. One of the most significant discoveries was the improvement in wounds with negative pressure–assisted wound closure. The aim and objective of the study was efficacy of topical negative pressure dressing with that of a control group using conventional moist wound dressings, in healing of wounds, were assessed with quality of wound healing.Methods: This prospective randomized controlled study 50 patients with acute and traumatic wounds, sub-acute wounds, chronic open wounds, of which 25 patients underwent topical negative pressure dressing. The remaining 25 patients underwent conventional moist wound dressings. The results were compared after second week. Wounds were assessed depending on wound size and percentage of reduction of wound size, wound bed score and increase in wound bed score, percentage of granulation tissue cover, graft take up as the percentage of ulcer surface area.Results: Our present study shows significant reduction in wound size, in the study group 19.52 cm2 as compare to control group, (6.64 cm2) found to be statistically significant (p <0.001). There is significant increase in wound bed score in the study group (mean difference was 9.60±2.16) where as in the control group there was not much increase in wound bed score (mean difference was 5.12±1.99) (p-valve 0.00001) which is statistically significant. The % of granulation tissue formation in the study group was 81.0±8.29 and in the control group was 53.60±19.23.Conclusions: Topical negative pressure dressing was better than conventional wound dressings in quality of wound healing.
A prospective clinico-pathological study of cervical lymphadenopathy
Authors: N. R. Narender , J. Yadagiri Rao
Published: November 2017

Background: Lymphadenopathy refers to one or more lymph nodes that are abnormal in size, consistency or number. There are various causes for lymphadenopathy which range from benign conditions to malignant either primary or secondary from draining primary tumour. Lymphadenopathy can be localised to a single group or generalised.Methods: Prospective observational study was performed for the patients attending outpatient department of general surgery at Kamineni academy of medical sciences, LB nagar Hyderabad, Telangana with complaints of enlarged or swollen lymph nodes in the neck. This study included 46 cases. In cases where fine needle aspiration cytology was inconclusive and there was need for excision biopsy, only these cases were included in the study. After biopsy lymph node was sent for gross and microscopic examination for expert opinion from department of pathology.Results: The present study includes 46 patients in a period of two years from 01-8-2015 to 31-7-2017. Of these case tuberculosis lymphadenopathy (n=25,54.3%) was the most common aetiology followed by nonspecific chronic lymphadenopathy (n=16,34.7%) followed by some relatively rare cases and unusual presentation Schwannoma, pleomorphic adenoma, Kikuchi disease, non-Hodgkin’s lymphoma and secondaries from carcinoma tongue (n=1,2.1%).Conclusions: In the present prospective study tubercular lymphadenopathy was the most common cause for cervical lymphadenopathy followed by chronic nonspecific lymphadenopathy.
Evaluation of intestinal injuries from blunt abdominal trauma
Authors: U. D. Manoranjan , S. Nikhil , M. S. Chandrashekar
Published: November 2017

Background: To Evaluate the cause, presentation, anatomical extent, diagnostic method, management and outcome of intestinal injuries from blunt abdominal injuries.Methods: The study included 40 patients who underwent laparotomy for intestinal injuries from blunt abdominal trauma over a period of 1 year. A retrospective study was conducted, and the patients were evaluated with respect to the cause, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and mortality.Results: 40 patients with 58 major injuries to the bowel and mesentery due to blunt abdominal trauma were reviewed. The male to female ratio was 9: 1 and the average age was 32.51 years. There were 38 injuries to the small intestine including 1 duodenal injury, 13 colonic injuries and 6 isolated injuries to the mesentery. Out of 29 patients with intestinal perforation, free peritoneal air was present on plain abdominal and chest radiography in 23 patients. The commonest injury was a perforation at the antimesenteric border of the small bowel. Treatment consisted of laparotomy followed by simple closure of the perforation, resection and anastomosis and repair followed by protective colostomy for colonic perforations. 3 (7.56%) deaths were recorded, while 6 (15%) patients developed major complications.Conclusions: Bowel and mesenteric injuries may be significant and require immediate surgery or may be nonsignificant and permit nonsurgical treatment. Although early recognition of intestinal injuries from blunt abdominal trauma is difficult only by clinical assessment, nevertheless important to establish the right diagnosis due to its high infective potential. Intestinal perforations are often found accompanying other severe intra-peritoneal injuries which probably, are the determining factors in morbidity and mortality hence the main emphasis lying on early detection of the injuries and reducing the time from admission to the surgery thus playing a role in the reduction of mortality and morbidity associated with intestinal injuries following blunt trauma abdomen.
Role of early debridement in non-healing ulcer
Authors: Tote Darshan , Jajoo Suhas , Tote Sachin
Published: November 2017

Background: Non-healing wound is a commonly encountered entity with a broader effect on both the sufferer and the treating doctor. Time taken in healing these wound is directly related to financial loss as well as loss of working hours, thus ultimately increasing the financial burden. Chronic wound has devitalized tissue at the base which is barrier to cell migration and acts as supportive environment for bacterial growth. Considering the effect of devitalized tissue on wound healing there lies importance of debridement in wound management. Debridement is an effective technique to achieve desirable wound bed preparation by removing the dead and devitalized tissue. Hence a study was conducted at a rural hospital with main aim to assess role of surgical sharp debridement in non-healing wound in complete healing or preparing wound for further definitive treatment.Methods: The study was conducted at AVBRH Sawangi (Meghe), Wardha. Random 50 patients of non-healing ulcer were selected for the study. One group was of early debridement while other group of dressing with moist dressing only. Wound were assessed for healing, wound contraction, scar quality at regular intervals. They were assessed for duration of wound to heal completely/ get ready for further intervention like SSG/ Flaps, Cost of treatment and Time taken by the patient to return back to work.Results: 36% of patients in moist dressing group heal completely by 4 weeks while 56% of patients in debridement group heal completely by 4 weeks. Early recovery leads to early normalcy so less loss of wages and thus making the group cost effective.Conclusions: Early debridement was found to be an effective tool in wound healing in non-healing ulcers.
A study of unusual burns at a tertiary burn unit: a prospective study
Authors: Durairaj Alagar Raja , Mahipathy Surya Rao Rao Venkata , Ramachandran Manimaran , Sundaramurthy Narayanamurthy
Published: November 2017

Background: Unusual burns are not uncommon. They occur in the industrial as well as the domestic side. These are mainly burns due to chemicals, tar, fire walk and lightning burns. These burns occur as a result of improper handling of chemicals with poor safety measures or due to accidents. Here, we discuss about these burns, their epidemiology with treatment and preventive measures.Methods: The study was conducted at a tertiary care burn centre for a period of two years from Jan 2009 to Jan 2011. Forty-four patients with unusual burns were admitted and evaluated with a thorough history and clinical examination. Initial resuscitation was done followed by specific therapy in each of the cases.Results: The forty-four patients with unusual burns were categorized into chemical burns, lightning burns, tar burn, camphor burns, fire walk burns and miscellaneous types. These burns mostly involved adult males and were generally due to domestic reasons. 93% were due to accidents of which most of them were of the miscellaneous type (83%).Conclusions: Unusual burns are an important to know as these are occurring with regular frequency in the present days. These burns are usually accidental occurring in industries and in household setups. Proper education and safety measures could reduce the incidence of these unusual burns.
TSH receptor antibodies in breast cancer and benign breast disease: a hospital based study
Authors: Krishnaswamy Jawahar , Sattar Reshma
Published: November 2017

Background: Associations between breast cancer, benign breast tumours and thyroid disorders are reported in numerous studies. Relationship between thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and breast cancer have been previously demonstrated. However, no analysis has been performed concerning an association between thyrotropin (TSH) receptor antibodies (TSHRAb) and breast cancer. The aim of the study was to evaluate the presence of TSH Receptor antibodies in women with breast cancer or benign breast tumours, and to analyze a possible relationship between TSH Receptor antibodies, and these two groups of breast diseases with emphasis to laboratory findings.Methods: Clinical and laboratory details of 87 women hospitalized were prospectively analyzed, using an Post hoc Tukey HSD for normally distributed continuous data, chi-square test for comparison.Results: TSH Receptor antibody levels in breast cancer was statistically significant. We observed TSHRAb more frequently in patients with breast cancer. We found that TSHRAb is the only variable possessing as a prognostic marker for breast cancer.Conclusions: The present study indicates that the serum levels of TSH Receptor Antibody are significant higher in patients with Breast cancer. These results have implications not only for the screening of patients but also for the development of new prognostic markers. Further high-quality prospective studies are needed to explore whether TSH Receptor Antibodies are potential prognostic markers for patients with Breast cancer.
D-dimer levels in predicting the severity of acute pancreatitis
Authors: Kumar Anil , Kothagattu Ranjith
Published: November 2017

Background:Coagulative disorder is known to occur in the early phase of acute pancreatitis. (AP) and D-dimer is a commonly used clinical parameter of haemostasis. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity in the 1.3.5 days after admission in patients with Acute pancreatitis.Methods: From September 2015 to September 2017, 60 patients admitted for AP were included in this observational study. The D-dimer level was measured during days 1,3,5 after admission and the acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and other clinical parameters were recorded at the same time. The maximum and the mean D-dimer values were used for analysis and compared with other prognostic factors of AP.Results:Both the maximum and mean levels of D-dimer were signiﬁcantly different between patients with and without clinical variables such as multiple-organ dysfunction syndrome (MODS), need for surgical intervention, and the mortality. Additionally, the D-dimer level correlated well with two usual markers of AP severity-the APACHE II score and the C-reactive protein level. Conclusion D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of AP.Conclusions:D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of SAP.
Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes
Authors: Sahani Indra Singh , Dhupia Rakesh , Kothari Archana , Rajput Madhurendra , Gupta Ajay
Published: November 2017

Background: Peritonitis is a common emergency encountered by surgeons the world over. Despite a better understanding of pathophysiology, advances in diagnosis, surgery, antimicrobial therapy and intensive care support, peritonitis remains a potentially fatal affliction. Intra-abdominal sepsis is important causes of mortality and morbidity. The treatment is based on rapid fluid resuscitation, initiation of antibiotic therapy and surgical intervention. The antibiotic chosen must cover the most frequently expected bacterial species depending upon the site of perforation. Objectives of the study was done to identify the type of organism present in bowel perforation and their sensitivity pattern to different antibiotics. A guideline will be framed for advising antibiotics to be used for different kinds of perforation.Methods: This was a prospective study of one year on 50 patients of secondary peritonitis due to bowel perforation, conducted in Amaltas institute of Medical Sciences, Dewas.Results: This study included 50 patients with an average age of 36 years (range: 3 days-75 years). There were 40 males and 10 females. The mean duration of hospitalization was 10.6 days (range: 3-25 days) with predominant site of perforation was ileum. E. coli emerged as main pathogenic microbe even in site specific culture, was closely followed by Klebsiella. A combination of third generation cephalosporins with sulbactam and metronidazole has been the most promising therapy to treat secondary bacterial peritonitis due to bowel perforation. It needs to be emphasized that although the sensitivity studies reveal an edge for meropenem over cefaperazone sulbactam, yet the preference of cephalosporin with sulbactam over meropenem is justified, considering the economic constraints and with a suitable foresight, to keep meropenem as a reserve drug because trends indicate that our microbes are fast becoming resistant to the promising combination of third generation cephalosporin with sulbactam and metronidazole.Conclusions: This study suggests that the current recommended empirical antibiotics need to be reassessed.
Correlation of CRP level with glycemic control in diabetic foot patients and its sequelae
Authors: A. Anand , . Maragathamani
Published: November 2017

Background:Diabetes mellitus is a major public health problem globally and in Indian population and diabetic foot is reported as the most common cause of non-traumatic amputation of the lower limbs in India. There is renewed interest in various inflammatory markers and their association with various chronic complications of diabetes mellitus. There is a scarcity of data on the subject in Indian population.Methods: The current study was a cross sectional study of 100 patients admitted to a Diabetic foot in Department of General Surgery, Stanley medical college and Hospital between January 2012-November 2012. The CRP level and fasting and plasma glucose levels were considered as the relevant variables for statistical analysis.Results:A total of 100 patients were included in the final analysis. The proportion of subjects with Wagners, grade 1, grade 2, 3, 4 and 5 ulcers were 48%, 27%, 16%, 3% and 6% respectively. Among the study population, 73% of patients had CRP value greater than 40 and 27% patients had CRP value less than 40. The proportion of subjects with Higher CRP level (>40) showed increasing trend with increasing level of fasting blood sugar and post prandial blood sugar in the study population. The proportion of people who underwent amputation was 27.5% in people with CRP value >40 and it was only 6.85% of people with CRP value <40, the association between CRP values and amputation was statistically significant. (P value 0.046).Conclusions:The study has established a strong positive association between poor blood sugar control and elevated CRP levels in the study population. The study has also documented a positive association between higher CRP levels and amputation.
A study to test the validity of diabetic ulcer severity score (DUSS) at tertiary care hospital
Authors: Kumar V. Hari , Barazandeh Moghadam Abdul Ghader
Published: November 2017

Background: For classification of ulcer of feet in diabetes, various systems of classification are in use. Notable among them are the University of Texas (UT) system and the Wagner system. One of the most recent such type of classification system is DUSS (Diabetic Ulcer Severity Score). Studies are required to validate the same. Objective was to test the validity of Diabetic Ulcer Severity Score (DUSS).Methods: Present follow up study was carried out among 50 known cases of diabetes having ulcer over foot. DUSS scoring was applied. Ulcer was graded into five grades. Patients were followed till the outcome was noted.Results: Most common ulcers were of DUSS score of 3. Major amputation was done in 15 (30%) patients and minor amputation in 12 (24%) patients. Toe amputation was done in total of 15 patients. None of the patients had forefoot amputation. Below knee amputation was done in total of 11 (22%) patients. Majority of the foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intension or skin grafting i.e., 1 (100%), 3 (75%) and 6 (46.15%) respectively. However, among those with score 3 and 4 majority required amputation i.e., 14 (70%) and 10 (83.33%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P=0.004). The probability of healing with DUSS score 0 was 100%, 75% with DUSS score 1, 84.61% with DUSS score 2, 30% with DUSS score 3, 16.67% with DUSS score 4. The mean time for healing was 77 days. The mean time for amputation was 100 days.Conclusions: The proposed score classification system for the diabetic foot may enable better quality of life for diabetic patients and promote better low-cost care for millions of individuals worldwide.
Analysis of psychiatric problems in burn patients in a tertiary burn unit: a prospective study
Authors: Ramachandran Manimaran , Durairaj Alagar Raja , Rao Venkata Mahipathy Surya Rao , Sundaramurthy Narayanamurthy
Published: November 2017

Background: Burn injuries in our part of the world generally occurs in the lower socio-economic groups. A large part of these patients suffers from underlying psychiatric disorders. This study is to see the prevalence rates and clinical diagnosis of psychiatric disorders and psychosocial problems as a predisposing factor to burns and squeal to burns in our population, hence necessitate the consultation with the psychiatric team management to improve the outcome from the time of critical phase recovery to the rehabilitation phase.Methods: 114 patients admitted with suicidal burns above the age of 15 years were included in the study at Dept. of Plastic, Reconstructive and Burn Surgery, Govt. Kilpauk Medical College and Hospital for a period of 2 years and evaluated.Results: The patients were mostly married females in the 2nd to 3rd decade of life. Most of them had some form of pre-morbid psychopathology. 60% of patients had >50% burns and only 17% were survivors. After 1 year of psychotherapy, most patients had returned to normalcy.Conclusions: In our study deformity related depression were more after recovery hence prevention of deformity with usage of appropriate splintage, wound management, early grafting and intense physiotherapy will produce a drastic change in their wellbeing and coping ability and help long term rehabilitation and return to normalcy.
Acute pancreatitis, its diagnosis with special reference to contrast enhanced CT scan (CECT) and serum enzyme studies: a comparative study in tertiary referral hospital of Odisha, India
Authors: Panda Srikanta , Tirkey Roshni , Swain Basanta Manjari , Jena Somanatha , Sarangi Ashok Kumar , Sarangi Anshuman
Published: November 2017

Background: Acute pancreatitis is sudden swelling and inflammation of the pancreas. It can be diagnosed on the basis of clinical and laboratory data. At times, it may be difficult to differentiate it from other acute abdominal conditions. In these patients, serum enzymes (amylase and lipase) study, imaging by ultrasonography (USG) and/or computed tomography (CT) is of immense value in arriving at a diagnosis. In this study, we have compared the role of serum enzymes (amylase and lipase) levels, with the imaging studies (US/CECT scan) in relation to early diagnosis of acute pancreatitis and to find out the most specific and sensitive diagnostic modality.Methods: 300 patients (220 males, 80 females) in age group of 21 to 62 years with a clinical diagnosis of acute pancreatitis, which were admitted to surgical ward of S.C.B. Medical College Hospital, Cuttack during a period from November 2013 to October 2015, were included in the study. All selected cases (clinically diagnosed as acute pancreatitis) were serially subjected to tests of serum amylase and lipase estimation, USG and CECT scan of abdomen.Results: In our study the most common cause found was gall stone disease followed by chronic alcoholism. Serum amylase test showed diagnostic accuracy of 46.66% whereas serum lipase it was 70 %. Further USG of abdomen diagnostic accuracy was 83.33%, finally CECT scan had a diagnostic accuracy of 93.33%.Conclusions: Comparing all the diagnostic modalities described above it was found that contrast enhanced CT scan has highest accuracy rate (i.e. about 93% in our study) in detecting acute pancreatitis. This study proved that CECT scan was very important in the following up of the patients in order to detecting regression of disease appearance and complication in relation to acute pancreatitis.
Role of modified Alvarado scoring system and USG abdomen in acute appendicitis: an overview
Authors: Singh Rajkishore , Singh Rajiv , Singh Kulwant
Published: November 2017

Background: Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults and, as such, the associated symptoms and signs have become a paradigm for clinical teaching. Appendicitis is sufficiently common that appendicectomy (termed appendectomy in North America) is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. In this study we correlate the usefulness of Modified Alvarado scoring system(MASS) and ultrasonography(USG) in management of acute appendicitis.Methods: The study was done on 60 patients of symptomatic appendicitis, requiring management accordingly, attending surgical OPD of People’s College of Medical Sciences(PCMS) and Research Centre, Bhopal, India from 1st October 2011 to 30th August 2013. The study includes 60 patients between 5-60 yrs of age. They were prospectively evaluated on admission using the modified Alvarado Score to determine whether or not they had acute appendicitis, all equivocal cases were subjected to ultrasonography examination. The score and ultrasonography were correlated with the operative and histological findings.Results: All 60 patients underwent surgery. The sensitivity of the modified Alvarado score was 89.65% and sensitivity of USG was 91.37%, out of 60 cases of acute appendicitis male were 36 and remaining 24 cases were female. So, it showed sex ratio of 36:24, 3:2 which correlate with literature and other studies. With use of both MASS and USG as diagnostic tool, out of 60 cases 57 cases were positive and with the help of histopathology, it was confirmed in 58 cases.Conclusions: The modified Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in minimizing the rates of negative appendicectomy. It can be used as an adjunct to surgical decision-making along with ultrasonography in doubtful cases. When combined, modified Alvarado score and ultrasonography can work very effectively in diagnosing acute appendicitis(AA) correctly and in reducing the number of negative appendicectomy.
Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital
Authors: Gopalam Padmaja Rani , Konidala M. V. Saila Suman
Published: November 2017

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.
Effect of adding various doses of clonidine as an adjunct in Transversus abdominis plane block in unilateral inguinal hernioplasty
Authors: Dhupia Rakesh , Jain Sunita , Sahani Inder Singh , Modi Vimal , Romday Rakesh , Kothari Archana
Published: November 2017

Background: Transverses abdominis plane (TAP) block is a new regional anaesthetic technique for postoperative analgesia in abdominal surgeries, as a part of multimodal analgesia. We evaluated effect of two different doses of clonidine as an adjunct in TAP block in patients underwent unilateral inguinal hernioplasty.Methods: Sixty adult patients undergoing unilateral inguinal hernioplasty were randomized into two groups, Group A (n=30) received bilateral TAP block with bupivacaine 0.25% 38cc + clonidine (1cc) 150 microgram +1cc NS=40cc, Group B (n=30) received bupivacaine 0.25% 38cc+clonidine (2cc) 300 microgram=40cc, at the end of surgery. The postoperative pain was evaluated by visual analog score (VAS) for pain scoring at 2, 4, 6, 12 and at 24 hours. Subjective assessment of duration of analgesia was done.Results: The VAS score in patients who received clonidine 300 microgram Group B as an adjunct was significantly lower than who received 150 microgram Group A. Duration of analgesia was longer in Group B. 2 patients in Group B showed bradycardia treated with atropine. Sedation score was lesser in Group A.Conclusions: Clonidine showed dose dependant analgesia and adverse effect in TAP block for postoperative analgesia. Higher doses of clonidine may be used as an adjunct in TAP block.
A qualitative study on the perceptions of patients with urethral stricture
Authors: Pramanik Sandip , Pal Dilip Kumar , Bandyopadhyay Arup , Paul Uttam Kumar
Published: November 2017

Background: Urethral stricture means narrowing of the urethra and is caused due to injury, instrumentation, infection etc. In as much as urethral stricture is a highly disabling condition and is common in our places, it definitely plays an important role in a sufferer daily life. In our project, we have ventured a qualitative study of perceptions and actual impositions on the life of patients suffering from chronic urethral stricture.Methods: The study was one of qualitative descriptive type involving in depth interviews (IDI) of 18 male patients of Urethral stricture who were diagnosed and treated at IPGMER.Results: The results showed that the IDIs could be divided into several categories each of which is further divided into several codes. The categories are given here with codes in parenthesis. Catheter related problems (leakage, block, physical problems, change, availability, health personnel, dress change, smell of urine, water drinking), disturbance of sleep (initiation, awakening, disturbance of bed partner, sleepless night), Role of family members (care giving, attitude, negligence), financial condition (jobless, help from friends, support, reversal of role, family crisis), social life (activity, enjoyment, getting hurt), mental health (loneliness, helplessness, sadness, getting hope) and sexual life (urge, erection, coital pain , discomfort).Conclusions: The major findings were that most of the patients had very good co-operation and care from the family; financial assistance was also obtained from family and friends. Majority of the patients were hopeful that they would be totally cured in near future.
Clinical relevance of MMP-9 in terms of neoplasm growth, invasion and metastasis in thyroid, breast and colorectal cancer
Authors: Kumar V. Hari , Hasan Omar Bin
Published: November 2017

Background: Cancer cells invade and metastasis commonly. This poses challenge in cancer management. MMP-9 can be clinically useful to predict the prognosis of the patients. Objective was to study clinical relevance of MMP-9 in terms of neoplasm growth, invasion and metastasis in Thyroid, Breast and Colorectal cancer.Methods: A hospital based cross sectional study was carried out in Department of General Surgery, Kamineni Institute of Medical Sciences, Narketpally for a period of two years. A total of 30 cases of carcinoma cases were studied. Out of these carcinoma cases, 10 were of gastrointestinal malignancy, 10 were of thyroid malignancy and 10 were of breast carcinoma.Results: For breast carcinoma, maximum cases were in the age group of 46-50 years (40%), for thyroid carcinoma, maximum cases were seen in the age group of more than 55 years (40%), for colo-rectal carcinoma, maximum cases were above the 50 years of age. For breast carcinoma, maximum cases were in stage III B (70%), for thyroid carcinoma, in III stage (60%) and for colo-rectal carcinoma, in Dukes C1 stage (60%). In breast cancer the positivity of MMP-9 was 66.7% in stage IIIA and it increased to 85.7% in stage IIIB. For thyroid cancer the positivity increased from 33.3% in stage III to 75% for stage IV A. In case of colo-rectal cancer, the positivity of MMP-9 expression increased from 66.7% for stage Dukes C 1 to 75% in stage Dukes C2 stage. Thus, for all types of carcinoma, the expression of MMP-9 increased with advancement of the stage.Conclusions: MMP-9 is a gelatinase which degrades extra cellular matrix and helps in tumor spread. It is expressed more in advanced stages of the malignant disease. It correlates with prognosis of the patient.
Comparison of bedside index of severity in acute pancreatitis (BISAP) and acute physiology and chronic health evaluation (APACHE II) score in assessing severity of acute pancreatitis
Authors: Pattanaik S. K. , Kumar V. Arvind , John Ajax
Published: November 2017

Background: Acute Pancreatitis (AP) is one among the major diseases in the surgery wards with high rate of mortality. In spite of many scoring systems introduced to grade the severity of AP for optimal and timely management, mortality rate is still in a high pace. The aim of this study is to compare BISAP scoring system and APACHE II scoring system for accuracy and easiness in predicting the severity and mortality of AP and to deliver appropriate and timely intervention.Methods: The first 100 patients with AP in the year 2016 (January to August) were studied prospectively by calculating APACHE II score and BISAP score. According to Revised Atlanta classification severe AP was ascertained and the sensitivity and specificity of both scoring systems were assessed from chi square table. By using ROC curve accuracy and diagnostic value of two scoring systems were compared.Results: 100 patients with an age ranging from 20 to 80 years with a mean of 41.18 and male female ratio of 10.1:1 were studied. 95% of the patients presented with a symptom of abdominal pain and 49 out of 100 were having alcoholism as etiology. The average hospital stay of the patients was 12.03 days. Four patients died out of 11 severe AP and rest 89 were grouped into mild AP. BISAP score more than or equal to three have 64.2% chance of severe AP and was statistically significant in predicting the severity of AP. Areas under curve of the ROC curve after depicting the sensitivity and specificity of BISAP scores for severity and mortality were 0.90 and 0.96 respectively. APACHE II scores more than or equal to nine have 23.8% chance of severe AP and was statistically significant in predicting severity of AP. When sensitivity and specificity of APACHE II score were charted in ROC curve, areas under curve were 0.853 and 0.75 for severity and mortality in AP respectively.Conclusions: Compared to APACE II, BISAP is better scoring system in predicting both severity and mortality of AP on considering accuracy and easiness.
Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3
Authors: Vutukuru Venkatarami Reddy , Gavini Sivarama Krishna , C. Chandramaliteeswaran , A. Dinakar Reddy , Dasari Varun , Settipalli Sarala
Published: November 2017

Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.
Fine needle aspiration cytology (FNAC) in pre-operative diagnosis of breast lesions in Kadapa region of Andhra Pradesh, India
Authors: Reddy Chakarala Obula , Mohana Reddy Garisa Chandra
Published: November 2017

Background: Various diagnostic methods have been developed to evaluate the palpable and non-palpable breast lesions, but Fine needle aspiration cytology of the palpable breast masses have become increasingly popular as a diagnostic technique to assess the breast lesions. To study the role of FNAC in diagnosis of breast lumps.Methods: 60 female patients (11-74 years age group) with palpable breast lump were utilized to study the role of Fine needle aspiration cytology for clinically palpable breast lump was carried out in Fathima Institute of Medical Sciences, Kadapa, Andhra Pradesh.Results: Fine needle aspiration cytology revealed benign in 22 patients, suspicious in 3 and 35 malignant lesions were 93.10% with false negative rate of 6.9% and false positive rate of 0%. The overall sensitivity of fine needle aspiration cytology in diagnosing the palpable breast lump in our study was 93.10%, specificity was 100%, positive predictive of 100% and negative predictive value of 90.47%.Conclusions: FNAC is easy to perform and painless procedure and standard tool for diagnosis of breast lumps with high percentage of true positives without virtual complications.
PANC 3 score as a simple cost-effective scoring system in predicting severity of acute pancreatitis
Authors: Panda Charan , Nayak Niranjan Kumar , Behera Manas Ranjan , Nayak Sanjit Kumar
Published: November 2017

Background: Acute pancreatitis presents as acute abdomen, is an inflammatory process of the pancreas associated with local and systemic complications requiring, in such cases, an intensive care. At present, there are lots of scores (such as Ranson’s, APACHE II, bedside index for severity in acute pancreatitis) that help us in predicting severity at the time of admission, but these are time consuming or require complex calculation and are costly. Our aim here is to analyse the simplified stratification system of the PANC 3 score, and its assessment in Predicting Severity of Acute Pancreatitis as decided by modified Marshals score.Methods: It is a prospective analytical observational study in which 74 patients were evaluated with PANC 3 scoring, who were diagnosed with acute pancreatitis and admitted to Dept. Of General Surgery, MKCG.Results: The results showed that PANC3 score had a 95.91% specificity, 68% sensitivity, 89.47% positive predictive value, and 85.45% negative predictive value, 86.48% diagnostic accuracy.Conclusions: PANC3 scoring system is one of the better systems because the three criteria used (haematocrit, body mass index, and pleural effusion) are simple, easy to assess, readily available, and economic Hence, the PANC3 score is a cost-effective, promising score that helps in predicting the severity of acute pancreatitis and triaging the patient, leading to prompt management.
Comparative study of rapid urease test and histopathological examination for detection of H. pylori infection
Authors: Athavale Virendra S. , Singh Vinit , Khandalkar Shivmurti N. , Nirhale Dakshayani S. , Lad Aditya , Shetty Iresh
Published: November 2017

Background: Aims and objectives of the study was to study the incidence of H. pylori infection in our Hospital. To find out the sensitivity and specificity of rapid urease test (RUT) and histopathological examination for the detection of H. pylori on gastric biopsy. To study the effect of anti H. pylori drugs by performing follow-up endoscopy in terms of positive or negative Rapid Urease Test and Histopathological Examination report.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2012-September 2014) and is a prospective and comparative randomized type of study using 100 patients. The study was approved by the Institute’s Ethics Committee.Results: Data analysis showed that: In our study 84 patients (84%) were detected positive by RUT method. In our study 83 patients (83 %) were detected positive by HPE method. There was an association between RUT and HPE finding in study group with the sensitivity being 96.38 % and specificity being 74.47 %, PPV was 95.24% and NPV was 81.25%. At the time of follow up after taking anti H pylori treatment, 79 patients were RUT negative and 8 were RUT positive who were defaulters (not taken complete dose) and again started on treatment with the accuracy of the drug being 98.85 %. At the time of follow up after taking anti H pylori treatment 78 patients were HPE negative and 9 were HPE positive who were defaulters (not taken complete dose) and again started on treatment. There was an association between RUT and HPE finding at follow up with the sensitivity being 88.89 % and specificity being 100%, PPV was 100% and NPV was 98.73%.Conclusions: Our study reveals that RUT is accurate for the diagnosis of H. pylori infection and its use will serve as a good alternative to histology in management of patients with dyspepsia in resource poor environments, except in patients who need histology for reasons other than H. pylori diagnosis.
Extra skeletal Ewing's sarcoma: extra skeletal Ewing’s sarcoma of mesentery masquerading dysgerminoma ovary
Authors: Aimanan Karthigesu , Saprudin Syazwan Arif , Kanthasamy Senthil Vassan , Tangarathnam Ramesh , Guan Chew Loon
Published: November 2017

Extraosseous Ewing's sarcoma is a rare entity that involves the lower extremities, paravertebral regions of the spine, retroperitoneum, pelvis, and the chest wall. Involvement of mesentery as this case has been only reported five times in English literature. An eleven-year-old girl was planned for gynaecological surgery for suspected ovarian dysgerminoma. Intraoperatively she was referred to the surgical team since tumor arising from mesentery of the terminal ileum. Complete resection of the tumor with a right hemicolectomy was done. Histopathological assessment of the tumor revealed features of small blue round cell tumor which after an expert immunohistochemical staining reported as extraosseous Ewing sarcoma. She underwent a course of adjuvant chemotherapy and currently well during follow up. Due to the rarity of this tumor, a proper consensus on management has not been outlined. However, complete resection and adjuvant chemotherapy remain a standard therapy which showed an excellent post-operative outcome.
Delayed onset post-herpetic pseudohernia: a case report
Authors: Sharma Munish , Kapur Ajita
Published: November 2017

Post herpetic pseudo hernia is a rare neurological complication of herpes zoster (HZ). It could lead to diagnostic confusion as abdominal wall herniation presents with similar clinical picture. We present a case of post herpetic pseudo hernia initially misdiagnosed by referring general physician as abdominal wall hernia. A 60-year-old man presented with painless swelling in the right flank for 1 week. The bulge was noticed two weeks after appearance of painful rash of HZ. On clinical examination, fading dried brown rashes were observed in right T10-11 dermatome. No hernial defect was palpable. The bulge became more prominent on standing and coughing. Abdominal sonography report was normal with absence of abdominal mass or hernial defect. The patient was diagnosed as a case of post herpetic pseudo hernia. The bulge resolved spontaneously in 3 months. Physicians should consider the possibility of Post herpetic pseudo hernia if abdominal bulge appears following HZ infection to prevent unnecessary interventions.
Strangulated direct inguinal hernia with intraperitoneal perforation
Authors: Bakhteyar Md Asjad Karim , Kumar Binod , Kumar Sushil
Published: November 2017

Usually direct inguinal hernia doesn’t present as strangulation or incarceration as compared to indirect inguinal hernia because of earlier has wider neck. A patient of recurrent direct inguinal hernia presents as intra-scrotal gangrene and intra-peritoneal perforation. We reported a case of 65 years old male presented with septicemia and right sided strangulated direct hernia. On exploration through inguino scrotal incision and mid line laparotomy, gangrenous loop was found in scrotum and perforation was found in intra-peritoneal part of small intestine. Resection-anastomosis was done for both the parts of intestine. Inguinal Incision was closed by posterior wall closure and modified Bassini’s herniorraphy. Abdomen was closed in layers with brain. Long standing direct hernia may present as strangulation or incarceration specially in elderly but perforation and gangrene of intra-peritoneal part of small intestine is very rare.
Multiple port sites metastasis after laparoscopic cholecystectomy: a case report
Authors: Huda Farhanul , Singh Sudhir K. , Gupta Arvind , Kumar Navin
Published: November 2017

Laparoscopic cholecystectomy is a surgical procedure of choice for gall stone disease. Incidental gallbladder cancer is found in about 0.25-3% of patients after routine cholecystectomy. Depending on the stage of tumour, additional radical surgery may be required. In recent years, several reports of port site metastasis have been published. Here, we report a case of a 55-year-old female patient who presented to us with simultaneous multiple port sites metastasis after an interval of 15 months of laparoscopic cholecystectomy for gall stone disease. We recommend the routine use of specimen bag for the retrieval of gall bladder during laparoscopic cholecystectomy and also to send the gall bladder for histopathological examination. To the best of our knowledge, metastasis to more than one port is a very rare occurrence.