To Compare the Efficacy of Tamsulosin and Deflazacort Combination with Tamsulosin Alone in Expulsion of Lower Ureteric Stones in a Medical College in South Haryana

Introduction: Men have been suffering from urinary stones since antiquity. Symptomatic ureteric stone is a very common emergency condition faced by general surgeons and urologists. There are many medical and interventional treatments for lower ureteric stones. Removal of stone with ureteroscopy is very effective but this is very costly also. Anesthetist is required; stent is placed in ureter which has to be removed afterward. Stones of size <4 mm will pass hopefully spontaneously. Stones more than 10 mm size will require surgery in general. The expulsion of stones of size 4–10 mm can be tried with the help of pharmacological agents. Materials and Methods: This prospective observational study was conducted in the Surgery Department at SGT Medical College located in South Haryana. A total of 150 patients of distal ureteric stones of sizes 4–10 mm were taken in this study, divided into two groups of 75 patients each. Group I patients were given tamsulosin 0.4 mg and deflazacort 30 mg once in a day and Group II patients were given tamsulosin 0.4 mg once in a day. Treatment was for 10 days. Results: In Group I, the stones were expelled in 24 (32%) patients. While in Group II, 11 (14.6%) patients passed stones. This is statistically significant with P = 0.023. The median time for stone expulsion was 192 h in Group I and 312 h in Group II with again a significant P = 0.039. Conclusion: We conclude that Group I (tamsulosin + deflazacort) showed a statistically significant advantage in stone expulsion rate than Group II (tamsulosin alone). Group I also showed a statistically significant advantage in stone expulsion time.

Prospective Observational Study to Review the Contemporary Management of Amoebic Liver Abscess

Introduction: Amoebic liver abscess is an inflammatory space-occupying lesion of the liver caused by Entamoeba histolytica.Trophozoites after lodging in sufficient numbers in venules lead to thrombosis and infarction and microabscesses formationand thence amoebic abscess. Fever and pain right upper quadrant are very common.Aims and Objectives: The aim of the study was to review the contemporary management of amoebic liver abscess.Materials and Methods: This hospital based observational study for 100 patients was performed in the Surgery Departmentin SGT Medical College, Budhera, Gurugram, Haryana. A detailed history and focussed clinical examination and requiredinvestigations were done. Patients were divided into three categories according to sizes of abscesses, <5 cm, 5–8 cm, and>8 cm. In Category I, patients were treated with metronidazole 40 mg/kg body weight in three divided doses. If toxemia wasthere, then metronidazole 100 ml, IV 8 hourly was given for 3–4 days and switched onto oral metronidazole. In CategoryII, if a trial of conservative treatment for 3 days did not relieve the symptoms, and in Category III, ultrasound-guided pigtailcatheterization was done.Results: In our study, maximum patients were between 21 and 60 years of age. Male:female ratio was 4.55:1. Patients presentedwith fever, pain right hypochondrium, and hepatomegaly. Liver enzymes were elevated. Total lymphocyte counts were raisedand serum albumin was decreased in some patients.Conclusion: Due to our concrete planning and meticulous care at every step, there was lack of infection at the port site ordeep-seated, and there has been no failure of resolution, no hemorrhage, recurrence, pleural complications, and fever andthere has been no death in our series.

Clinical Approach to Management of Solitary Thyroid Nodule, A Concrete Plan in 42 Patients, in a Tertiary Centre

Introduction: A discrete swelling in an otherwise impalpablethyroid gland is termed as solitary thyroid nodule. Thechances of malignancy are more in a solitary nodule than in amultinodular goitre. The diseases is more common in womenthan in men. We have made a concrete clinical plan so thatmalignancy is not missed during treatment of solitary thyroidnodule.Materials and methods: Study Site: This hospital basedprospective observational study was performed in 42 patientsin Surgery Department in SGT Medical College, SGTUniversity, Budhera, Gurugram. Detailed history and focussedclinical examination and investigations like thyroid functiontests, thyroid scintiscan, USG, FNAC, other investigations forfitness for surgery and histopathology were done.Results: On the basis of investigations, diagnosis of hottoxic nodule, warm toxic nodule, cysts, follicular adenoma,colloid goitre and malignancy was made. As per ourstreamline approach, we treated some patients conservatively,in others hemi thyroidectomy, total thyroidectomy or totalthyroidectomy with modified radical neck dissection wascarried out.Disscussion: Because of our streamline approach, we coulddetect malignancy in two patients of cysts and follicularadenoma each. Clinically it may look very simple to treat asolitary thyroid nodule, but we feel that without a streamlineapproach, malignancy could be missed. Because of ourconcrete plan, all our patients are faring well.