Résumé
Background: Appendectomy is the most common surgicalprocedure performed in emergency surgery. Appendectomy isstill being performed by both open (OA) and laparoscopic (LA)methods as no other technique is formulated. In this study, weaimed to compare the laparoscopic procedure and thestandard technique in the treatment of acute appendicitis.Methods: Retrospectively collected data from 60 consecutivepatients with acute appendicitis were studied. These comprised30 patients who underwent conventional appendectomy and 30patients treated laparoscopically. The two groups werecompared for Intra operative parameters like duration ofsurgery, conversion, complications, and post-operativeparameters like pain, requirement of pain medications, woundcomplications, hospital stay, any other complications, andcosmetic outcome.Results: In our study Laparoscopic Appendectomy have ashorter hospital stay (Mean duration of hospital stay aftersurgery was 3.1 & 1.9 day in OA & LA group respectively),Operative time was significantly less in the open group (Meanduration of surgery was 71.2 minutes in OA group and 48.8minutes in LA group). Total number of complications werefewer in the LA group with a significantly less incidence ofwound infection (5 Vs 11, P <0.04).Conclusion: The laparoscopic method is a safe andcompetent operative method in appendicectomy. Postoperativepain in our study is notably lesser in laparoscopic group ascompared to open appendectomy, also post-operativecomplication especially wound infections are less frequent inlaparoscopic group of patients. Patient’s recovery fromoperation is also better in laparoscopic appendicectomy groupwhich includes early bowel activity, minimum hospital stay andearly return to work. Overall cosmetic outcome is preferable inlaparoscopic group of patients.
Résumé
Background: Peritonitis is one of the most common surgicalemergencies with significant morbidity and mortality. Multiplescoring systems have been proposed and assessed inpredicting the outcome in patients with peritonitis. A scoringsystem should be able to assess the need, type, and quality ofthe care required for a particular patient. Realizing the need fora simple and accurate scoring system in these conditions, thepresent study was undertaken to evaluate the Prognosticevaluation of intraperitoneal sepsis in perforation peritonitis byevaluating the efficacy of Elebute and Stoner grading andMannheim peritonitis index (MPI) in predicting the overall riskof morbidity and mortality in patients with peritonitis. This studywas conducted to identify the predicting ability of both thesescores and to compare MPI with Elebute and Stoner grading(ESG) system.Aim: To predict outcome of patients with peritonitis using theElebute and Stonjej grading of sepsis and Mannheim peritonitisindex in these patients and to predict the possible clinicaloutcome and to compare the results of both the scoringsystems.Patients & Methods: The present work is based on theobservations made in 48 patients of perforation peritonitisadmitted in surgical ward of Rama Medical College Hapur,Uttar Pradesh, India from March 2017 to March 2018. Thediagnosis of perforation peritonitis was made on the basis ofdetailed history, physical examination, investigations andoperative findings. A detailed record was maintained carefullyfor every patient and evaluation of Elebute and Stoner gradingof sepsis and Mannheim peritonitis index were made and thenresults of both the scoring systems are compared.Results: Comparison of both the scoring systems showed thatsensitivity was almost equal in both the scoring systems (80%).But specificity and accuracy were slightly improved withElebute and Stoner grading of sepsis (89.42% and 87.36% Vs84.16% and 83.22%) respectively. This may be because ofmore organ systems incorporated in Elebute and Stonergrading of sepsis like hepatobiliary system, temperature,bleeding diathesis, central nervous system which had not beenincorporated in Mannheim Peritonitis index.Conclusion: In the univariate analysis both scoring systemsstudied, were relatively accurate for identifying patients athigher risk for dying from peritonitis. It was found thatprediction among the dead was better than survived in both thescoring systems.
Résumé
Objectives: The purpose of the study was to place cadaverdermal allograft in patients with burn and non-healing ulcerwounds and observe their biologic response.1. To identify clinical success rate of take of cadavericdermal allograft2. To evaluate infection / rejection rate of cadaveric dermalallograft3. To confirm take of allograft by histological features andneovascularization after applying cadaveric dermalallograft.Method: This study was done on 50 patients suffering fromburn and nonhealing ulcer wounds. Patients of all age groupsand both sexes were taken. Dermal allografts were harvestedfrom cadaver after taking consent from relatives. These graftswere applied to wound sites after treating it with glycerol andcryopreservation and their biological responses wereassessed.Results: In this study, on follow up for 2 months, out of 50patients, the graft was survived in 41 (82%) patients andrejected in 9 (18%) patients. Out of 41 patients, the graft wasdetached and wounds were completely healed in 33(66%)patients and graft was still intact in 8(16%) patients. Graft takeup success was assessed by histopathologically showingneovascularization.Conclusion: It was observed that epidermis depleted allografthas proved to be an effective material for wound coverage dueto absence of langerhans cells. Further cryopreservationincreased its viability and reduced immune reaction. Glycerolacted as an effective virucidal agent.