ABSTRACT
Introduction: Acute pancreatitis is a potentially lethal disease with wide variation in severity ranging from mild and self-limiting to a rapidly progressive illness leading to multiorgan failure. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. Mild acute pancreatitis causes disturbance in the homeostatic mechanism of the body is minimal; the treatment is aimed at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate and safe nutritional supplementation. Objectives: To assess the occurrence of infective and non-infective complications in cases of acute pancreatitis on early enteral nutrition. Materials & Methods: This is a prospective study conducted on patients who were admitted to SSIMS AND RC Davangere with symptoms suggestive of acute pancreatitis from July 2019 to July 2021. Patients with a clinical picture consistent with the diagnosis of acute pancreatitis, along with more than a 3-fold elevation of serum amylase and elevated serum lipase were considered to have acute pancreatitis. After initial diagnosis and assessment, patients were duly informed regarding the study and consent was obtained. A 16-gauge nasogastric Ryle’s tube was inserted for all patients included in the study. The feeding patterns were initiated depending upon the severity of acute pancreatitis. Feeding was started after calculating the nutrition requirement. In the early feeding group, patients were given a protein powder to achieve a target nutrition in a stepwise manner. The tolerance to feeds, infective and non-infective complications and the time taken to start on an oral diet were noted and analysed. Results: The incidence of infective complications in our study was found to be 2% with none of the infections involving the pancreas itself. The incidence of non-infective complications in our study was found to be 30% with 13% involving the pancreas proper. Conclusions: The use of early enteral feeding does not influence the incidence of infective and non-infective complications in mild and moderate acute pancreatitis. Early enteral feeding delivers nutrition, in a simpler and more cost-effective. Nasogastric and oral feeding reduces the morbidity of the patient by accelerating the return to normal activities.
ABSTRACT
Background: This study was conducted to determine the effectiveness of hyperbililrubinemia as diagnostic tool to predict perforated appendicitis.Methods: Patients presenting to department of general surgery of SS Medical College and Hospital during the period from June 2017 to June 2019 with features of appendicitis and liver function tests on admission undergoing laparoscopic or open appendectomy were included in this study. Age, duration of symptoms, temperature, white blood cell counts, bilirubin levels and histological data were collected. Culture and sensitivity of peritoneal fluid was done. Patients were grouped according to histological examination of appendectomy specimens and comparison was made between the groups.Results: The mean bilirubin level of all patients was 0.95 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.8 mg/dl and o.5 mg/dl, p<0.001). Hyperbilirubinaemia had a specificity of 88% and a positive predictive value of 88.89% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 70%.Conclusions: patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels. Hyperbilirubinemia alone is not a strong enough predictor, but might be more useful when integrated into a scoring system.
ABSTRACT
Background: The term “thoracoscopy” means endoscopy of the interior of the chest. Jacobeus is considered its father wherein in 1910; he used a modified cystoscope to cut adhesions in the pleural cavity. Over past 3 decades, indications and uses of video-assisted thoracic surgery (VATS) were expanded, in early stages, it was mainly of diagnostic purpose with minor thoracic surgeries, but now its use has been expanded to major surgeries such as decortications, pericardial effusion, resection of part or whole lung, and resection of esophagus. Aims and Objectives: In this study, we aimed to highlight the various uses and indications of VATS as empyema decortication, hydatid cyst, bronchiectasis, segmentectomy. The age group, sex distribution, conversion rate of VATS to open thoracotomy, average length of stay, Intercostal tube drainage (ICD) removal and post-operative complications, the culture and sensitivity of the collection, and histopathology reports were considered. Materials and Methods: The study consisted of various cases admitted under pediatric surgery unit of S. S. Institute of Medical Sciences and Research Centre from January 2008 to December 2015, over 78 cases who underwent VATS for various indications were included, in the age group of 1 month till 18 years. Results: Least age to get operated was baby of 1 month and most 17 years, median being 11 years, 50 were males (64.12%), most common indication was empyema 52 (66.67%), and out of 52 cases of empyema, 47 were Stage 2 empyema, 6 early third stage, and 5 late third stage, it was observed that all late third stage patients needed to be converted, 23 (29.5%) were converted into open thoracotomy for various reasons; conversion was considered to be wiser decision rather than complication, other complications were site infection in open cases, bronchopleural fistula which was treated conservatively and bleeding intraoperative. None of 78 cases needed a second surgery, the mean duration of stay in hospital was 12.84 days and 5.45 days was mean number of days ICD in situ; blood loss was intraoperative was very less in cases with VATS about 100 ml, and it was much more in cases which needed conversion to open thoracotomy about 300 ml, prophylactically post-operative blood transfusion was done in 72 cases (92.30%). Culture turned out to be Staphylococcus pneumonia in about 61 cases (78.20%), and histopathology report was fibrinous material in 59 cases (75.64%). Conclusion: To conclude, VATS is a newer and modified method to be used in all major procedures in the thorax; its use can be extended from empyema decortication to lung resection. In our institute, we used it in mostly for empyema decortications in pediatric patients, a safe approach with decreased morbidity and mortality, early recovery while treating empyema with VATS the ability to stage the disease plays a major role and crucial to operate too.