Clinical profile and management of head injury at tertiary health care center in rural area, India.

Background: Trauma is a major public health issue and head injury is a frequent cause of morbidity and mortality worldwide. Head injury is the injury on head with alteration in the level of consciousness with or without vomiting. Alcohol is the major contributing factor causing majority of cases. Methods: This study analyzes the increasing occurrence of head injury in the developing rural area in India. Because of increasing trend of head injury, a total of 100 cases were studied from a period of March 2012 to July 2015. Results: Most of the cases were due to road traffic accident, assault and fall from height with maximum cases in young age group. In our study CT scan was decisive in 43% cases which were operated. The role of paramedical staff taking care at the site of accident and on the way up to hospital causing reduction in the death and disability. For the improvement of outcome there should be easily recognition and prevention of secondary insults and for this CT scan has a decisive and important role. Conclusions: By studying the common causes of head injury, identifying the preventable factors causing mortality and morbidity and explaining the important role of pre hospital management, we would like to conclude how we can prevent the morbidity and mortality and improving the overall outcome of head injury from road traffic accident by early treatment in the tertiary hospital.

Comparison between rapid urease test and carbon 14 urea breath test in the diagnosis of Helicobacter pylori infection.

Background: The most common human infection of upper gastrointestinal region is Helicobacter pylori. Most individuals remain asymptomatic due to misuse of antibiotic and proton pump inhibitors. Methods: 50 patients admitted or on outpatient department basis were selected based on the upper gastrointestinal symptoms and whether they were 18 years and above. Results: The Rapid Urease Test (RUT) had 84% sensitivity and 91% specificity, with an overall accuracy of 88%. The results of the Urea breath Test (UBT) showed 88% sensitivity and 83% specificity, and an overall accuracy of 85%. Conclusions: The invasive procedure OGD scopy need not be done in patients for the sole purpose of diagnosing HP infection as the diagnostic efficacies of RUT & UBT tests are similar.

A rare extra scrotal spermatocele: a rare case presentation.

Right Inguinal region pain is a common complaint evaluated in surgical department. The number of differential diagnoses is lowered when the pain in a male patient is associated with a palpable tender mass. These diagnoses include inguinal hernia, inflamed inguinal lymph node, rectus sheath hematoma, cryptorchidism, mass derived from the spermatic cord, and polyorchidism. Right Inguinal region mass and pain caused by a spermatocele are unusual. Here we report a case of extra scrotal spermatocele causing right Inguinal region swelling and pain. To our knowledge this is a second reported case.

Positive feedback: a tool for quality education in field of medicine.

Background: Feedback in medical education is an integral and important constituent of teaching as it encourages and enhances the learners' knowledge, skills and professional performance. Feedback has to be delivered in an appropriate setting; it should focus on the performance and not on the individual; should be clear and specific; delivered in non-judgmental language; should emphasize positive aspects; be descriptive rather than evaluative; and should suggest measures for improvement. Methods: 20 Post Graduate Student from surgery department was selected for the study. Results: Constructive feedback is defined as the act of giving information to a trainee through the description of his/her performance in the observed situation. It emphasizes the strengths of the session and areas which require improvement. The processes of giving and receiving feedback are skills that can be acquired only with practice with improvement in Pg student’s skill and knowledge. Conclusion: To integrate the concept of feedback in medical education, training of the trainers pertaining to techniques of adult learning and how to give feedback to trainees are foremost requirements. Interactive feedback is indispensable in bringing about professional development and overall improvement in doctors.

A rare case of herniation of liver through incision of cabg: A case report and review of literature.

Herniation of liver through an incision of previous surgery is a very rare phenomena. Here we present a case of herniation of part of left lobe of liver through a defect in the anterior abdominal wall due to previous coronary artery bypass surgery (CABG) surgery. Up till now only two cases have been reported for liver herniation through scar of previous of CABG surgery and this would be the third case as per our knowledge.

Squamous cell carcinoma in left flank due to saree: Largest reported case.

Saree is a female costume unique for Indian ladies. This includes a superficial cloth and a skirt underneath which is fastened securely to the waist by a cord. Persistent and long term wearing of this costume has resulted in waist dermatoses. Waist dermatoses theoretically may present with malignant transformation. Here we present a case of 60 year old female who presented with left flank ulcer following chronic irritation from saree, biopsy was taken and it showed squamous cell carcinoma (SCC). We decided to do wide excision with tension free suturing. Post operatively the patient followed up for 12 week and has shown to be disease free. This turns out to be the third case being reported and the largest ever to be reported in the literature.

Pedunculated perianal lipoma: a rare presentation.

Lipomas are ubiquitous lesions. Most of the lipomas have a fibrous capsule and are divided into lobules by delicate septae. On gross examination and histological analysis, lipomas resemble mature fatty tissue. They are more compact on the cut surface than normal adipose tissue and the lobules are smaller on histological analysis. There is undoubtedly some physiologic difference between fat of lipoma and normal fat. Perianal lipomas are rare and may have deeper or interspincteric extensions. Preoperative evaluation to rule it out is a necessary part of the work up for any perianal lipoma. The case report is of a soft swelling on left side in the perianal region, which was investigated to rule out nature of the lesion or deeper and interspincteric extension. Case was managed by complete enucleation of the lipomatous swelling. Gross and microscopic examination of the surgical specimen revealed a perianal pedunculated lipoma.

Round worm infestation in fundus of stomach: a rare case presentation.

A case of a 27-year-old female, in whom a 10cm long round worm (Ascaris lumbricoides) was found in the fundus of stomach, is reported here. In this patient, Ascaris lumbricoides upward migration of the worm to the fundus of stomach, its rare phenomenon, worm mostly seen in the small intestine. This is mainly because of the high gastric ac idity. In this patient, we believe proton pump inhibitor (PPI) use caused hypochlorhydria and coexistence H. pylori infection caused chronic atrophic gastritis, which resulted in the retrograde migration of the roundworm to the stomach in our patient.

Sigmoid perforation post laser ablation of fistula in ano.

Laser ablation of fistula tract is a safe, effective, sphincter-preserving therapy that can be successfully performed by surgeons. Various studies and papers have been published advocating the use of lasers. However clinical experience and technical expertise is necessary for the use of lasers. Here we present a case of a 45 year old male presenting with acute abdomen following laser ablation of fistula in ano. The patients X-Ray abdomen showed free gas under the diaphragm and was explored. The exploration revealed a pyoperitoneum and a sigmoid perforation for which closure of perforation and a diverting colostomy was done. The patient was further operated for fistula excision and Seton suturing and is planned for colostomy closure.

Actinomycotic lid abscess: a rare presentation.

Actinomycosis is a gram positive filamentous branching anaerobic bacilli that Is difficult to Isolate and Identify. We present this case of a 15 year old patient who developed repeated infection over a Contused lacerated wound (CLW) on forehead. Cytology revealed Actinomycosis. He subsequently developed upper eyelid actinomycotic inflammatory swelling. Modified Welsh treatment was started and five months of therapy resulted in complete resolution of the infection. Hence any wound with repeated infection should be examined for Act inomycosis. When identified at the right time, such infections show dramatic response to Modified Welsh Therapy

Myxoid liposarcoma presenting like a cystic neck swelling.

Soft tissue sarcomas are rare and unusual neoplasm’s, accounting for approximately 1% of adult human cancers and 15% of pediatric malignancies. Most liposarcomas occur in deep soft tissues of the extremities and retroperitoneum; only a very small percentage (as low as 2%) occurs in the head and neck. Here we present a case of a 48yr old male with a painless mass in the neck clinically presenting as a cystic swelling. The CT neck was suggestive of cystic lesion in the neck representing benign cystic lesion. The swelling was excised and sent for histopathology which was suggestive of myxoid liposarcoma. The patient was planned for wide excision of the edges and scar and adjuvant chemo and radio therapy.

rare case of Bochdalek diaphragmatic hernia with concomitant partial situs inversus.

Congenital diaphragmatic hernias clinically presenting in adulthood are exceedingly rare lesions, mainly left-sided defect (Bochdalek). Bochdalek hernias most commonly manifest during the patient’s first few weeks of life. Diagnosis beyond the first 8 weeks of life is estimated to represent 5-25% of all Bochdalek hernias. Here we have a 32 year old female patient who presented with 10x10 cm diaphragmatic hernia with dextrocardia who was asymptomatic for years.

A complication of coronary angiography: rare presentation of pseudo aneurysm with groin swelling.

Pseudo aneurysm (PSA) is one of the most common vascular complications of cardiac and peripheral angiographic procedures. In this case we had an old man presenting with a large hard immobile pseudo pulsatile, severe painful swelling in groin region post21 days of coronary angiography.

Study of comparison between skin sutures and skin staplers: 400 case studies.

Background: There are various ways the skin approximation whether be it sutures, staplers, glues, sterile tapes all of these have the same purpose of but the one which provides the best scar with least wound infection and consumes least time is the one that should be used. So here we have studied 400 patients over a period of 20 months comparing skin sutures with staplers and their outcome with respect to time consumed and percentage of complication. Methods: A prospective type of study was conducted from January 2013 to August 2014 at Dr. D Y Patil Hospital, Nerul for comparison between skin sutures and skin staplers in terms of effectiveness and complications in 400 patients who underwent various surgical procedures. The patients included in this study were randomly selected from those who underwent various surgical procedures which were either elective or emergency with various incisions. Results: The average time taken for skin closure by staplers is 1.84 min per 10 cm of wound & for skin sutures, it is 6.61 min per 10 cm of wound and complication rate for suturing is 30% & for staplers it is about 12%. Conclusion: Outcome of staplers is cosmetically superior to skin sutures with overall less complication as compared to skin sutures.

Study of diabetic ulcer with surgical complications of diabetes, their outcome and management modalities in 72 cases studied in Navi Mumbai.

Background: Diabetes and its long term major complications include septic, vascular (either micro vascular or macro vascular) and neuropathic lesions which affect the various anatomical regions of the body. Majority of admissions to surgical wards is due to these surgical complications of diabetes. So this is a study of these surgical complications of diabetes, their outcome and management modalities. Methods: This “Clinical study of surgical complications of diabetes” consists of a study of minimum of 50 or more cases admitted to surgical wards of Dr. D Y Patil hospital & research centre, from June 2010 to Oct 2012. A series of 72 cases were compiled for this study during this period. This study is to know more about the mode of presentation, clinical features and outcome of management of surgical complication of diabetes mellitus. Results: In present study, 30 cases were conservatively managed with meticulous debridement. 13 cases underwent incision & drainage and came for regular follow-up. 10 cases underwent disarticulation of toes. Four patients underwent below knee amputations whereas 8 patients underwent above knee amputations and 7 patients needed split skin grafting for covering of raw area. Conclusions: Patients on irregular medication usually from age group 51-60 majorly male who undergo trauma (lower limb >>upper limb) are prone to diabetic ulcer complication. Mortality in these patients is due to complications. Conservative management is the mainstay of this condition followed by I & D and finally amputation.

Study to evaluate the role of laparoscopy in chronic abdominal pain.

Background: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. Methods: All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2011 to Oct. 2012. The patient’s demographic data, length of time with pain, diagnostic studies, intraoperative findings, interventions and follow-up were determined. Results: A total of 25 patients (19 women and 6 men) with an average age of 34.64 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral fimbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. Conclusion: Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen.