Indian Journal of Surgery最新文献

This case report describes the rare occurrence of a projectile ballistic injury resulting from the detonation of a locally made firecracker, also known as “TOPDA,” during Diwali festivities. The 18-year-old male patient presented with a penetrating injury to the right chest wall, causing immediate unconsciousness and hemodynamic instability. Emergency interventions, including chest tube insertion and resuscitation, were performed. A metallic foreign body near the right atrial appendage was identified on imaging. Surgical removal via thoracotomy was successfully done, with repair of the lung parenchyma. The case emphasizes the importance of maintaining a cardiopulmonary bypass setup for potential cardiac emergencies.

The role of lymph node dissection in radical prostatectomy in the survival of patients with clinical N0 high-risk localized prostate cancer, has not yet been elucidated. Patients with high-risk localized prostate cancer who underwent radical prostatectomy ± lymph node dissection were identified in the Surveillance Epidemiology and End Results (SEER) (2010–2015). Patients were divided into two groups: no lymph node dissection (LNN group) and lymph node dissection (LND group). Propensity score matching (PSM) was used to balance the baseline characteristics. Overall survival and cancer-specific survival were analyzed using Kaplan–Meier's method and cox multivariate analyses, and subgroup analyses according to the Gleason score were performed. After PSM, there were 12,309 pairs of White patients in the LNN and LND group, age (odds ratio [OR] = 1.076, 95% confidence interval, CI 1.066–1.087, p < 0.001), Gleason score 7 (OR = 0.542, 95% CI 0.432–0.680, p < 0.001), and Gleason score > 7 (OR = 0.531, 95% CI 0.441–0.640, p < 0.001) were associated with overall survival. Subgroup analysis indicated that LND contributed to a limited 2 months better prognosis for patients with a Gleason score > 7 (101.97 VS 99.33 months, p = 0.013), but not for patients with a Gleason score of 7 (103.90 VS 104.16 months, p = 0.24), comparing to these LNN groups. No significant difference was found in subgroup analysis for the Black population when OS and CSS were compared between the no lymph node dissection and lymph node dissection groups. Patients with high-risk prostate cancer should be carefully selected for lymph node dissection. Only some patients can obtain short-term survival benefits, while other patients cannot benefit from lymph node dissection but have the risk of increased complications.

The use of prosthetic mesh to augment suture repair of large paraoesophageal hernias is widespread but controversial. Our aim was to identify the risk of mesh-specific complications from a large series of consecutive patients undergoing hiatal hernia repair augmented with a lightweight polypropylene mesh (TiMesh) over a 12-year period. A case series review of patients who have had prosthesis-reinforced hiatal repair with TiMesh between February 2005 and October 2017. Pre-operative, intra-operative, and post-operative data were collected for all patients undergoing hiatal repair. In total, 393 patients had TiMesh augmented hiatal repair between February 2005 and October 2017. There were no intraoperative mesh-specific complications. Mesh was explanted in one patient (1/393, 0.25%) who underwent emergency paraoesophageal hernia repair complicated by sepsis. Asymptomatic mesh erosion was found in two patients (2/393, 0.51%) at endoscopy 3 and 9 years following surgery, respectively. No cases of oesophageal or hiatal strictures were identified. From our large series, albeit without routine endoscopic and radiological follow-up, we demonstrate acceptably low rates of mesh-related complications. We identified two cases of asymptomatic erosion during 393 TiMesh repairs, and the rate of mesh-specific complications in this patient series is low. This unit will continue to perform selective TiMesh hiatal repair in cases where a suture repair only is felt to be inadequate at the time of surgery. For the purposes of patient consent and ongoing discussion, we report the risk of mesh erosion and mesh explantation to be 0.51% and 0.25%, respectively.

Background

This study delves into the critical issues related to delay in diagnosis and associated factors surrounding cancer care in the elderly, particularly focusing on the Indian demographic. The research approved by an institutional ethics committee, involved analyzing patient records and conducting interviews at a hospital to understand the time taken for cancer diagnosis and initiation of treatment in older patients.

Method and Result

A total of 80 study participants with histologically confirmed cancers were included in this study. The majority of patients belonged to the 65–75 years age group (n = 62, 77.5%). Only 18 (22.5%) were in the age group of 76–85 years. Of the total patients, the disease was confined to the primary site in 45 (56.2%) and it had nodal spread or metastasized in 35 (43.7%) at the time of first diagnosis. After treatment completion, during the first month of follow-up, 2 cases of gastrointestinal cancer died, and 1 case of genitourinary and other cancers died. During the second month of follow-up, 3 cases of gastrointestinal cancer died, 4 cases of genitourinary cancer died, and 2 cases of other cancers died. During the sixth month of follow-up, 2 cases of head & neck and genitourinary cancer died, and 5 cases of gastrointestinal and other cancers died.

Conclusion

The study highlights the need for increased awareness of delays in diagnosis and treatment of cancer in the geriatric age group and government intervention in the form of setting up geriatric cancer units to provide affordable cancer treatment aiming to improve the quality of life survival rates in this vulnerable population.

Patients with penetrating abdominal stab wounds who do not require emergency laparotomy should be followed up for a certain period of time for the possible need for laparotomy. The aim of this study was to determine the optimal duration of nonoperative follow-up of patients with penetrating anterior abdominal stab wounds before discharge. Emergency laparotomy was performed in patients with penetrating anterior abdominal stab wounds who were hemodynamically unstable and had signs of peritonitis on initial admission. Patients who did not require emergency laparotomy in the initial evaluation were hospitalized for observation and followed up with a physical examination for 48 h due to possible peritonitis. At the end of this period, patients who did not require laparotomy were discharged nonoperatively. Demographic characteristics of the patients and the time from admission to laparotomy were investigated and the data were analyzed. The study included 481 patients, 440(91.48%) of whom were men. Of these patients, 143(29.73%) underwent laparotomy and the remaining 338 patients were discharged nonoperatively. Of the 143 laparotomies, 67 (46.85%) were emergency, 91 (63.63%) within 4 h (including emergency laparotomy), 115 (80.42%) within 8 h, 126 (88.11%) within 12 h, 137 (95.80%) within 24 h, and 141 (98.60%) within 48 h. Two (1.40%) patients underwent laparotomy beyond 48 h. Asymptomatic patients with penetrating anterior abdominal stab wounds not requiring laparotomy can be discharged after 48 h of observation with a small missed risk of intra-abdominal injury.

Humans acquire Echinococcus infestation by ingesting eggs, typically developing childhood infections with symptoms emerging 5 to 20 years later. Cysts often form in the liver (55–60%), lungs (20–30%), and other organs including kidneys, heart, bones, muscles, brain, spleen, and rarely in atypical sites. Pelvic hydatid cysts especially urinary bladder wall cyst are rare and occur due to the rupture of liver cyst or hematogenous dissemination. Diagnosis is challenging due to cysts mimicking malignancies, relying on clinical, serological, and imaging techniques such as ultrasound showing distinct features like “hydatid sand” and the “water lily sign.” Treatment includes surgical resection and cysticidal agents, with albendazole effective in some non-surgical cases. We present a unique case of hydatid cyst in urinary bladder wall presenting with recurrent urinary retention.

Sepsis due to Fusobacterium necrophorum has been a deadly condition for centuries. Several other bacteria have been identified to cause similar condition known as Lemierre’s syndrome. First described by French bacteriologist André-Alfred Lemierre, this condition is associated with multiple abscess formation in lungs, abdomen, solid organs, etc. With the invention of antibiotics, this incidence has reduced significantly. However, the handful of such rare case that we encounter poses significant challenge in management. This article describes one such case explaining the multiple issues including the difficulties to diagnose and treat. This also shows how a multi-disciplinary approach is needed for best outcome for patients.

Obturator hernia, a very rare type of abdominal hernia, presents diagnostic and management challenges, due to lack of exposure to such cases. We report a case of a 60-year-old lady, reluctant for surgery; the patient underwent successful surgical management via an open approach due to preoperative complication of intestinal obstruction. This case highlights the importance of tailored surgical strategies and vigilant post-operative care in managing obturator hernia, particularly in complex clinical scenarios.

Hand trauma is an underestimated condition with a huge functional and economic impact on the individual and society; the scarcity of resources and qualified hand surgeons means that treatment of these injuries is often inadequate. We developed a new remote diagnostic modality based on the Hand KISS (Keep It Simple and Standard) protocol. The protocol is developed in five key points and involves the application of a standardized questionnaire consisting of seven sections. This protocol involves the combination of telemedicine and first aid, making early trauma screening possible with minimal investment of resources. The questionnaire was created to combine the experience of the remotely connected surgeon with the direct experience of the operator in the field. This application makes it possible to expand the scope of treatment of traumatic hand injuries in rural areas otherwise lacking adequate health care facilities.