Routine versus early nasogastric decompression in gastrointestinal surgeries: a randomized controlled trial.

Background: Traditionally nasogastric decompression is carried out in post operatively in patients undergoing gastrointestinal surgery. The purpose of the study is to assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries. Objectives: To assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries, to assess the complications associated with nasogastric tube insertion, and to assess the effect of early nasogastric tube removal on the patients’ postoperative morbidity and comfort level. Methods: This was a randomized control trial done in the Shree Sayajirao General Hospital, Vadodara. According to patient flow and previous study details the estimated sample size was 300 patients. Patient allotment was 150 patients in each group. Patients admitted on odd dates will be followed for routine nasogastric decompression, and patients admitted on even dates will be followed for early nasogastric decompression. Inclusion criteria for the study include laparotomies performed by any abdominal incisions on emergency as well as elective bases. Variables to be studied were patient comfort (according to patient’s opinion), vomiting (episodes, type, amount, content, on which post-operative day), abdominal distension, appearance of normal bowel sounds, passage of flatus and/or stools (according to patient’s history), incidence of aspiration pneumonia and total duration of the hospital stay with wound complications. Data will be processed and analyzed by chi square test and t-test. Results: In the study total 300 patients were included. No significant difference between both the groups in case of postoperative vomiting with p- value of 0.6028 (i.e. p > 0.05) and abdominal distension with p- value of 0.5183 (i.e. p > 0.05). Significant difference seen in the appearance of the bowel sound in post-operative period with p- value of 0.0002 (i.e. p < 0.05) and passage of flatus or stool with p-value of <0.0001. In case of early decompression group mean postoperative day for the suture removal was 11.9 days and for routine decompression group it was 12.3 days, the difference was statistically significant with p- value of 0.0006 (i.e. p < 0.05). The mean for the total hospital stay for early decompressed group was 10.04 days and for routine decompression group it was 10.47 days which was highly statically significant with p- value of 0.0001 (i.e. p < 0.05). Post-operative wound complication which was statically significance with p-value of 0.0394 (i.e. p < 0.05) and respiratory complications was also significant with p-value of 0.0367 (i.e. p < 0.05). In case of early decompression post-operative nausea, vomiting and abdominal distention were higher but not significant statistically. Conclusions: Early removal of Ryle’s tube leads to less incidence of respiratory complications and wound complications ultimately early suture removal and less hospital stay. Early removal of Ryle’s tube leads to early resolution of postoperative paralytic ileus indicated by early appearance of bowel sounds and early passage of flatus and stool.

Unusual presentation: fracture neck femur in 18 months old child.

An 18 months old child was brought to the emergency department with alleged history of trauma due to hit by two wheeler and sustained injury over right hip. Child was not able to move the right lower limb. Physical examination of child revealed contusion over right hip region and injury over perineal region. There was no active vaginal bleeding. Rest of the systemic examination was normal. Routine blood was normal. On X-ray of pelvis with both hip showed fracture of neck femur on right side without any pelvic injury. Patient was treated with hip spica cast and complete bed rest for 1 month. After 1 month of the treatment, on follow-up the patient was able to weight bear and fractured was united on X-ray.

Endoscopic tympanoplasty vs microscopic tympanoplasty in tubotympanic csom: a comparative study of 44 cases.

Background: Tympanoplasty is one of the commonest operations performed on the middle ear. Endoscopes are increasingly used for various middle ear surgeries. The objective was to determine merits and demerits of the endoscope as compared to the microscope in myringoplasty surgery and to compare the results of both group. Methods: Between the time period of January 2014 to September 2014, 44 patients underwent myringoplasty, 22 were endoscope assisted and 22 were microscope assisted. Results of surgery were compared at the end of 3 months post surgery. Results: In both groups, equal number of patients i.e. 15 (68.18%) had a successful outcome. Conclusion: Panoramic, wide angle, and magnified view provided by endoscope as well as ability to easily negotiate through EAC and provide uninterrupted image overcomes most of the disadvantage of microscope. In our study success rate was equal between endoscopic and microscopic technique. In terms of morbidity and postoperative recovery endoscope produced better results. Loss of depth perception and one handed technique are some of the disadvantage of endoscope that can be overcome with practice. Thus, Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty.

Orthopaedic aspect of anatomy and radiology of proximal femur.

Femoral pathology is common in relation to the orthopedic. There is complex anatomy of the proximal femur and hip joint. So, its knowledge regarding anatomy and radiological correlation is necessary to the well-known fact for the orthopedics for the routine day to day practice. This review article briefly illustrates important anatomical and radiological aspect of the proximal femur.

Rasmussen’s encephalitis in an Indian child.

A 5 year old boy with history of recurrent seizures and progressive weakness in left upper & lower limb. On MRI scan atrophy of right cerebral hemisphere with prominent right sided sulci & sylvian fissure. Temporal horn of right lateral ventricle appears prominent. Body and genu of corpus callosum appears hypo plastic. Electroencephalography revealed moderate voltage record showing mixed activity comprising ill-defined 8-10 Hz alpha rhythm plus 4-7Hz waves and random background delta components at 3Hz frequency. A clinical diagnosis of focal tonic-clonic epilepsy was made secondary to Rasmussen’s encephalitis, based on the features MRI scan findings of the brain.