Comparative Study Of Medical Therapy Versus Medical Therapy With Aspiration Of Pus In Treatment Of Liver Ab

Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. The advances in radiology like ultrasonography and CT scan since last 30 years including imaging and interventional techniques resulted in introduction of radiological guided aspiration and drainage of intra-abdominal abscesses [1]. The most common mode of treatment of liver abscess is Medication. Many cases are refractory to medical therapy and secondary bacterial infection may complicate 20% of amoebic liver abscess. In such patients, aspiration and/or drainage have been the traditional mode of treatment.Operative drainage is associated with significant (10 to 47%) mortality and morbidity.

Intra-Operative Assessment Of Laparoscopic Cholecystectomy

Gallbladder-related disease is now one of the commonest indications for elective and emergency surgery. Management of cholecystitis and its complications has evolved dramatically.1There have been significant paradigm shifts in the management of patients since the introduction of laparoscopic cholecystectomy in the mid1990s.2Laparoscopic cholecystectomy is the current gold standard for the treatment of symptomatic cholelithiasis.3But the severity of cholecystitis may be different in every patient and performing laparoscopic cholecystectomy may be difficult accordingly. Conversion from laparoscopic to open cholecystectomy is the essential part of the safe surgical practice if the anatomy is unclear, if complications arise, or if there is failure to make reasonable progress in a timely manner.4 Recently the importance of index admission laparoscopic cholecystectomy has been highlighted.5 In many large series and meta analyses detailed patient demographics and imaging findings have been recorded. A number of international guidelines recommend pathways of care.Attempts have been made to standardize definitions particularly relating to cholecystitis6,7.Despite these advances, significant variability in approaches to care and outcomes in gall-bladder disease management are reported.8While a number of preoperative scoring systems are reported there is no operative classification of findings at laparoscopic surgery.9,10.This limits the ability to compare outcomes or provide a common benchmark for future research. This prospective study was aimed to assess and grade the degree of difficulty in laparoscopic cholecystectomy and their postoperative outcome using intraoperative scoring system devised by Sugrue M et al.

Study of recent trends in acute pancreatitis.

Background: Acute pancreatitis is an acute condition presenting with abdominal pain and usually associated with raise pancreatic enzyme level in the blood or urine as a result of inflammatory disease of pancreas. Pancreatitis is a disease of wide clinical variation ranging from mild discomfort alone to a severe illness with hypotension, metabolic derangement, sepsis, multiple organ failure and death. Mortality from acute pancreatitis has decreased from around 12 to 2 percent, according to a large epidemiologic study of acute pancreatitis. However, mortality rates remain much higher in subgroups of patients with severe disease. Aims & Objective: To study recent trends in acute pancreatitis, to study the various etiological factors for development of acute pancreatitis, assessment of various clinical features, complication, investigations and diagnosis of acute pancreatitis and its complications, to evaluate various modalities of the treatment for acute pancreatitis and its complications. Material and Methods: Material of this study consists of 50 patients of acute pancreatitis who were admitted in our Hospital. The clinical presentation clinical examination was carried out, and physical findings, associated medical conditions, laboratory and radiological investigations, severity, management and outcome were studied and the etiology was determined by reviewing the medical records of all cases documented to have acute pancreatitis during the period of study. Results: Average hospital stay for 50 patients in our study is approximately 7 days. The diagnosis of acute pancreatitis was considered when abdominal pain is associated with elevation of serum amylase level. Abdominal pain (100%), fever (82%), vomiting (86%), abdominal distension (40%) and dyspnoea (50%) are its common clinical symptoms. Conclusion: Gallstones and alcohol abuse are the main causes of acute pancreatitis. There is no mortality in our study. Among all the patients, only 4 patients in the follow-up developed complications approximately after 2 months of duration of attack; and they undergone for operation. Clinical examination, serum amylase and ultrasonography are still the diagnostic tool for pancreatitis. Most cases of pancreatitis can be managed conservatively with early diagnosis, aggressive medical management and by treatment of cause.

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess.

, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.

Comparison between total and subtotal thyroidectomy in Graves’ disease.

Objective: To compare the results of total thyroidectomy and subtotal thyroidectomy amongst the surgically treated patients with Graves’ Disease. Material and Method: This study includes 50 patients of Graves’ disease out of which 27 patients underwent for total thyroidectomy and 23 underwent for subtotal thyroidectomy. Comparison done in regards to postoperative complication between total and subtotal thyroidectomy in terms of advantages and disadvantages. Results: Incidence of transient or permanent recurrent laryngeal nerve palsy and hypocalcemia were high amongst the patients operated for total than subtotal thyroidectomy. Thyroid function tests were normal in all patients after total thyroidectomy with hormone replacement therapy and 17.39% of patients had hypothyroidism after subtotal thyroidectomy. Recurrence rate was nil and 21.73% respectively in total and subtotal thyroidectomy. One patient of subtotal thyroidectomy had occult carcinoma in histopatholical examination which required revision of surgery. Conclusion: Total thyroidectomy is superior to subtotal thyroidectomy based on the considerable surgical risk and lack of recurrence in total thyroidectomy as well as the risk of occult carcinoma and questionable ability of the subtotal thyroidectomy to maintain the euthyoid state.