ABSTRACT
Background: Varicose veins of the lower extremities are the most common peripheral vascular disease and their treatment is as old as mankind. This prospective clinical study of surgical management of varicose vein was conducted to study the age, sex and occupational distribution of varicose veins of lower limb. Evaluations of clinical features and surgical methods of treatments that were in practice in the management of varicose veins in terms of recurrence and symptoms improvement were also studied. Methods: Two years prospective study was conducted in our institution from May 2007 to April 2009. During this period 62 cases of varicose veins of lower limbs were admitted to our hospital of which 50 cases were selected and were studies in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 21 (42%) had only long saphenous vein involvement, 7 (14%) had short saphenous vein involvement and in 5 (10%) cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 17 (34%) cases. Among them prominent veins and pain were the main complain in 38 (78%) patients. Itching and pigmentation were present in 4 (8%) patients. Ankle edema was present in 6 (12%) patients. Pain and ulceration of lower leg were present in 2 (4%) patients. After clinical assessment appropriate surgical procedures were followed for each of patients. These cases were followed for 3 year durations. Out of 50 patients 7 (14%) patients had recurrence of varicose vein. 7 (14%) patient complained of recurrence of pain after 2 years of surgery but no appearance of varicose vein. One patient (2%) complained of persistence of pigmentation after surgery. 2 (4%) patients complained of persistence of ankle edema and there was complete healing of ulcer which was present earlier. Conclusions: Commonest age group of varicose vein of lower limb was 20 to 40 years. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of treatment is an ideal treatment for varicose vein. For incompetent perforators, sub-fascial ligation appears to be a better method of treatment than extra fascial ligation. Because in the former all the perforators could be visualized and dealt with, while in the latter there were chances of missing one or two perforators. If cases are selected properly with good operative technique the complications are negligible
ABSTRACT
Background: This study was conducted to compare the plain radiography with the abdominal ultrasonography in the detection of pneumoperitoneum in suspected cases of hollow viscus perforation. Methods: A total number of 60 patients with suspected hollow viscus perforation were studied. All the patients had undergone plain radiography (Erect x-ray abdomen and left lateral decubitus views), ultrasonography and exploratory laparotomy. The investigational findings were compared with that of laparotomy findings. They were compared in terms of their sensitivity, specificity, predictive value of a positive and negative results and their percentage of false positive and false negative results. Results: Of the 60 patients, who underwent laparotomy, 57 had hollow viscus perforation. Out of 3 non-hollow viscus perforated cases 2 had appendicular perforation and 1 had mesenteric lymphadenitis. In the diagnosis, ultrasonography vs. radiography, their respective parameters were sensitivity (73.7% vs. 80.7%), specificity (66.7% each), predictive value of a positive test (97.7% vs. 97.9%), predictive value of a negative test (11.8% vs. 15.4%), percentage of false negative (26.3% vs. 19.3%) and percentage of false positive (33.3% each). Conclusion: In detection of pneumoperitoneum plain radiography appears to be more sensitive than ultrasonography with comparable specificity. Ultrasonographic finding of pneumoperitoneum is considered as an added finding.
ABSTRACT
We report a rare case of accidental toothbrush swallowing by a normal adult which was successfully removed by rigid esophagoscope. A 25 year young man presented to casualty of KIMS, Hubli, with ingestion of toothbrush accidentally half an hour before. Patient’s general physical examination and systemic examination was normal. Oral cavity, oropharynx and indirect laryngoscopic findings were normal. An emergency upper GI Endoscopy was done and foreign body was confirmed to be present at 35 cm from upper incisor teeth. Foreign body was removed by rigid esophagoscope under GA. Otolaryngologist is the most common medical faculty consulted for management of aero digestive foreign bodies. Toothbrush swallowing in normal adults is a rare accident. Most of them are found in esophagus and spontaneous passage is unknown and hence the need for early removal.
ABSTRACT
Background and objectives: This study was conducted to compare the diagnostic accuracy of fine needle aspiration cytology in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation and also to study the accuracy of the needle tip localizing the tumor during fine needle aspiration cytology procedure. Methods: Two years prospective study was conducted in our institution and in that 100 patients underwent fine needle aspiration cytology of the palpable breast lump after thorough physical examination. The cytological diagnosis was classified in to 3 groups benign, suspicious and malignant. After this reporting all the patients were later subjected to open/excision biopsy and its histopathological confirmation. Later diagnostic accuracy of cytology reporting was compared with that of histopathology. Accuracy of the needle tip in localizing the tumor in fine needle aspiration cytology was also studied by comparing the normal glandular cell aspirate with tumor cell aspirate. Repeat cytology was carried out before open/excision biopsy if the pathologist reports the cytology slide as “inadequate”. Results: We had accuracy rate of 100% for benign lesion and 93.10% for malignant lesion with false negative rate of 6.9% and false positive rate of zero with fine needle aspiration cytology in the diagnosis of palpable breast lump. The overall sensitivity of fine needle aspiration in diagnosing the palpable breast lump is 93.10%, specificity is 100%, positive predictive value is 100% and negative predictive value is 90.47%. Since inadequate sampling rate is 2% in our study, the accuracy rate of needle tip in localizing the tumor in fine needle aspiration cytology is 98%. Conclusion: Since our diagnostic accuracy rate and predictive values are very high and comparable to any other published series it can be advised that the patients in which fine needle aspiration cytology is unequivocally diagnostic for cancer can be managed directly by mastectomy (or any other definitive therapy). A diagnosis of suspicious for cancer must be confirmed by an open biopsy or intraoperative frozen section or rapid hemotoxyline and eosine staining (depending on availability). Since the accuracy of the needle tip in localizing the lump is very high (98%), the diagnostic accuracy of fine needle aspiration cytology can be increased by performing repeat aspiration on the lump for which previously being reported as inadequate or unsatisfactory sampling before advising for open biopsy.