Evaluation of Medical and Surgical Treatment of Gastroesophageal Reflux in Severely Restarted Subjects: A Comparative Study

Background:Gastroesophageal reflux disease (GERD) is of the common disease affecting a significant proportion of the world population. GERD is a chronic disease that typically requires long term management in the form of lifestyle modification, medical therapy and, for a subset of patients, surgical therapy. Hence; we conducted the present study to assess and compare the outcome of medical and surgical treatment therapy in severely retarded subjects with GERD. Materials & Methods: The present study included comparison of efficacy of medical and surgical treatment in retarded patients with GERD. A total of 24 patients were included in the present study and were randomly divided into two study groups. Group A included patients that underwent medicinal treatment while group B included patients in which surgical treatment was planned. Nissen fundoplication and gastrostomy was performed in group B patients. Complete follow-up details of all the patients were maintained and compared. All the results were analyzed by SPSS software. Results A total of 24 patients were included in the present study which were broadly divided into two study groups. Mean age of the patients of group A and group B were 25.2 years and 24.2 years respectively. Respiratory symptoms were found to be present in 1 and 4 patients of group A and group B respectively. Significant results were obtained while comparing the respiratory symptoms in patients of group A and group B. Conclusion: Improvement in respiratory symptoms occurred significantly faster in patients undergoing medicinal treatment. However; no other significant changes were obtained in patients undergoing medicinal and surgical treatment.

Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications.  Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the department of Surgery Government Bangur Hospital, Pali, Rajasthan, India. Structured performa was prepared to obtained details of patients and ethical clearance from the institute was also taken prior to the study. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality.

Tubularized incised plate urethroplasty with de-epithelialized flap

Aim: To improve the results of tubularized plate urethroplasty by adding de-epithelized flap. Patients and Methods: Twenty-five cases of hypospadias who underwent Snodgrass urethroplasty using de-epithelialized flap were studied. The minimum period of follow-up in this series was 1 year. Results: The resultant neo-meatus was vertically oriented and slit like. Glans was conical which is cosmetically well accepted. Penile raphe was in the midline. None of the patient had residual chordee; penile torsion; or glans dehiscence. Excellent cosmetic results were observed in all cases. The complication rate in our series was 8(two cases). Two patients developed fistula. Conclusion: De-epithelialized flap is a simple method to provide additional covering to the constructed neourethra after Snodgrass urethroplasty. It achieves our goal of noncrossing suture lines and providing maximum vascularity

Congenital paraesophageal hernia presenting with severe gastroesophageal reflux.

Paraesophageal hernia in children is relatively rare entity. These children usually present with recurrent respiratory tract infection or vague GI symptoms. An 11 year female presented with episodic vomiting, heartburn and features of hypocalcemic tetany. Investigations revealed right paraesophageal hernia. Reduction of the contents and repair of the defect with fundoplication was done. Patient is asymptomatic on follow-up.

Atypical presentation of Tuberculosis.

Incidence of tuberculosis is increasing with emergence of many cases of multi-drug resistance and extrapulmonary manifestation. We report three cases of tuberculosis presenting in very atypical ways.

ABCD syndrome revisited.

A four-day-old neonate presented with severe abdominal distention, intermittent bilious vomiting, typical black lock, partial albinism and heterochromatic iris. Ileostomy was done proximal to the transition zone at mid-ileal region (50 cms proximal to ileo-cecal region) All biopsy specimens till the transitional zone were negative for ganglion cells. Distinct features of total colonic aganglionosis and recto-sigmoid Hirschsprung's disease are delineated here.