ABSTRACT
Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.
ABSTRACT
Introduction: Cholelithiasis is one of the most commonsurgical diseases. Laparoscopic cholecystectomy has beenuniversally accepted as gold standard for treatment ofcholelithiasis. Although many studies have shown postoperative changes in liver function tests after high pressurepneumoperitoneum during laparoscopic cholecystectomy,but very few studies have investigated the effects of lowpressure pneumoperitoneum on hepatic functions.The presentstudy was designed to compare post-operative changes inliver function tests among patients randomized to either lowpressure laparoscopic cholecystectomy(LPLC) (i.e.8 mmHg)or high pressure laparoscopic cholecystectomy(HPLC) (i.e.14mmHg).Material and methods: After taking a well informed writtenconsent,150 cases undergoing laparoscopic cholecystectomywere enrolled in the study and randomised preoperatively intotwo groups (LPLC and HPLC). Liver function tests (LFTs)including Total Bilirubin, Conjugated Bilirubin, AspartateTransaminase (AST), Alkaline Phosphatase(ALP), AlanineTransaminase (ALT), Gamma-glutamyl Transferase (GGT),Total Serum Protein, Total Serum Albumin) were done onpost-operative day (POD) 1 and day 7 and compared withpreoperative LFTs in both groups.Results: The study demonstrated significant increase inConjugated bilirubin on POD 1(p < .001), AST on POD1 (p: .005), ALT on POD 1 (p <.001), ALP on POD 1(p < .001) in HPLC as compared to LPLC patients. LFTsin both groups were found to be normal on POD 7 withoutsignificant difference between the two groups.Conclusion: Low pressure laparoscopic cholecystectomy hasless adverse effects on liver functions as compared to the highpressure laparoscopic cholecystectomy
ABSTRACT
Verrucous carcinoma also known as Ackerman’s tumour is a variant of well differentiated squamous cell carcinoma that affects cutaneous and mucosal surfaces. Ackerman’s tumour accounts for 1-10% of cases of Squamous Cell Carcinoma in the epithelial lining of oral mucosa and gingiva. It appears as slowly enlarging warty, exophytic cauliflower like overgrowth, grey or white in colour and is seen commonly in older males.1 Tobacco consumption has been the primary aetiology of verrucous carcinoma.2,3 The oncogenic viruses HPV 16 and 18 are also implicated in the aetiology of this condition.4 Other etiological factors may include smoking, poor hygiene and alcohol abuse. Verrucous carcinoma shows typical clinical behaviour being locally invasive. The rate of nodal metastasis is less, neck dissection and radiotherapy are the least opted modalities for treatment. The treatment of this is usually surgical excision and prognosis is fair. In this paper we report a typical gingival presentation of verrucous carcinoma bilaterally along with the clinicopathological diagnosis and a review of scientific literature.
ABSTRACT
Introduction: Appendix is surely, the most commonlyharvested organ of the body. On looking up the literature,we found, that the negative appendectomy rates have beenconsistently maintained all through these years. Negativeappendectomy not only increases economic burden on healthcare facilities of a developing country like India, but alsohas a negative impact on the overall health of the patient.The following study was therefore, taken up to evaluate thediagnostic accuracy of the Modified Alvarado scoring systemand its ultimate effect on mortality and morbidity of the patient.Though this is an old score, but we restudied it, to revalidateas well as to promote the use of this simple, economicaland objective clinical score which actually uses establishedclinical methods, important for residents training program, toreach the diagnosis instead of the costly radiological methods.Material and methods: 50 patients presenting with thelower quadrant abdominal pain and fulfilling the inclusioncriteria were selected randomly and included in the study.Modified Alvarado Score was calculated for each one ofthem. Confirmation of the diagnosis was done after thehistopathological examination of appendix.Results: Modified Alvarado Score >7 was found in 80% (i.e.82.75% of males and 76.19% of females) of patients withappendicitis. In addition to these findings, we also got exactinformation about the age and sex distribution along withthe most common presenting complaint, the postoperativecomplications and the need for post operative stay inappendicitis patients.Conclusion: Modified Alvarado Score is a fast, simple,noninvasive, repeatable and highly economical score. Whenapplied purposefully and objectively, it can prevent delayin surgeries and hence complications as well as can reducenegative appendectomies.