A Study of Clinical Features and Presentation of Patients with Grade I & II Haemorrhoids and Injection Sclerotherapy as a Treatment Modality

Introduction: Haemorrhoids are the clinical manifestation of the downward disruption of normal functional architecture known as the anal cushion. A wide variety of treatment options are currently available for haemorrhoidal disease. For grade I & II of haemorrhoids, Minimal Invasive Procedures are done routinely in which Injection Sclerotherapy is included in this study. Methods: 150 patients presenting with Grade I & II haemorrhoids, admitted through the outpatient department, under General Surgery Department at our Hospital, who underwent Injection sclerotherapy between April 2019 to April 2022 were included. Objective: To study clinical presentation of patients with Grade I & II of haemorrhoides & sclerotherapy as a management modality. Results: Male gender and middle age group were predominant risk factors for haemorrhoides & sclerotherapy was found to be cost effective as well as compliant management modality. Conclusion: Injection Sclerotherapy is a day care procedure & is highly effective in treating Grade I and Grade II of haemorrhoids. It is economical, well accepted, well tolerated over other management modalities for haemorrhoids.

Incisional Hernia: A Comprehensive Study on the Incidence and Management of Abdominal Incisional Hernia

Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.

Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Management Modalities of Choledocholithiasis: Endoscopic Retrograde Cholangiopancreatography Versus Open Common Bile Duct Exploration and Laparoscopic Cholecystectomy

Background and Objective : Common bile duct stone typically requires surgical intervention, which primarily involves open CBD exploration + Laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic CBD exploration. Open CBD exploration has multiple complications, high mortality rate and long recovery time. Methodology : A total of 50 cases presenting as choledocholithiasis between July 2018 to August 2020 were taken for study. 1st group of 20 patients underwent open cholecystectomy with open CBD exploration. 2nd group of 20 patients underwent ERCP followed by interval (6 weeks) laparoscopic cholecystectomy. Results : ERCP found to be better when compared with open CBD exploration in terms of less post-operative complications (5% in ERCP vs 20% in Open CBD exploration) and less mean duration of hospital stay(5 days in ERCP vs 8 days in Open CBD exploration). Interpretation and Conclusion : For management of CBD stone patient, gold standard treatment is ERCP followed by Laparoscopic Cholecystectomy. While in patients with incomplete clearance of CBD stone after ERCP, CBD exploration either laparoscopically or by open approach should be preferred. While in patients with CBD stone greater than 2 cm size, direct open CBD exploration is the preferred option380008

Mythological conceptualization, cognitive and ego development: Is there a correlation ?

Background: In today’s world there is a continuous struggle between science and spirituality, with a lot ofdoctors feeling that religion gets in the way of scientific treatment and sometimes also leads to very direand dangerous consequences. While a lot of older concepts are invalid today, there is a reason why suchconcepts existed in the first place and they were also backed by some sort of logic and rationale. It istherefore essential to compare and correlate the older concepts with the newer ones since they shall alsogive an insight regarding the existing psychological concepts at that time.Methodology: We studied and compared the various stages of ego development currently accepted mainlyincluding Loevinger’s and Piaget’s stages of ego and cognitive development and correlated it with theIndian mythological concepts of Manas, Buddhi, Chitta and Ahamkara. They can also be correlated withcertain concepts by Freud, Jung and Erikson. The sources of this information were various religiousscriptures like the Vedas and the Bhagwad Gita and at the same time we have correlated it with variousinterpretations mentioned in encyclopaedias like Britannica and DK.Result: While the study is our interpretation of the review of literature, we do realize that mythologicalconcepts are very abstract due to the wide time span; and various writers and scripture producers and theirinterpretations are also very subjective. The clinical significance of this paper comprises of correlation ofvarious symptoms with older concepts like disorders in Manas may mean perceptual disturbances ordisturbances in Buddhi may translate to disturbances in executive functions.Conclusion: While a lot of mental healthcare professionals do have a lot of scepticism in being open to themythological concepts of human psychology, this paper emphasises that there was a certain observableand objective basis to these concepts exist, which can also be co-related with the modern-day concepts ofpsychology.

Clinical Profile of Postoperative Enterocutaneous Fistulas.

Background : Enterocutaneus fistula (ECF) is a result of complex intraperitoneal infection process. Even with modern and advanced surgical suturing techniques, staplers, newer antibiotic therapy and modern investigations, mortality of the disease remains up to 50%. Though there is a reduction in the number of enterocutaneus fistulas post-operatively by percentage, once the fistula develops, morbidity and mortality are very high. The serious sequences lead us to study the disease at our set up and compare the results with international works. Methodology : Patients having enterocutaneus fistulas and admitted in municipal general hospitals of Ahmedabad were observed and data were collected in the proforma consisting details of patient's history, clinical findings, pathological and microbiological findings, conservative management, operative management, complications, and outcome. Results : Observations and analysis of the data of present series was very interesting and important aspects were compared with standard series. Importance of total parenteral nutrition, total gut irrigation, and earliest definitive surgery, was established. Mortality was 44% in this series, mostly caused by serious infectious diseases like typhoid fever and tuberculosis. Conclusion : Patients can be helped to recover from this dreaded disease by early diagnosis and management of malnutrition, fluid and electrolyte imbalance, infection process and simultaneous medical diseases