ABSTRACT
Background: a fecal fistula is dreadful complication both for patients ,surgeons and care takers after the major abdominal surgery. though rarely encountered but very challenging as the chance of operability and future healing always remains a question in surgeon's mind and sigh of relief isn't possible until patients starts tolerating oral feeds. A conservative management option always hit the surgeon's mind, the same idea has been evaluated here in detail. the objective was to analyze and check the Objectives: effectiveness of conservative management option of fecal fistula in our patients and to which extent it is viable to adhere it in patients. We have choose some parameters to assess it which has been described later. Patients and Methods: In this study, a comparative study was done about evaluation of total gut irrigation method for the closure of fecal fistula. The total 40 patients over the period of 2 years were included in the study and 20 patients were divided in each group, in one group we had given the total gut irrigation and in another group we did not give any gut irrigation. We evaluated the both groups on following parameters.1. spontaneous closure of fecal fistula 2. Skin conditions 3. Time to start the oral feed 4. Days of hospitalization 5. Development of features of intestinal obstruction 6. Sepsis in patients. Results: In this study we found that for the low output fistula and some selective cases of medium output fistula, the TGI is good and attractive option, though the statistical test doesn't show difference on some points mentioned above but in half of the parameters they were significant. In high output fistula group we found not much usability of TGI but in previous two types there was clear positive difference on almost all parameters. Total gut Conclusion: irrigation(TGI) is a simple and an important bedside test whose methodology when applied to acute fecal fistula helps to characterize the fistula from a functional aspect. In our study of 40 patients we found the clear mandate of TGI in low output and selective medium output fistula
ABSTRACT
BackgroundIn India, the oral tongue cancer is the fourth most common type of cancer among all cancers andsecond most common in cancers of oral cavity in males. Though there are advances in thediagnosis and treatment of the oral malignancies including the tongue, the failure rates in cancerof the oral tongue are high as the tongue malignancy has higher chances of spreading to necklymph nodes compared with other oral cancers.MethodA retrospective review of the case records of 55 patients who underwent surgery for thetreatment of carcinoma of the tongue was carried off in the department of General Surgery andOnco-surgery at the GCS Hospital, Ahmedabad to ensure the pattern of cervical lymph nodemetastasis and to assess the sensitivity of depth of malignant tongue ulcer in predicting its nodalspread.ResultsAmong 55 patients, diagnosed with carcinoma tongue and operated for hemi glossectomy alongwith MRND, Lymph node metastasis was present in 22 (40%). Out of these 22 patients, themean depth of invasion was 11 mm. In patients without lymph node metastasis, the mean depthof invasion was 8.3 mm.Chances of cervical lymph node metastasis increases with increment in the depth of malignanttongue ulcer.ConclusionThe infiltration depth of the malignant tongue ulcer can be used as an autonomous predictor forthe presence of nodal metastasis.