Can difficulties in laparoscopic cholecystectomy be anticipated preoperatively: evaluation of a scoring system

Background: Laparoscopic cholecystectomy is often associated with intra operative difficulties leading to increased intra and post-operative morbidity. Accurate prediction of a difficult laparoscopic cholecystectomy can reduce the complication rate, rate of conversion and overall medical cost. This study was an attempt to validate a scoring system developed to predict difficult laparoscopic cholecystectomy.Methods: 100 patients undergoing laparoscopic cholecystectomy were included. Details such as age, sex, BMI, previous surgical history, history of hospitalisation for biliary disease, sonographical wall thickness, pericholecystic collection and presence of impacted stone were noted. With these, pre-operative score was calculated using the scoring system. Intra operative details and complications were noted and were classified as easy, difficult and very difficult. Student t test and chi square test was used to test the difference of significance (p<0.05).Results: Male sex, higher BMI, a history of previous surgery, a history of prior hospitalisation for biliary disease, a palpable gall bladder, a thickened gall bladder wall, impacted stone and pericholecystic collection all had a statistically significant accurate prediction of the difficulty in laparoscopic cholecystectomy. The mean duration of surgery was 62.7±33.15 minutes. The scoring system developed by Randhawa et al predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.Conclusions: The proposed scoring system predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.

Study of maternal and fetal outcome in eclampsia at Government Medical college, Aurangabad, Maharashtra, India

Background: Eclampsia is an obstetric enigma. Eclampsia as a clinical entity has been known from times immemorial. Even today it is one of the dreaded complications. Today also eclampsia is a life-threatening emergency that continues to be a major cause of serious maternal and perinatal morbidity and it’s still the leading cause of maternal mortality in our country.Methods: Method analysis of case records of all eclampsia cases from study period of October 2013 to September 2015, a observational study.Results: The incidence of eclampsia was found to be 1.06% in GMC, Aurangabad. The number of maternal deaths of eclampsia patients was 7 out of 335 eclampsia cases. Maternal mortality in eclampsia patients was 2.08% in 2-year study, however maternal mortality in hospital was 0.23% in 2 years study and the perinatal mortality rate in eclampsia was 361 per 1000 total births. while it is 84 per 1000 total birth for total deliveries in GMC Aurangabad during study. Majority of patients i.e. 87.75% were in the age group of 16-25 years, 55.82% of total eclampsia were primigravida 57% eclampsia cases were referred from government or private hospitals, 11% booked in GMC and 32% patients were self.  Antepartum eclampsia was the commonest type 82.11%. 80% patients of eclampsia were delivered vaginally and 18% underwent caesarean section ,2% instrumental deliveries. 12% of babies had birth weight 1000gm. 41% babies delivered with weight 2001 gm. Out of 264 live births 92 babies required NICU admission and 45 babies died in early neonatal period.Conclusions: With good antenatal, intranatal and postnatal care with judicious use of anti-hypertensive, anti-convulsant and battery of investigations and judicious obstetric intervention, maternal and perinatal mortality can be reduced.

Nature Heals: Spontaneous Resolution of Liver Abscess through Hepato-colic Fistula.

Rupture of a liver abscess is a fairly common phenomenon in surgical practice. It is commoner in developing countries like India. Sites of rupture often predict the clinical course of the patient and affect the natural history of the disease, more common being the pleural and peritoneal cavity. Rupture into the bowel with fistulization is a rare phenomenon in liver abscess. Hepato-colic fistulae are being encountered following radiofrequency ablation for hepato cellular carcinoma. This occurring in the setting of liver abscess is highly uncommon. We report the first ever case in English literature, wherein an amoebic liver abscess was complicated by the occurrence of a hepato-colic fistula. The patient was a 48-year-old male who had a liver abscess in a background of alcoholic liver disease. On further investigation, he was found to have abnormal communication between the abscess cavity and the hepatic flexure of the colon. He was managed conservatively followed by spontaneous closure of the fistula.

Evaluation of the Blood-Glucose Reducing Effects of Aqueous Extracts of the Selected Umbelliferous Fruits used in Culinary Practices

PURPOSE: Oxidative stress in diabetes coexists with a reduction in the antioxidant status; which can increase the deleterious effects of free radicals. Many plant extracts and plant products have been shown to have significant antioxidant activity. The role of antioxidant plants in diabetes has not been studied. Food additives like spices; which have free radical scavenging activity; may also be useful in maintaining normal glucose levels in diabetic patients. The objective of the study is to evaluate the aqueous extracts of selected umbelliferous fruits for hypoglycaemic and antidiabetic activities in normal and diabetic rats respectively. METHODS: All the aqueous extracts of (Caraway) CA; (Coriander) CO; (Cumin) CU; (Dill) DI and (Fennel) FE were administered at dose levels of 300 mg/kg body weight orally to different groups each containing 5 animals. A control group was also maintained simultaneously and received distilled water orally.Blood samples were collected from retro-orbital plexus of each rat before and at 2; 4; 6 and 8 h after extract administration and were analyzed for glucose content by using glucose oxidase peroxidase (GOD-POD) method using a visible spectrophotometer at 505 nm. RESULTS: In normal rats only caraway extract produced significant hypoglycaemic action. The rest of the extracts produced hypoglycaemia; which was not significant different from that of control animals. In diabetic rats also the caraway was found to be the best among the extracts. CONCLUSION: The study indicates that since the umbelliferous fruits are used in the preparation of foods; they may be useful in the control of postprandial rise of blood glucose particularly in diabetic condition. Additionally; their daily use may help in reducing complications associated with chronic diabetes

Pancreatitis in enteric fever.

Pancreatitis in enteric fever is rare. We report two patients with enteric fever, one due to Salmonella typhi infection and other due to S. paratyphi, who on investigation were found to have pancreatitis. Both patients recovered uneventfully.

An evaluation of pH changes of human dental plaque after oral rinsing of commonly prescribed syrup medications.

The study was carried out on 60 school going children (dft/DMFT 2-5) aged 8-13 years randomly distributed into six age groups of ten subjects each. One group acted as a control in which subjects rinsed with 10% sucrose while in the other five groups, the subjects rinsed with 5 commonly prescribed syrup medications for 10 seconds. Plaque samples were collected before rinsing and at 5,10,20,30 min. intervals post rinsing and plaque pH was measured extraorally. All the 5 groups showed drop in the plaque pH, similar to control group 10% sucrose solution, but not to the extent of critical pH (5.5).