Pub Date : 2020-04-30DOI: 10.17511/ijoso.2020.i02.10
R. Kulkarni
Background: Acute Appendicitis is a common surgical emergency which even with modern diagnostic facilities remains a challenging task for the surgeon. The variation in the presentation can confuse even experienced surgeons. On looking at the literature, it was found that a negative Appendicectomy rate has been consistently mentioned Aim- The following study was therefore conducted for Evaluation Of Significance Of Alvarado Score In Diagnosis Of Acute Appendicitis In Tribal Area. This is an old standard scoring system, very economical, noninvasive, and revalidation was done in the tribal area to reach the diagnosis. Material and Methods: A Study of 180 patients of acute appendicitis was conducted in tribal areas and Alvarado score carries high significant value in diagnosis and management of acute appendicitis. The period to study was from August 2018 to January 2020. Result: 180 patients were subjected to Appendicectomy. Out of the 33 were operated by laparoscopy (18.33%). All the Appendicectomy specimens were studies macroscopically and microscopically. All the specimens were cut open and inspected for pathology. Conclusion: The present study concludes that the Alvarado score, an economical, noninvasive clinical scoring system, carries high significant value in the diagnosis and management of acute appendicitis in the tribal area.
{"title":"Evaluation of the significance of Alvarado score in the diagnosis of acute appendicitis in tribal area","authors":"R. Kulkarni","doi":"10.17511/ijoso.2020.i02.10","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i02.10","url":null,"abstract":"Background: Acute Appendicitis is a common surgical emergency which even with modern diagnostic facilities remains a challenging task for the surgeon. The variation in the presentation can confuse even experienced surgeons. On looking at the literature, it was found that a negative Appendicectomy rate has been consistently mentioned Aim- The following study was therefore conducted for Evaluation Of Significance Of Alvarado Score In Diagnosis Of Acute Appendicitis In Tribal Area. This is an old standard scoring system, very economical, noninvasive, and revalidation was done in the tribal area to reach the diagnosis. \u0000Material and Methods: A Study of 180 patients of acute appendicitis was conducted in tribal areas and Alvarado score carries high significant value in diagnosis and management of acute appendicitis. The period to study was from August 2018 to January 2020. \u0000Result: 180 patients were subjected to Appendicectomy. Out of the 33 were operated by laparoscopy (18.33%). All the Appendicectomy specimens were studies macroscopically and microscopically. All the specimens were cut open and inspected for pathology. \u0000Conclusion: The present study concludes that the Alvarado score, an economical, noninvasive clinical scoring system, carries high significant value in the diagnosis and management of acute appendicitis in the tribal area.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"196 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123277874","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 : 2020-04-30DOI: 10.17511/ijoso.2020.i02.02
Gaurav P. Vala, N. Patel, J. Vora
Aim: To analyse the functional outcome of Medial malleoli after Internal Fixation of medial malleolar fracture with fully threaded 4 mm cancellous cannulated screws. Introduction: Ankle fractures are one of the commonest fractures encountered by an orthopaedic surgeon with the majority being treated with open reduction and tension band wiring but it has a midterm and long term complications like hardware prominence, low-grade infection and hardware removal. Purpose of this study on medial malleolus fracture is to evaluate functional outcome after open reduction and fully threaded 4 mm cancellous cannulated screw fixation which has a very low complication rate. Materials and Method: This is a prospective study done in c u shah medical college and hospital Surendranagar. In the present study 30 cases of bimalleolar ankle fracture.Common Mechanism of Injury was Road traffic accidents and fall from height. the diagnosis was confirmed by Anteroposterior, lateral and Mortise radiograph. Classifications used are Lauge-Hanse Classification and DenisWeber Classification. Fully threaded 4 mm Cannulated cancellous screw was used for medial malleolus fixation.The anatomical plate used for fibula fixation. Post-op protocol: Postoperatively limb were immobilized in a plaster splint for 6 weeks and limb were elevated. Results: According to Baird and Jackson scoring system out of 30 cases, 56.67% were excellent and 26.67% were good, 13.34% were fair and 3.32% were poor. Conclusion: Open reduction and tension band wiring fixation of medial malleolus has biomechanically proved stable fixation but it has a midterm and long term complications like hardware prominence, low-grade infection and hardware removal. The current study has studied that open reduction and fully threaded 4 mm cancellous cannulated screw in medial malleolus fracture have a comparable functional outcome with a low complication rate.
{"title":"A study of functional outcome of bimalleolar fracture treated with fully threaded 4 mm cancellous cannulated screw in medial malleolus fracture","authors":"Gaurav P. Vala, N. Patel, J. Vora","doi":"10.17511/ijoso.2020.i02.02","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i02.02","url":null,"abstract":"Aim: To analyse the functional outcome of Medial malleoli after Internal Fixation of medial malleolar fracture with fully threaded 4 mm cancellous cannulated screws. \u0000Introduction: Ankle fractures are one of the commonest fractures encountered by an orthopaedic surgeon with the majority being treated with open reduction and tension band wiring but it has a midterm and long term complications like hardware prominence, low-grade infection and hardware removal. Purpose of this study on medial malleolus fracture is to evaluate functional outcome after open reduction and fully threaded 4 mm cancellous cannulated screw fixation which has a very low complication rate. \u0000Materials and Method: This is a prospective study done in c u shah medical college and hospital Surendranagar. In the present study 30 cases of bimalleolar ankle fracture.Common Mechanism of Injury was Road traffic accidents and fall from height. the diagnosis was confirmed by Anteroposterior, lateral and Mortise radiograph. Classifications used are Lauge-Hanse Classification and DenisWeber Classification. Fully threaded 4 mm Cannulated cancellous screw was used for medial malleolus fixation.The anatomical plate used for fibula fixation. \u0000Post-op protocol: Postoperatively limb were immobilized in a plaster splint for 6 weeks and limb were elevated. \u0000Results: According to Baird and Jackson scoring system out of 30 cases, 56.67% were excellent and 26.67% were good, 13.34% were fair and 3.32% were poor. \u0000Conclusion: Open reduction and tension band wiring fixation of medial malleolus has biomechanically proved stable fixation but it has a midterm and long term complications like hardware prominence, low-grade infection and hardware removal. The current study has studied that open reduction and fully threaded 4 mm cancellous cannulated screw in medial malleolus fracture have a comparable functional outcome with a low complication rate.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133158684","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 : 2020-04-30DOI: 10.17511/ijoso.2020.i02.11
Navneet Mishra, PG Resident Professor, S. Goyal
Endoscopic Retrograde Cholangiopancreatography (ERCP) is the most widely used diagnostic and therapeutic modality for hepatobiliary and pancreatic diseasesbut is not free from complications. Though rare, the common complications are migration of biliary stent, perforation, pancreatitis, hemorrhage, cholangitis, intra-abdominal sepsis, obstruction, etc. Here, we report a rare complication of ERCP presented as colocutaneous fistula. Colocutaneous fistulas are abnormal communications between the colon and the abdominal skin. They can occur spontaneously in patients with inflammatory bowel disease (most common) as well as after an injury or a surgical procedure. About one-third of fistulas close spontaneously with medical treatment and surgery being reserved for failures after optimal medical treatment. This case of colocutaneous fistula following ERCP presented to us was successfully treated as a single staged procedure without any complication. To the best of our knowledge, this is the first case reported of colocutaneous fistula following ERCP.
{"title":"A rare complication of ERCP: colocutaneous fistula","authors":"Navneet Mishra, PG Resident Professor, S. Goyal","doi":"10.17511/ijoso.2020.i02.11","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i02.11","url":null,"abstract":"Endoscopic Retrograde Cholangiopancreatography (ERCP) is the most widely used diagnostic and therapeutic modality for hepatobiliary and pancreatic diseasesbut is not free from complications. Though rare, the common complications are migration of biliary stent, perforation, pancreatitis, hemorrhage, cholangitis, intra-abdominal sepsis, obstruction, etc. Here, we report a rare complication of ERCP presented as colocutaneous fistula. Colocutaneous fistulas are abnormal communications between the colon and the abdominal skin. They can occur spontaneously in patients with inflammatory bowel disease (most common) as well as after an injury or a surgical procedure. About one-third of fistulas close spontaneously with medical treatment and surgery being reserved for failures after optimal medical treatment. This case of colocutaneous fistula following ERCP presented to us was successfully treated as a single staged procedure without any complication. To the best of our knowledge, this is the first case reported of colocutaneous fistula following ERCP.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128271400","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 : 2020-03-31DOI: 10.17511/ijoso.2020.i02.04
D. Rao, Dr. PV Ramana Chowdary, Dr. Aditya, Dr. Kiran Deedi
Background: The use of a dynamic hip screw (DHS) for stable trochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years. DHS fixation on unstable trochanteric fractures still has a more failure rate, particularly in osteoporosis patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the lesser trochanter fragment stable fixation. Material and methods: This cross-sectional, observational, and follow-up study was conducted in the Department of Orthopedics, GSL Medical College and General Hospital, Rajamahendravaram with a total of 40 cases of trochanteric fractures. All surgeries were performed under spinal anesthesia. Surgery done was an internal fixation with DHS and 135-degree angled blade plate. Results: Among 40 cases, 32.5% were Type I, and 67.5% were Type II Trochanteric fractures. 40% cases had grade 3 osteoporosis and 30% had grade4-osteoporosis rest of the patients were having grade 2 (20%), grade 5 (7.5%), grade 6 (2.5%) and grade1 (0%), according to Singh’s index. The clinical and functional outcomes of the procedure were excellent in 10 hips (25%), Good in 20 hips (50%), Fair in 6 hips (15%), and 4 (10%) of the patients had poor results. Conclusions: Trochanteric fractures are essentially fractured of the elderly, with osteoporotic bones. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures.
{"title":"Study of surgical management of trochanteric fracture of the femur with dynamic hip screw","authors":"D. Rao, Dr. PV Ramana Chowdary, Dr. Aditya, Dr. Kiran Deedi","doi":"10.17511/ijoso.2020.i02.04","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i02.04","url":null,"abstract":"Background: The use of a dynamic hip screw (DHS) for stable trochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years. DHS fixation on unstable trochanteric fractures still has a more failure rate, particularly in osteoporosis patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the lesser trochanter fragment stable fixation. \u0000Material and methods: This cross-sectional, observational, and follow-up study was conducted in the Department of Orthopedics, GSL Medical College and General Hospital, Rajamahendravaram with a total of 40 cases of trochanteric fractures. All surgeries were performed under spinal anesthesia. Surgery done was an internal fixation with DHS and 135-degree angled blade plate. \u0000Results: Among 40 cases, 32.5% were Type I, and 67.5% were Type II Trochanteric fractures. 40% cases had grade 3 osteoporosis and 30% had grade4-osteoporosis rest of the patients were having grade 2 (20%), grade 5 (7.5%), grade 6 (2.5%) and grade1 (0%), according to Singh’s index. The clinical and functional outcomes of the procedure were excellent in 10 hips (25%), Good in 20 hips (50%), Fair in 6 hips (15%), and 4 (10%) of the patients had poor results. \u0000Conclusions: Trochanteric fractures are essentially fractured of the elderly, with osteoporotic bones. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121633507","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 : 2020-02-10DOI: 10.17511/IJOSO.2020.I01.05
A. Sharma, Gourav Sharma, Vinaydeep Bidoliya, Kirtiraj Nagina
Introduction: Fracture of humeral shaft account for roughly 3% of all fractures. Previously, non-operative treatment has been accepted modality of treatment. Three main operative techniques are in vogue for treating displaced humeral shaft fractures namely intramedullary nailing, conventional plating osteosynthesis (CPO) and minimally invasive plate osteosynthesis (MIPO). Material and Methods: 40 fractures of humerus shaft were treated with MIPO technique, in a prospective study between December 2015 and September 2017 at our institute. The cases were followed up for a minimum period of 2 years. Results: The average age was 41 years (23-71 years). Twenty-three (57.5%) were males and 17 (42.5 %) females. Twenty-nine cases (72.5%) had injury in their dominant arm. The mean surgical time was 45.5 minutes and the mean radiation exposure was for 85.3 seconds. The mean follow-up of our cases was 33 months. Conclusion: MIPO is a better choice for treating humeral shaft fractures than CPO, though there is no significant difference between MIPO and CPO in terms of operative time, fracture union rate, and fracture union time.
{"title":"Evaluation of results of minimally invasive plate osteosynthesis for humeral shaft fractures. A study involving 40 patients","authors":"A. Sharma, Gourav Sharma, Vinaydeep Bidoliya, Kirtiraj Nagina","doi":"10.17511/IJOSO.2020.I01.05","DOIUrl":"https://doi.org/10.17511/IJOSO.2020.I01.05","url":null,"abstract":"Introduction: Fracture of humeral shaft account for roughly 3% of all fractures. Previously, non-operative treatment has been accepted modality of treatment. Three main operative techniques are in vogue for treating displaced humeral shaft fractures namely intramedullary nailing, conventional plating osteosynthesis (CPO) and minimally invasive plate osteosynthesis (MIPO). \u0000Material and Methods: 40 fractures of humerus shaft were treated with MIPO technique, in a prospective study between December 2015 and September 2017 at our institute. The cases were followed up for a minimum period of 2 years. \u0000Results: The average age was 41 years (23-71 years). Twenty-three (57.5%) were males and 17 (42.5 %) females. Twenty-nine cases (72.5%) had injury in their dominant arm. The mean surgical time was 45.5 minutes and the mean radiation exposure was for 85.3 seconds. The mean follow-up of our cases was 33 months. \u0000Conclusion: MIPO is a better choice for treating humeral shaft fractures than CPO, though there is no significant difference between MIPO and CPO in terms of operative time, fracture union rate, and fracture union time.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129748584","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 : 2020-02-01DOI: 10.17511/ijoso.2020.i01.10
Dr. N V Narasimha Rao, Dr. Ravikanth K, Dr. Tetali Venkata Rama Reddy, Dr. T Jaya Chandra
Introduction: The tibia being the most commonly fractured long bone. A study was conducted to analyze the efficacy of closed intramedullary nailing tibial shaft fractures. Materials and methods: Study was conducted in the Department of orthopedics. Individuals with closed tibial diaphyseal fractures of >18 years, open diaphyseal fractures of tibia type I, type II were included. Open diaphyseal fractures of tibia Type III A, B, C, tibial fractures with intraarticular extensions and medically ill were excluded. Under spinal anesthesia, intramedullary locking was done as per the protocol. Results: During the study period, 50 fractures were included. the male-female ratio was 5.25. The youngest patient was 19 years and the oldest patient was 67 years. 60% of the participants had right tibial fractures and 40% with left. Thirty-nine (78%) participants simple and 22% (11) had type I and type 11 compound fractures. The majority of fractures (58%; 29) were united within 18-20 weeks. The average healing time was 19 weeks. Conclusion: In this study 16.9 weeks was the average healing time and 76% patients showed excellent outcome.
{"title":"Surgical management of fracture shaft tibia with closed interlocking intramedullary nailing – A clinical study","authors":"Dr. N V Narasimha Rao, Dr. Ravikanth K, Dr. Tetali Venkata Rama Reddy, Dr. T Jaya Chandra","doi":"10.17511/ijoso.2020.i01.10","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i01.10","url":null,"abstract":"Introduction: The tibia being the most commonly fractured long bone. A study was conducted to analyze the efficacy of closed intramedullary nailing tibial shaft fractures. \u0000Materials and methods: Study was conducted in the Department of orthopedics. Individuals with closed tibial diaphyseal fractures of >18 years, open diaphyseal fractures of tibia type I, type II were included. Open diaphyseal fractures of tibia Type III A, B, C, tibial fractures with intraarticular extensions and medically ill were excluded. Under spinal anesthesia, intramedullary locking was done as per the protocol. \u0000Results: During the study period, 50 fractures were included. the male-female ratio was 5.25. The youngest patient was 19 years and the oldest patient was 67 years. 60% of the participants had right tibial fractures and 40% with left. Thirty-nine (78%) participants simple and 22% (11) had type I and type 11 compound fractures. The majority of fractures (58%; 29) were united within 18-20 weeks. The average healing time was 19 weeks. \u0000Conclusion: In this study 16.9 weeks was the average healing time and 76% patients showed excellent outcome.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117198985","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 : 2020-02-01DOI: 10.17511/IJOSO.2020.I01.12
G. Dhivahar, Shankar Balasubramanian, D. Raghunath, S. Misra
SGLT2 inhibitors are being increasingly prescribed for the treatment of type 2 diabetes mellitus. Apart from lowering HbA1c, they are also potentially beneficial in reducing body weight and blood pressure. The awareness among Indian doctors of the potentially fatal complication of SGLT2 inhibitor induced diabetic ketoacidosis may not be widespread. To complicate things further, the blood glucose levels may not be as high as would be expected in a case of diabetic ketoacidosis, making the diagnosis more challenging. We present a case of empagliflozin induced euglycemic ketoacidosis in a post Whipple’s surgery patient. A 52 years old man with upper abdominal pain was found to have a duodenal mass on evaluation. He was a known diabetic on tablets sitagliptin and empagliflozin. Patient underwent Whipple’s surgery for the duodenal mass. Patient had severe metabolic acidosis with ketosis in the immediate post-operative period with mild elevation of blood sugar. The common causes of ketoacidosis were eliminated and the diagnosis of drug induced ketoacidosis was clinched. Patient was successfully treated with intravenous fluids, dextrose and insulin infusion and discharged in good health. It is important to be aware of this adverse effect so that the correct treatment is instituted in a timely fashion.
{"title":"SGLT 2 inhibitor induced euglycemic ketoacidosis","authors":"G. Dhivahar, Shankar Balasubramanian, D. Raghunath, S. Misra","doi":"10.17511/IJOSO.2020.I01.12","DOIUrl":"https://doi.org/10.17511/IJOSO.2020.I01.12","url":null,"abstract":"SGLT2 inhibitors are being increasingly prescribed for the treatment of type 2 diabetes mellitus. Apart from lowering HbA1c, they are also potentially beneficial in reducing body weight and blood pressure. The awareness among Indian doctors of the potentially fatal complication of SGLT2 inhibitor induced diabetic ketoacidosis may not be widespread. To complicate things further, the blood glucose levels may not be as high as would be expected in a case of diabetic ketoacidosis, making the diagnosis more challenging. We present a case of empagliflozin induced euglycemic ketoacidosis in a post Whipple’s surgery patient. A 52 years old man with upper abdominal pain was found to have a duodenal mass on evaluation. He was a known diabetic on tablets sitagliptin and empagliflozin. Patient underwent Whipple’s surgery for the duodenal mass. Patient had severe metabolic acidosis with ketosis in the immediate post-operative period with mild elevation of blood sugar. The common causes of ketoacidosis were eliminated and the diagnosis of drug induced ketoacidosis was clinched. Patient was successfully treated with intravenous fluids, dextrose and insulin infusion and discharged in good health. It is important to be aware of this adverse effect so that the correct treatment is instituted in a timely fashion.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131936803","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 : 2020-02-01DOI: 10.17511/IJOSO.2020.I01.11
B. Kuppusamy, Tamil Nadu India Imsr Coimbatore, S. Misra
Endometriosis is defined as the presence of endometrial mucosa implanted in locations other than the uterine cavity. Endometriosis is usually a disease involving women of reproductive age. A probable estimate is that 5–10% of women in their reproductive age have endometriosis. When they do occur, women experience mostly dysmenorrhea, heavy or irregular periods, pelvic pain or dyspareunia. The most common sites for endometriosis are the ovaries (60%), uterosacral ligament (60%), posterior cul-de-sac (28%), broad ligament (15%), bladder (15%) and sigmoid colon (7%). Colonic endometriosis is a rare sequelae. It usually presents vaguely with nonspecific abdominal pain, dyspareunia, tenesmus, rectal bleeding or painful defecation. Laparoscopy is considered the best diagnostic modality for endometriosis with a sensitivity of 97% and specificity of 77%. Although there are some rare cases of large bowel obstruction due to endometriosis in pre-menopausal women, it is extremely rare in the postmenopausal group. Our report highlights such a case, mimicking a malignant rectosigmoid stricture leading to a large bowel obstruction with minimal extracolonic endometriosis involvement. Conclusion: This case report shows that colonic endometriosis, although rare, can be significantly infiltrative and lead to complications such as a large bowel obstruction. Very rarely, isolated colonic involvement without pelvic endometriosis can mimic malignant obstruction as in this patient. Diagnosing this condition can be challenging and usually requires histological confirmation.
{"title":"Endometriotic rectosigmoid stricture- a rare clinical entity","authors":"B. Kuppusamy, Tamil Nadu India Imsr Coimbatore, S. Misra","doi":"10.17511/IJOSO.2020.I01.11","DOIUrl":"https://doi.org/10.17511/IJOSO.2020.I01.11","url":null,"abstract":"Endometriosis is defined as the presence of endometrial mucosa implanted in locations other than the uterine cavity. Endometriosis is usually a disease involving women of reproductive age. A probable estimate is that 5–10% of women in their reproductive age have endometriosis. When they do occur, women experience mostly dysmenorrhea, heavy or irregular periods, pelvic pain or dyspareunia. The most common sites for endometriosis are the ovaries (60%), uterosacral ligament (60%), posterior cul-de-sac (28%), broad ligament (15%), bladder (15%) and sigmoid colon (7%). Colonic endometriosis is a rare sequelae. It usually presents vaguely with nonspecific abdominal pain, dyspareunia, tenesmus, rectal bleeding or painful defecation. Laparoscopy is considered the best diagnostic modality for endometriosis with a sensitivity of 97% and specificity of 77%. Although there are some rare cases of large bowel obstruction due to endometriosis in pre-menopausal women, it is extremely rare in the postmenopausal group. Our report highlights such a case, mimicking a malignant rectosigmoid stricture leading to a large bowel obstruction with minimal extracolonic endometriosis involvement. \u0000Conclusion: This case report shows that colonic endometriosis, although rare, can be significantly infiltrative and lead to complications such as a large bowel obstruction. Very rarely, isolated colonic involvement without pelvic endometriosis can mimic malignant obstruction as in this patient. Diagnosing this condition can be challenging and usually requires histological confirmation.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132033070","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 : 2020-02-01DOI: 10.17511/ijoso.2020.i01.09
T. Chandra, P. S. Kumar
Introduction: As per the WHO guidelines, confirmed and definitive microbiological diagnosis of OATB is required before initiation of anti TB treatment. A study was conducted to find the utility of ZN staining in the diagnosis of confirmed cases of OATB cases. Materials and Methods: Study was conducted in the Department of Microbiology, GSL Medical College. Informed written consent was taken from all the volunteers. The study protocol was approved by the institutional ethics committee. Individuals aged > 18 years who were clinically confirmed to be OATB were included in the study. Individuals with acute pyogenic osteoarticular infections were excluded. A simple FNAC technique was conducted in the outpatient unit for the collection of aspiration. Smears were prepared and stained by Ziehl Neelsen staining. Smear preparation and staining were done as per the RNTC guidelines. Results: During the study period 38 participants with suspected OATB were included. The smear positivity was 23 (60.5%). The male-female ratio was 1.08; statistically there was no significant difference (P = 0.753954). Age-wise maximum smear-positive cases were diagnosed in 58-67 years age group. Conclusion: In resource-limited areas, ZN staining is a good alternative for the diagnosis of OATB.
{"title":"A study to find the utility of ZN staining in the diagnosis of confirmed cases of bone tuberculosis","authors":"T. Chandra, P. S. Kumar","doi":"10.17511/ijoso.2020.i01.09","DOIUrl":"https://doi.org/10.17511/ijoso.2020.i01.09","url":null,"abstract":"Introduction: As per the WHO guidelines, confirmed and definitive microbiological diagnosis of OATB is required before initiation of anti TB treatment. A study was conducted to find the utility of ZN staining in the diagnosis of confirmed cases of OATB cases. \u0000Materials and Methods: Study was conducted in the Department of Microbiology, GSL Medical College. Informed written consent was taken from all the volunteers. The study protocol was approved by the institutional ethics committee. Individuals aged > 18 years who were clinically confirmed to be OATB were included in the study. Individuals with acute pyogenic osteoarticular infections were excluded. A simple FNAC technique was conducted in the outpatient unit for the collection of aspiration. Smears were prepared and stained by Ziehl Neelsen staining. Smear preparation and staining were done as per the RNTC guidelines. \u0000Results: During the study period 38 participants with suspected OATB were included. The smear positivity was 23 (60.5%). The male-female ratio was 1.08; statistically there was no significant difference (P = 0.753954). Age-wise maximum smear-positive cases were diagnosed in 58-67 years age group. \u0000Conclusion: In resource-limited areas, ZN staining is a good alternative for the diagnosis of OATB.","PeriodicalId":267909,"journal":{"name":"Surgical Update: International Journal of Surgery and Orthopedics","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134173678","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 : 2020-01-27DOI: 10.17511/IJOSO.2020.I01.03
Abhishek Kumar, S. Snehlata
Background: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. Methods: This study included 90 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre register from June 2014 to May 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. Results: A total of 68 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. Conclusion: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.
背景:急性阑尾炎是全世界急诊科最常见的外科疾病。临床评分系统，如Alvarado和改进的Alvarado评分系统，开发的目标是将阑尾切除术阴性率降低到5%-10%。Raja Isteri Pengiran Anak Saleha阑尾炎(RIPASA)评分系统于2008年专门为亚洲人群建立。本研究的目的是比较科威特人群中改进的Alvarado和RIPASA评分系统。方法:本研究纳入了2014年6月至2018年5月在手术室登记的90例阑尾切除术患者，记录为“急性阑尾炎”或“腹痛”。采用SPSS统计软件得出改进的Alvarado和RIPASA评分系统的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、诊断准确率、预测阴性阑尾切除及受试者工作特征(ROC)曲线。结果:根据我们的标准，共有68例患者纳入本研究。修改后的Alvarado评分的截止阈值为7.0，敏感性为82.8%，特异性为56%。PPV为89.3%，NPV为42.4%。RIPASA评分的截止阈值为7.5，敏感性为94.5%，特异性为88%。PPV为97.2%，NPV为78.5%。改良的Alvarado和RIPASA评分系统预测阑尾切除术阴性率分别为10.7%和2.2%。阴性阑尾切除术率显著下降，改良Alvarado评分系统从18.4%降至10.7%，RIPASA评分系统降至2.2%，两种评分系统差异有统计学意义(P<0.001)。结论:基于本研究结果，RIPASA评分是一种简单的评分系统，在亚洲人群中比改良的Alvarado评分系统具有更好的敏感性和特异性。它由14个临床参数组成，这些参数可以从良好的患者病史、临床检查和实验室调查中获得。RIPASA评分系统比科威特人口改良的Alvarado评分系统更准确和具体。
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