Résumé
Background: Objective of the present study was to evaluate applicability of primary peritoneal drainage under local anesthesia in moribund patients as pre-laparotomy support when laparotomy under general anesthesia could not be done. Also to assess outcome in terms of survival, patients needing definitive surgery and complications associated with the procedure on immediate and follow up basis.Methods: We conducted this study in Teerthanker Mahaveer Medical College, Moradabad, UP, India from October 18 to October 2019. 71 patients were admitted as cases of perforation peritonitis in moribund condition, demographic data of all patients was noted, peritoneal drainage under local anesthesia in flanks was done and variable amount of fluid was drained in different patients, simple parameters were taken in to consideration in pre and post drainage phase. We also noted the complications after the definitive surgery.Results: Out of 71 patients, admitted in late and in very critical state, 61 patients improved after drainage and resuscitative procedures, although in ASA grade 3 and 4 they underwent surgical treatment and we were able to save their lives. 13 patients expired after definitive surgery inspite of best efforts.Conclusions: Peritoneal drainage under local anesthesia in late reporting and critical patients, not only improves general condition but makes patients better to undergo further surgery, and can prove to be life saver. It being a simple procedure can easily be done at even PHC level, before patient is referred or shifted to higher centre for further management.
Résumé
Background: Fournier’s gangrene is life threatening, necrotizing fasciitis, affecting external genetalia of male greater than female with mortality 7 to 53%. Fournier gangrene severity, LRINR and LNR scoring used to evaluate morbidity and mortality. Aim and objective of our study was to simplify a system, especially for Indian peripheral health centers which can predict mortality, morbidity.Methods: This study was conducted in department of surgery of Teerthankar Mahaveer University. Body mass index, blood urea nitrogen and patient demography used to develop the scoring system with minimum and maximum points and correlated our results.Results: Our simplified scoring system also has a direct bearing on mortality, morbidity, recovery and hospital stay. In our study 3 male and 2 females died.Conclusions: Simplified scoring and grading system will be helpful in predicting the morbidity and mortality, early surgical intervention, hospital stay, time for reconstruction.
Résumé
Discrete breast mass in young women are common cause of anxiety though majority of these lesion are benign.It is frightful experience for the patient to undergo invasive procedure i.e. biopsy of breast mass. So there is obvious need of such diagnostic tool which is noninvasive or minimally invasive, quick , reliable , equivalent or nearly equivalent to current existing diagnostic procedure to avoid unnecessary biopsy, reduce patients anxiety and cost effective.Aims and objective–To study the role of modified triple test in the diagnosis of palpable breast mass.Material and method- The study was a prospective study done in tertiary care center Dehradun from June 2017 to June 2018. It was carried out in the department of surgery in SGRRIM and HS and included 148 patients who presented with palpable breast mass. Patients who were already diagnosed case of carcinoma breast were excluded from the study. Thorough clinical examination of breast was done. All the patients were investigated firstly by sonomammography then FNAC.Either core biopsy or excisional biopsy of breast mass was done in all the cases. Findings were recorded and data analysis was done. Sonomammography report was recorded according BIRADS protocol besides giving probable diagnosis. Breast mass histopathology (HPE) report was considered to be gold standard and all the results were compared with HPE of the same breast mass.Result: results of MTT is comparable with histopathology of the same breast mass. Conclusion: modified triple test is sufficient and reliable investigation for diagnosing palpable breast mass and biopsy of breast mass should be reserved only for doubtful cases.
Résumé
Varicose veins have troubled mankind for thousands of years, and their various treatments and complications have been documented from the times of Hippocrates. Although thrombophlebitis is a relatively common condition in the superficial veins of the upper or lower limbs, it usually follows some intravenous intervention or trauma. Thrombosis followed by thrombophlebitis in varicose veins has seldom been reported in literature but the occurrence of spontaneous thrombosis in only the above knee perforator veins of the lower limb has been seldom mentioned. We report the case of a patient with long standing varicose veins of the left lower limb presenting with spontaneous thrombosis of only the above knee perforators and our subsequent management.