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Comparative Diagnostic of Cervical Tuberculous Lymphadenitis: PCR is a Fast, Efficient, and Improved Diagnostic Approach. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:3312250. [PMID: 37346247 PMCID: PMC10281827 DOI: 10.1155/2023/3312250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Methods The study included 100 clinically suspected cases of TBLN. Fine needle aspirate (FNA) samples were processed for cytology staining and cultured on LJ & BACTEC 12B media. The biochemical tests were performed to identify the isolates at the species level. Additionally, for PCR, DNA was extracted and used for the diagnosis and identification of mycobacterial species. Results Patients ranged from 2 to 45 years with a mean age of 24.96 ± 9.10 years. Out of 100 patients, 73% had clinical symptoms of weight loss, followed by fever (72%), anorexia (66%), and night sweats (58%). 24% of patients were found to be smear-positive after Ziehl-Neelsen (ZN) staining and statistically highly significant with PCR. On LJ medium 34% and on BACTEC radiometric 45% of samples were smearing positive. Overall, 48% of cases were PCR-positive for TBLN. When compared with culture, the sensitivity and specificity of PCR were 93.75% and 100%, respectively, which are higher than cytology. The true positive predictive value (PPV) and negative predictive value (NPV) were 83.3% and 61.5%, respectively. Conclusion This study suggests that PCR is a rapid, sensitive, and specific tool for correct diagnosis of TBLN cases as compared to staining and culture which lead to the early and proper management of mycobacterial diseases.
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A Rare Case of Gastrointestinal Mucormycosis. Cureus 2021; 13:e17748. [PMID: 34659961 PMCID: PMC8493042 DOI: 10.7759/cureus.17748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
Gastrointestinal Mucormycosis (GIM) is a rare life-threatening angio-invasive infection. The classic risk factors include immunosuppression and metabolic derangement. Usually, there are classical risk factors in patients affected by Ileocecal mucormycosis. Few case reports have shown the absence of salient clinical presentation of mucormycosis in prolonged hospitalisation. The presence of association of mucormycosis in patients of typhoid infection is rare. Here, we present a case of invasive ileal mucormycosis occurring as a sequel to typhoid infection which lacked the typical risk factors for mucormycosis.
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First Case of Enterovesical Fistula Caused by Ischaemic Enteritis. Cureus 2021; 13:e16452. [PMID: 34422482 PMCID: PMC8369859 DOI: 10.7759/cureus.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/09/2022] Open
Abstract
We present the case of an enterovesical fistula (EVF) caused by ischemic enteritis. Ischemic enteritis is caused either by mesenteric macrovasculature occlusion or any pathophysiologic vasospasm of the microvasculature. In other words, ischemic enteritis (IE) occurs when the inflow of blood to the small intestines is reduced. The frequency of ischemic enteritis is less as compared to ischemic colitis because of the vast blood supply to the small intestine. It is the first case to be reported in the medical literature to date. EVF is a rare entity. It is a pathological connection between the bowel loops and the urinary bladder. EVF is a result of an underlying disease or injury. EVF is mostly caused by diverticular diseases, carcinoma colon, Crohn's, and inflammatory bowel disease, iatrogenic, appendicitis, carcinoma cervix, etc. Due to the formation of this abnormal connection, contents of the intestines, including the air, food content, etc., are usually found in the urine. Patients usually present with the complaint of irritative urinary tract symptoms and recurrent urinary tract infection (UTI). Surgical management is the mainstay of treatment although medical management is tried for those who cannot bear to undergo surgery.
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SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Aggressive angiomyxoma of renal pelvis in a horseshoe-shaped kidney: Rare tumor at an unusual site. INDIAN J PATHOL MICR 2021; 63:460-462. [PMID: 32769340 DOI: 10.4103/ijpm.ijpm_74_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mesenchymal neoplasm is rare in renal pelvic region. Aggressive angiomyxomas are the neoplasms seen predominantly in female genital region. These tumors are locally aggressive with rare cases presenting with metastasis. Its occurrence in renal pelvis is extremely rare with only five cases reported in the literature. The present case is the sixth case reported in a 15-year-old girl who presented to the surgery department as a case of horseshoe kidney. The mass was excised and a diagnosis of aggressive angiomyxoma was rendered.
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Management of Liver Abscesses at a Teaching Hospital in Rural Haryana- A Prospective Study. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/47920.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: With the rise of change in imaging modalities like Computed Tomography (CT) scan or Ultrasonography (USG) the treatment of liver abscess has changed leading to reduction in morbidity and mortality. Liver abscess is more common in developing countries like India. Aim: To determine the methods for aetiological diagnosis of liver abscesses and to evaluate various methods for treatment of liver abscesses and select appropriate treatment modality on the basis of clinicomicrobiological findings. Materials and Methods: The present study was a prospective study of 60 cases diagnosed as liver abscesses both amoebic and pyogenic which were managed in rural tertiary care centre between the period of November 2018 to April 2020 were included in the study. A preformed protocol was made for the management of all patients diagnosed with liver abscess and various parameters contributing to the illness like age, gender, associated conditions and clinical features. The prognosis was evaluated and assessed by using laboratory investigations, radiological findings to check the response to treatment by selecting appropriate treatment modality. Statistical analysis was done with the help of Statistical Package for the Social Sciences (SPSS) 20.0 for windows; Chicago, USA. Results: In this study amoebic liver abscess was more common as compared to pyogenic liver abscess {42 (70%) and 18 (30%)}. Liver abscess was more common in males as compared to females (4:1). History of alcohol consumption was strongly associated with the aetiology of liver abscess. Abdominal pain was the most common symptom in these patients. Conclusion: Proper clinical evaluation along with radiological imaging modalities has led to the early diagnosis of liver abscess. Microbiological investigations like blood antibody Enzyme Linked Immuno Sorbent Assay (ELISA) for Entamoeba histolytica is not in favour of diagnosing amoebic liver abscess. Conservative management is effective for minor abscesses.
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Primary leiomyosarcoma kidney – A rare entity with a diagnostic challenge. J Cancer Res Ther 2020; 18:1186-1188. [DOI: 10.4103/jcrt.jcrt_107_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tumor budding in infiltrating breast carcinoma: Correlation with known clinicopathological parameters and hormone receptor status. INDIAN J PATHOL MICR 2019; 62:222-225. [DOI: 10.4103/ijpm.ijpm_120_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Utility of FNAC in Dermatological Manifestations of Metastatic Cancer with the Review of the Literature. J Cytol 2018; 35:237-241. [PMID: 30498297 PMCID: PMC6210811 DOI: 10.4103/joc.joc_158_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives Cutaneous metastasis (CM) though rare, indicates a terminal event in any malignancy and has a grave outcome. The present study reiterates the role of fine needle aspiration cytology (FNAC) in the diagnosis of metastatic cutaneous nodules. Materials and Methods From 2015 to 2017, the department received 22,000 cases for FNAC. Among these cases, aspirations from the skin and subcutaneous region were performed on 6,083 cases. After excluding primary tumors of skin/subcutis, 25 cases on cytology were suggestive of metastasis. Clinicoradiological and histopathological profiles in these cases were reviewed. Results Among these 25 patients, the male to female ratio was 1:1.09 (F, 12; M, 13) in the age group of 18-72 years. Most common primary malignancy in females was of breast and in males was gall bladder. The most common manifestation was a palpable skin nodule, with the abdominal wall being the predominant site. The most common diagnosis, on cytology, was metastatic adenocarcinoma. Conclusion FNAC is a minimally invasive method, which aides in prompt detection and appropriate management of cases presenting with skin nodules and clinically unsuspected of malignancy. Whereas in known primary tumor, it indicates dismal prognosis by diagnosing CM; in cases with unknown primaries, cytomorphology in conjunction with clinicoradiological findings often gives a clue to the possible primary site.
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Haemophilic pseudotumour: surgical management of a rare case. Indian J Surg 2015; 77:62-4. [PMID: 25829715 DOI: 10.1007/s12262-013-1016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022] Open
Abstract
Haemophilia is a common cause of genetically inherited bleeding disorders. Pseudotumours occur in 1-2 % of persons with severe forms of haemophilia. These are a result of repeated haemorrhage into soft tissues, subperiosteum or a site of bone fracture with inadequate resorption of the extravasated blood. There are a number of therapeutic alternatives for this dangerous condition: surgical removal, percutaneous management, irradiation, embolization etc. In this case report, we describe the natural history, clinical course and successful surgical management of a patient with haemophilia who presented with a massive pseudotumour. We also briefly review the relevant literature on the various therapeutic modalities that have been implemented in the management of this rare complication. Though surgeons may be averse to operate on haemophiliacs, primary surgical management as done in our case may prove to be the definitive treatment option for such patients.
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Abstract
Squamous cell carcinoma (SCC) of the scrotum was one of the first occupational diseases to be described, and acquired its eponym from Sir Percivall Pott. The condition has now become rare owing to the establishment of industrial health norms. A 45-year-old male with a history of long-term exposure to petrochemicals presented to our institution with a scrotal lesion and underwent wide-local excision of the same. Histopathology revealed well-differentiated SCC involving the epididymis. Treatment options included excision with ilio-inguinal bloc dissection (in the event of lymphadenopathy) with subsequent chemotherapy and/or radiotherapy. Tumors following occupational exposure thus continue to contribute to the rapidly decreasing incidence of scrotal carcinoma.
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Angiogenesis in Breast Cancer and its Correlation with Estrogen, Progesterone Receptors and other Prognostic Factors. J Clin Diagn Res 2015; 9:EC05-7. [PMID: 25737993 PMCID: PMC4347084 DOI: 10.7860/jcdr/2015/10591.5447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/27/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of study is to evaluate angiogenesis using CD34, in estrogen, progesterone positive and negative breastcancer and to correlate the microvessel density with known histological prognostic factors, morphological type of breast carcinoma and lymph node metastasis. MATERIALS AND METHODS Twenty eight untreated cases of breast cancer were included in the study and paraffin embedded sections were obtained from representative mastectomy specimen of breast cancer patient. The sections were stained with hematoxylin and eosin stain and immunohistochemistry was performed using CD34, estrogen, progesterone, cytokeratin and epithelial membrane antigen antibody. Angiogenesis was analysed using CD 34 antibody. For statistical analysis, cases were grouped into estrogen, progesterone positive and negative receptors. RESULTS Mean microvessel density in ER-/PR-, ER-/ PR+, ER+/PR-, ER+/PR+ was 15.45, 14.83, 11, 10.89 respectively. A significant correlation was found between ER receptors and mean vascular density with p-value (< 0.05). A significant difference was observed in mean vascular density between the four groups comprising (p-value < 0.05). Infiltrating duct carcinoma (NOS) grade III has got the highest mean microvessel density (14.17) followed by grade II (12.93) and grade I (12.33). CONCLUSION Information about prognostic factors in breast cancer patients may lead to better ways to identify those patients at high risk who might benefit from adjuvant therapies.
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Pulmonary hydatid disease with coexistent aspergillosis: An incidental finding. Indian J Med Microbiol 2013; 31:85-6. [DOI: 10.4103/0255-0857.108740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Retrorectal cystic hamartoma (tailgut cyst): report of a case and review of literature. Indian J Surg 2012; 75:204-7. [PMID: 24426565 DOI: 10.1007/s12262-012-0633-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/12/2012] [Indexed: 02/07/2023] Open
Abstract
Retrorectal cystic hamartoma is a rare type of congenital cystic lesion usually diagnosed in middle-aged women. Although mostly asymptomatic, patients may present with symptoms resulting from local mass effect or with a complication. The most important complications of these cysts are infection with secondary fistulization and malignant degeneration. Because of such non-specific nature of symptoms and rare incidence, it is not unusual to have a delay in clinical diagnosis. MRI has evolved to be the investigation of choice for the evaluation of presacral tumors as it can provide excellent anatomic detail and soft tissue contrast. Role of preoperative biopsy is controversial especially with improvements in the imaging techniques. When diagnosed these lesions should be excised because of the risk of malignant transformation.
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A prospective, randomized study of comparison of clipless cholecystectomy with conventional laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2011; 21:203-8. [PMID: 21375416 DOI: 10.1089/lap.2010.0455] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy has become a gold standard in the treatment of symptomatic gallstone disease. Amalgamation with upcoming technology makes the present-day procedure faster and safer. Ultrasonic shears, which perform dissection and ligation by cavitation and coaptation of vessels, are the latest addition to the armamentarium of laparoscopic surgeons. Acceptance of its safety and efficacy awaits its use as the sole instrument in the widely accepted procedure. METHODS A prospective, randomized control trial was conducted in 200 patients with symptomatic gallstone disease, who were randomly divided into two comparable groups, one undergoing cholecystectomy using ultrasonically activated shears and the other using conventional clip and electrocautery. Various parameters such as duration of surgery, removal of gallbladder, blood loss, postoperative pain scores, analgesic requirement, duration of stay, and complications were compared between the two groups. RESULTS Patients who underwent laparoscopic cholecystectomy using ultrasonic shears had a faster surgery (64.7 versus 50 minutes; P < .002) and removal of gallbladder from gallbladder bed (3.94 versus 7.46 minutes; P < .001) with less blood loss and pain scores (1.86 versus 3.01; P < .002). They had a shorter duration of hospital stay (1.89 versus 2.52 days; P < .001) and decreased risk of gallbladder perforation (9 versus 18; P < .005). The analgesic requirement was also less on the first postoperative day. There was no incidence of any major complication or bile leak during a 6-month follow-up period in either of the groups. CONCLUSION Ultrasonically activated scalpel can be used safely in laparoscopic cholecystectomy without risk of major injuries or leaks. It fairs better than electrocautery in terms of faster and safer surgery with decreased associated morbidity, less pain, and early return back home.
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Oncocytic papillary cystadenoma of parotid gland: a diagnostic challenge on fine-needle aspiration cytology. Diagn Cytopathol 2010; 39:627-30. [PMID: 21761584 DOI: 10.1002/dc.21501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 06/14/2010] [Indexed: 01/29/2023]
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Psychosocial disorders in women undergoing postoperative radiation and chemotherapy for breast cancer in India. Indian J Cancer 2010; 47:296-303. [DOI: 10.4103/0019-509x.64729] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Primary malignant melanoma of anorectum: A rare entity. Indian J Cancer 2009; 46:347-8. [PMID: 19749471 DOI: 10.4103/0019-509x.55561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
STUDY DESIGN A prospective, observational study using a novel procedure of video-assisted thoracoscopy and conventional, long spinal instruments for decompression of dorsal tubercular spondylitis. OBJECTIVES To assess the efficacy of video-assisted thoracoscopic decompression of dorsal tubercular spondylitis and compare it with the published data of classic thoracotomy procedures. SUMMARY OF BACKGROUND DATA Surgical decompression of dorsal tubercular spine with the transpleural transthoracic method is a standard procedure. It is a major surgery with significant morbidity in terms of blood loss, intensive care unit (ICU) and hospital stay, postoperative incision pain, and chest tube insertion. A procedure that has the potential to achieve comparable recovery in patients with dorsal tubercular spondylitis but with a surgery of lesser magnitude and morbidity has immense potential. METHODS There were 16 patients with mid-dorsal tubercular spondylitis with paraplegia/paraparesis requiring surgery who were included in the study. Every patient had a recent paradiscal disease at a single level. A soft tissue shadow was visible on plain radiographs of the spine, and conservative treatment for at least 3 weeks had shown no recovery. Patients with obvious respiratory insufficiency and likely to have significant pleural adhesions were excluded from the study. Single lung anesthesia and ipsilateral lung collapse using a double-lumen tube were administered. A 3-portal thoracoscopy approach was used, and conventional but long spinal instruments were used through an open port to decompress the spine. Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of chest tube insertion, ICU and hospital stay, and neurologic recovery. Patients were observed for a minimum of 6 months. RESULTS Of 16 patients, 14 (88%) had good neurologic recovery. In 1 patient, thoracoscopy was abandoned, and open thoracotomy was performed because of persistent bleeding. Another patient did not recover, and anterolateral decompression was performed 10 weeks after thoracoscopy. She recovered subsequently. Other complications included fracture of the sixth rib in 1 patient and breakage of suction tip in another. Adequate tissue biopsy for histopathologic examination could be obtained in all patients. Duration of surgery was 223 minutes (+/-56), blood loss was 497 ml (+/-302), and blood transfusion was required in 3 patients (3 U in 1 and 1 U in 2). Postoperative analgesic (tramadol) was 243 mg (+/-70) for 2-4 days (median 3), median hospital stay was 5.5 days (range 4-9), chest tube requirement was 3 days (range 2-7), and 2 patients were required to stay in the ICU for 1 day each. CONCLUSION Video-assisted thoracoscopic decompression of tubercular dorsal spondylitis is a viable option to achieve significant neurologic recovery with less morbidity, blood requirement, and hospital stay compared to the open thoracotomy procedures.
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Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 2005; 189:56-60. [PMID: 15701493 DOI: 10.1016/j.amjsurg.2004.03.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 03/20/2004] [Accepted: 03/20/2004] [Indexed: 01/25/2023]
Abstract
BACKGROUND The new technique of circular stapler for the treatment of hemorrhoids has shown early promise in terms of minimal or no postoperative pain, early discharge from hospital, and quick return to work. This study was designed to compare stapled technique with the well-accepted conventional Milligan Morgan hemorrhoidectomy. METHODS After fulfilling the selection criteria, 84 patients were randomly allocated to the stapled (n = 42) or open group (n = 42). All patients were operated on under spinal anesthesia. The 2 techniques were evaluated with respect to the operative time, pain scores, complications, day of discharge, return to work, and level of satisfaction. RESULTS The mean age of patients was 46.02 years (SD, 12.33) in the stapled group and 48.64 years (14.57) in the open group. Grade III or IV hemorrhoids were more common in men (ie, 80.9% and 85.7% in the stapled and open group, respectively). The mean operative time was shorter in the stapled group 24.28 minutes (4.25) versus 45.21 minutes (5.36) in the Milligan-Morgan group (P < .001). The blood loss, pain scores and requirement of analgesics was significantly less in the stapled group. Mean hospital stay was 1.24 days (0.62) and 2.76 days (1.01) (P < .001) in the stapled and open group, respectively. The patients in the stapled group returned to work or routine activities earlier (ie, within 8.12 days [2.48]) as compared with 17.62 (5.59) in the open group. Only 88.1% of patients were satisfied by the open method compared with 97.6% after the stapled technique. The median follow-up period was 11 months with a maximum follow-up of 19 months (range 2-19 months). CONCLUSIONS Stapled hemorrhoidectomy is a safe and effective day-care procedure for the treatment of grade III and grade IV hemorrhoids. It ensures lesser postoperative pain, early discharge, less time off work, complications similar to the open technique, and in the end a more satisfied patient with no perianal wound. However, more such randomized trials are essential to deny any long-term complication.
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Evaluation of fundus-first laparoscopic cholecystectomy. JSLS 2004; 8:255-8. [PMID: 15347114 PMCID: PMC3016813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Laparoscopic cholecystectomy is the gold standard for gallbladder surgery. Cholecystectomy from the fundus to the cystic duct may be advantageous when cystic duct exposure becomes difficult due to adhesions on Calot's triangle. The aim of this study was to compare conventional laparoscopic cholecystectomy with the fundus-first procedure and to evaluate whether the fundus-first technique can prevent conversion in difficult cases. METHODS The study included 145 patients treated over 18 months. The inclusion criterion was the presence of ultrasound proven gallstones. Patients were excluded from the study if there was evidence of common bile duct stones, a bilioenteric fistula, or carcinoma of the gallbladder. RESULTS The fundus-first approach was started in 45 patients; all procedures were completed laparoscopically. Conventional laparoscopic cholecystectomy was begun in 100 patients. Twenty-seven of the 100 patients were converted to fundus dissection (adhesions within Calot's triangle). Four of the 27 were further converted to open surgery. One patient had a drop in blood pressure on creation of pneumoperitoneum. Time taken for severely inflammatory and noninflammatory cases was significantly greater (P<0.05) in the fundus-first group. The average hospital stay was 48 hours in both groups. No major complications were observed. CONCLUSION The rate of conversion in the conventional laparoscopic cholecystectomy group decreased from 18.75% (27/144) to 2.08% (3/144). The fundus-first technique has the potential to decrease conversion in difficult cases.
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The role of laparoscopy in the localization and management of adult impalpable testes. JSLS 2004; 8:43-6. [PMID: 14974662 PMCID: PMC3015505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Very few studies are available that describe the role of laparoscopy in adults with impalpable testes. This study compares laparoscopy with ultrasonography in this subset of patients. METHODS Fourteen adults, having a mean age of 21 years, with 19 undescended testes were evaluated. None of the testes was palpable, preoperative ultrasound localized 7 testes (36.8%), but a change in findings was observed in 3 of these cases (42.8%) on subsequent laparoscopy. On laparoscopy, 18 (94.7%) of the testes were localized as intraabdominal. The remaining patient had a case of true anorchia. Seven patients with unilateral undescended testes underwent laparoscopic orchiectomy, and 2 patients with unilateral undescended testes and all the patients with bilateral undescended testes underwent laparoscopic-assisted orchiopexy. No complication was noted in any of the cases. Hernia, present in 4 patients, was simultaneously repaired laparoscopically. CONCLUSION Laparoscopy is a safe and effective modality in the localization and management of adult undescended testes. In adults, orchiectomy with the subsequent reduction in the risk of malignancy is the major issue of concern. Also, the repair of concomitant hernias is desirable. Both of these procedures can be done laparoscopically in the same sitting without the need for inguinal exploration.
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Open port placement of the first laparoscopic port: a safe technique. JSLS 2004; 8:364-6. [PMID: 15554282 PMCID: PMC3016831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Blind insertion of the Veress needle and of the first trocar is a significant cause of complications in laparoscopic surgery. Despite this risk, the closed technique is still more popular than the open one. Our aim is to report the results of our experience with the routine use of the modified open technique in laparoscopic surgery and to describe the technical details of the creation of pnuemoperitoneum by the open technique that we used. METHODS A prospective study was conducted in the department of surgery at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi. A modified method of open laparoscopy was performed on 755 consecutive patients requiring laparoscopy or laparoscopic surgery over a 5-year period from August 1998 to February 2003 in 1 surgical unit. RESULTS The mean time taken was 4 minutes (range, 2 to 10). No intraoperative complications occurred during trocar insertion. Forty-nine (6.49%) patients had minor umbilical sepsis, 22 (2.91%) had periumbilical hematoma, but none had umbilical hernia during 3 months of follow-up after surgery. CONCLUSION Based on our own experience, we recommend open laparoscopy as a safe and easy approach for routine laparoscopic interventions.
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A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS 2002; 6:59-63. [PMID: 12002299 PMCID: PMC3043388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A prospective study was conducted from March 1999 to April 2000 that included 73 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. The study was conducted at one surgical unit in the Department of Surgery and Department of Radio-diagnosis and one surgical unit in the Department of Surgery, Maulana Azad Medical College and the associated Lok Nayak Hospital, which is the largest referral hospital in northern India and is located in the capital of India. A preoperative ultrasound was performed just prior to surgery, and 4 ultrasonographic parameters were analyzed. namely gallbladder wall thickness, contracted gallbladder, impaction of gallstones at the neck of the gallbladder, and common bile duct stones. The surgical findings were objectively graded as difficult or easy laparoscopic cholecystectomy according to 5 operative parameters, namely total time taken for the surgery, time taken to dissect gallbladder bed, spillage of stones, tear of gallbladder during dissection, and conversion to the open procedure. Of the 73 cases, 17 (23.3%) were conversions to the open procedure. Of the 21 (28.76%) cases predicted to be difficult, 17 (23.3%) were technically difficult, of which 13 (17.8%) were converted to the open procedure. Of the 52 (71.23%) cases predicted to be easy on ultrasonography, only 7 (9.38%) were found to be difficult on surgery, of which only 4 (5.48%) had to be converted to the open procedure. Based on our results, we conclude that preoperative ultrasonography is of great value in selecting patients preoperatively for laparoscopic cholecystectomy and minimizing complications and conversion to the open procedure.
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Experiences with ESR (endolymphatic sac revascularization) in cases of sensorineural hearing-loss. J Laryngol Otol 1984; 98:139-51. [PMID: 6693815 DOI: 10.1017/s0022215100146328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Experience based on 14 cases of severe-to-total sensorineural deafness, treated with endolymphatic sac revascularization, operation, is presented. Changes seen in the endolymphatic sacs and lateral sinuses of these patients have been detailed. Irrespective of the degree and duration of deafness, significant hearing gain (with good improvement in speech discrimination) was obtained in nine out of 14 cases (64.28 per cent). There was no improvement at all in one out of 14 (7.14 per cent), and there was a relapse of the hearing-loss two months post-operatively in one case (7.14 per cent). Tinnitus disappeared in the operated ear in three out of five cases (60 per cent) and vertigo improved considerably in four out of six cases (66.66 per cent). The follow-up in this series has been up to two years.
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Abstract
Absorption spectra of human bone and its two major constituents (collagen and apatite) were obtained in the wavelength region extending from 2000 to 12,000 A. In the last two cases a minimum transmission (maximum absorption) was uniformly observed in the ultraviolet region. The two samples after exposure to ultraviolet radiations show a shift in the peak positions. Absorption peaks in the total bone spectra are not reproducible in its two constituents. After exposure to UV radiations the position of maximum absorption is displaced. A possible interpretation of the observed results is presented.
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Abstract
Indications and results of 125 Vidian neurectomies done in 64 patients have been presented. The indications were grouped as: Rhinorrhoea (37.5%), Nasal Polyposis (3.12%); Headaches and Faceaches (45.32%); and Bronchial Asthma (14-06%). Four initial Vidian neurectomies were done unilaterally and produced only partial relief in symptoms. Bilateral Vidian neurectomy relieved completely all the rhinorrhoea cases, all the nasal polyposis cases, 79-3% of headache and faceache cases and 55-5% of bronchial asthma cases.
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The effect of ultraviolet radiation on the electrical conductivity of human bone. CALCIFIED TISSUE RESEARCH 1975; 19:223-7. [PMID: 1212635 DOI: 10.1007/bf02564006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The electrical conductivity of intact bone, collagen and apatite mineral was determined in the region of moderately high fields. After exposure to ultraviolet (UV) radiation the conductivity of the specimens was redetermined. Following exposure marked decreases in electrical conductivity occurred in all specimens. The possible modes of interaction of UV radiation with bone are discussed. It is suggested that protonic conduction may be an important mode of charge transport in bone.
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Abstract
A unique case of liposarcoma of the mastoid in a 4-year-old child presenting as acute mastoiditis and subperiosteal abscess has been reported.
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Stapedectomy. JOURNAL OF THE INDIAN MEDICAL ASSOCIATION 1975; 64:6-10. [PMID: 1133462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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34
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Differences in mode of action of cellulolytic enzymes from Curvularia lunata & Chaetomium globosum. INDIAN JOURNAL OF EXPERIMENTAL BIOLOGY 1973; 11:40-2. [PMID: 4779294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Evaluation of insecticidal, fumigant and repellent properties of lemongrass oil. INDIAN JOURNAL OF EXPERIMENTAL BIOLOGY 1966; 4:128-9. [PMID: 4380199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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