Enteral glutamine supplementation reducing infectious morbidity in burns patients: a randomised controlled trial

PURPOSE

Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on patients with burns is not completely studied. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity and in turn, the hospital-stay in patients with burns.

METHODS

Thirty patients with burns were randomly divided into two groups with 15 patients in each, the study (glutamine supplemented) and control group. Patients were randomised to receive either isonitrogenous mixture without glutamine or isonitrogenous mixture with glutamine until complete healing of the burn wound occurred. Incidence of positive blood culture, wound culture, total leucocyte count, hospital-stay and mortality was recorded.

RESULTS

The results showed that the incidence of positive blood culture was considerably reduced in the study group (0.20±0.41) vs. control (0.73±0.96; p = 0.065). The incidence of positive wound culture was significantly reduced in the study group (1.00 ± 1.25) vs. control (3.53 ± 2.47; p = 0.001). In addition, the wound healing was better and hospital-stay days were reduced in the study group (22.73 ± 9.13 days) vs. (39.73 ± 18.27 days; p = 0.003).

CONCLUSIONS

These results indicate that enteral glutamine supplementation in adult burn patients could abate the degree of infectious morbidity and reduce hospital-stay.

Conventional laparoscopic appendectomy versus double-incision, three-port laparoscopic appendectomy: A 1-year randomized controlled trial

INTRODUCTION

Management of appendicitis has evolved dramatically in the last 120 years, from McBurney's large incision to minimally invasive laparoscopic appendectomy to hardly noticeable incisions with SILS. As a bridge between conventional laparoscopic surgery and SILS, double-incision laparoscopic surgery further minimizes the invasiveness of laparoscopic surgery by reducing the number of incisions. This study aimed to establish the efficacy of double-incision, three-port laparoscopic appendectomy (DILA) as an alternative to conventional three-port laparoscopic appendectomy.

METHODS

A total of 60 patients were divided randomly into two groups: the conventional laparoscopic appendectomy (CLA) group and the DILA appendectomy group. Demographics, diagnostic history, additional intraoperative findings, and duration of operation were recorded. Postoperative pain after 6 h and 24 h and cosmetic outcome after the surgery were also evaluated. Statistical analysis was done using Fisher's exact test, χ² test, and Student's t-test.

RESULTS

No significant difference was observed in demographic and clinical characteristics in either group (P > 0.05). No significant difference in mean postoperative pain was observed between the two groups at 6 h (P = 0.62) or 24 h (P = 0.484). However, patients in the DILA group were more satisfied with their cosmetic outcomes than those in the CLA group (P = 0.04). The mean operative time was 26.4 min in the CLA group and 27.6 min in the DILA group (P = 0.62).

CONCLUSION

DILA can be performed with operative outcomes that are equivalent to CLA but with superior cosmetic outcomes.

Solid pseudo papillary tumor of pancreas: Presenting as acute abdomen in a female child

Solid pseudo papillary tumor (SPT) or Frantz's tumor is a slow-growing low-grade malignant tumor, commonly seen in young patients with a female predominance, which is commonly located in the body and tail of the pancreas. We report a case of SPT arising from the body of the pancreas in a 12-year-old girl who presented with acute abdomen and was treated successfully by local excision of the tumor with preservation of head of pancreas and spleen.

Outcome of Pancreaticoduodenectomy at Low-Volume Centre in Tier-II City of India

Currently, pancreaticoduodenectomy (PD) is considered a common and feasibly performed surgery for periampullary tumours, but it is still a high-risk surgical procedure with potential morbidity and mortality rates. Previously, it was emphasised for the need of high-volume centres to perform specialised surgery such as PD. The authors have made an attempt to know the relation between low-volume centre and outcomes of PD. The study was conducted in a Tier-II city referral hospital located in Karnataka, India. A total of 37 patients with suspected periampullary neoplasms underwent surgical exploration with curative intent over a period of 4 years, i.e. from May 2012 to May 2016. Out of 37 patients, 26 underwent PD, either classic Whipple resection (n = 01) or pylorus-preserving modification (n = 25). In 11 patients, resection was not possible, where biliary and gastric drainage procedures were done. All patients were treated by standardised post-operative care protocols for pancreatic resection used at our centre. We recorded the perioperative outcome along with demographics, indications for surgery, and pre- and intra-operative factors of PD. Post-operative pancreatic fistulae were evident in 4 patients. Two patients had hepaticojejunostomy leak. One patient had chyle leak. Three patients had infection at the surgical site. One patient had post-operative pneumonia leading to mortality. None of the patients had post-op haemorrhage. The surgeon volume and surgeon experience may have minimal contributing factor in post-operative morbidity, especially if there is availability of well-equipped ICU and imaging facilities, along with well-experienced personnel like oncosurgeon, anaesthesiologist, intensivist, radiologist, and nursing staff. There is a need of a multicentre study from Tier-II city hospitals/low-volume centres and high-volume centres to come with perioperative surgical outcomes following PD.

A cross-sectional study to detect the prevalence of hyperhomocysteinemia in cases of deep vein thrombosis

Hyperhomocysteinemia is a known risk factor for the development of deep vein thrombosis (DVT). Various studies have been conducted in the western countries to know the prevalence of hyperhomocysteinemia in patients with DVT and in general population. There is no documented literature of the prevalence of hyperhomocysteinemia in Indian population. Thus the aim of this study was to determine the prevalence of hyperhomocysteinemia in cases of DVT in our population. To evaluate the prevalence of hyperhomocysteinemia, a prospective cross sectional study done on a total of 70 patients admitted in KLES Dr Prabhakar Kore hospital, Belgaum, India. DVT was confirmed by Doppler examination. Serum homocysteine was measured and the data analysed. Statistical significance was calculated using chi square test. A total of 70 patients were studied of which 53 were males and 17 were females. The prevalence of hyperhomocysteinemia among the cases of DVT was 31.428%.The prevalence among males was 35.85% and among females was 17.64%.There was statistically significant association between hyperhomocysteinemia and presence of ischaemic heart disease with a p value of 0.005 on chi square analysis. The prevalence of hyperhomocysteinemia in cases of deep vein thrombosis in our population was 31.428%. There was a statistically significant association between hyperhomocysteinemia and ischaemic heart disease.

Chemoport-associated Complications and Its Management

Chemoport is being routinely used to administer chemotherapy, blood, blood products, total parenteral nutrition, and also to draw blood for investigations. We started using chemoport in our institute. We use it exclusively to administer chemotherapy. We analyzed our results of chemoport usage and confirm that the rate of complications associated with chemoport usage is at par with the available literature. We also conclude that with regular use, the intra-op and post-op complications will reduce further.

Hybrid Minimally Invasive Esophagectomy for Carcinoma Oesophagus: Experience at Tertiary Care Centre in North Karnataka

Surgery remains the mainstay for curative treatment of carcinoma of midthoracic and lower thoracic oesophagus. In the twentieth century, open esophagectomy was the standard of care. In the twenty-first century, treatment for carcinoma oesophagus has revolutionized with incorporation of neoadjuvant treatment and application of various minimally invasive techniques for esophagectomy. At present, there is no consensus about the optimum position to perform minimally invasive esophagectomy (MIE). We share our experience of MIE with modification in the port position in this article.