bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonoelastography in the diagnosis of breast mass: an extended armamentarium
Authors: Kannappan K. Manickkam , Dev Bhawna , Ramakrishnan Ramya 
Published: January 2018

Background: To presenting with breast lumps are very common in surgical practice and the routine use of ultrasound in the diagnosis is well validated. But there are gray zones in equivocal cases which increase the number of negative biopsies. To increase the sensitivity and specificity of ultrasound by adding another non-invasive modality, namely strain elastography, can reduce this rate. To evaluate the sensitivity and specificity of strain elastography in the diagnosis of breast masses.Methods: As part of the triple assessment patients presenting with breast lumps underwent ultrasonography and strain elastography, where strain ratios were calculated. Based on which they either underwent percutaneous biopsy or surgical excision. A total of 30 patients with breast lesions underwent sonomammogram in which the breast lesions were both graded with BIRADS and also the elastography and strain ratio was calculated.Results: Strain ratio has higher sensitivity and specificity which makes it a valid diagnostic tool in the evaluation of breast masses.Conclusions: It can also help in reducing the number of benign lesion biopsies and also reduce the number of negative biopsies. Being a non-invasive modality, it is much more patient compatible and economically cheaper when compared with MRI and modalities.
Eras: is it possible to follow it in a tertiary government hospital set up?
Authors: Pattanayak Sibaprashad , Maharana Binoy Kumar , Behera Manoj Kumar , Malla Tapan Kumar , Kumar Manish 
Published: January 2018

Background: Fast-track surgery (enhanced recovery after surgery) is a set of protocols to reduce surgical trauma and postoperative stress by decreasing pain and complications, improving outcomes and decreasing length of hospital, while expediting recovery following elective procedures without an increase in complications or readmission.Methods: This was a prospective study over 2 years from March 2015 to February 2017 with 6 months follow up. 647 patients undergoing elective general surgery were followed up. Details regarding the age, sex, health status parameters and diagnosis collected. Preoperative evaluation, operative parameters and postoperative complications recorded. Post-operative course in hospital and any deviation of normal post-operative course and its management recorded and analyzed.Results: In government hospital (MKCG Medical College, Berhampur, Odisha), following ERAS protocol completely is impossible. But most protocols in preoperative, intraoperative, postoperative phases were followed, leading to early discharge of patients without any complications in most cases. In my study, drains were given in 157 cases, nasogastric tube in 89 abdominal surgeries. 129 cases were performed under general anaesthesia and 518 cases under spinal/epidural/mid thoracic epidural anaesthesia. 60 underwent overnight fasting. All received carbohydrate loading, antibiotic prophylaxis, thrombo-prophylaxis before surgery. Bowel preparation done in 50 abdominal surgeries.Conclusions: The study provided a strong evidence that ERAS is safe to practice in elective general surgeries. It is associated with decreased incidence of complications, significant reduction in duration of hospitalisation and reduction in overall morbidity and decreased rate of re-admission. Thus, improves patient’s compliance.
Clinical presentation and outcome in diabetic foot cases: a prospective study in a tertiary care teaching hospital of Uttarakhand, India
Authors: Bijalwan Anurag , Mishra Ratnanjali , Beg Mirza A. 
Published: January 2018

Background: Aim of study was to investigate the clinical presentation, management of soft tissue infection and their outcome in diabetic foot patients in a tertiary care teaching hospital.Methods: A total of 106 patients with diabetic foot presented to General Surgery department of SGRRIMHS, Dehradun, were included in the present study. Grading of ulcers was done by using Wagener grading. Peripheral neuropathy was confirmed or ruled out using tuning fork (128 hz). The diagnosis of vascular insufficiency was made by palpating pedal pulses of the involved foot and/or by colour Doppler.Results: Out of 106 patients, 87(82.7%) were male and 19 (17.92%) were female. Mean age of the patients was 56.04±10.31 years, 40 (37.73%) were smoker, 62 (58.49%) were anaemic, 80 (75.47%) patients had poorly controlled diabetes and mean duration of diabetes was 8.2 years. The majority of ulcers belonged to grade 3 and grade 4, i.e. 50 (47.17%) and 30 (28.30%) respectively. 80 (75.47%) patients had peripheral neuropathy and 67 (63.20%) had arteriopathy. 17 (16.03%) patients required only dressings, while 89(83.97%) needed surgical interventions.Conclusions: In the present study, most of the patients presented with diabetic foot were treated by surgical intervention.
Hemithyroidectomy with or without use of drain a randomized prospective clinical study
Authors: G. V. Ravi Kumar , S. Madhu B. , Jhajharia Ajay Kumar 
Published: January 2018

Background: The practice of using the drain in thyroid surgery including hemithyroidectomy is common to avoid complications like a hematoma. The aim of this study is to evaluate the necessity of routine drainage in hemithyroidectomy.Methods: In this randomized prospective clinical study conducted in tertiary care government training hospital,60 patients who underwent hemithyroidectomy for various thyroid disorders were randomly allocated to either non-drainage (group A) or drainage (group B). The various complications including hematoma, seroma, wound infection, post-operative pain, the length of hospital stay was then compared.Results: Both groups were comparable according to age, gender, thyroid size and histopathological diagnosis. A total number of 60 patients evaluated among them 45 females (75%) and 15 males (25%) were there. No significant difference in complications was observed between two groups regarding hematoma, wound infection, but the length of hospital stay was significantly reduced in the non-drainage group compared to drainage group (p-0.004), along with the significant reduction in post-operative pain (p-0.001).Conclusions: In present study, author observed that there is a significant reduction in length of hospital stay and post-operative pain in non-drainage group compared to drainage group. So suction drainage should be done in selected patients rather than a routine procedure and it is safe without suction drain especially in hands of experienced surgeons.
Small bowel obstruction: need for surgery based on history and radiology
Authors: Meena L. N. , Bhatt Neha , Jain Sanchit 
Published: January 2018

Background: Small bowel obstruction is a common clinical challenge because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognise the presence of strangulation-obstruction and hence the need for urgent operative intervention; and on the other hand, can avoid a non-therapeutic laparotomy along with its associated morbidities and further adhesion formation with its potential sequelae. The study was done to identify relevant features in the patient’s clinical and CT abdomen findings which when present would be highly predictive of the requirement of an operative intervention in a patient with small bowel obstruction.Methods: The study was a hospital based analytical observational study on patients admitted from March 2013 to May 2014 with a diagnosis of small bowel obstruction and who underwent a concurrent CT abdomen. Correlation of line of management was done with respect to the three chosen parameters, obstipation (history), mesenteric edema (CT imaging) and lack of small bowel feces Sign (CT imaging).Results: A total of 74 patients were included with Male:Female ratio being 3.1:1. Forty patients were managed conservatively and remaining underwent surgery with adhesions being the most frequent etiology. The most common operative procedure performed was adhesiolysis with or without band release. Twenty-three cases were performed by open method and remaining laparoscopically. Evaluation of the three parameters revealed that these variables, when present independently or in combination, are predictive for need for operative intervention (p-value <0.001). The sensitivity and specificity to predict the need for exploration when all 3 features were present concurrently was 38.24% and 100%, respectively.Conclusions: Small-bowel obstruction is a common surgical dilemma, the management of which is dealt on a daily basis by surgeons and non-surgeons. The management using variables based on history and radiology may help classify patients into those requiring conservative management and those in need of early exploration.
Preoperative predictors of a difficult laparoscopic cholecystectomy
Authors: Kulkarni Shrirang V. , Kumar Sukumar S. 
Published: January 2018

Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.
A study the profile of pathological disorders resulting in acute abdominal non-traumatic surgical emergencies in a tertiary care hospital, North India
Authors: Zahid Mohamamd , Raza Mohd Arshad , Mohan Manjul , Agrawal Ranjan , Kumar Pramod 
Published: January 2018

Background: Acute abdomen has a sudden onset, can persist for several hours to days and is associated with wide variety of clinical features requiring evaluation and treatment. The present study has been done to establish the etiopathological details and diagnostic verification of the patients presenting with non-traumatic pain in abdomen. Also, the management and admitted care of non-traumatic abdominal surgical emergencies and their outcome has been discussed.Methods: A prospective observational study was done in Rohilkhand Medical College and Hospital (RMCH) during November 2015 to October 2016. The study includes acute abdominal non-traumatic surgical emergencies presenting in general surgery department. All the data were analyzed through SPSS 22.Results: A total of 182 patients were included in the study. The most common complaint among patients was pain in abdomen followed by constipation and vomiting. The most common cases were intestinal perforation (57%) followed by acute appendicitis (14.89%), acute pancreatitis (9.34%), acute intestinal obstruction (9.34%) and others. Most common treatment modalities applied were Exploratory Laparotomy with true Graham’s patch repair (30.22%), non-operative/conservative treatment (26.92%) and Exploratory Laparotomy with ileostomy (13.19%). Total 13 cases (7.14%) expired (all post-operatively) and 8 cases (4.39%) developed major complications.Conclusions: The clinical course and outcome of acute abdominal emergencies in present study showed that a judicious and careful use of clinical evaluation with high index of suspicion along with radiological and biochemical findings help to reach a diagnosis based on which the appropriate management strategy ensures good outcome.
Voice changes after thyroidectomy: an experience with 364 cases of thyroid surgery
Authors: Prabhat Arvind K. , Dash Niranjan , Gadekar J. M. 
Published: January 2018

Background: To study voice changes and to evaluate the impact of thyroidectomy and effects of factors such as patient age, sex, operation-type, surgeons-experience, laryngeal nerve injury and orotracheal intubation on voice of patients undergoing thyroidectomy.Methods: Author prospectively analyzed 364 cases of multinodular goiter (MNG) and neoplastic thyroid disorders, undergoing sub-total/total-thyroidectomy and completion-thyroidectomy in the department of surgery, during the study period of June 2016 to December 2016.Results: The study comprised of 364 patients, with 298 females and 66 males. Voice changes were seen in 216(59.34%) patients. Transient voice changes were seen in 212(98.15%) patients and permanent in 4(1.85%) patents. Out of 216 patents, age group ≥65 years were 128(59.25%) and age group <65 years were 88(40.75%) patients(p:0.012324). Out of 216 patients in which voice changes were seen,165(76.39%) patients were females and 51(23.61%) patients were males(p:0.001046). Voice changes were seen in 190(88%) patients in which sub-total/total-thyroidectomies were performed and in 26(12%) patients completion-thyroidectomies were performed. Voice changes were statistically significant in which completion-thyroidectomies were performed(p:0.002102). Voice changes were seen in 205(68.56%) cases and 11(16.92%) cases which were performed by post-graduate-trainee and experienced-surgeon respectively. Voice changes were seen in 122(67.77%) cases in which orotracheal intubation was performed and in 94(51.65%) cases cervical-epidural anaesthesia was given (p:0.00281). RLN palsy was seen in 2(0.60%) cases in which sub-total/total-thyroidectomy were performed and 2(6.25%) cases in which completion-thyroidectomy was performed (p:0.003426).Conclusions: Voice changes is common after thyroid surgery but usually transient and sometimes, permanent. So, patients must be informed about the risk of voice-impairment after thyroid surgery. Present study is novel as it investigates not only laryngeal neve injury but also highlights patient age, sex, types of operation, surgeons experience and laryngeal complications during orotracheal intubation.
Outcome of traumatic head injury in unknown patients
Authors: Ahuja Ankit , Verma Siddhartha , Chaudhary Aditya Narayan 
Published: January 2018

Background: Traumatic brain injury is the most common cause of death in trauma victims accounting for about half of deaths at the accident site. Most commonly, traumatic brain injury occurs in the presence of additional injuries to other major organ systems, but it can also occur in isolation. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The objective of this study was to determine the outcome of traumatic head injury in patients admitted in the Department of Neurosurgery as unknown.Methods: All patients admitted as “unknown” to Neurosurgery department with traumatic head injury were studied retrospectively. Data was collected regarding demography, mode of injury, clinical presentation at the time of admission, management and outcome of these patients.Results: Data pertaining to 107 unknown patients were collected. Most patients were found to be males in 3rd decade of their lives with vehicular accidents as the common mode of injury. Patients presenting with Glasgow coma scale (GCS) score <8 at the time of admission had poor outcome and associated with higher mortality. Intra-cranial hemorrhage were predominantly found on CT scan. Only one-third of the patients were discharged after treatment while half of them suffered untimely death.Conclusions: Outcome of these neglected patients is poorer in comparison to patients who are accompanied by their relatives. Their management from pre-hospital to treatment and discharge from hospital is fraught with challenges. They need special care from trained nursing staff as well as help from social workers for recovery and rehabilitation.
Low dose computed tomography KUB region for management of urolithiasis in Indian scenario
Authors: Sharma Satyadeo , Chaudhari Rajeev , Rawal Krutik , Khant Shahil 
Published: January 2018

Background: The incidence, prevalence and recurrence of urolithiasis are very high; especially in the north-western part of India. Ultrasonography has decreased sensitivity and specificity as compared with NCCT for detection of both renal and ureteral calculi. Drawbacks of NCCT in terms of radiation exposure, cost and repeatability can be overcome by Low dose NCCT protocols. Low dose NCCT can be an investigation with high diagnostic accuracy, less radiation hazards and financial acceptability. Aim of this study was to evaluate use of Low dose CT-KUB over ultrasound (US) for diagnosis of urolithiasis, in Indian scenario.Methods: This is a prospective study, at Tertiary Care Hospital. Patients with acute flank pain, who underwent both US and Low dose NCCT within an interval of 24 hours, at Tertiary Care Hospital. Helical CT scanner (Phillips 128 slice medical systems) with exposure factors setting of KVp 120 and mAs 70 was used.Results: A total of 136 Patients with mean age of 33.01 years (range 19-62 years, SD 10.93), were examined with 82(60.29%) males and 54(39.7%) females, average BMI was 25.07(range 17.2 to 35.02). Low Dose NCCT has a sensitivity of 95% (CI of 89.43-98.14%) and specificity of 87.50% (95% CI of 61.65-98.45%) in the diagnosis of urolithiasis. Mean effective dose of radiation administered in low dose CT-KUB was 1.8-2.2 mSv.Conclusions: In view of information, reliability, repeatability, radiation exposure and cost acceptability; unenhanced Low dose CT-KUB region should be the preferred investigation for the management of urolithiasis, in the scenario of a developing country.
Laparoscopic cholecystectomy in anemia patients: a retrospective cohort study
Authors: Al-Mulhim Abdulrahman Saleh 
Published: January 2018

Background: Preoperative anemia is associated with adverse outcomes after surgery, but no evidence study demonstrates this risk after laparoscopic cholecystectomy. This study aimed to measure the prevalence of preoperative anemia, and to assess its effect on early clinical outcome in laparoscopic cholecystectomy patients.Methods: Data of 6342 consecutive laparoscopic cholecystectomy patients between Januarys 1995 to January 2015 were evaluated. Preoperative anemia was defined as a hemoglobin level of less than 120gm/l in female, and less than 130gm/l in male. Logistic regression used for analysis.Results: Preoperative anemia identified in 37.4% of laparoscopic cholecystectomy patients and it more prevalence in women. Analysis showed that patients with severe [odds ratio1.83 (95% Confidence interval 1.62-3.66)], moderate [odds ratio 1.21 (95% Confidence interval 1.11-1.38)], and mild [odds ratio 1.04 (95% Confidence interval 0.91-1.13)] anemia had higher morbidity than those with normal preoperative hemoglobin.Conclusions: Anemia is common among laparoscopic cholecystectomy patients, and it is associated with more complications.
Transperitoneal laparoscopic pyeloplasty: a single center experience of 28 cases
Authors: Chaudhary Ranjit , Dausage Chirag Shanti 
Published: January 2018

Background: To evaluate prospectively the results obtained in 28 patients undergoing laparoscopic pyeloplasty through transperitoneal access.Methods: From January 2014 to June 2016, twenty-eight patients between 12 and 55 years old underwent laparoscopic pyeloplasty for primary ureteropelvic junction (UPJ) obstruction via a transperitoneal approach. Eighteen cases had the obstruction on the left side and the other ten on the right side. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function. Anderson-Hynes dismembered pyeloplasty was performed in 25 patients and Fenger technique in the other 3 cases. Three patients had non-obstructing renal stones and underwent concomitant pyelolithotomy. Patients were evaluated clinically and by imaging in the postoperative period at 3 and 6 months and then followed-up annually.Results: The operative time ranged from 190 to 330 min. The average blood loss was 70 mL. Analgesic requirements were also minimal with patients requiring PCA for an average of 1.1 days. Average days to free fluids were 1.5 days. The mean hospital stay was 3.76 days. The time to return to normal activities ranged from 7 to 12 days. Crossing vessels were identified in 16 patients, intrinsic stenosis in 14 patients and 5 patients had high implantation of the ureter. There were no conversions to open. One patient had longer urinary fistula (9 days), 2 patients had prolonged ileus and 3 patients had port site infection. The follow up ranged from 6 to 72 months. From the later postoperative complications, 2 patients had re-stenosis. The success rate was 92.85%.Conclusions: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.
Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study
Authors: Toro Mohna M. , John Sheetal , Faruqui Atiya R. 
Published: January 2018

Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.