Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00033.3
S. Suma, M Vikranth Suresh, M. Nikhil, P N Sreeramulu
Background Pain relief remains milestone achievement ascribed to laparoscopic cholecystectomy. Post laparoscopic cholecystectomy patient still complains of port site/incisional pain, shoulder pain and vague upper abdominal pain. A simple method of portal or incisional infiltration and intra-peritoneal spraying of a local anesthetic agent over gall bladder fossa can reduce postoperative pain. Method This study was conducted to determine whether Bupivacaine wash at gall bladder fossa and infiltration of local anesthetic at trocar sites has any effect in postoperative pain relief. This prospective study was conducted on 68 patients, where 20 ml of normal saline wash was given in group A and 20ml of 0.25% bupivacaine wash was given in group B at the gall bladder fossa and in both the groups, the same local anesthetic was infiltrated at the port sites and the outcomes was studied. Results Pulse rate and blood pressure were significantly low in group B than group A. The median pain score was significantly low in group B than group A. Also, the total number of analgesic doses used in group B was significantly less than the group A. Conclusions Instillation at gall bladder fossa and infiltration to the port sites using 0.25% bupivacaine is an effective method of postoperative pain relief after laparoscopic cholecystectomy.
{"title":"Intra-Peritoneal Bupivacaine Instillation for Post-Operative Pain Relief after Laparoscopic Cholecystectomy: A Prospective Study","authors":"S. Suma, M Vikranth Suresh, M. Nikhil, P N Sreeramulu","doi":"10.5958/2321-1024.2019.00033.3","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00033.3","url":null,"abstract":"Background \u0000Pain relief remains milestone achievement ascribed to laparoscopic cholecystectomy. Post laparoscopic cholecystectomy patient still complains of port site/incisional pain, shoulder pain and vague upper abdominal pain. A simple method of portal or incisional infiltration and intra-peritoneal spraying of a local anesthetic agent over gall bladder fossa can reduce postoperative pain. \u0000Method \u0000This study was conducted to determine whether Bupivacaine wash at gall bladder fossa and infiltration of local anesthetic at trocar sites has any effect in postoperative pain relief. This prospective study was conducted on 68 patients, where 20 ml of normal saline wash was given in group A and 20ml of 0.25% bupivacaine wash was given in group B at the gall bladder fossa and in both the groups, the same local anesthetic was infiltrated at the port sites and the outcomes was studied. \u0000Results \u0000Pulse rate and blood pressure were significantly low in group B than group A. The median pain score was significantly low in group B than group A. Also, the total number of analgesic doses used in group B was significantly less than the group A. \u0000Conclusions \u0000Instillation at gall bladder fossa and infiltration to the port sites using 0.25% bupivacaine is an effective method of postoperative pain relief after laparoscopic cholecystectomy.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133888081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00017.5
N. Verma, N. Mann, Jaspreet Kaur, S. Gill
Introduction Various methods of fixation have been advocated for the treatment of maxillofacial fractures. A new type of plating system, initially developed by Raveh et al. is locking plate/screw system. This system has various advantages over conventional non locking plating system like better stability, ease of plate adaptation, early restoration of function, internal locking system which decreases the chance of screw loosening and infection. Objectives A comparative evaluation of locking plates system versus conventional miniplates in maxillofacial fractures. Method Twenty patients presenting with maxillofacial fractures were treated with locking plates and conventional non locking plates in two years from 2014 to 2016. Ten patients were treated with locking plate system in group A and 10 patients with conventional non locking plates in group B. Patients were evaluated on clinical and radiographic parameters during three months follow up. Results Postoperative outcomes for both groups were extremely favorable with a relatively small number of complications. There was no case of postoperative wound dehiscence, infection, damage to tooth roots, plate exposure and plate removal, malunion and any other complication in both the groups. Postoperative occlusion disturbance was seen in 20% cases in both group A as well as group B in mandible fractures. In maxillary fractures postoperative occlusion disturbance was seen in one case (20%) in group B. Conclusion This study concluded that despite the significant theoretical advantages of locking system seen in biomechanical studies, no statistical significant results were found between these two systems. The postoperative outcomes for both groups were almost similar with a relatively small number of complications.
{"title":"Locking Versus Non-Locking Plate Fixation in the Management of Maxillofacial Fractures: A Prospective Comparative Study","authors":"N. Verma, N. Mann, Jaspreet Kaur, S. Gill","doi":"10.5958/2321-1024.2019.00017.5","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00017.5","url":null,"abstract":"Introduction \u0000Various methods of fixation have been advocated for the treatment of maxillofacial fractures. A new type of plating system, initially developed by Raveh et al. is locking plate/screw system. This system has various advantages over conventional non locking plating system like better stability, ease of plate adaptation, early restoration of function, internal locking system which decreases the chance of screw loosening and infection. \u0000Objectives \u0000A comparative evaluation of locking plates system versus conventional miniplates in maxillofacial fractures. \u0000Method \u0000Twenty patients presenting with maxillofacial fractures were treated with locking plates and conventional non locking plates in two years from 2014 to 2016. Ten patients were treated with locking plate system in group A and 10 patients with conventional non locking plates in group B. Patients were evaluated on clinical and radiographic parameters during three months follow up. \u0000Results \u0000Postoperative outcomes for both groups were extremely favorable with a relatively small number of complications. There was no case of postoperative wound dehiscence, infection, damage to tooth roots, plate exposure and plate removal, malunion and any other complication in both the groups. Postoperative occlusion disturbance was seen in 20% cases in both group A as well as group B in mandible fractures. In maxillary fractures postoperative occlusion disturbance was seen in one case (20%) in group B. \u0000Conclusion \u0000This study concluded that despite the significant theoretical advantages of locking system seen in biomechanical studies, no statistical significant results were found between these two systems. The postoperative outcomes for both groups were almost similar with a relatively small number of complications.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114298878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00016.3
Abhishek Gupta, S. Sharma, J. Sharma
Background This study attempted to determine the disease burden in terms of clinical profile and outcome of diabetic foot admissions at a tertiary care hospital in a developing country. Method This study was done in Department of Surgery at Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Indiresh Hospital, Dehradun. Duration of the study was 1 year. The demographic characteristic, type of foot lesion, etiology, isolated micro-organism, treatment, and outcome were reviewed. Results A total of 49 patient were diagnosed with Diabetic Foot. All patients had type 2 diabetes with no gender predominance. Majority of the patient were above age of 40 years and diabetes control was very poor. Before admission, the ulcers had already developed for 4.7 ± 2.9 weeks; however, the majority of patients were unaware of the preceding causes. More than 70% of ulcers were in Wagner gradeg3 with infection event in nearly all patients. The most common isolates from culture were Gram-negative bacteria. A total of 8 patient required lower extremity amputations (LEAs) at various level of the foot were carried out, including major LEA. Conclusions Diabetic foot problems constitute a source of morbidity, a reason for LEA surgery as well as being a cause of death among patients with diabetes mellitus
本研究试图从一个发展中国家三级医院糖尿病足入院的临床概况和结局方面确定疾病负担。方法本研究在德拉敦的Shri Guru Ram Rai医学与健康科学研究所和Shri Mahant Indiresh医院的外科进行。研究时间为1年。回顾了人口统计学特征、足部病变类型、病因、分离微生物、治疗和结果。结果49例患者确诊为糖尿病足。所有患者均为2型糖尿病，无性别优势。大多数患者年龄在40岁以上，糖尿病控制很差。入院前溃疡已发展4.7±2.9周;然而，大多数患者不知道上述原因。超过70%的溃疡为Wagner g3级，几乎所有患者都有感染事件。培养中最常见的分离物为革兰氏阴性菌。共有8例患者需要进行足部不同水平的下肢截肢(LEAs)，包括大下肢截肢。结论糖尿病足问题是糖尿病患者发病率的来源，是进行LEA手术的原因之一，也是糖尿病患者死亡的原因之一
{"title":"Clinical Profile and Outcome of Diabetic Foot in a Tertiary Care Centre","authors":"Abhishek Gupta, S. Sharma, J. Sharma","doi":"10.5958/2321-1024.2019.00016.3","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00016.3","url":null,"abstract":"Background \u0000This study attempted to determine the disease burden in terms of clinical profile and outcome of diabetic foot admissions at a tertiary care hospital in a developing country. \u0000Method \u0000This study was done in Department of Surgery at Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Indiresh Hospital, Dehradun. Duration of the study was 1 year. The demographic characteristic, type of foot lesion, etiology, isolated micro-organism, treatment, and outcome were reviewed. \u0000Results \u0000A total of 49 patient were diagnosed with Diabetic Foot. All patients had type 2 diabetes with no gender predominance. Majority of the patient were above age of 40 years and diabetes control was very poor. Before admission, the ulcers had already developed for 4.7 ± 2.9 weeks; however, the majority of patients were unaware of the preceding causes. More than 70% of ulcers were in Wagner gradeg3 with infection event in nearly all patients. The most common isolates from culture were Gram-negative bacteria. A total of 8 patient required lower extremity amputations (LEAs) at various level of the foot were carried out, including major LEA. \u0000Conclusions \u0000Diabetic foot problems constitute a source of morbidity, a reason for LEA surgery as well as being a cause of death among patients with diabetes mellitus","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114907806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00036.9
C ChandraKumarP, Venkatesh Kharalkar, B. Raghavendra
Background Secondary peritonitis presents common life-threatening conditions associated with high mortality and morbidity. Management of perforative peritonitis poses significant challenges to the treating surgeons with respect to surgical outcome thereby demanding thorough evaluation and appropriate management in such cases. Objectives To study the clinical profile, management of perforative peritonitis and its surgical outcomes. Methodology A case series study of 513 patients with Perforative Peritonitis was studied in setting of tertiary care hospital in the department of general surgery at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka during the period of June 2015 to January 2018. Among the selected patients the clinical profile, etiological profile and the surgical interventions were undertaken and the outcome were noted. Appropriate descriptive statistics were used to analyse the findings and to draw the inferences. Results There were 390 males and 123 females. The mean age of patients was 35.95 ± 24.87 years. Common cause of perforative peritonitis were acid peptic disease (35.7%), infectious disease (23%), trauma (13%) and malignancy (2.3%). Complication rate and mortality among the patients was 47.2% and 9.6% respectively. Elderly age, comorbid condition, infectious disease etiology and malignancy and site of perforation were the important determinants of mortality among the patients. Conclusion GI perforations are one of the most common surgical emergencies. Mortality depends on the age and general condition of the patient, associated pre-operative co-morbidities, site of perforation and etiology.
{"title":"A Clinical Study of Management of Perforative Peritonitis and Its Surgical Outcome","authors":"C ChandraKumarP, Venkatesh Kharalkar, B. Raghavendra","doi":"10.5958/2321-1024.2019.00036.9","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00036.9","url":null,"abstract":"Background \u0000Secondary peritonitis presents common life-threatening conditions associated with high mortality and morbidity. Management of perforative peritonitis poses significant challenges to the treating surgeons with respect to surgical outcome thereby demanding thorough evaluation and appropriate management in such cases. \u0000Objectives \u0000To study the clinical profile, management of perforative peritonitis and its surgical outcomes. \u0000Methodology \u0000A case series study of 513 patients with Perforative Peritonitis was studied in setting of tertiary care hospital in the department of general surgery at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka during the period of June 2015 to January 2018. Among the selected patients the clinical profile, etiological profile and the surgical interventions were undertaken and the outcome were noted. Appropriate descriptive statistics were used to analyse the findings and to draw the inferences. \u0000Results \u0000There were 390 males and 123 females. The mean age of patients was 35.95 ± 24.87 years. Common cause of perforative peritonitis were acid peptic disease (35.7%), infectious disease (23%), trauma (13%) and malignancy (2.3%). Complication rate and mortality among the patients was 47.2% and 9.6% respectively. Elderly age, comorbid condition, infectious disease etiology and malignancy and site of perforation were the important determinants of mortality among the patients. \u0000Conclusion \u0000GI perforations are one of the most common surgical emergencies. Mortality depends on the age and general condition of the patient, associated pre-operative co-morbidities, site of perforation and etiology.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125921564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00015.1
Abhayjeet Singh, Harsimrat Singh, Himani Singh
Background Acute otitis media (AOM) is a community-acquired respiratory tract infection in childhood frequently encountered by primary-care physicians and can cause a significant morbidity. Increasing bacterial resistance has led to concern about the current options for empirical antibiotic treatment and has prompted a search for effective treatments. Objectives To evaluate the clinical efficacy and safety of Sarclav (cefpodoxime proxetil) in the treatment of children with acute otitis media. Patients and Method A prospective, multicenter study was conducted on 1380 children aged from 1 to 13 years with AOM who were prescribed a 5–10 day course of Sarclav (cefpodoxime proxetil) (8 mg/kg/day). Patients were followed-up after 7–14 days from baseline visit. Efficacy was assessed by the percentage of patients with clinical cure, improvement or failure at the follow-up visit. Safety was evaluated by recording the occurrence and severity of any adverse events and by the physicians’ and patients’ assessment of overall tolerability. Results Clinically, 82.5% of patients were cured, 16.4% were improved and there was failure of therapy in 1.1% of the patients. The overall combined cure and improvement rate of all related signs and symptoms was 98.9%. Adverse events, diarrhea and skin rash, were reported by only 16 patients (1.2%). The overall tolerability according to the physicians’ and patients’ assessment was excellent in 93.9% and 88.9%, respectively. Compliance was attained in 99.5% of patients. Conclusion Sarclav (cefpodoxime proxetil) is an effective, safe, well-tolerated antimicrobial agent for treatment of acute otitis media in children. It can be considered as an excellent choice for the empirical treatment of bacterial AOM.
{"title":"Efficacy and Safety of Sarclav in the Treatment of Acute Otitis Media in Children","authors":"Abhayjeet Singh, Harsimrat Singh, Himani Singh","doi":"10.5958/2321-1024.2019.00015.1","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00015.1","url":null,"abstract":"Background \u0000Acute otitis media (AOM) is a community-acquired respiratory tract infection in childhood frequently encountered by primary-care physicians and can cause a significant morbidity. Increasing bacterial resistance has led to concern about the current options for empirical antibiotic treatment and has prompted a search for effective treatments. \u0000Objectives \u0000To evaluate the clinical efficacy and safety of Sarclav (cefpodoxime proxetil) in the treatment of children with acute otitis media. \u0000Patients and Method \u0000A prospective, multicenter study was conducted on 1380 children aged from 1 to 13 years with AOM who were prescribed a 5–10 day course of Sarclav (cefpodoxime proxetil) (8 mg/kg/day). Patients were followed-up after 7–14 days from baseline visit. Efficacy was assessed by the percentage of patients with clinical cure, improvement or failure at the follow-up visit. Safety was evaluated by recording the occurrence and severity of any adverse events and by the physicians’ and patients’ assessment of overall tolerability. \u0000Results \u0000Clinically, 82.5% of patients were cured, 16.4% were improved and there was failure of therapy in 1.1% of the patients. The overall combined cure and improvement rate of all related signs and symptoms was 98.9%. Adverse events, diarrhea and skin rash, were reported by only 16 patients (1.2%). The overall tolerability according to the physicians’ and patients’ assessment was excellent in 93.9% and 88.9%, respectively. Compliance was attained in 99.5% of patients. \u0000Conclusion \u0000Sarclav (cefpodoxime proxetil) is an effective, safe, well-tolerated antimicrobial agent for treatment of acute otitis media in children. It can be considered as an excellent choice for the empirical treatment of bacterial AOM.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115647166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00027.8
S. Mishra, S. Mahmood
Objective To determine the knowledge of postgraduate and non-postgraduate general and orthopedic surgical residents regarding pressure ulcer (PU) prevention, staging and wound description. Study Design Cross sectional, descriptive survey. Place and Duration of Study Six major tertiary care hospitals in India, from Sep-2018 to Nov-2018. Methodology All consenting postgraduate and non-postgraduate general and orthopedic surgical residents were included in the study using convenience sampling. An adapted version of Pressure Ulcer Knowledge Test (PUKT) comprising of 47-true/false items was used as a research tool. For every correct response, 1 point was awarded. Whereas, an incorrect or NK response was scored as 0. All the data was entered and analyzed using SPSS version 21. Results A total of 126 trainees comprising 120 (95.23%) males and 6 (4.76%) females participated in the study. The average PUKT score obtained by the surgical residents was 30.2+3.7 (65.65%), thus indicating a “low” level of knowledge. Conclusion The current levels of knowledge regarding PU prevention among the surgical residents in our study was “low”. The authors recommend continuous education for PU prevention in a hospital care setting.
{"title":"Assessing Pressure Ulcer Knowledge of General and Orthopedic Surgical Residents Using the Pieper Pressure Ulcer Knowledge Test","authors":"S. Mishra, S. Mahmood","doi":"10.5958/2321-1024.2019.00027.8","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00027.8","url":null,"abstract":"Objective \u0000To determine the knowledge of postgraduate and non-postgraduate general and orthopedic surgical residents regarding pressure ulcer (PU) prevention, staging and wound description. \u0000Study Design \u0000Cross sectional, descriptive survey. \u0000Place and Duration of Study \u0000Six major tertiary care hospitals in India, from Sep-2018 to Nov-2018. \u0000Methodology \u0000All consenting postgraduate and non-postgraduate general and orthopedic surgical residents were included in the study using convenience sampling. An adapted version of Pressure Ulcer Knowledge Test (PUKT) comprising of 47-true/false items was used as a research tool. For every correct response, 1 point was awarded. Whereas, an incorrect or NK response was scored as 0. All the data was entered and analyzed using SPSS version 21. \u0000Results \u0000A total of 126 trainees comprising 120 (95.23%) males and 6 (4.76%) females participated in the study. The average PUKT score obtained by the surgical residents was 30.2+3.7 (65.65%), thus indicating a “low” level of knowledge. \u0000Conclusion \u0000The current levels of knowledge regarding PU prevention among the surgical residents in our study was “low”. The authors recommend continuous education for PU prevention in a hospital care setting.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134538414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00024.2
Rao Aftab Alam, P. Singhal, Anurag Bijalwan, Syed Altamash
Introduction An ileostomy is an opening constructed between the small intestine and the abdominal wall usually by using distal ileum but sometimes more proximal small intestine. It is a lifesaving surgery that enables the individuals with co-morbidities to recover from the acute stress of a major surgery. An ileostomy may be permanent or temporary depending upon the reason for surgery. An ileostomy is associated with multiple morbidities. Aims & Objectives To study the morbidity in patients with ileostomy. Material and Method The present study was a prospective and descriptive study which was conducted on patients admitted in general surgery department of Shri Guru Ram Rai Institute of Medical and Health Sciences in patients who underwent ileostomy as a part of abdominal surgery. Total number of 50 patients were studied. The parameters studied were site of ileostomy, dermatitis, abdominal pain, stomal complications, odour, wound infection, nutritional status, anaemia, diarrhoea, electrolyte imbalance and psychological problems at 2wk, 1mth, 2mth, 3mth post-operative period. Conclusion The study shows significant morbidity like electrolyte abnormalities (52%), skin problems(32%), stoma diarrhoea(54%), psychosocial disturbances(50%) in first 2 week post surgery. It also shows that Typhoid and tubercular pathology is the commonest indication for loop ileostomy. It is of paramount importance that ileostomies are properly sited, improper siting may increase the incidence of dermatitis, leakage, foul odour and other complications. Whenever possible ileostomy should not be located too proximal to the terminal ileum, to avoid high output, electrolyte abnormalities and malnutrition. Despite of ileostomy, proper care of peristomal skin, nutritional status, taking food with high residue and proteins, electrolyte and fluid requirements of patients can be managed and can lead to near normal life style of patient.
回肠造口术是在小肠和腹壁之间建立一个开口，通常使用远端回肠，但有时更近端小肠。这是一种挽救生命的手术，使患有合并症的个体能够从大手术的急性压力中恢复过来。回肠造口可能是永久性的，也可能是暂时性的，这取决于手术的原因。回肠造口术与多种并发症有关。目的探讨回肠造口术患者的并发症。材料和方法本研究是一项前瞻性和描述性研究，研究对象是Shri Guru Ram Rai医学和健康科学研究所普通外科收治的接受回肠造口术作为腹部手术一部分的患者。共研究50例患者。术后2周、1月、2月、3月观察回肠造口部位、皮炎、腹痛、造口并发症、气味、伤口感染、营养状况、贫血、腹泻、电解质失衡及心理问题。结论术后2周内电解质异常(52%)、皮肤问题(32%)、造口腹泻(54%)、心理障碍(50%)发生率较高。它也显示伤寒和结核病理是最常见的指征回肠袢造口术。回肠造口的正确位置至关重要，不正确的位置可能会增加皮炎、瘘、恶臭等并发症的发生率。只要有可能，回肠造口不应位于离回肠末端太近的地方，以避免高输出、电解质异常和营养不良。尽管有回肠造口，但对患者的肠周皮肤、营养状况、高残留和高蛋白质食物、电解质和液体需求的适当护理可以得到管理，并可使患者接近正常的生活方式。
{"title":"Morbidity Pattren in Patients of Ileostomy: An Observational Study","authors":"Rao Aftab Alam, P. Singhal, Anurag Bijalwan, Syed Altamash","doi":"10.5958/2321-1024.2019.00024.2","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00024.2","url":null,"abstract":"Introduction \u0000An ileostomy is an opening constructed between the small intestine and the abdominal wall usually by using distal ileum but sometimes more proximal small intestine. It is a lifesaving surgery that enables the individuals with co-morbidities to recover from the acute stress of a major surgery. An ileostomy may be permanent or temporary depending upon the reason for surgery. An ileostomy is associated with multiple morbidities. \u0000Aims & Objectives \u0000To study the morbidity in patients with ileostomy. \u0000Material and Method \u0000The present study was a prospective and descriptive study which was conducted on patients admitted in general surgery department of Shri Guru Ram Rai Institute of Medical and Health Sciences in patients who underwent ileostomy as a part of abdominal surgery. Total number of 50 patients were studied. The parameters studied were site of ileostomy, dermatitis, abdominal pain, stomal complications, odour, wound infection, nutritional status, anaemia, diarrhoea, electrolyte imbalance and psychological problems at 2wk, 1mth, 2mth, 3mth post-operative period. \u0000Conclusion \u0000The study shows significant morbidity like electrolyte abnormalities (52%), skin problems(32%), stoma diarrhoea(54%), psychosocial disturbances(50%) in first 2 week post surgery. It also shows that Typhoid and tubercular pathology is the commonest indication for loop ileostomy. It is of paramount importance that ileostomies are properly sited, improper siting may increase the incidence of dermatitis, leakage, foul odour and other complications. Whenever possible ileostomy should not be located too proximal to the terminal ileum, to avoid high output, electrolyte abnormalities and malnutrition. Despite of ileostomy, proper care of peristomal skin, nutritional status, taking food with high residue and proteins, electrolyte and fluid requirements of patients can be managed and can lead to near normal life style of patient.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134214068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00034.5
Y. Kumar, V. R. Singh, Sushil Gaur
Background The prevalence of multinodular goitre in all over the world is high, commonly in developing countries. Incidence of differentiated thyroid carcinoma among patients with multinodular goitre is increased in recent literature. Aim of Study To determine the incidence rate of differentiated thyroid carcinoma among patients with multinodular goitre. Patients and Method This study is a cross sectional study carried out in Surgical Ward of Saraswati Institute Of Medical Sciences,Hapur, during the period from September 2016 to July 2017 on convenient sample of 60 patients with multinodular goitre. Clinical history and examination, fine needle aspiration and postoperative histopathology examination was done to confirm the diagnosis. Results Mean age of patients was 43.9 years, with 5 males and 55 females. Fine needle aspiration test showed that 13 (21.7%) multinodular goitre patients had differentiated thyroid carcinoma, while 47 (78.3%) patients had benign goitre. The histopathology of multinodular goitre patients revealed that 41.7% of them had colloid goitre, 16.7% of them had micro-papillary carcinoma and 38.3% of them had follicular adenoma. Differentiated thyroid carcinoma among multinodular goitre patients was significantly associated with smoking and exposure to ionizing radiation. Conclusions The incidence of differentiated thyroid carcinoma among multinodular goitre patients is high.
{"title":"Incidence of Differentiated Thyroid Carcinoma in Multinodular Goitre Patients in Western UP","authors":"Y. Kumar, V. R. Singh, Sushil Gaur","doi":"10.5958/2321-1024.2019.00034.5","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00034.5","url":null,"abstract":"Background \u0000The prevalence of multinodular goitre in all over the world is high, commonly in developing countries. Incidence of differentiated thyroid carcinoma among patients with multinodular goitre is increased in recent literature. \u0000Aim of Study \u0000To determine the incidence rate of differentiated thyroid carcinoma among patients with multinodular goitre. \u0000Patients and Method \u0000This study is a cross sectional study carried out in Surgical Ward of Saraswati Institute Of Medical Sciences,Hapur, during the period from September 2016 to July 2017 on convenient sample of 60 patients with multinodular goitre. \u0000Clinical history and examination, fine needle aspiration and postoperative histopathology examination was done to confirm the diagnosis. \u0000Results \u0000Mean age of patients was 43.9 years, with 5 males and 55 females. Fine needle aspiration test showed that 13 (21.7%) multinodular goitre patients had differentiated thyroid carcinoma, while 47 (78.3%) patients had benign goitre. The histopathology of multinodular goitre patients revealed that 41.7% of them had colloid goitre, 16.7% of them had micro-papillary carcinoma and 38.3% of them had follicular adenoma. Differentiated thyroid carcinoma among multinodular goitre patients was significantly associated with smoking and exposure to ionizing radiation. \u0000Conclusions \u0000The incidence of differentiated thyroid carcinoma among multinodular goitre patients is high.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126840256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00014.X
A. Chauhan, B. Patel, P. Sharma, F. S. Mehta
Background Diabetic foot is one of the most significant and devastating complications of diabetes. Not all foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention. Various dressings are available that fulfils a number of functions like cosmesis, haemostasis, protection, support and absorption. Objectives To study and compare the efficacy of different topical agents like phenytoin sodium powder, eusol solution, nanocrystalline silver gel in patient with diabetic foot ulcer by recording the mean ulcer size pre-treatment, during the course of treatment (1 week, 2 week, 3 week and 4 week follow up) and post- treatment and mean percentage of the wound size healing after treatment. Material & Method This prospective study was conducted in the Department of General Surgery, Geetanjali Medical College & Hospital, affiliated to Geetanjali University from January 2017 to June 2018. 90 patients with diabetic foot ulcers without any other co-morbid conditions and ulcers belonging to Grade I & II as per Wagner diabetic foot ulcers classification were compared with the efficacy of different topical agents. Results Out of 90 patients, there was a highly significant reduction in the mean ulcer size after 2 week, 3 week and 4 week follow up in nanocrystalline silver gel group (p<0.05) as compared to the phenytoin sodium powder and eusol solution group and the formation of granulation tissue was higher in nanocrystalline silver gel group (90%) as compared to phenytoin sodium powder (80%) and eusol solution (73.33%). Conclusion Dressings done with nanocrystalline silver gel was found to be more efficacious than the other topical agents in patients with diabetic foot ulcers in terms of increased rate of wound healing, greater reduction in the mean ulcer size after treatment, absence of pain, swelling and type of discharge after treatment, greater incidence of formation of granulation tissue and less duration of antibiotic therapy and hospital stay.
{"title":"A Prospective, Randomized, Controlled Study For Efficacy of Phenytoin Sodium Powder, Eusol Solution, Nanocrystalline Silver Gel in Diabetic Foot Ulcer","authors":"A. Chauhan, B. Patel, P. Sharma, F. S. Mehta","doi":"10.5958/2321-1024.2019.00014.X","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00014.X","url":null,"abstract":"Background \u0000 \u0000Diabetic foot is one of the most significant and devastating complications of diabetes. Not all foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention. Various dressings are available that fulfils a number of functions like cosmesis, haemostasis, protection, support and absorption. \u0000 \u0000Objectives \u0000To study and compare the efficacy of different topical agents like phenytoin sodium powder, eusol solution, nanocrystalline silver gel in patient with diabetic foot ulcer by recording the mean ulcer size pre-treatment, during the course of treatment (1 week, 2 week, 3 week and 4 week follow up) and post- treatment and mean percentage of the wound size healing after treatment. \u0000Material & Method \u0000This prospective study was conducted in the Department of General Surgery, Geetanjali Medical College & Hospital, affiliated to Geetanjali University from January 2017 to June 2018. 90 patients with diabetic foot ulcers without any other co-morbid conditions and ulcers belonging to Grade I & II as per Wagner diabetic foot ulcers classification were compared with the efficacy of different topical agents. \u0000Results \u0000Out of 90 patients, there was a highly significant reduction in the mean ulcer size after 2 week, 3 week and 4 week follow up in nanocrystalline silver gel group (p<0.05) as compared to the phenytoin sodium powder and eusol solution group and the formation of granulation tissue was higher in nanocrystalline silver gel group (90%) as compared to phenytoin sodium powder (80%) and eusol solution (73.33%). \u0000Conclusion \u0000Dressings done with nanocrystalline silver gel was found to be more efficacious than the other topical agents in patients with diabetic foot ulcers in terms of increased rate of wound healing, greater reduction in the mean ulcer size after treatment, absence of pain, swelling and type of discharge after treatment, greater incidence of formation of granulation tissue and less duration of antibiotic therapy and hospital stay.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121773929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.5958/2321-1024.2019.00020.5
A. Mathur, Manmeet Kaur
Background Choledochoduodenostomy as a surgical management of common bile duct obstruction aims at free flow of bile to duodenum, being more physiological, relatively quick, simple and with fewer anastomotic sites. Objectives Investigate the safety and long term outcome of this procedure and to access its uses in present era of endoscopy and interventional radiology.. Material and methods- Study was conducted in the Department of Surgery at Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun. Over a period of 7 years retrospectively until 2015 and prospectively from then on till december 2017. A total of 34 patients who underwent Choledochoduodenostomy(CDD) were evaluated by going through their hospital records and regular OPD follow up. Results – the results were encouraging with 33 of our patients did well in the long term follow up. Average duration of surgery was 115 minutes. Postoperatively one patient had haematemesis, later on she went to develop recurrent stricture. She later also developed long-term impairment of hepatic functions. No case of feared sump syndrome, or reflux cholangitis was observed. Conclusions Authors are of the view that Side to side choledochoduodenostomy, should be considered by surgeons, as a simpler, less technically demanding and physiologically better procedure. It does not carry the problems usually feared with it. The excellent long term results of this series allow us to have more frequent but indicated use of this procedure, even in the young patients.
背景胆总管十二指肠吻合术作为一种治疗胆总管梗阻的手术方法，其目的是使胆汁自由流向十二指肠，具有生理性强、相对快速、简便、吻合部位少的特点。目的探讨该手术的安全性和远期疗效，并探讨其在当今内镜和介入放射学时代的应用。材料和方法——研究是在德拉敦Shri Guru Ram Rai健康和医学科学研究所的外科部门进行的。追溯至2015年，并预期自2015年起至2017年12月，为期7年。对34例行胆总管十二指肠吻合术(CDD)的患者进行住院记录和常规门诊随访。结果-结果是令人鼓舞的33名患者在长期随访中表现良好。平均手术时间为115分钟。术后1例患者出现呕血，后来又出现复发性狭窄。她后来还出现了肝功能的长期损害。无恐惧池综合征、反流性胆管炎病例。结论双侧胆总管十二指肠吻合术是一种较为简单、技术要求较低、生理条件较好的手术方法，值得外科医生考虑。它不会带来人们通常担心的问题。该系列的良好长期结果使我们能够更频繁但有针对性地使用该手术，即使在年轻患者中也是如此。
{"title":"Choledochodudenostomy Revisited: The Present Scenario","authors":"A. Mathur, Manmeet Kaur","doi":"10.5958/2321-1024.2019.00020.5","DOIUrl":"https://doi.org/10.5958/2321-1024.2019.00020.5","url":null,"abstract":"Background \u0000Choledochoduodenostomy as a surgical management of common bile duct obstruction aims at free flow of bile to duodenum, being more physiological, relatively quick, simple and with fewer anastomotic sites. \u0000Objectives \u0000Investigate the safety and long term outcome of this procedure and to access its uses in present era of endoscopy and interventional radiology.. Material and methods- Study was conducted in the Department of Surgery at Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun. Over a period of 7 years retrospectively until 2015 and prospectively from then on till december 2017. A total of 34 patients who underwent Choledochoduodenostomy(CDD) were evaluated by going through their hospital records and regular OPD follow up. Results – the results were encouraging with 33 of our patients did well in the long term follow up. Average duration of surgery was 115 minutes. Postoperatively one patient had haematemesis, later on she went to develop recurrent stricture. She later also developed long-term impairment of hepatic functions. No case of feared sump syndrome, or reflux cholangitis was observed. \u0000Conclusions \u0000Authors are of the view that Side to side choledochoduodenostomy, should be considered by surgeons, as a simpler, less technically demanding and physiologically better procedure. It does not carry the problems usually feared with it. The excellent long term results of this series allow us to have more frequent but indicated use of this procedure, even in the young patients.","PeriodicalId":113416,"journal":{"name":"International journal of contemporary surgery","volume":"258 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115103710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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