Study of clinical outcome following cervical spine surgery: prognostic indicators

Background: Cervical spine surgeries done through anterior approach and posterior approach. Anterior approach is preferred in degenerative conditions and cervical spine injury. Posterior approach preferred in pathological conditions like intra dural extra tumor. Our study is to analyse the functional outcome and recovery of patients who undergone cervical spine surgeries by anterior cervical discectomy and fusion (ACDF) by bone graft with or without instrumentation, anterior cervical decompression by corpectomy and fusion and posterior cervical decompression by laminectomy.Methods: This cross-sectional study contains patients admitted in Surgery Department, Gandhi Medical College and Hamidia Hospital, Bhopal between July 2017 to April 2019 with degenerative disease/trauma/pathological (tumor) having neurological deficit or not, to know the clinical outcome after cervical spine surgeries anterior approach and posterior approach after approval from ethical committee.Results: In 70 cases of study 09 patients had mild preoperative neurology score (15-17) in which 3 patients had no improvement after 6 months and 06 patients improved (normal function). 39 patients had moderate preoperative neurology score (12-14) in which 28 patients improved with moderate to mild score and 03 patients remain same (no improvement). 03 patients improved after 1 year with mild score. 22 patients had severe preoperative neurology score (0-11) in which 05 cases improved with severe to moderate score and 05 cases improved with severe to mild score. These 05 cases improved with mild score after 1 year.Conclusions: Anterior approach is better than posterior approach in our study which is comparable with existing studies in terms of hospital stay, neurological recovery and final outcome.

Assessment of preoperative serum albumin level and its correlation with postoperative wound complication in major elective abdominal surgeries

Background: Patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves. It is common and occurs in about 30% of surgical patients with gastrointestinal diseases and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications. The serum albumin level is the most readily available and clinically useful parameter. A serum albumin level greater than 3.5 g% suggests adequate protein stores and it confers a protective effect through several biological mechanisms. It predicts perioperative morbidity and mortality.Methods: Our study was conducted on a cohort of 100 Patients admitted in Department of General surgery Hamidia Hospital for major elective surgery between October 2016 and September 2017. Sample size taken was 100.Results: The present study shows that patients with serum albumin less than 3 g/dl has more postoperative complications and patients with serum albumin >3.5 g/dl has less postoperative complications which was statistically significant. The study concludes that as the serum albumin level increases the complication rate decreases.Conclusions: Our study shows that sr. albumin is a good indicator of postoperative complications. The patients with sr. albumin <3.0 g/dl had a higher complication rate which was statistically significant (p<0.05). Patients with sr. albumin >3.5 g/dl had less complications which was statistically significant (p<0.05). The correlation between the serum albumin and complication rate was statistically significant in the malignant diseases when considered separately.

Parametrial hydatid cyst with cystovesical fistula: a rare presentation

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Theoretically, echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. However, uterus and and adnexa have an incidence of 0.5-1%. Till date, three cases have been reported in which a parametrial hydatid cyst formed a bladder fistula. A 57 year old female was admitted with complaint of burning micturition along with white coloured urine for the last 15-20 days with no other significant history. On examination and evaluation, it was suspected to a neoplastic pelvic mass causing gross right sided hydronephrosis. All biochemical markers were within normal limits. The patient was explored surgically on which a thick-walled lesion was found in right parametrium. The cavity of the lesion was filled with daughter hydatid cyst, along with communication into the bladder via a fistula. Open cystectomy was done after evacuation of daughter cysts and irrigation with scolicidal agents. The fistula was repaired. The patient recovered uneventfully and was doing well on follow-up. The incidence of hydatid cysts in the female reproductive system is very low and constitutes less than 0.5% of all hydatid cysts. However, rare cases have been reported, thus the clinician must be aware of this rare disease and should take precautions while operating, as any spillage may lead to anaphylactic shock.

Urinary bladder paraganglioma – A rare dreaded tumor.

Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and t sympathetic ganglia are referred to as pheochromocytomas and extra adrenal catecholamine secreting paragangliomas (extra adrenal pheochromocytomas), respectively. Bladder paragangliomas are rare entities with initial non-specific presenting symptomatology. Differentitaion of urinary bladder pheochromocytomas from other bladder tumors has important treatment implications. We have presented here the case of a 55 year old female who presented to our outpatient urology clinic with complains of hematuria for 3 months and headache for 1 month. Cystoscopy revealed diffusely thickened bladder wall with a well circumscribed smooth surfaced mass protruding from the right lateral wall of the bladder. Multiple biopsies were taken and sent for histopathology. After cystectomy, diagnosis of paraganglioma of bladder was done by histopathology and immunohistochemistry.

A rare case of right inguinal hemangiopericytoma – Masking the occurrence of right indirect inguinal hernia.

A hemangiopericytoma is a rare tumor that originates in the pericytes in the wall of capillaries. it is usually benign in nature and is located in the soft tissues. These tumors can originate anywhere in the body where there are capillaries. The most common locations reported are the brain, lower extremities, pelvic area, head, and neck and abdominal cavity. We have reported here a case of hemangiopericytoma in inguinal region in a 70 year old male patient, who presented with right inguinal mass, which was masking the occurrence of right indirect inguinal hernia and diagnose hemangiopericytoma by histopathology.

Ileosigmoid knotting: An unusual cause of intestinal obstruction.

Ileosigmoid knot or double volvulus is an unusual cause of intestinal obstruction and presents as a surgical emergency. It affects men of middle and old age. It occurs due to entangling of ileal and sigmoid loops producing obstruction and strangulation. Here, We have described a case 60 years old male presented with features of intestinal obstruction. Emergency laparotomy revealed ileosigmoid knotting with gangrene of involved segment. Resection of unviable portion with knot was done with double primary anastomosis and covering ileostomy.

Prevalence of pathogens and their antimicrobial susceptibility in catheter associated urinary tract infection.

Hospital-acquired urinary tract infection (UTI) is the most common infection acquired in hospitals. Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated with urinary tract follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledge of organisms that cause UTI and the antibiotic susceptibility is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeutic or prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was the most common cause of catheter associated infection and highest sensitivity was found to Amikacin.