New Indian Journal of Surgery

 Single system ectopic ureters are rare and bilateral single system ectopic ureters (BSSEU) are even rarer. Common locations of openings of such ureters include vagina and vestibule in the females, and posterior urethra and seminal vesicles in the males. BSSEU opening into a vaginalized urogenital sinus with absence of urinary bladder is an extremely rare occurrence. Such a case is being reported and its management is discussed briefly.

 Background: Fournier’s gangrene is a potentiallyfatal acute, necrotizing fascitis of the scrotum andperineal region associated with a synergistic bacterialinfection of the subcutaneous fat and superficialfascia with a mortality rates ranging from 20-30%.Aims and objectives: The study was carried out withthe objective to assess the role of Fournier’s gangreneseverity index (FGSI) as a predictor of outcome inpatients with Fournier’s gangrene. Materials andMethods: A prospective study was carried out on 54consecutive male Fournier’s gangrene cases. The datawas collected in the Department of Surgery,Vardhman Mahavir Medical College, SafdarjangHospital. All patients were treated with broadspectrum antibiotics and serial surgical debridements.Results: Age of the patients varied from 27 yrs to 62yrs with the mean duration of stay being 19.6 days.Mortality rate observed in our study was 17(31.5%)out of the 54. 38.9%(21) of the cases were diabetic and51.9%(28) were alcoholics. 22(40.7%) cases had nosignificant history before the development of thedisease, whereas 32(59.3%) had some predisposingcondition prior to onset of gangrene. Majority of our patients 24(44.4%) had a polymicrobial infection with Pseudomonas aeruginosa 11(20.4%) being the next most common organism. The Fournier’s gangrene severity index score in the survivors (n=37) varied from a score of 1 to 7 compared to the non survivors in whom it was more than 7. All 17 cases who succumbed to the disease had an average Fournier’s gangrene severity index score of 9.4 (Range: 8-18) at the time of admission. The average FGSI score in the survivors was 3.8 (Range 0-7). Conclusions: Fournier’s gangrene still persists in our country and is a lethal condition, if not treated early and energetically. Diabetics are more susceptible to developing the disease and more often than not there is a definite predisposing factor before the onset of disease. Most of the cases have poly-microbial infection and some secondarily get infected by hospital acquired organisms. Fournier’s gangrene severity index is a simplified way of comparing patients with the disease and also has significance in predicting outcome and guiding management.

 Cervical lymphodenopathy is a common clinical condition. A study was conducted to evaluate the incidence in HIV patients. 54% of the cervical lymphodenopathy was due to Kochs lesion. 11% of the Koch’s lymphaadenitis patients were found to be HIV positive.

 An observational to study and analyze the Age and sex distribution, Types, Etiology, Co-morbid factors, Microbiology, Treatment modalities Outcome and follow up of various leg and foot ulcers. Peripheral neuropathy, peripheral vascular diseases are the significant contributing factors in diabetic ulcers. All Malignant ulcers are treated in a multimodality approach like surgery, radiotherapy. Amputations can be prevented by health education and proper care.

 Objective: Our objective was to assess the clinical outcomes (benefits and drawbacks) and change in level of inflammatory parameter IL-6 in patients undergoing single incision laparoscopic cholecystectomy and comparison with classical four port laparoscopic cholecystectomy. Methods: Between September 2013 to July 2015 a prospective randomised study was conducted. Sixty patients were included in the study and they underwent elective gall bladder removal by applying the laparoscopic technique. All the patients were divided into two groups. Single incision laparoscopic cholecystectomy (group I) and four port laparoscopic cholecystectomy (group II). Outcome Measures included operative time, pain intensity post operatively and consumption of pain killers, hospital stay, need for conversion, complications, cosmetic effects and change in the level of serum Interleukin-6 post operatively as an inflammatory marker. Results: Mean operating time in group I was 71 min and group II 39 min. Intensity of pain evaluated by using the VAS at 8 hours after surgery in group I was 6.5 and in group II 6.5, whereas after 7 days in group I it was 2.7 and in group II 3.6. The pain killer requirement in group I was smaller than group II. Mean hospital stay after the operation in group I was 2.2 days and in group II 2.0 days. There were 2 conversions in group I and 1 in group II. Cosmesis evaluated by a 0 to 10 scoring system which showed better cosmesis in group I patients. Change in the serum level of IL-6 post operatively was more in case of multiport laparoscopic choecystectomy than single incision laparoscopic cholecystectomy. Conclusion: Single incision laparoscopic cholecystectomy is a safe and feasible procedure which has a better cosmesis and faster recovery.

 Purpose: Congenital short colon (CSC) is an unusual abnormality in which a pouch like dilatation of a shortened colon is associated with ano-rectal malformation (ARM). The clinical features and anatomical features are very well described in the literature but the management remains difficult and controversial. The present paper aims to study the effectiveness of window colostomy (WC) as preliminary diversion procedure in the management of congenital short colon (CSC). Methods: All patients of CSC admitted to our department during a period of 10 years, in whom the WC was performed have formed the basis of this study. Out of total 137 patients admitted with CSC, window colostomy was done in 125 patients. These patients were retrospectively studied and the data sheets were analyzed regarding complications related to WC and the management offered. 5 patients expired before the procedure was undertaken, and transverse colostomy was done in 7 cases of incomplete CSC. Results: Eighty six patients were followed-up after WC and underwent all stages of management (WC followed by coloplasty and ileostomy and ileostomy closure in last stage).The procedure was associated with some distressing complications. Stenosis of the window colostomy needing dilatation was seen in 22 patients. 19 patients had minor prolapse of the pouch, while 6 of the patients had significant amount of prolapsed pouch needing revision procedures.18 patients had significant periostomy excoriation. The overall mortality related to the procedure was 11%. Conclusion: The formation of an initial window colostomy in the cases of CSC, may lead to incomplete fecal diversion, and the pouch fails to decompress properly. There are also complications associated with the stoma itself. However the procedure is short, easy to perform, and is life-saving and provides adequate time period to allow weight gain and be fit for second stage surgery. It eventually does not affect the final outcome in these patients with congenital short colon.

 Aim: To find out the correlation of Clinical Diagnosis and Investigative Techniques, to determine the diagnostic accuracy of Clinical diagnosis, ultrasonography and fine needle aspiration cytology (FNAC) in lymphadenopathy using histopathologic examination of the excised lymph node as gold standard. Study: Cross sectional study. Department of Surgery along with Department of Pathology and Department of Radiodiagnostics at Acharya Vinobha Bhave Rural Hospital (AVBRH) attached to Jawaharlal Nehru Medical College (JNMC) which come under Datta Meghe Institute of Medical Sciences (DMIMS) Deemed University.From October 2013 to October 2015. Material and Methods: A total of 102 patients suffering from lymphadenopathy were selected. After taking informed consent,the patients were then subject to Ultrasonography and FNAC. Thereafter the same lymph node was removed under local anesthesia for histopathology. All Specimens were sent separately to Cytology and Histopathology units at. Data was analyzed using SPSS version 10. Result: 102 patients with a mean age of 35.87 (±17.33) years was sampled, Commonest age group was 41-50 years. the neck was the most common site of lymphadenopathy. The most common cause found for lymphadenopathy was reactive lymphadenopathy followed by tubercular lymphadenitis. clinically size of the lymph node more than 2 cm, duration of more than 2 weeks, consistency and matting were indicators for a neoplastic aetiology. onsonological examination, Longitudinal to transverse ratio, internal echoes and presence of hilum were important finding on ultrasonography to reach at a specific diagnosis. In our study we found that FNAC had a high Specificity (100%) and positive predictive (100%) value in diagnosing secondary metastatic conditions and lymphomas. However in diagnosis of Tubercular lymphadenitis the specificity of FNAC was 81.82% . Conclusion: Clinical evaluation of the patient is imperative. Ultrasonography proves to be an important investigative tool that aids in the diagnostic accuracy. Ultrasonography is also important where extent and severity of the disease needs to be identified. FNAC has a high sensitivity and specificity for diagnosis of malignant condition and is useful in those conditions where tissuediagnosis is not required. Where diagnosis is questionable, early excisional biopsy is recommended.

 Warfarin-Induced Skin Necrosis (WISN) is severe complication of oral anticoagulant therapy. Incidence is 0.01 to 0.1 percent of Warfarin-treated patients. Other cause hereditarydeficiency of protein C. patients with rapid loading of Warfarin and thrombophilic diseases is at high risk. Early recognition and prompt intervention of the condition is very important as anticoagulation is being used for major illness. Various theories of pathogenesis have been described. Skin necrosis represents as acomplicated and recalcitrant to conservative treatment. Since patient is not hemodynamically stable major surgery also cannot be done. Hence the condition remains a major diagnostic and therapeutic challenge for surgeon. We present a severe case of WISN of bilateral thigh which was managed with a minimal invasive bed side under local anesthesia by External Tissue Expansion Wound Contraction (ETEWC) and wound healed completely in short period of time.