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Background: Centchroman has been studied earlier and literature mentions it to be a novel non-steroidal, selective estrogenreceptor modulator, antiestrogen, and mild anti-inflammatory drug with a significant decrease in size of fibroadenoma. Ourstudy aims to check the reduction in the size of fibroadenoma in response to centchroman.Materials and Methods: A prospective observational study was carried out in patients of fibroadenoma attending surgeryoutpatient department and wards of Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(Madhya Pradesh) from August 2015 to July 2016. Patients were included in the study after obtaining an informed consent.Patients were followed up for 12 weeks.Results: In our study, the maximum number of fibroadenomas was found in the left upper outer quadrant; of 102 patients,total lesions (fibroadenoma) were 130. Of 102 patients studied for the effect of centchroman on fibroadenoma, there was aresponse in 36 patients, which accounted for 35.29%. In 66 (64.8%) patients, there was no response after the treatment withcentchroman and they were subjected to excision and biopsy. The mean difference in volumes of fibroadenoma was statisticallyinsignificant. However, there was a reduction in size of mean volume of fibroadenoma which was 4.085 at the presentation andwhich was 3.24 at the end of the 12th week.Conclusion: Fibroadenoma was common in the age group of 21–30 years. The left breast was more involved in fibroadenomas.The most common site for fibroadenoma was the left upper outer quadrant. The effect of centchroman on decrease in volume offibroadenoma was seen in 35.29% of patients. Reduction in volume of fibroadenoma was statistically insignificant. More than 50%reduction in volume of fibroadenoma was seen only in 3 patients (2.94%). Surgical excision and biopsy were the preferred modalityof treatment for fibroadenomas in patients where the drug centchroman showed no response in regression in volume (64.8%).
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Introduction and Objective: Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability, and socioeconomic losses in India and other developing countries. It is a global health epidemicthat has deleterious consequences for the individuals with the brain injury, their families, and the society. The development and validation of effective treatments are imperative. The present study aims to compare the outcomes of early surgical intervention and conservative line of management in traumatic ICH patients. Materials and Methods: The present study was carried out on patients admitted in surgical wards as a case of head injury due to road traffic accidents, assaults, and falls who attended Casualty Department or Surgery/Neurosurgery Outpatient Department, Sanjay Gandhi Memorial Hospital during June 1st, 2016 to May 31st, 2017. Patients who presented within 24 h of TBI and had evidence of a traumatic ICH on CT with a confluent volume of 20 mL or more were included in the study. Only traumatic ICH patients for whom the treating neurosurgeon was in equipoise about the benefits of early surgical evacuation, compared with initial conservative treatment, were eligible for the study. Result: 63.15% of severe head injury patients who underwent early surgical evacuation of hematoma died and 36.85% had a poor outcome as compared to 80% of severe head injury patients under conservative management group died and 20% had a poor outcome. 62.5% of moderate head injury patients who underwent early surgical evacuation of hematoma had a good outcome where as only 45.45% of moderate head injury patients who were managed conservatively had good outcome. Also mortality of moderate head injury patients was higher in conservatively treated group where 36.37% patients died where as only 18.75% of patients died in early surgical evacuation group. 100% of patients of mild head injury under early surgical evacuation of hematoma group had a good outcome as compared to 96.00% of mild head injury patients of conservative management group had a good outcome and 4.00% had a poor outcome. Conclusion: There is a strong evidence in favor of early surgical evacuation of hematoma in patients with traumatic intracerebral hemorrhage who have a GCS of 9–12. Those who have mild head injury (GCS 13–15) can probably be watched carefully for any deterioration because there is a safety margin, which diminishes as the GCS of the patient descends. Once the GCS has descended below 9, surgical intervention appears to be less effective. A larg
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Objective: A comparative study between laparoscopic appendectomy and conventional open appendectomy (OA). Materials and Methods: Our study was carried out on 88 patients admitted in surgical wards of Sanjay Gandhi Memorial Hospital associated with S. S. Medical College Rewa, Madhya Pradesh. Patients of acute and/or recurrent appendicitis, or cases who came for interval appendectomy, admitted through casualty or transferred from other department or reported in OPD during the period of study were included in the study. Detailed history and clinical examination, baseline blood investigations, and radiological investigations were done. Initial conservative management, including IV fluid resuscitation with Ringer’s lactate solution/Foley’s catheterization/nasogastric intubation, was done as per need. Operative procedure (laparoscopic appendectomy or OA) was planned and performed as per the patient choice and patient’s consent of that particular operation and patient’s pre-operative condition. Both procedures were compared in relation to duration of operation, post-operative pain, postoperative hospital stay, complications, conversion rate, time taken for return to normal activity, diagnosis of additional pathologies, relief of symptoms, and cosmesis. Result: Laparoscopic appendectomy is better as compare to OA in relation to post-operative pain, post-operative hospital stay, early return to normal activity, diagnosis of additional pathologies (especially in female patients and patients with diagnostic uncertainty), and subjective cosmesis. Disadvantage of laparoscopic appendectomy is longer mean operating time and conversion into OA. Overall complication rate and relief of symptoms are similar in laparoscopic and OA group. Conclusion: Laparoscopic appendectomy is thus a safe, simple, and efficient technique for treatment of appendicitis in experienced hands. Cases with unsure anatomy due to adhesions were the most difficult to complete lap
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Introduction: Anal fissure was first described by Recamier in 1829. It is a linear ulcer in the anoderm. Anal fissures are most commonly seen in young adults and have a slight female preponderance. Although a relatively minor entity, the morbidity in the general population is very large. Our knowledge of the pathophysiology and management of anal fissure has rapidly progressed over the past 15 years. All methods of treatment aim to reduce the anal sphincter spasm and aid in pain relief and healing of fissure. Aim: The main aim of this study is to compare the efficacy of topical 2% Diltiazem ointment and lateral internal sphincterotomy (LIS) in the management of chronic fissure in ano. Materials and Methods: This is a prospective study of 70 patients with chronic fissure in ano. A number of 35 patients were treated with diltiazem (2%) topical ointment and 35 patients were treated with LIS. The effectiveness of both treatment modalities was assessed on 2, 4, and 6 weeks follow-up. Result: Healing of fissure was complete in 24 (68.7%) patients of topical diltiazem group and 33 (94.28%) patients of LIS group after 6 weeks of treatment. A maximum number of patients (97.14%) achieved symptomatic relief who underwent LIS at 4 weeks follow-up. Patients who underwent LIS had an immediate pain relief when compared to those who were treated with topical diltiazem 2% ointment. Both topical diltiazem 2% ointment and LIS were equally effective in reducing bleeding per rectum in patients with chronic fissure in ano. Conclusion: Time taken for fissure healing in topical diltiazem group is long in comparison to LIS group. Surgical treatment with LIS is the treatment of choice in chronic fissure in ano.
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Background: The aim and objectives of the study is to validate the role of Alvarado score in diagnosis of acute appendicitis. Methods: A total of 310 patients with clinical diagnosis of acute appendicitis were included in this study. Patients were examined thoroughly, investigated and managed accordingly. The relevant data collected and analysed. Results: Out of 310 patients, surgical procedures were performed in 22.90% of the patients. The overall negative appendicectomy rate was 9.86%, and the percentage of Positive Predictive Value (PPV) for Alvarado score was 90.14%. Conclusion: Our study validates the Alvarado score as fast, simple and reliable diagnostic tool for acute appendicitis.
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Background: Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or 1/3th of the total Indian population. In India, up to one-fourth of hospital admissions and approximately 15% of deaths in children are due to injury. The burden of child injuries in India is not clearly known, as there is a lack of proper trauma database in India and even in Indian studies the population covered was metro city based. Aim: The present study aims to analyze the different aspects related to trauma in children particularly from rural background. Materials and Methods: A prospective, observational study was carried out in 510 patients of the age group 0-15 years admitted to the surgical wards of a tertiary care hospital, with a history of trauma during the period from August 2013 to July 2014. Results: Incidence of pediatric trauma was found to be 20.08%. The cases among males were 297 (58.24%) and females were 213 (41.76%) with male:female ratio of 1.39:1. Road traffic accidents (RTA) 32.15% and fall from height (30.78%) were the most common modes of injury. Isolated head injuries 216 (60.5%) were the leading type of injuries. Poly-trauma patients had the highest mortality rates. Conclusion: RTA and fall from height are the most common causes of pediatric trauma. Pediatric trauma and injury are preventable conditions. Educating the health care providers about the pediatric trauma care centers and the establishment of the same at nodal or tertiary care centers is advisable for the proper treatment of pediatric trauma victims. The management of pediatric trauma is specialized teamwork.