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Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention. Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20. Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology. Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients.
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Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.
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Background: The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss presentation, etiology, management and outcome of perforation peritonitis in our hospital. Methods: The 60 patients with features of perforation peritonitis admitted from September 2021 to August 2022 in the department of general surgery, PMCH, Patna were chosen. Descriptive statistics was used for analysis. Detailed history was taken, physical examination and X-ray was done. Signs and symptoms, duration of illness, age of presentation, intra-op findings regarding size and location, its management, post-op complications were documented. Results: Total 60 cases of perforation peritonitis were included in this study, among that 80% (48) were males and 20% (12) were females, with male to female ratio of 4:1. Pain abdomen was a universal symptom. Generalized pain abdomen was seen in 54 (90%) cases, followed by lower quadrant in 3 cases (5%) and epigastrium pain seen in 3 cases (5%). Radiation of pain to right iliac fossa was seen in 6 cases (10%). Blunt injury was seen in 9 (15%) case. 14 patients were treated with anti-ulcer medications. Three patients with duodenal ulcer perforation were treated with nonsteroidal anti-inflammatory drugs. Liver dullness was obliterated in 28 patients (47%). Bowel sounds were either sluggish or absent in most cases. Conclusions: Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.
RESUMEN
Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention. Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20. Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology. Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients.
RESUMEN
Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work. Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna. Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins. Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.
RESUMEN
Background: The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss presentation, etiology, management and outcome of perforation peritonitis in our hospital. Methods: The 60 patients with features of perforation peritonitis admitted from September 2021 to August 2022 in the department of general surgery, PMCH, Patna were chosen. Descriptive statistics was used for analysis. Detailed history was taken, physical examination and X-ray was done. Signs and symptoms, duration of illness, age of presentation, intra-op findings regarding size and location, its management, post-op complications were documented. Results: Total 60 cases of perforation peritonitis were included in this study, among that 80% (48) were males and 20% (12) were females, with male to female ratio of 4:1. Pain abdomen was a universal symptom. Generalized pain abdomen was seen in 54 (90%) cases, followed by lower quadrant in 3 cases (5%) and epigastrium pain seen in 3 cases (5%). Radiation of pain to right iliac fossa was seen in 6 cases (10%). Blunt injury was seen in 9 (15%) case. 14 patients were treated with anti-ulcer medications. Three patients with duodenal ulcer perforation were treated with nonsteroidal anti-inflammatory drugs. Liver dullness was obliterated in 28 patients (47%). Bowel sounds were either sluggish or absent in most cases. Conclusions: Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.
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Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.
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Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.
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Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.
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Background: Mechanical bowel preparation for colorectal surgeries is thought to clear the bowel lumen of stool, thus decreasing intraluminal pressure of hard, potentially impacting stool and reduce ischemia at the new anastomosis. This reduces the dreaded complication of organ space surgical site infection (SSI) that leads to anastomotic leak which is most commonly seen in colorectal surgeries. Oral antibiotic preparation is thought to reduce the bacterial concentration of colonic mucosa which is thought to further bring down the incidence of organ space SSI in colorectal surgery. Aim of this study was to evaluate the role of oral antibiotics given preoperatively as an adjunct to mechanical bowel preparation and intravenous antibiotics, in reducing SSI in colorectal surgeries. Methods: Comparative study of 60 cases of colorectal surgery divided into two equal groups (group A-patients who received oral antibiotic preparations (OABP) with mechanical bowel preparations (MBPs) and ivAb preoperatively (oral antibiotic preparation and mechanical bowel preparation +intravenous antibiotic) versus group B-patients who only received MBP and ivAb preoperatively. Outcomes of SSI results were compared. Results: Incidence of SSI in group A was 16% whereas it was 40% in group B. Incidence of anastomotic leak in group A was 3.3% and in group B was 13.3%. E. coli was found in the pus culture of 60% cases of SSI in study groups whereas S. aureus was found to be the causative organism in rest of the cases that developed SSI. Conclusions: The study supports the use of OABP as an adjunct to MBP and ivAb preoperatively in colorectal surgery for the prevention of SSI and its related complications.
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Background: Acute inflammation of a gall bladder that contains stones is acute calculous cholecystitis, laparoscopic cholecystectomy is now the gold standard treatment for patients with gall stone disease. laparoscopic cholecystectomy for acute cholecystitis was initially considered technically challenging and potentially risky for the patient. Aim was to evaluate results of laparoscopic cholecystectomy in patients presenting with acute cholecystitis at different duration in a tertiary centre in eastern India. Methods: Comparative study of 71 cases of acute cholecystitis who presented at different days and were treated by laparoscopic cholecystectomy. Outcome was compared. Results: The incidence of conversion to open was 12.6%. Day of presentation 5 to 7 had the maximum 21% risk of conversion. Major intraoperative complications included 4 cases of common bile duct injury, 4 cases of vascular injury and 3 cases of bowel injury out of which vascular injury and one case of bowel injury was managed laparoscopically. 9 cases converted to open surgery. patient with DOP 1, 2 and 3 had an average hospital stays of 3 days. It was 5 for those with DOP 4 and 7 days for patients with DOP 5 to 7. Conclusions: The study supports laparoscopic cholecystectomy in acute cholecystitis specially in patients presenting within 72 hours of onset of pain. Laparoscopic cholecystectomy can be attempted in patients who present at DOP 4 and DOP 5 to7 after explaining them the risk and benefit of the procedure to the patient. Conversion to open surgery should not be stigmatized.
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Allergoids of Prosopis juliflora pollen were prepared by formalinization of crude allergen and glycoprotein. Fractionation of crude allergen and allergoids on Sephadex G-100 resulted in separation of proteins of varying molecular size and a glycoprotein of 81 to 13 KD. Allergoids prepared from the glycoprotein fractionated into two proteins of approximately 200 KD and more than 200 KD. Crossed immunoelectrophoresis indicated 12 and gel diffusion test 3 precipitating antigens incrude allergen extract; by these tests allergoids depicted 8 and 3 precipitin bands, respectively. The precipitin analysis showed heterogeneity of allergenic determinants and also variation in cross-immunogenicity of the formalinized derivatives. The skin prick and radioallergosorbent tests depicted greater activity of fractionated crude allergens than the allergoids. The above tests suggest altered and concealed antigenic determinants as result of formalinization of P. juliflora pollen which, however, showed reduced allergenic activity relative to the native allergen.