ABSTRACT
Background: Scalpel skin incision produces a clean, incised wound with minimal tissue destruction. Cutting diathermy also produces an incised wound that heals as well as the one that is created by cold scalpel but with an added advantage of achieving quick hemostasis and saving operative time. The main thing of the present study is to verify and compare the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: The study was conducted in Medical College and Hospital, in 60 patients randomly selected for diathermy and scalpel incision, between 14-65 years age group, between January 2011-June 2012. Post operative pain, seroma, hematoma, discharge were observed and results were analyzed and compared for the two groups using Mann-Whitney U Test.Results: Diathermy group, with incision related time of 6.20±0.97 sec/cm, was significantly quicker (p=0.003) than scalpel incision, with incision time of 6.76±0.84 sec/cm. Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups.Conclusions: We demonstrate that the diathermy provides efficient cutting of skin, with no superior wound-healing profile, comparable to that of the traditional scalpel blade.
ABSTRACT
Background: Hernia of the umbilical cord is a rare clinical entity which presents with hernia of the small bowel into the proximal part of the umbilical cord. This is sporadically associated with other congenital malformations. This is usually poorly identified and mistakenly termed as 'omphalocele minor. Inadvertent clamping of the cord in these cases leads to iatrogenic bowel wall injury. The aim of this study is to present a spectrum of cases presenting with umbilical cord hernia in a tertiary care Govt medical college, along with demography, intra operative findings, associated malformations and postoperative outcome and 1 year follow up.Methods: This is an ambispective study on neonates who attended the Outpatient Department (OPD) or Emergency department. The babies were evaluated by age, birth weight, gender, any gross clinical malformation. They were also evaluated intraoperatively for any associated anomalies. Post-surgery the babies were followed up until 2 years of age in pediatric surgery OPD of the same institute and outcome was recorded.Results: Out of 90 babies, 88 babies (97.77%) had body weight more than 2.5 kg, and rest 2(2.22%) had bodyweight of 1.5kg and 1.8 kg. Regarding content of contents of umbilical cord hernia, out of 87 patients, 43 patients (49.42%) had ileal loop as, 32 patients (36.78%) had ileum with Meckel's diverticulum, 6 patients (6.39%) had cecum with appendix.Conclusions: Most of this study cases had ileal loops as content of the hernial sacs, and 36.78% cases had Meckel's diverticulum associated, which is a remnant of Vitello intestinal duct. Prompt identification of the condition and early intervention and adequate post-natal care are affective to prevent long term morbidity.
ABSTRACT
Background: Thalassemia are inherited blood disorders that can result in the abnormal formation of hemoglobin. Splenectomy is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement and prevents adequate control of body iron with chelation therapy. Ninety percent of recipients transfused with HIV antibody-positive blood are found to be HIV infected at follow-up. Prevailing literature on effects of splenectomy on CD4 count suggests that splenectomy causes an abrupt and prolonged increase in CD4 cell count. The aims and objectives this is an Institution based prospective observational study with the aim to observe postoperative outcome in immunocompromised thalassemic patients following splenectomy, postoperative outcome following splenectomy in a patient with low CD4 count and to analyze the effect of CD 4 count if any on different patients in terms of wound infection, chest infection , urinary tract infection or infection at any other site.Methods: The study included twenty immunocompromised thalassemia Patients attending in Pediatric Surgery OPD and admitted to Paediatric Surgery department of Medical college and hospital Kolkata with splenomegaly and HIV infection for splenectomy, between January 2015 to December 2016.Simple comparative analysis of gathered data was used to evaluate postoperative outcome m and the preop and the post op CD4 count levels of splenectomised thalassaemic patients.Results: Most patients in this study were in the (3-8) years age group and all are HIV positive patients with thalassemia. In this study author found there was increased CD4 count after splenectomy and postoperative period one patient developed postoperative oral candidiasis.Conclusions: HIV-infected thalassaemic patients on ART can now safely undergo major splenectomy surgery with encouraging results and in patients with a low CD4 count, there is no relation of CD4 count and splenectomy outcome.
ABSTRACT
Background: Hirschsprung's Disease (HSCR) is the commonest congenital gut motility disorder and is characterized by the absence of ganglion cells in a variable length of the distal gut. According to literature , HRSCD may be associated with a chromosomal abnormality or other congenital anomalies in approximately 20% of cases HSCR appeared to be a multifactorial malformation with low, sex dependent penetrance and variable expression according to the length of the a ganglionic segment, suggesting the involvement of one or more gene (s) with low penetrance. So far, eight genes have been found to be involved in HSCR. This frequent congenital malformation now stands as a model for genetic disorders with complex patterns of inheritance. The objective of this study was to collect and study personal and family history and any information regarding known associated anomalies in patients diagnosed as Hirschsprung's disease.Methods: Here author present a series of 89 consecutive HSCR patients who were admitted or attended the Pediatric Surgery OPD of in a tertiary care Government medical college, who were evaluated for associated malformations with the help of available non-invasive investigation.Results: Congenital heart diseases and Down's syndrome were the two most common associated anomalies. Genitourinary anomalies, Limb anomalies and central nervous system anomalies were other associated anomalies. Conclusions: This study confirmed the underestimation of certain associated anomalies in Hirschsprung patients, such as CNS anomalies. Based on the results of this study, in addition to meticulous general examination author suggest performing cardiologic assessment in patients diagnosed with Hirschsprung's disease based on clinical features and according to the standards of care adopted for the general population.