RESUMEN
Background:Appendectomy is one of the most commonly performed emergency operation. The diagnosis requires distinguishing from other causes of pain in that region of the abdomen like acute ureteric colic, right sided salphingoophoritis. Presently ultrasonogram and contrast enhanced CT scan are the diagnostic modalities of choice. Although these facilities are readily available in urban areas but rural areas still suffer from lack of timely diagnosis and negative appendectomy, enhancing the need for a reliable scoring system for diagnosis of acute appendicitis. Here we will evaluate modified Alvardo scoring system in diagnosis of acute appendicitis. Methods:This is an observational cross-sectional hospital-based study at KPC medical college, Kolkata with 92 consecutive cases of suspected acute appendicitis, who were admitted, investigated and treated during 1st February 2022 to 31stJanuary, 2023. Modified Alvardo score is calculated of each patient and compared with the histopathological findings of operated appendix.Results:The above study shows that modified Alvardo score 7-9 has high sensitivity of 93.10% in men and in female sensitivity is 77.78%. Overall sensitivity of modified Alvardo score of 7-9 came out to be 83.63%.Conclusions:It can be concluded that modified Alvardo score of 7-9 can be used as a potent diagnostic tool in male. But in females due to lower sensitivity and significant number of negative appendectomy, it can be used an diagnostic aid in addition to imaging studies for diagnosis
RESUMEN
Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gall bladder. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. Laparoscopic cholecystectomy has become the gold standard for cholecystectomy in the past decade. Most patients are being discharged on the first or second post-operative day. The aim of the study was to evaluate effect of instillation of intra-peritoneal bupivacaine for pain relief in laparoscopic cholecystectomy. The primary outcome is to evaluate pain scores after this procedure., , Methods: It’s an institutional based, observational and randomised control study was conducted in a patients undergoing laparocopic cholecystectomy with gall bladder disease in KPCMCH between 18-70 years of age. The study period was 12 months (from June 2021 to May 2022). 100 patients were included in this study., , Results: Our study showed that, less number of patients had right shoulder tip pain (in Numerical rating scale) and requirement of rescue analgesia in case compared to control group., , Conclusions: We concluded that instillation of intra-peritoneal bupivacaine reduces pain scores after difficult laparoscopic cholecystectomy.
RESUMEN
Background: Now a days Cholecystectomy is one of the commonly performed operations. Most common cause is Gallstones. So, we planned this study to determine to find out any association between gallstone and microbiological spectrum in bile in cholelithiasis patients undergoing laparoscopic or open cholecystectomy.Methods: Total 140 patients of chronic calculous cholecystitis admitted in the department of general surgery, KPC medical college & hospital, Jadavpur, Kolkata, during August 2021 to July 2022 for cholecystectomy were included in this study. All patients underwent either laparoscopic or open cholecystectomy. During cholecystectomy bile was collected and sent to the department of microbiology for bacteriological profile of bile. Gallstone is classified based on morphology following gallstone retrieved from the gall bladder.Results: Out of 140 cases 115 cases done laparoscopic cholecystectomy and 25 cases done open cholecystectomy. In this study bile culture test negative in 105 cases and positive in 35 of cases. Escherichia coliwas the most common micro-organism found in 20 cases, Enterococcusspecies in 8 cases, in 5 cases Staphylococcus aureusand 2 mixed infections. In culture negative case mostly gallstones were larger, 2 to 3 in number and yellowish in colour. In culture positive cases mostly, gallstone was more than 3in number, smaller, black and brown in colour.Conclusions: In the light of above obtained results, the authors concluded that multiple, small, dark and brown in colour gallstone in cholelithiasis patients often show bactibilia. Thelow incidence of bacterbilia may suggest restriction of use of antibiotics in mild biliary pain.
RESUMEN
Background:Spermatic cord block is a useful technique for providing anesthesiawith scrotal pain and it has been described and published in the urology and anesthesia literature for more than 40 years. Spermatic cord block for inguinal hernioplasty along with spinal anaesthesia avoids the potential risks of neuraxial and general anesthesia and provides long-lasting postoperative analgesia. The aim of this study is to evaluate the postoperative effect of 0.5% Bupivacaine for spermatic cord block along with spinal anaesthesia in inguinal hernioplasty. Methods:This study was carried out in KPC medical college and hospital on 100 patients with ASA physical status I and II, age older than or equal to 18 years undergoing elective open inguinal hernioplasty from September 2021 to August 2022. Patients were randomly allocated into two equalgroups: 50 patients received spermatic cord block after mesh placement by bupivacaine 5 ml (0.5%), and 1ml normal saline (group 1), and 50 patients received 6ml saline injection in spermatic cord. Results:There was no significant difference between the demographic data, patient characteristics, heart rate, mean arterial blood pressure, and oxygen saturation in the studied groups. There was significantly rapid onset and prolonged duration of blockade, significant decrease in visual analog scale score at 6 h and 12 h postoperatively and the amount of rescue analgesia in group 1 respectively. Conclusions:Spermatic cord block in inguinal hernioplasty surgery improves onset of the block, prolongs postoperativeanalgesia and reduces the consumption of of postoperative rescue analgesics.