RESUMO
Background: There is need for conversion in laparoscopic cholecystectomy (LC) in some special situation to open cholecystectomy (OC) in order to minimize intraoperative and post-operative complications. The risk factors may be patient related, the gallbladder’s pathology and the surgeon. Most studies with regards finding the risk factors for conversion in LC involved multiple surgeons which is one of the factors. Our study is prospective study where in all cholecystectomy were done by the single surgeon so as to find out other risk factors for conversion.Methods: This was a prospective study conducted between January 2017 to 2020, where in a total 152 patients posted for LC and 27 got converted to OC. The factors analyzed were the age and sex of the patient, elective or emergency surgery, acute or chronic cholecystitis, comorbid conditions, previous abdominal surgery, post endoscopic retrograde cholangiopancreatography, intra operative adhesions, intraoperative complication like bile duct injury, bleeding from cystic artery or gall bladder bed, bile leak.Results: Out of 152 patient 27 (17.8%) got converted to open cholecystectomy. Mean age was 48.86 with lowest 15 and highest age operated was 83 years, among them 63 (41.4%) were male and 89 (56.8%) were female. Fibrosis at Calot’s triangle, intraoperative adhesions, cirrhosis of liver and age older than 60 years, were all significantly correlated with an increased conversion rate to laparotomy.Conclusions: The risk factors may help to predict the difficulty of the procedure. This would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
RESUMO
Background: Breast cancer has emerged as the commonest cancer in Indian women. In a large population country like India we need a rapid, economical, and accurate investigation to diagnose breast cancer in its earlier stage. The objective of this study was to compare the effectiveness of mammography, sonography and infrared thermography in detection of breast cancer.Methods: Patients presenting to the surgical OPD with suspicious breast lump were evaluated by infrared thermography, sonography and mammography followed by biopsy of the breast lump. Results of the all 3 above radiological modalities were compared with the histopathological biopsy for the presence of the cancer. The study was done between 1st December 2012 to 31st August 2014 in Sassoon General Hospitals attached to B. J. Government Medical College, Pune. We compared the performance of all diagnostic methods individually and in combination using the results from all patients. Statistical analysis was performed for all variables with fisher's exact test.Results: Out of 50 patients, 31 patients had malignant breast lesions and 19 patients had benign lesions on biopsy. The mammography showed higher diagnostic accuracy and specificity than ultrasonography and thermography. As an individual modality the sensitivity of the sonography was higher than mammography and thermography.Conclusions: Sonography is found to have higher sensitivity than mammography and infrared thermography but it is less specific than mammography. Mammography is found to be more specific (89.47%) than sonography and infrared thermography.