Lower Limb Amputations- A Necessary Evil- An Observational Study from a North Indian Tertiary Care Hospital

Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and complications of lower limb amputations among patients admitted to MMIMSR, Mullana, Ambala, India, which is a tertiary care centre.METHODSThis was a prospective, observational study that was conducted at MMIMSR, Ambala, for a period of 18 months. 50 patients underwent lower limb amputations in our hospital during the study period.RESULTSThe age ranged between 23 to 85 years. Males outnumbered females by a ratio of 4.5:1. Toe disarticulations were the most common. Diabetes mellitus (DM) was the most common cause (62%) followed by Non-DM peripheral vascular disease (PVD) (22%). Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Hospital stay ranged from 6 days to 40 days.CONCLUSIONSAlthough trauma is still the most common cause of lower limb amputations (LLA) in the developing nations, amputations for complications of diabetes is on the rise and may be the leading aetiology in future. Diabetic gangrene followed by PVD were the common causes of amputation in our settings. The study shows that most of the causes are potentially avoidable. Community health education programmes that are primarily focussing on road safety measures, early presentation to the physician and good diabetic control are pivotal to decrease the incidence of amputations for preventable indications.

Diagnostic Value of Upper Gastrointestinal Endoscopy Prior to Cholecystectomy in a Tertiary Care Institute

Cholelithiasis is one of the most common problems encountered in surgery department. It has always been a challenge to distinguish upper gastrointestinal symptoms due to gall stones from other causes. The persistence of abdominal symptoms even after cholecystectomy is highly discouraging for surgeons.METHODSThis is a prospective study conducted on 50 cases at the Department of Surgery, MMU Hospital, Mullana among ultrasonographically proven gall bladder stones. After history taking and examination, all the patients were subjected to endoscopy 1-2 days prior cholecystectomy, and biopsies were obtained for histopathology if required.RESULTSOut of a total of 50 patients, 44 (88%) were females and 6 (12%) were males with a M:F ratio of 3:22. 28 (56%) presented with typical pain and 22 (44%) presented with atypical pain. All patients were subjected to upper gastrointestinal endoscopy (UGE) and no lesion was found on endoscopy of 28 patients who presented with typical pain while out of 22 patients who presented with atypical pain, 18 (81.8%) had abnormal endoscopic finding and only 4 (18.2%) had normal endoscopy (p<0.001). Gastritis (72.2%) was the most common finding on upper gastrointestinal endoscopy followed by duodenitis (27.8%), oesophagitis (22.2%) and peptic ulcer (11.1%). On follow-up after 1 week of cholecystectomy all the patients except 10 from atypical group had persistence of preoperative symptoms.CONCLUSIONSPresence of atypical pain in patients with gall stones is highly likely to have other coexisting upper gastrointestinal pathologies. Hence, upper gastrointestinal endoscopy prior to elective cholecystectomy in patients with atypical presentation can be clinically helpful.

Comparative Study of Post-Operative Pain in Open (Lichtenstein) Repair Versus Laparoscopic Repair for Unilateral Inguinal Hernia.

Introduction: Inguinal hernia repair is the most commonprocedure that general surgeons undertake all over the world.The increasing popularity of laparoscopic inguinal herniarepair is, in part, due to the clinical potentials with lesspost operative pain and a shorter duration of convalescencecompared with an open hernia repair technique. The studyfocuses to compare the operative time, postoperative painalong with requirements of analgesics.Material and methods: The present study was conducted on60 patients admitted with diagnosis of inguinal hernia overthe period of one and half years (Jan 2014-June 2015) in theDepartment of General Surgery, MMIMSR, MULLANA(DISTT AMBALA), Haryana, India. These patients weredivided at random by lottery system in two groups of 30patients each i.e. Group A and Group B. Group A was treatedby Tension Free Hernia Repair by Lichtenstein technique.Group B was treated by Laparoscopic technique of herniarepair.Results: VAS score in the Lichtenstein inguinal hernia repairgroup ranged from 1 to 8 for which the mean was 3.80 ±1.86during the 1st 12 hours whereas VAS score in the laparoscopicrepair group ranged from 1 to 7 whose mean was 2.87±1.78.Analgesic tablet was given to the patients of both the grouppost-operative day 2 onwards as per requirement after 24hours of operation. The mean analgesic tablet consumed was5.27±1.72 in Lichtenstein open mesh repair and 3.53±1.93 inlaparoscopic repair which was statistically significant.Conclusion: Laparoscopic procedure showed clear advantagessuch as less postoperative and chronic pain, lower incidenceof use of pain medication.

Sonographic and Doppler Evaluation of Carotid Artery in Hypertension - A Correlative Study with Biochemical Parameters.

Introduction: Hypertension is an important cause of seriouscardiovascular diseases and premature mortality from suchdiseases. 80–95% of hypertensive patients are diagnosedas having “essential” hypertension. Hypertension plays animportant and critical role in atherosclerotic cardiovasculardisease. Increase in Intima-media thickness (IMT) of anartery has been used as a surrogate marker of the earlyatherosclerotic process. Duplex Sonography combining highresolution Imaging and Doppler spectrum analysis has provedto be a popular, noninvasive, accurate, cost effective meansof detecting and assessing carotid disease. The present crosssectional study was undertaken to assess the Carotid IMTchanges and associated changes in hypertensive patients usinghigh frequency ultrasound and color Doppler.Material and methods: This case control study was carried outat Aarupadai Veedu Medical College & Hospital, Pondicherryfrom September 1st 2016 to August 31st 2018(2years) withtotal of 100 cases (50 patients and 50 controls).Results: Out of 100 cases, we selected 50 hypertensivepatients aged above 50 years and 50 normotensive subjectsof same age group. In normotensives, 25 (50%) of patientswere between 55-60 years, and in hypertensives, 26 (52%) ofpatients were between 55-60 years. Mean of both right and leftCCA Intima Media Thickness (IMT) was significantly higherin hypertensive patients when comparing to normotensivepatients. The mean CCA Resistive Index (RI) wassignificantly higher in hypertensive patients when comparingto normotensive patients.Conclusion: High frequency ultrasound and Color Dopplercan be effectively used to study both IMT and RI of CCAtogether which are significantly increased in hypertensivepatients.