New Indian Journal of Surgery

Lysol is a commercially available product commonly used for cleaning and disinfectant purposes. Although in lower concentrations they may not causing ill effects on human being. In higher concentrations or in undiluted forms they will produce adverse health effects. Lysol induced skin burns are not commonly described in literature and no specific management protocols have been described. Here we are sharing our experience on Lysol burns and its management.

Keywords: Lysol; Chemical Burn.

 

Morphological variations of liver are considered to be rare. Presence of such variations can have a clinical presentation involving the liver or the adjacent viscera. Accessory fissures and grooves of the liver can be either congenital or acquired. We present a case of Corset liver, a rare acquired malformation with transverse fissures and multiple grooves. Such variations should be kept in mind by surgeons and radiologists when evaluating patients of Hepaticpathology.

Keywords: Accessory Fissures; Corset Liver; Corset Constriction.

 

Objectives: To study varied presentation and managing penile carcinoma in a medical college and teaching hospital.

Materials and methods: A retrospective study was carried out in teaching hospital from the period of Jan2015 till Dec 2017. Five patients of carcinoma penis were found. The varied presentation, clinical feature and management of penile carcinoma cases was studied with follow up.

Result: A total of five patients studied over a period of two years. All the patients of penile carcinoma were in 6thand 7thdecade. On clinical examination one patient had lesion over prepucial skin, two had on glans, one lesion on the shaft penis and one had on the inguinal region. All cases were squamous cell carcinoma except one which was primary mucinous adenocarcinoma. All patients underwent surgical treatment and follow up.

Conclusions: Carcinoma of penis is rare disease. Clinical suspicion of malignancy, good clinical and histopathological examination with patient education will be the key to detect early, treat effectively and prevent morbidity.

Keywords: Carcinoma Penis; Squamous Carcinoma Cell; Glans Penis.

 

Acute pancreatitis (AP) is an inflammatory condition of the pancreas with a clinical course hat varies from mild to severe, leading to activation of pancreatic enzyme and causing selfdigestion of the pancreas. The overall mortality rate of AP is 2–5%, but the mortality of severe  acute pancreatitis (SAP) may range upto 20–30%. So it is important to assess the disease severity in a timely and accurate manner There are variety of score systems such as Ransom’s criteria[1], Acute Physiology and Chronic Health Evaluation (APACHE) II [2] and Computed Tomography Severity Index (CTSI). But these systems have their own distinct pros and cons. A new mortality based prognostic scoring system for use in acute pancreatitis has been derived and validated which was named the Bedside Index of Severity in Acute Pancreatitis (BISAP). The 5­point BISAP score system incorporates the variables: Blood urea  nitrogen level >25 mg/dl, Impaired mental status, Systemic inflammatory response syndrome (SIRS), and age > 60years, and presence of pleural  effusion. Thus the BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24h of presentation. 

Keywords: Acute pancreatitis; BISAPS Score; Ransons criteria; Systemic inflammatory response syndrome (SIRS) 

Introduction: Till recently Milligan – Morgan haemorrhoidectomy i.e. conventional or open haemorrhoidectomy is the most popular surgical treatment for haemorrhoids. With the advent of minimal invasive surgery, the scenario has changed. More recently, stapler haemorrhoidectomy is becoming popular as a day care procedure with minimal postoperative pain and early return to work.

Aim: The present study is designed to compare make a comparative assessment of the Stapled haemorrhoidectomy against Conventional haemorrhoidectomy in the surgical treatment of haemorrhoids.

Material and Methods: A hospital based Non­randomised comparative study was conducted in Dept. of Surgery of at a tertiary care hospital. A total of 50 eligible cases scheduled for haemorrhoidectomy in our hospital were included in the study. These 50 patients were then divided into two groups i.e. 25 for stapled procedure and other 25 patients for conventional procedure.

Results: Mean operative time was significantly less in stapler group (39.12 vs 45.75 mins; p<0.01) while mean hospital stay was significantly longer in conventional surgery group (7.02 vs 3.01 days; p<0.01). Post­op complain of pain, immediately after surgery (6 hrs.) and at day 1 and day 3 was significantly less in stapler group (p<0.01). Postop complications after conventional surgery include bleeding (28%), urinary retention (12%), wound infection, anal incontinence (8% each) and anal stenosis  (4%). Complications of stapler surgery include bleeding (16%) and urinary retention (4%). Mean time for return  to work was significantly less in stapler group as compared to conventional surgery group (4.91 vs 13.8 days; p<0.01).

Conclusion: Stapler haemorrhoidectomy requires less operative time, reduces hospital stay and decreases post­operative pain. Return to normal activity is also significantly faster with stapler surgery. 

Keywords: Conventional Haemorrhoidectomy; Haemorrhoids; Stapler Haemorrhoidectomy; Postoperative Pain; Return to Work.

 

Profound pain and anxiety is associated with burn management. This study outlines our experience with using music as a therapy to assist the patient in managing the pain and anxiety along with the usual pharmacological adjuncts. This descriptive prospective study was performed from Jan 2017 to March 2017 on eight patients admitted in JIPMER Tertiary Burns Care Center. The study group was defined and analyzedfirst without music therapy and then with the same. The parameters assessed were the pulse rate and blood pressure after the dressing change with and without music therapy, standard self­report scales for pain and a tension rating form for anxiety. There was a definite benefit of music therapy noted and a larger randomized control trial is needed to validate the same. Music is a valuable, inexpensive and efficacious modality for burn wound care.

Keywords: Music Therapy; Burns; Pain Management.

 

“Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized, and may result from infection (often due to rupture of a hollow abdominal organ as may occur in abdominal trauma or inflamed appendix) or from a non­infectious process.”Early prognostic evaluation of patients with peritonitis is desirable to select high­risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. This study attempts to evaluate the use of scoring Mannheim Peritonitis Index (MPI) in patients with  peritonitis. This prospective study was conducted between July 2016 to September 2017 on patients with abdominal pain admitted to S.B.K.S.& M.I.RC. Dhiraj Hospital Piparia Vadodara.

Keywords: Peritonitis; Mannheim Peritonitis Index.

Background and Aim: Outcome of Colonoscopic Sclerotherapy in the management of active internal haemorrhoidal Bleeding. Aim of the present study was to investigate the outcome of Colonoscopic Sclerotherapy in the management of active internal haemorrhoidal bleeding.

Methods: A prospective study (2014­2017) was conducted in the Department of Surgery, at P.D.U medical college & Vedant hospital Rajkot on 100 adult patients with internal haemorrhoids, irrespective of their gender were selected by non­probability convenient sampling from general surgical OPD, casualty and wards. To grade internal haemorrhoids, Goligher’s classification system was used. After adequate bowel preparation sclerosant (1.5% polidocanol) 0.5­1 ml was injected into the each haemorrhoid with endoscopic injection catheter with 23­gauge under direct vision.

Results: Out of 100 adult patients 76 were males and 24 were females. In the present study the mean age was 50± 12.32 years. Majority of the patient’s age fell in the range of 35­55 years. The duration of symptoms was ranging 3 months to 2­3 years. Majority of patients of both grades I (91.8%) and II (84.6%) responded well to single session of Colonoscopic Sclerotherapy. Out of 100 patients only 24 patients required more than one session of Sclerotherapy. Out of 100 patients 36 (36%) patient complained for bloating sensation due to insufflation of air into rectum. 17 (17%) patients had mild rectal pain. Rebleeding was seen in 14 (14%) patients. None of the patient presented with rectal or perianal abscess, urinary retention, portal pyaemia or septicaemia.

Conclusion: Compare conventional to anoscope or rigid proctoscope, flexible video endoscope provides precise endoscopic vision and better manoeuvrability. Hence, minimal complications and excellent results. Can be performed outdoor patient basis. Any physician with reasonable of endoscopy knowledge can perform. Colonoscopic Sclerotherapy is safe, well tolerated and effective modality for management of bleeding internal hemorrhoids with minimal complications. 

Keywords: Colonoscopic; Sclerotherapy; Internal Haemorrhoidal Bleeding.

 

Introduction: Management of breast diseases is a multidisciplinary endeavor dependent on skill and expertise of an array of clinical specialists. Study evaluates efficacy of the individual components of triple test in diagnosis of palpable breast lesions.

Materials  and Methods: Present study was a hospital based prospective study done over a period of 2 years and included 100 female patients with palpable breast lesions in a tertiary care hospital at Telangana. Detailed clinical history and physical examination was done, followed by mammography, fine needle aspiration cytology. The histopathological report was considered the reference standard.

Results: Triple test is the combination of clinical examination, mammography and fine needle aspiration cytology. If all the 3 tests were benign then triple test was concluded as benign, and if all 3 tests were malignant then it was concluded as malignant. Triple test revealed 97.29% sensitivity and 98.41% specificity, with 1 false positive and false negative each. Triple test was scored as concordant if all the 3 tests, had either all malignant or all benign results. Triple test was scored as nonconcordant if all the 3 tests had neither all malignant nor all benign results. Triple test was concordant in 82 (82%) cases.

Conclusion: Triple Test is a powerful clinical tool that is, easy to perform, minimally invasive, and provides rapid, cost­effective, reliable, and accurate diagnosis of breast malignancies. Triple Test Score is safe and efficacious for establishing diagnosis and managing the ever­increasing number of patients presenting with breast masses. 

Keywords: Clinical Breast Examination; Mammography; Fine Needle Aspiration Cytology; Triple Test; Triple Test Score. 

 

Sepsis is a complication of severe infection. It is characterised by a systemic inflammatory response to severe trauma. It is a potent cause of systemic number of road traffic accidents occurring. Such patients of road traffic accidents require long term hospital care and are at high risk of developing sepsis. Recent data has stated that 18 million of new sepsis cases occur every year worldwide. The aim of this study is to determine the levels of procalcitonin in trauma patients, with sepsis and evaluate the role of procalcitonin in patients of sepsis. Also, whether it can be used as a diagnostic marker in patients of trauma with sepsis.

Keywords: Septic Patients; Procalcitonin

 

Introduction: Volvulus is the abnormal twisting or rotation of a portion of the bowel about its mesenteric axis. This may cause occlusion of the lumen at each end of the segment with resultant obstruction and vascular compromise.

Aim of the study: The aim is to study various modes of presentations of Sigmoid Volvulus and various modalities of management in Gandhi Hospital.

Materials and Methods: Total of 20 cases of sigmoid volvulus, which presented to
emergency department, Gandhi General Hospital were studied, in a period of two and half years from August 2012 to November 2014. Abdomen was taken and in few patients, in whom, sigmoid volvulus could be diagnosed pre­operatively, conservative measures were attempted, by passing flatus tube and /or S/W enema, after excluding strangulation or gangrene clinically as emergency sigmoidoscopy is not available, conservative measures were not successful. In all the cases, intra abdominal findings during surgery were noted. Subsequently to the procedure, they were placed in postoperative ward. All post operative complications were noted and dealt appropriately.

Results and Conclusion: Sigmoid volvulus is common in old age group i.e., 5th & 6th decades. Almost equal incidence in both sexes with slight preponderance in males with male to female ratio 1.2:1. In 60% of the patients the predisposing cause is long mesosigmoid with long dilated and redundant sigmoid colon. Gangrene is common (25% of cases) and is not related to duration of symptoms. Gangrene is  common in elderly compared to young patients. Conservative measures failed to relieve obstruction even temporarily in non­gangrenous sigmoid colon. (Emergency sigmoidoscopy is not available.) Fixation of sigmoid colon in the form of sigmoidopexy is associated with high recurrence rate (50%).  Unless general condition precludes, fixation of sigmoid colon should not be done as it is associated with high recurrence rate and it should be followed by elective sigmoid resection. In non­gangrenous sigmoid volvulus, resection and EEA is the best option. In selected group of patients where condition of the colon permits primary anastamosis can be done.

Keywords: Sigmoid Volvulus; Surgery.

 

Introduction: Surgery for Inguinal hernia can be performed under a variety of anaesthesia techniques such as general anaesthesia, spinal anaesthesia and epidural anaesthesia. Patient safety and the provision  of optimal operating conditions for the surgeon are  the main criteria for the selection of anaesthesia technique [1].

Aims & objectives: To compare the results of Lichtenstein inguinal hernia tension free mesh repair operated under Propofol, Total Intravenous Anaesthesia (TIVA) + Local Infiltration with those operated under Regional Anaesthesia (Spinal/ Epidural) in terms of various parameters.  

Methodology: Prospective comparartive study of 52 patients for hernia repair by Lichtenstiens technique under regional anaesthesia (groupI) versus total intravenous anaesthesia+local anaesthesia (group  II).

Results: Hernia predominantly occurred in age group of 41­ 51 years, inguinal swelling as chief complaint with similar variation in pulse rate, respiratory rate before surgery and systolic blood pressure during and after surgery in both the groups, while respiratory rates after sugery was stastifically significant. Light headedness, urinary retention was seen in group I patientswhile group II patients were able to walk early with shorter duration of hospitalization compared to group I patients. 

Conclusion: Patients operated under total intravenous aneasthesiahad several advantages over those operated under regional anaesthesia like ­ less postoperative pain, requiring less analgesics, no urinary retention, early ambulation, reduced incidence of nausea and spinal headache, with a shorter duration of hospitalization. 

Keywords: Lichtenstein Tension­Free Mesh Inguinal Hernia Repair; Total Intravenous Anaesthesia (TIVA); Regional Anaesthesia.

 

Background: The issues in the management of the donor site after harvesting a spilt thickness skin graft are taking care of discomfort and pain prevent sepsis, and promote primary healing with minimal scarring. The purpose of this study was to compare wound healing with a collagen dressing, against that produced by a Vaseline gauze dressing.

Material & Methods: The Study was carried over a period of two years in the Department of Plastic Surgery, at tertiary care hospital at New Delhi from September 2010 to August 2012. The study population consisted of subjects requiring a split skin graft for a burn, for a raw area after trauma or local sepsis. A total of 40 patients were selected for the study. Amongst this Vaseline Gauze was used to dress the donor site of STSG in 20 patients. In the other 20 patients, Collagen dressing was used. All grafts were taken from anterior and lateral aspect of thigh. Both groups were compared for following parameters pain, soakage and epithialization.

Result: The data was analyzed by matched pair analysis to calculate statistical significance of the observations. For each observation Chi­Square and p value was calculated. Following are the results for each observation:

Pain: ChiSquare was 33.02 and P value was 0.001, Soakage on 7th day: Chi­Square result was 29.03 and P value was 0.048, Epithlialization on 14th Day: Chi­Square result was 27.03 and P value.>0.676.

Conclusion: At the end of 24 hours 70% of collagen group were graded as low pain, while in the Vaseline group only 15% fell into group. This was a significant difference (p=0.001). The soakage under collagen dressing was significantly less (p=0.048). There was no statistical significant difference between the two dressing in terms of epithelization. (p =0.676).

Keywords: Collagen Dressing; Vaseline Group.

 

Background: Trauma is the leading cause of death in children in developed countries. In developing countries accidents are shown to be as numerous as in developed countries and it remains the major cause of blunt abdominal trauma in children. It is irony that thousands of children saved from nutritional and infectious diseases were killed or maimed by injuries. The management of these unfortunate children remains a challenge in developing countries where the advanced facilities and expertise are localized to only few centers, catering a vast population. The present study shares  our experience in managing children with blunt abdominal trauma. Causes of blunt abdominal trauma in children, their mode of presentation and subsequent challenges met in the management is discussed. 

Materials and Methods: All Patients with diagnosis of blunt abdominal trauma admitted to the Department of pediatric surgery, Government Medical College, Srinagar, Kashmir, India, from June 2011 to January 2018 were retrospectively analyzed. Individual case records were analyzed regarding mode of injury; presentation, associated injuries and treatment offered were studied. The data sheets were analyzed for the investigations ordered and the operative management if offered to the patients. The postoperative recovery and complications if any were recorded.

Results: A total of 251 children with a diagnosis of blunt abdominal trauma were admitted in the study period. There were 192 (76.4%) male patients and 59 (23.5%) were females. Road traffic accident was the commonest cause of  trauma (62%) followed by fall (29%), sports (3%) and animal violence related injuries (4%). Operative management was indicated in a total of 105 patients (41%). 80 patients with signs of pneumoperitoneum. 16 patients with solid organs injury needed operative intervention, while 9 patients with bladder and urethral injuries were operated. Rests of the patients were managed conservatively. Associated non­abdominal injuries were found in 67 (26.6%) patients. The mortality in the study was 7.5%. Those who expired had delayed presentation with low general condition at the time of presentation or had associated grievous injuries. 

Conclusion: Trauma is increasing rapidly as a cause of child mortality in developing countries, both in absolute numbers and in terms of populations. Children are more prone to blunt abdominal injuries due to various social factors. Anatomic differences and variations in body habitus seen in children may account for significant internal abdominal injuries in the absence of obvious external signs. Most of the pediatric abdominal injuries can be managed conservatively.  Those who need operative intervention are those having viscus perforations or multiple organ injuries. Mortality was related to delayed presentation and associated nonabdominal grievous injuries.

Keywords: Blunt Abdominal Trauma; Children; Management; Developing Country.

 

Context: Liver abscess continues to be disease with considerable mortality in our country. Amoebic liver abscess, pyogenic and tubercular aetiologies should always be entertained in the differentials. The incidence of tubercular liver abscess (TLA) has increased in recent past due to increased incidence of predisposing factors like alcoholism, immunodeficiency, irrational usage of antibiotics, and emergence of multi drug resistant bacilli. Primary prevention by improving sanitation, health education, early diagnosis and prompt treatment may result in lowering mortality / morbidity associated with the disease. This study has tried to delineate clinical profile, risk factors and management strategies of liver abscesses.

Aims: • To determine Demographic profile, Etiology, Clinical Spectrum, laboratory investigations in cases of liver abscess • The study the efficacy of Ultrasonogy in determining the etiology. • To study the bacteriological characteristics including it’s antibiotic sensitivity. • To study the influence of alcohol, diabetics & immunocompromised diseases in incidence of Liver abscess and, • To evaluate efficacy, recurrence rate, complications, morbidity & mortality, duration of hospital stay associated with Management Strategies followed.

Settings and Design: A Prospective ClinicoPathological study with 100 patients diagnosed to have Liver Abscess and undergoing treatment in Narayana General Hospital, Nellore between October 2012 to September 2014 inclusive of a follow up period of 6 months.

Methods and Material: Inclusion criteria: • All cases of liver abscess (bacterial and parasitic0 diagnosed clinically and/or ultrasonographically. • All cases in evolving, liquified & ruptured stage with or without peritonitis Exclusion criteria: • Age <18yrs not included. • Traumatic and Past history of liver abscess Patient data collection and evaluation. Detailed history of patient was entered in proforma. Complete haemogram, LFT, PT, Ultrasound Abdomen was done on day of presentation. Patient was put on conservative line of management and followed up daily. Repeat Ultrasound / CT /MRI Abdomen & pelvis will be done immediately if patient condition does not improve/worsens or after 3­4 days as a routine. Complicated cases like ruptured liver abscess were immediately taken up for surgery. Pus was sent for gram’s stain and culture and sensitivity.

Management: Percutaneous needle aspiration was done on patients who had abscesses <5cms under ultrasound guidance. Antibiotics were given according to cultures. If abscess was > 5cms or > 200cc pig tail drainage is done under local anaesthesia. Patients were examined daily for improvement of pain, fever, anorexia, hepatomegaly. Mean Hospital Stay was recorded. Laparotomy was done in cases of ruptured abscess with peritonitis. Relapses were noted and repeat aspirations were performed when necessary. Follow up of patients: Patients were followed up, monthly for first 3 months, then once after 6 months, for recurrent attacks or development of complications and to monitor the efficacy of the treatment given. Cure was defined as improvement clinically with subsidence of fever, and local signs, symptoms, decrease in WBC count and follow­up ultrasonography showed reduction in size < 3 cm in diameter and no evidence of relapses. Statistical analysis used: The Statistical software namely SPSS 15.0, used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc.

Results: The highest incidence occurred in the age group 31­60 years (71%) with mean age of 46 years. Males (89%) were more commonly affected. Pain abdomen and Fever were most consistently occurring symptom in 100%, 94% respectively. Diarrhoea, cough, hepatomegaly, Jaundice and shock, pleural effusion, basal consolidation was other modes of presentation. Alcohol was the single most consistent etiological factor in all patients of liver abscess. Leucocytosis, anaemia, diabetis, altered RFT and LFT, Prolonged PT, were the most common abnormal lab findings. 44 cases had amoebic liver abscess and 30 had pyogenic abscess. E.coli, Klebsiella, Staph were the most common organism isolated in pyogenic liver abscess. Ultrasonography revealed solitary abscess in 70.0% and multiple abscesses in 30.0%. Isolated right lobe abscess was seen in 66.0% and left lobe abscess in 04%. Cases of multiple small and solitary abscesses were managed conservatively. 26 cases had recurrence. 30 were subjected to percutaneous aspiration, 32 cases underwent Pig Tail Catheter Drainage, 12 required Laparotomy and Drainage along with (3%) ICD insertion for rupture into pleural cavity. Patients were followed up. Recurrences were noted in 8 cases in Conservative & aspiration management group. Out of 30 cases 25 cases underwent single aspiration, 4 cases underwent twice aspiration and 1 case underwent thrice aspiration. Cryptogenic was the most common aetiology in Amoebic liver abscess (97.1%) and Pyogenic liver abscess (73.3%). Peritoneal rupture (21.0%) was the most common complication associated with Liver abscess. In this study 3 cases were positive for HIV serology. Mortality occurred in 6 cases in our study.

Conclusions: Liver abscess is a very common condition in India. India has 2nd highest incidence of liver abscess in world. Liver abscesses occurred most commonly between 30­60 years males. Pain abdomen, fever are consistently occurring symptom. Alcohol consumption was the single most important etiological factor for causation of liver abscesses. Alkaline phosphatase is the most consistently elevated among all Liver Function Tests. Raised WBC count, Alkaline phosphatise level, Diabetes, Hypoalbuminaemia, Prolonged Prothrombin time were considered as the predictive factors of complicated (Ruptured) liver abscess in this study. Diabetes mellitus was more frequently associated condition in cases of liver abscess and especially Pyogenic liver abscess cases. Liver abscess usually present as a solitary abscess most commonly in the right lobe of liver. Enterococcus was the most common organism isolated in pyogenic liver abscess. Patient management depends on number and size of abscess. Cryptogenic was the most common aetiology in Amoebic liver abscess as well as in Pyogenic liver abscess. Peritoneal rupture was the most common complication associated with Liver abscess. Mortality was seen in 6 cases in this study.

Keywords: Liver Abscess; Pyogenic Abscess; Amoebic Liver Abscess; Crytogenic Abscess.


 

Objective of the study: 1. To study the clinical profile [mode of presentations– ulcer, gangrene, callosity, cellulitis] of diabetic foot. 2. To study the morbidity profile [limb salvage surgery, amputations] of diabetic foot. 3. To study the microbiological profile [type of organisms], antibiotic sensitivity and correlate it with prognosis.

Materials and Methods: Study includes patients admitted in surgery department M.V.J Medical College & Research Hospital, Hoskote, Bangalore for diabetic foot. A total of 100 patients studied who had diabetic foot were studied. The study period was from january 2015 to July 2016.

Conclusion: Based on the results of our study, it can be concluded that diabetic foot inVarious forms accounts for significant morbidity in the surgical wards. The factors Contributing mainly are poor glycemic control at the time of admission, presence of gangrene, associated risk factors like smoking, alcohol consumption and associated comorbidities (anemia, peripheral vascular disease, Hypertension, Ischemic disease). Diabetic foot infections are more prone for recurrence so preventive measures like diabetic control, foot care is needed. Multidisciplinary approach is needed in the control of diabetic foot infections and its complications. 

Keywords: Clinical Profile of Diabetic Foot; Microbiological Profile.

 

Aim: To study the prevalence and bacteriological profile of multi­drug resistant organism (MDRO) infection in diabetic foot ulcers.

Methods: 150 Diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analysed, in detail, for each patient. The multi­drug resistant organisms (MDRO) were identified, using internationally accepted criteria.

Results: 153 MDROs were isolated, out of a total of 279 organisms (54.8%). These were isolated from 99 out of 150 patients (66%). The commonest MDRO isolated was Escherechia coli, followed by Pseudomonas aeruginosa.

Conclusion: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers.

Keywords: Diabetic Foot Ulcer; Multi­Drug Resistant Organisms (MDRO).

 

Introduction: Diabetes Mellitus is a heterogeneous primary disorder of carbohydrate metabolism with multiple etiologic factors that generally involve absolute or relative insulin deficiency or insulin resistance or both leading to hyperglycemia and various long term complications. The glycated hemoglobin (HbA1C) level, defined as the ratio between HbA1C concentration and total Hb concentration, is considered to be a very useful diagnostic marker for diabetic patient in addition to the measurement of the glucose level and has important relation with the healing process.

Objective: To find association between HbA1c and diabetic wounds healing rate & decrease Hospital stay in diabetic patients with wounds.

Methods: Participants  were selected from the patients of Sir. T hospital and single baseline measurement of HbA1c using clinically relevant cut­points of <7.0%, 7.0–8.0%, and  8.0% We determined the location and area of wounds in diabetic patients both at baseline and a second visit a median of 1 month later.

Results: Among 50 cases studied, percentage of male patients was higher than that of female patients in each age group.In this study Maximum no. of patients (90%) have healing of ulcers, having a range of HbA1c between 7­10%.

Conclusion: Lower extremity ulcers are frequent occurance in individuals with diabetes significantly affecting quality  of life.HbA1c levels have effects not only on chances of healing but also the rate at which the ulcer heals.

Kewwords: HBA1C; Ulcer.

 

The most common cause of Peptic ulcer perforation is ulcer disease. In a perforation (1) which appears to have sealed itself already, as shown by diminished pain and improved abdominal signs. (2) Heart or lung disease, which increases the surgical and anaesthetic risks. (3) The patient who is admitted after a day or two and is almost moribund with diffuse peritonitis, non­operative treatment may be best. We undertook a prospective study in the Department of General Surgery at PESIMSR, Kuppam in the period between September 2017 to May 2018 over a period of 9 months with a study population of 20 patients, to evaluate the results and to assess the feasibility of a non­operative treatment for sealed off perforated peptic ulcers.  All were treated conservatively with Herman-Taylor regime i.e, NPO, RT drainage, IV Fluids, IV antibiotics (Changed as per peritoneal tap culture), PPIs and Parenteral nutrition. Flank drains were placed if necessary. Once allowed orally after few days (>48hrs) patients were started on HP kit (for 14 days), multivitamins, high protein diet and good hydration. All 20 patients successfully recovered and thus we conclude the importance of conservative management in sealed off peptic ulcer perforations and thus reducing the mortality, morbidity and monetary burden associated with surgical management.

Keywords: Ulcer; Peptic ulcer; Perforations.

 

Background: Congenital Paraesophageal Hernia (CPH), though rare in the pediatric age group, can cause significant respiratory and gastrointestinal symptoms ranging from repeated attacks of chest infection and vomiting to serious complications like intrathoracic gastric volvulus. Our experience with five such cases over five years is presented in this study.

Material and Methods: Five children (4 males:1 female) were diagnosed and managed in our department as congenital paraesophageal hernia from January 2013 through December 2017. The characteristics recorded included age at presentation, sex, duration of symptoms, investigation, associated anomalies, operative procedures, side and size of hernia were recorded from the operative notes. Follow up period ranged from 3 months to 4.5 years.

Results: Age at presentation ranged from 6 months to 3years (mean 1.6 years). Two patients presented with recurrent vomiting, 2 had recurrent chest infection and one baby presented with respiratory distress. Duration of symptoms ranged from one week to eight weeks (mean 3 weeks and four days). One child had associated congenital heart disease and one had right inguinal hernia. Computed Tomography in 2 and upper GI contrast in 3 patients confirmed the diagnosis. Final diagnosis was confirmed intra­operatively, with right sided defect in all the 5 cases. Repair of the crura only was done in 2 patients while as Nissen’s fundoplication and gastropexy were added in one and two patients, respectively. Herniation recurred in one case in the immediate post­operative period and was managed by redo­repair of hernia with gastropexy. All the patients were followed over a mean period of 2.5 years and are symptom free with optimal weight gain.

Conclusion: Congenital paraesophageal hernia should be strongly suspected in case of repeated chest infection or repeated attacks of vomiting or respiratory  distress. Chest x­ray followed by contrast upper GI study are simple investigations to confirm the diagnosis and computed tomography may rarely be needed. Gastropexy and/or an anti­reflux procedure, in select cases, may be added to surgical reduction of the hernia with repair of crura. 

Keywords: Paraesophageal Hernia; Hiatus; Crura; Gastric Volvulus; Diaphragm.

 

Introduction: The prevalence of Diabetic patients in India is 9% of total population [1]. The risk development of foot ulcer in diabetics during their lifetime is 25% [2]. More than 20% diabetics get operated for lower extremity amputation. The present study was aimed to study treatment of foot lesions indiabetics in patients presenting in Pravara Rural Hospital, Loni.

Materials and Methods: This prospective cross sectional study was undertaken in 50 patients carried out over a period of 2 years. Patients, irrespective of their age and gender, admitted in the inpatient department of surgery with Diabetes mellitus having foot problem and consenting for taking part in the study were included. Treatment and its outcome were recorded for all patients.

Results: Most patients present with diabetic foot lesion were in 7th decade of life. Females were more commonly affected with male to female ratio 1:1.5. Ulcer was the common lesion seen here which was present in 24 (48%) patients while abscess seen in 3 (6%) patients, was the least common lesion. Staphylococcus aureus was the commonest grown organism form the pus sample of foot lesions. On staging the patients according to Wagner staging, most of the patients belonged to stage III (23) and IV (14). Maximum patients revealed decrease in insulin requirement after control of infection. In this study 23 (46%) patients out of 50 with diabetic foot categorized with Wagner’s grade III, and Wagner stage III, IV, V had higher incidents of amputations 46% of patients with Wagner stage III had different kinds of amputations and 14 (28%) of patients with stage IV needed amputations . Patients with Wagner’s stage V needed major amputations like below knee amputations and above knee amputations, one each. Most patients 41 (82%) had recovered within four weeks however 9  patients took more than four weeks of recovery.

Conclusion: Wagner stage is an important factor determining the treatment of diabetic foot.This study also revealed that patients with diabetic foot lesion treated conservatively with higher antibiotics debridement and split skin graft might reduce chances of amputations.

Keywords: Diabetic Foot; Wagner Staging; Staphylococcus Aureus; Amputation; Debridement.

 

Introduction: Acute appendicitis is one of the commonest emergency presenting at general surgery department calling for an emergency appendectomy either by open laparotomy or laparoscopic technique is performed. Thus a rapid yet accurate diagnosis becomes important to prevent wrong procedure.

Objectives: We intend to compare the diagnostic accuracy of Modified Alvarado Score System (MASS) and ultrasound in the diagnosis of acute appendicitis at our institution in Dakshina kannada.

Materials and methods: A prospective study was conducted between October 2015 to October 2017 at our institution. 100 patients were included in the study after obtaining an informed consent. A detailed clinical examination was performed following which the clinical finding and laboratory findings including total leucocyte count and differential count were in noted in the patient’s study proforma. Patients were then subjected to ultrasound examination for appendicitis. The radiological findings were also then tabulated. Appendectomy was then performed followed by histopathological examination of the specimen for  confirmation of the diagnosis. The histopathological diagnosis of acute appendicitis was considered as positive report and using SPSS software and MEDCALC Software descriptive statistics were calculated for MASS and ultrasound.

Results: Out of 100 patients 52 were males and 48 were females. MASS and ultrasound showed sensitivity, specificity, positive predictive value and negative predictive value of 60%, 90%, 98.18%, 20%, 93.3%, 20%, 91.3%, and 25% respectively. Application of Chi­square test showed that MASS had better correlation histopathological finding with a statistically significant p value of 0.000 (< 0.005).

Conclusion: Both MASS and Ultrasound examination  have a distinct advantage and limitation when used independently. But utilisation of both modalities complementarily serves as a better management strategy in acute appendicitis.

Keywords: MASS; Ultrasound; Sensitivity; Specificity; p value; Complementary Value.

 

Purpose: Our study aims to evaluate the efficacy & safety of targeted therapy (Sunitinib) for metastatic renal cell carcinoma (mRCC) in Indian population.

Methods: The hospital records of total ninety four patients were reviewed retrospectively in this study who were offered sunitinib for mRCC between 2008 to 2015. Out of ninety four patients 16 pateints (neo­adjuvant cases) were excluded and 78 were included in this study. All patients received Tyrosine kinase inhibitor, sunitinib therapy (50 mg OD, 4/2 scheme). All 39 patients underwent radical nephrectomy prior to initiation of sunitinib therapy. Patients were followed up every cycle for their clinical symptoms following sunitinib therapy and at every 3 month with chest Xray, ultrasonography and bone scan, CT scan (if required). The RECIST criterion was used to evaluate the overall tumor response.

Results: The median survival was 28.5 months (range 9.253­47.7) and progression free survival (PFS) was 9.16 months (range 6.08­12.23). Clear cell histology was found in 60 (76.9%) patients, papillary variety in 12 (15.39%) patients, chromophobe type was seen in 2 patients and rest had mixed sarcamatoid papillary and rhabdoid clear cell variety. Forty eight patients (61.5%) had multiple metastases. Most frequent metastasis was seen in lungs in 28 patients (36%) and bone in 24 patients (31%). Metastasis was also seen in draining lymph nodes, adrenal, omentum, skin, liver, brain.

Conclusion: In our study, use of sunitinib showed similar outcome to previously  published articles. Our study supports the use of sunitinib in metastatic renal cell carcinoma. 

Keywords: Metastatic Renal Cell Carcinoma; Tyrosine Kinase Inhibitor; Sunitinib.

 

Background and Objectives: Bowel perforation is most common cause of surgical emergency. Perforation of the small intestine causing peritonitis is the most common abdominal surgical emergency encountered. The objective of the study was to analyse the ClinicoPathological Relations of Small bowel perforations to better understand the condition.

Materials and Methods: This study was prospective clinico­pathological study starting from September 2015 to September 2017 carried out in Dhiraj General Hospital, Vadodara in General Surgery Department. 30 patients presenting with features of small bowel perforation were studied.

Conclusion: Perforation commonly occurs in young males. Pain, abdominal distension along with Generalised tenderness was commonly found in all. Non­specific inflammation was most common nontraumatic cause of illeal perforation after blunt abdominal trauma. Stress, smoking and NSAIDS were common risk factors involved in causation of bowel perforation

Keywords: Small Bowel; Perforation; Tuberculosis.

Aim: To find out the outcome of TEF surgery in our hospital. Material and methods: A retrospective study for 5 years was done from the records in our institution. Chi­Square test and Fisher’s exact test were used to find out the statistical significance and the P­Value <0.05 considered as significant.

Results: Total 118 cases were included into the study. Only 26 (22%) cases survived postoperatively and discharged. Babies entering into our institution during first day of life survive more compared to others (29.4% Vs 8.7% & 14.3%). Primary TEF repair babies survive more compared to EG babies (24% Vs 11.1%). Conclusion: Babies entering first day of life into our care and primary TEF repair seems to survive more compared to others.

Keywords: New Born; Outcome; Surgery; Tracheoesophageal Fistula (TEF).

 

Carcinoma of penis has been a significant world health problem especially among people of poorer socioeconomic status. It is one of the first neoplastic diseases described. Even though the exact aetiology of carcinoma of penis is not known early circumcision in Jews and Muslims may account for low incidence in them. Low socioeconomic status and non circumcision are related to higher incidence. This study was undertaken in KIMS, HUBLI during the period November 2005 to October 2006. This study was too small to establish incidence of carcinoma in general population. An epidemiological study in the general population will establish the true incidence of disease. Total 4% incidence was seen in the present study intervention. The highest incidence was observed in the age group 41­50years 33.33% it was found to be statistically significant p  0.0001 followed by 31­40 years 22.22% p0.0221, 51­60years 16.60 p  0.3283 least incidence was found in 21­30years 11.10%  p=0.1608 respectively. IQR range was 36­85 years, Youngest was in 36 yrs old and oldest was 85 years. It was commonly seen in uncircumcised population with prior history of Phimosis, chronic balanoposthitis and poor genital and sexual hygiene. The disease was also noted be common in adult life between 40­60 years. Proper education, early circumcision, better sexual and genital hygiene can prevent causation of the disease.
Keywords: Penis Carcinoma; Incidence; Uncircumcised; Disease. 

Management of Infected Diabetic wounds is fundamental in surgical practice. Diabetic ulcers have variable infective etiology and many dressing agents are used for local application. EUSOL and Acetic Acid are commonly used for slough removal over infected ulcers. Aim of the study is to determine the efficacy of EUSOL and Acetic Acid in removal of slough over Diabetic ulcers infected with Proteus, Pseudomonas and other Bacterial growth. This study was conducted in the Department of General Surgery at PES institute of medical science & research, Kuppam, Chittoor District, Andra Pradesh in the period between September 2017 to March 2018 over a study population of 30 patients. 15 patients with Pseudomonas culture positive ulcers and remaining 15 with other bacterial growth positive ulcers and dressings done with Acetic acid and EUSOL respectively and findings noted in terms of slough removal and formation of granulation tissue. By this study We recommendthe selection of suitable solution (Acetic acid for Pseudomonas and EUSOL for other bacterial growth) that helps in quick slough removal and wound healing.