ABSTRACT
Background: Amputation is among the oldest operation known to man. It is the surgical removal of a limb or body part and performed to remove diseased tissue or relieve pain. Amputation is associated with some complications. Infection and failure of stump to heal are major complications. The Diabetes related Lower Extremity Amputation (LEA) is likely to be associated with a worse outcome as compared to the non-diabetic amputations because of the presence of several risk factors which hamper the wound healing process. Amputees with diabetes are more likely to undergo amputation at a younger age and need higher-level amputations when compared with patients without diabetes. With this background, the present study was planned to understand the factors that place diabetic patients at increased risk of amputation in the study area so that further morbidity can be prevented. Methods: The current prospective study was conducted in the Department of Surgery, Dr. B.R.A.M. Hospital, Pt. JNM Medical College, Raipur (C.G.) India, among 60 patients admitted in the General Surgery wards during January 2013 to August 2014. Study subjects were categorized into those related to diabetes mellitus and those due to other causes. All Investigations relevant to the study (Random blood sugar, Serum albumin, Complete blood count, renal function test and Doppler) were done in all the patients. Postoperatively the cases were examined for various complications of amputation stump in post operative period were noted. Results: Mean age for diabetic cases was 50 years and that for non-diabetic cases was 47 years. In this study, among the diabetic amputations, 84 % were males and 16 % were females. Total 60 amputations were performed in the study. Stump infection (50 % in diabetics and 29 % in non-diabetics) was the most common stump complication. Followed by wound dehiscence (25 % in diabetics and 11 % in non-diabetics) Conclusion: Diabetic amputations are at a higher risk of complications. They need to be carefully screened and selected for appropriate level of amputation and watched meticulously for occurrence of complications.
ABSTRACT
To evaluate the morbidity and mortality associated with thoracic surgery in adult patients over a period of one year. Prospective, descriptive, clinical study. Thirty patients [24 men and 6 women], who underwent various thoracic surgeries over a period of one year [1 December 2008 to 31 December 2009], were studied. The primary outcome was discharge from the hospital within 14 days after surgery. The mean age of the patients was 28.37 +/- 14.12 yrs. The surgical procedures were as follows: 13[43%] decortications, 6[20%] thoracoplasty, 6[20%] excision of a cyst, 2[7%] segmentectomy, 2[7%] lobectomy, and 1[3%] pneumonectomy. Mean duration of surgery and anaesthesia were 134.5 +/- 44.79 min and 144.5 +/- 45.59 min respectively and most of the patients [26/30[87%]] were extuabted in the operating room. Twenty [68.97%] patients were discharged from the hospital 14 days. Factors associated with prolonged hospital length of stay [>14 days] included: long duration of smoking, low FEV1, metabolic acidosis; higher intraoperative blood loss and longer duration of surgery. We conclude that patients having above risk factors should be aggressively managed and monitored intra and postoperatively
ABSTRACT
Cardiopulmonary dysfunction has been observed after the removal of benign hydatidiform mole which can lead to substantial morbidity and mortality. We report a 20 year old woman who came to casualty with a gush of per vaginal bleeding; associated findings were hypotension, anemia and tachypnoea. Evacuation of the mole was done under general anesthesia as an emergency procedure. Immediately after evacuation she developed acute massive pulmonary edema that progressed to adult respiratory distress syndrome. In spite of extensive peri-operative management in the form of vasopressors and ventilatory support, mortality occurred after 12 hours post operatively