ABSTRACT
Background: Inguinal hernia results from the failure of embryonic closure of the deep inguinal ring and is the most common cause of swelling in the groin region. However, an inguinal hernia is not the only cause for swelling in that region. Objectives: The main aim and objective of this study were to evaluate female patients with swellings in the inguinal region in terms of incidence, clinical presentation, age distribution, and differential diagnosis. Methods: The present clinical study was carried out at the Department of General Surgery; Shimoga Institute of Medical Sciences, Shimoga from March 2014 to March 2015. All the patients were thoroughly investigated, and surgical procedures were done. Results: Among the 10 cases studied, 6 cases were the regular inguinal hernia and the rest 4 cases were a subcutaneous lipoma. The ultrasonography of the part had revealed it has hernias. Surgical procedures were done and specimens obtained were sent to histopathological examination. Conclusion: The present study reveals that all inguinal swellings need not be a hernia and it can be due to other causes also and ultrasonography of the part is not the conclusive diagnostic tool.
ABSTRACT
Background: Varicose veins of the lower extremities are the most common peripheral vascular disease and their treatment is as old as mankind. This prospective clinical study of surgical management of varicose vein was conducted to study the age, sex and occupational distribution of varicose veins of lower limb. Evaluations of clinical features and surgical methods of treatments that were in practice in the management of varicose veins in terms of recurrence and symptoms improvement were also studied. Methods: Two years prospective study was conducted in our institution from May 2007 to April 2009. During this period 62 cases of varicose veins of lower limbs were admitted to our hospital of which 50 cases were selected and were studies in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 21 (42%) had only long saphenous vein involvement, 7 (14%) had short saphenous vein involvement and in 5 (10%) cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 17 (34%) cases. Among them prominent veins and pain were the main complain in 38 (78%) patients. Itching and pigmentation were present in 4 (8%) patients. Ankle edema was present in 6 (12%) patients. Pain and ulceration of lower leg were present in 2 (4%) patients. After clinical assessment appropriate surgical procedures were followed for each of patients. These cases were followed for 3 year durations. Out of 50 patients 7 (14%) patients had recurrence of varicose vein. 7 (14%) patient complained of recurrence of pain after 2 years of surgery but no appearance of varicose vein. One patient (2%) complained of persistence of pigmentation after surgery. 2 (4%) patients complained of persistence of ankle edema and there was complete healing of ulcer which was present earlier. Conclusions: Commonest age group of varicose vein of lower limb was 20 to 40 years. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of treatment is an ideal treatment for varicose vein. For incompetent perforators, sub-fascial ligation appears to be a better method of treatment than extra fascial ligation. Because in the former all the perforators could be visualized and dealt with, while in the latter there were chances of missing one or two perforators. If cases are selected properly with good operative technique the complications are negligible
ABSTRACT
Background: This study was conducted to compare the plain radiography with the abdominal ultrasonography in the detection of pneumoperitoneum in suspected cases of hollow viscus perforation. Methods: A total number of 60 patients with suspected hollow viscus perforation were studied. All the patients had undergone plain radiography (Erect x-ray abdomen and left lateral decubitus views), ultrasonography and exploratory laparotomy. The investigational findings were compared with that of laparotomy findings. They were compared in terms of their sensitivity, specificity, predictive value of a positive and negative results and their percentage of false positive and false negative results. Results: Of the 60 patients, who underwent laparotomy, 57 had hollow viscus perforation. Out of 3 non-hollow viscus perforated cases 2 had appendicular perforation and 1 had mesenteric lymphadenitis. In the diagnosis, ultrasonography vs. radiography, their respective parameters were sensitivity (73.7% vs. 80.7%), specificity (66.7% each), predictive value of a positive test (97.7% vs. 97.9%), predictive value of a negative test (11.8% vs. 15.4%), percentage of false negative (26.3% vs. 19.3%) and percentage of false positive (33.3% each). Conclusion: In detection of pneumoperitoneum plain radiography appears to be more sensitive than ultrasonography with comparable specificity. Ultrasonographic finding of pneumoperitoneum is considered as an added finding.