A Profile of Fundus First Laparoscopic Cholecystectomy.

Fundus first laparoscopic cholecystectomy is becoming an option with experienced laparoscopic surgeons to deal with difficult anatomy at Calot's triangle and thereby reducing the conversion rate and rate of complications. Fundus first laparoscopic cholecystectomy was done in 40 patients between three year. There were 26 female & 14 male patients with mean age of 36 years (range 29-64). Reasons for opting for fundus first method were: dense adhesions at Calot's trianglein 26 patients, stones in Hartmann's pouch with short cystic duct 8 , small contracted gall bladder in 4 and Mirizzi's syndrome in 2 patients. Mean operating time was 96 minutes (range 80-135 mts). 3 Patients were converted to open cholecystectomy because of obscure anatomy, intraoperative hemorrhage and CBD injury. The Patient with CBD injury was managed by hepaticojejunostomy. 5 Patients developed postoperative biliary fistula and one Patient had prolonged ileus. Out of the 5 Patients 2 were managed with percutaneous drainage and the biliary leak stopped and 3 Patients required ERCP and stenting. The Patient with ileus was managed conservatively and was discharged on the 6th day. The average hospital stay was 4 days. Fundus first laparoscopic cholecystectomy offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectomy. It is a viable and a safe option in the hands of an experienced laparoscopic surgeon and it helps in reducing the conversion rate and may also decrease the risk of injury to biliary system.

Profile of Human Bite Facial Injuries and Their Management.

Human bite facial injuries pose a challenge to the reconstructive surgeons. The site of defect, the three dimensional nature of defect and the need for restoration of the cosmesis of facial unit involved is technically demanding. We describe our experience of 26 patients of human bites to the face with soft tissue loss requiring reconstruction using one or the other modality over a period of 4 years presenting to our hospital.

Ulcer protective potential of standardized hesperidin, a citrus flavonoid isolated from Citrus sinensis

Free radicals play an important role in stomach ulcer formation. The present investigation validates the anti ulcer activity of hesperidin, isolated from Citrus sinensis (L.) Osbeck, Rutaceae, through the assessment of its antioxidant potential over stomach mucosal tissue by histological examination. Hesperidin was isolated from the dried peel of C. sinensis, and authenticated by TLC, IR and HPLC. The anti-ulcerogenic potential of this fruit was assessed using indomethacin and hypothermic restrain stress-induced ulceration models on rats at 150, 300 and 450 mg/kg dose orally. The parameters measured were gastric pH, volume, free and total acidity, ulcer index, and mucin, glutathione, super oxide dismutase, catalase and protein content. Hesperidin at 300 and 450 mg/kg dose showed significant (p < 0.01-0.001) increase in pH, decrease in acidity and ulcer index against indomethacin and hypothermic restrain stress, along with histological evidence of cytoprotection. Glutathione, super oxide dismutase, catalase and mucin levels increased significantly at 450 mg/kg (p < 0.05-0.001) after indomethacin ulceration, whereas hypothermic restrain stress only increased glutathione and mucin levels. Hesperidin prevents oxidative cell injury by significant rise of super oxide dismutase, glutathione and catalase levels in gastric mucosa. Hesperidin allowed the regeneration of ulcerated tissue, and prevented hemorrhagic injury of gastric mucosa. The potential anti-ulcer effect of hesperidin may be due to antioxidant, mucoprotective and cytoprotective activities.

The effect of induction chemotherapy followed by chemoradiotherapy in advanced head and neck cancer: a prospective study.

Background: Objective of current study was to observe the local control, progression free survival and organ preservation for locally advanced head and neck cancer by using induction Chemotherapy followed by concurrent chemoradiotherapy. Methods: 102 patients enrolled in this study with stage III-IVB of head & neck cancer. Patients were assessed and treated by faculty of the department as per NCCN guidelines. Group A patients received three courses of cisplatin (100mg/m2) and paclitaxel (175mg/m2) at every 21 days interval followed by concurrent chemoradiothearpy with cisplatin 30mg/m2 on weekly basis while group B received only concurrent chemoradiothearpy. Radiotherapy consisted of total dose up to 66-70 Gy. by conventional fractionation schedule. Results: From August 2011 to July 2013, total 102 patients have completed 14 months of follow up after completing definitive treatment group A : 48 and group B: 54 patients. Response evaluation was done after one and half months of completion of chemoradiotherapy in both arms. Complete response rate was 60.42% and 38.88 % in study and control arm respectively while partial response was 72.92% and 55.56%. Most common grade III or IV toxicity was mucositis in group A and skin reaction in control arm. At a median follow-up 13 months the median progression free survival in group A was 11.5 months and 9 months in group B. Conclusion: Response to induction chemotherapy was useful as predictive factor for ultimate outcome and progression free survival. But our study shows statistically significant improvement in complete response rate in group A as compared to group B (p<0.05). Our induction chemotherapy with two-drug regimen followed by concurrent chemoradiotherapy was well tolerated with manageable toxicity and good locoregional control.

Pattern of oral cancer registered at a tertiary care teaching hospital in rural Western Maharashtra.

Non-communicable diseases including cancer are emerging as major public health problems in India. Cancer usually means malignancy, has become one of the ten leading cause of death in India. The leading sites of cancer vary from country to country. Oral cancer ranks in the top three of all cancers in India, accounting for over 30% of all cancers reported in the country and its control is quickly becoming a global health priority. The present study was conducted to find out the contribution of different type of oral cancer in a tertiary care teaching hospital of western Maharashtra, India. A retrospective hospital record based study was carried out for the period of 2007-2011 in the department of Radiotherapy of Pravara Rural Hospital, Loni, Maharashtra, India. A total of 5879 patients who were diagnosed with cancer, of them 633 (10.76%) patients had oral cancer. Data was collected on the basis of the patient’s record in the hospital and analyzed in the form of percentage and proportions whenever appropriate. A total of 633 oral cancer patients were screened, of which 411 (64.93%) were males and 222 (35.07%) were females. Among oral cancer, buccal mucosa was highest (37.12%); followed by tongue (36.80%), oropharynx (4.74%) and lip and palate (3.15%). Oral cancer is one of the common malignancies in developing countries like India. It is common in males compared to females and is usually seen after middle age.

Uterine Perforation with Bowel Infarction in a case of Unsafe Abortion.

We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.

The Accuracy of Ultrasound in Diagnosis of Palpable Breast Lumps.

To find the sensitivity, specificity and positive predictive value of ultrasound in detection of palpable breast lumps and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology (FNAC), or histopathology. Ultrasonagraphic evaluation of 100 palpable breast lumps was done in our institute in the department of radiology. Diagnosis was made considering four features of the lumps i.e. shape, margins, width: AP ratio and echogenicity. Diagnosis was confirmed by fine needle aspiration cytology or histopathology.The sensitivity of ultrasound in detection of palpable breast lumps was 95%. The incidence of breast lumps was highest in the age group of 20-29 years. Lump alone was the presentation in 78% of the cases. 54% of the lumps were present in outer upper quadrant of the breast. The sensitivity, specificity and positive predictive value of ultrasound in fibroadenoma of the breast was 81.6%, 94.7% and 91.2% respectively. The sensitivity for carcinoma of the breast was 65% and for cystic masses it was 92%. The ultrasound features that most reliably characterized breast masses as benign were round or oval shape (95% were benign), circumscribed margins (86% were benign) and width: AP ratio > 1.4 (87% were benign). Features that characterised masses as malignant were irregular shape (47% were malignant), non-circumscribed margins (41% were malignant) and width: AP ratio 1.4 (39% were malignant).Ultrasound is a useful tool in differentiation of cystic from solid masses of the breast. It is useful in young females and pregnant women where mammography is not advisable. However its role in diagnosis of carcinoma of the breast needs further evaluation before it can be used for screening of carcinoma breast.

Application of Alvarado Scoring System in Diagnosis of Acute Appendicitis.

This is a prospective study to assess the accuracy of the Alvarado Scoring System in predicting acute appendicitis in our set up.100 consecutive patients with suspected acute appendicitis were included in the study. They were given specific scores according to variables of Alvarado scoring system and then divided into 3 groups. Group A included patients with score of 7 or more and they underwent surgery, Group B included patients with score of 5-6 and they were admitted for observation and Group C included patients with score of 4 or less and they were discharged after symptomatic treatment. Patients from group B with increased symptom intensity (score 7 or more) in re-evaluation underwent surgery. Diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by calculating negative appendectomy rate and positive predictive value .Out of a total of 100 patients 74 underwent surgery and appendicitis was confirmed by histopathological examination in 62 patients, thus giving negative appendectomy rate of 16.21% and positive predictive value of 83.79%.Alvarado Scoring System is a simple, easy and reliable tool in the diagnosis of acute appendicitis.

Radical radiotherapy treatment (EBRT + HDR-ICRT) of carcinoma of the uterine cervix: outcome in patients treated at a rural center in India.

AIM: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT). MATERIALS AND METHODS: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. RESULTS: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well. DISCUSSION AND CONCLUSION: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.

Microbiological Profile of Chronic Burn Wounds among Patients Admitted in Burn Unit.

A prospective study of bacterial wound colonization in 51 burn patients with chronic wounds of more than 3 weeks duration was carried out over a period of one year (2004) with an objective of determining microbial profile and antibiotic sensitivity patterns. A total of 178 surface swabs were taken, out of which 110 microbial isolates were cultured which included 104 solitary and 3 twin isolates. The most frequent isolate was coagulase negative Staph. epidermidis (56.36%) followed by Pseudomonas (18.18%) and Staph. aureus (13.63%). There was a high degree of resistance by these organisms to commonly available antibiotics. The most sensitive antibiotics in our setup were Gatifloxacin and Amikacin irrespective of the organisms cultured and should be used empirically pending reports of culture and sensitivity if systemic antibiotics need to be started. Restriction in the misuse of antibiotics on empirical basis, establishment of proper infection control measures and supportive measures like psychological support, physiotherapy and protein rich diet will help lower the incidence of infection.

High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: a study from rural centre of Maharashatra, India.

AIM: To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary brachytherapy (ICBT). MATERIALS AND METHODS: Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C). The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups--less then 80% (< 80%), 80-100% and above 100% (>100%). A total of 180 applications for 60 patients were calculated for the above analyses. RESULTS: There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by 'A' radiotherapist were within the limits in the self as well as in the shared groups more number of times, by 'B' radiotherapist was more times exceeding the limit and by 'C' radiotherapist doses were in between the A and B. DISCUSSION AND CONCLUSION: For the rectal and bladder doses most important factors are patient's age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.