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Background: Adequate lymphadenectomy in middle? and lower?third esophagus cancer is still a matter of debate. This study aims to find out the extent of histopathological supracarinal lymph nodes positivity rate to establish an adequate lymph node dissection in esophageal squamous cell carcinoma cases operated up?front or after neoadjuvant chemotherapy (CT) + radiotherapy (RT) and its short?term oncological outcome. Materials and Methods: After approval from institutional board review, a retrospective study was conducted from April 2017 to September 2019. A total of 76 patients having mid? or lower?third carcinoma esophagus were operated at our institute for partial/total esophagectomy with extended two?field lymph node dissection were followed. Intraoperative nodal stations were harvested separately and lebeled individually according to the Japanese Esophageal Classification and sent for histopathological examination. Results: The patients had an average age of 52 years. Histologically all were squamous cell carcinoma (SCC). Forty?four patients received preoperative concurrent RT plus drug therapy, whereas 18 cases were operated up?front. Fourteen patients were operated after palliative treatment (CT/RT). The average total lymph node yield was 22 nodes (range 3�). In 26 patients (34.2%), lymph nodes were positive (N+ disease). Supracarinal nodes were positive in 20 cases (26.31%). The average supracarinal lymph node yield was 10.33 nodes (range 2�). Five patients (6.5%) had only supracarinal lymph nodes positive on histopathological examination. Seventeen patients had a complete pathological response rate (pCR). Conclusion: In cases of mid?third esophageal carcinoma, extended two fields with supracarinal lymphadenectomy is strongly recommended even after the patient has received neoadjuvant treatment, although the same for lower?third/gastroesophageal (GE) junction tumors should be considered.
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Background: Acid corrosive injury to stomach is not uncommon in India due to easy availability. Corrosive ingestion results in significant morbidity. We present our experience in surgical management of such cases. The aims and objectives of this study to review the experience of surgical management of gastric corrosive injury and to assess long term outcome and functional results.Methods: This study was retrospective analysis of prospectively collected data of 23 cases of acid corrosive injury managed in a single surgical unit.Results: Median age was 31 years, male to female ratio was 12:11. Surgical procedures were tailored according to extent and degree of stricture. Posterior gastrojejunostomy was done in 8 (38.0%) cases, near total gastrectomy in 3 (14.3%) cases, total gastrectomy and Billroth I in 2 (9.5%) cases each. 4 cases were lost to follow up after preliminary feeding jejunostomy. 2 cases had mortality after feeding jejunostomy. 2 cases were managed successfully without active surgical intervention. All patients undergoing definitive procedure had good results in terms of nutritional status and symptoms of gastric outlet obstruction.Conclusions: The outcome of gastric stricture secondary to acid ingestion can be significantly improved by adequate preoperative preparation and planned approach depending upon type of injury.
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Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.
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Introduction: Rabies is a zoonotic disease having almost100% fatality. Proper and timely management of animal bitecases can prevent the fatal disease. We conducted this studyto assess the attitude and practices of animal bite victimregarding animal bite management at Anti rabies clinic, RDBPJaipuria hospital.Methods: This observational study was conducted among 107attendees of anti-rabies clinic of Govt. R.D.B.P. Jaipuriahospital associated with RUHS College of medical sciences,Jaipur from February 2018 to July 2018. Data was collectedusing a predesigned semi-structured questionnaire. Data wereanalysed using IBM SPSS software version 20.0.Results: 107 participants were enrolled in the study. Maximumparticipants were males (72%), from age group of 26–35 years(43%), urban area (72%), and studying in 10th standard(22.5%). 76% of the participants were having good attitude butonly 36% participants were having good practices regardingmanagement of animal bite cases. Good attitude regardingreaction after animal bite, seriousness of disease, whom toconsult, what to do immediately after bite of animal, vaccinationof bite victim, pet dog vaccination and vaccination of contactswas among 55.14%, 48.6%, 88.78%, 56.07%, 93.46%,66.35% and 37.38% respondents respectively. Only 56% werehaving practice of washing wound with soap and water while16.82% were practicing application of red chilli, 14% werepracticing lime application and 13% participants were havingpractice of applying nothing on animal bite wound. 44% victimsdid not wash the wound before visiting the clinic. Majority(98.13%) visited doctor after animal bite while 1.87% visited totraditional healers first.Conclusion: Practices of applying red chilli and lime on theanimal bite wound is widely prevalent in the community.Community health awareness campaign should involvepreventive measures of rabies and immediate actions afteranimal bite.
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Background: Surgical site infection and wound dehiscence are the most common postoperative complications of emergency abdominal surgery in class 3 contaminated /class4 dirty of wound classification. Greatly increasing the mortality as well as morbidity of patients, in addition to prolonging hospital stay. Factors affecting the SSI are emergency surgery, age, sex, anaemia, nutrition, co-morbidities. Methods: This is a 6 months prospective study carried on 60 patients of more than 18 years age operated in department of surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh after permission with institutional ethical committee. Results: Incidence rates of SSI were 53.3% and of wound dehiscence 43.3% with male to female ratio 4:1 and most common age group being 41-50 years followed by 31-40 years. Most common associated illness was respiratory diseases, anaemia and malnutrition. SSI and wound dehiscence were mainly occurred 5th to 7thpost-operative day presented as erythema, pain and pus discharge. Wound swab for culture & sensitivity were sent and debridement done. Staphylococcus and Klebsiella were commonly causative bacteria and SSI best controlled by injection gentamycin, meropenem, piperacillin+tazobactam and colistin. After control of infection wound were allowed to heal (1) conservatively with dressing and abdominal binder or (2) with delayed suturing. Conclusion: Although incidence of postoperative wound dehiscence in emergency exploratory laparotomy was high as 43.3% but this can be decreased by proper planned preoperative patient preparation,adequate antibiotic prophylaxis and better surgical expertise.
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A hemangioma is a benign tumor of the endothelial cells that line the blood vessels. It is characterized by an increased number of normal or abnormal vessels filled with blood. Usually, it presents as a painful or painless swelling in extremities. Surgical excision is the treatment of choice for large excisable tumor. Here, we present the case of a young girl, referred to our department by orthopedician with a complaint of painful swelling below the right knee that was gradually increasing in size for the past 7 years. Initially, it was misdiagnosed as a hematoma. Hence, incision and drainage were tried but unsuccessful. Finally, computed tomography angiography showed that it was a vascular structure like the hemangioma. The aim of presenting this case is to create awareness and acknowledge the possibility of a hemangioma arising from a joint is usually rare, but it should be kept as a differential diagnosis
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Background: Chronic Suppurative Otitis Media (CSOM) is an important cause of preventable hearing loss. Global emergence of resistant strains is of great concern. The aim of the present study was to determine the etiology and antibiotic sensitivity pattern of bacterial isolates from CSOM cases with special emphasis on ESBL (Extended Spectrum Beta- Lactamases) and AmpC beta lactamases. Methods: Patients with sign and symptoms suggestive of CSOM, ESBL (Extended Spectrum Beta-Lactamases), AmpC beta lactamases and MBLs (Metallo beta lactamases) were included. Two ear swabs were taken from all the patients and cultured on blood agar and MacConkey agar. Bacterial identification of isolates was done using standard biochemicals. Antimicrobial susceptibility was performed by Kirby-Bauer's disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines using antibiotic discs (HI MEDIA). Results: Out of 130 patients, 110(84.62%) had bacterial growth. The common pathogenic species were Pseudomonas aeruginosa 36(37.89%), Staphylococcus aureus 31(32.63%), Citrobacter koseri 9(9.47%) and Proteus vulgaris 6(6.32%). P. aeruginosa showed maximum sensitivity to colistin (94.4%), polymixin-B (91.3%) and imipenem (91.3%). Gram positive cocci showed maximum sensitivity to vancomycin (99%). MRSA (Methicillin Resistant Staphylococcus aureus) and HLAR (High Level Aminoglycoside Resistance) were detected in 9(29%) S. aureus and 1(50%) Enterococcus faecalis respectively. ESBL and AmpC were detected in 11(18.3%) and 12(20%) Gram negative bacteria, respectively and MBL producer was not detected. Conclusion: P. aeruginosa was found to be the most common isolate in CSOM cases and colistin, polymixin-B and imipenem was found to be most effective antibiotics.
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Introduction: Tuberculosis (TB) causes enormous social and economic disruption and hampers nation’s development. DOTS strategy under RNTCP is one of the largest public health programes found to be beneficial against TB. The key component of DOTS is that each dose during continuous phase of treatment should be administered to patients under the supervision of a DOT provider, either from the community or the health system. This may sometime leads to loss of wages or incurs transportation charges for treatment in the program. Material and methods: A cross sectional study was conducted in 2 randomly selected DOTS centre of Jalandhar. Total number of patients registered during third quartile of 2014 was 107, out of which 102 patients can be contacted. Information regarding indirect costs i.e. wage loss, expenditure on transportation and extra nutrition was collected from all the patients. The data so collected was entered in analyzed using SPSS 16 software. Results: Overall mean expenditure of category 1 and 2 patients treated under DOTS was Rs 2072/- and 2319/- month. The major share of indirect costs (3/4 th) can be attributed to wage loss due to decreased capacity to work or work absenteeism. Majority of the patients (79%) preferred to take additional nutrients, which contributes to around one fourth of the total indirect costs. Travel costs as means of indirect expenditure were minimal (1.5%). Conclusion: Around half of the patients had undergone decrease in their monthly income. The major share of indirect costs (74%) can be attributed to wage loss due to decreased capacity to work. Recommendations: The patients registered under RNTCP should be covered under some food subsidy schemes with the help of Government sector/ NGOs. Patients unable to continue with their jobs should be assisted by social security schemes/ insurance coverage.
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Treatment of fused teeth needs special care and attention to the bizarre anatomy. This paper describes root canal treatment of a fused carious tooth presenting with apical periodontitis. It is a rare case of fusion of the mandibular second molar with a paramolar. There is no literature regarding placement of crown over endodontically treated fused teeth. In this case, the fused teeth were endodontically treated and restored by a porcelain fused to metal crown.