Clinicopathological Profile of Childhood Primary Abdominal Tumours in Kashmir.

Primary abdominal tumours attract considerable notice because of their serious prognosis, high cost of treatment and the emotional and psychological trauma. Abdominal tumours can present with pain, vomiting, constipation or less commonly intestinal obstruction. The presentation of cancer in children mimic those of childhood conditions like infections particularly viral infections, urinary tract infections, gastro-oesophageal reflux, malnutrition, constipation, lymphadnenitis, glomerulonephritis and congenital urinary tract anomalies.

Predictors of mortality and morbidity in peritonitis in a developing country.

OBJECTIVE: Generalized peritonitis is still a common emergency managed by most general surgeons throughout the world. If the outcome in these patients can be correctly predicted, then better management can be instituted to those patients in need. This study aims to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. These factors could be later used to predict the outcome in patients with generalized peritonitis. MATERIAL AND METHODS: A total of one hundred patients with peritonitis were studied. Factors including age, pulse and respiratory rate, temperature, hemoglobin, total leukocyte count, hematocrit, urea, creatinine, sodium, potassium, pH, PaO2 levels at the time of surgery along with peritoneal contamination and duration of surgery were noted. Using the Students t test, factors were identified which had a statistically significant influence on the outcome. RESULTS: Thirty-six patients in the study developed complications and 17 died. Statistics showed that 8 factors influenced morbidity and 11 influenced mortality. CONCLUSION: Identifying variables which influence the outcome of patients with peritonitis is an important initial step. Once these factors have been identified, the outcome of patients can be correctly predicted and better management can be instituted to those patients in need.

Knowledge, attitude and practice of contraception in rural kashmir.

BACKGROUND: Human fertility is determined by many factors such as customs, morals and habits of social groups with regard to marital obligation of life. Acceptance of family planning methods varies within and between societies and there are many factors which are responsible for such variation at community, family and individual level. Socioeconomic environment, culture and education are few of them that play a vital role. Jammu and Kashmir state in general and Kashmir valley in particular is a Muslim-dominated population with traditionally a conservative society. Apart from family customs and influence of the elders, religious background has always been behind the passive resistance, or at the best indifference towards contraception. This study makes an attempt to assess the knowledge, attitude and practice of contraception in rural Kashmir. OBJECTIVE: To assess the knowledge, attitude and practice of contraception in rural Kashmir. STUDY DESIGN: Community-based Cross-Sectional study. STUDY PERIOD: December 2006 to May 2008. PARTICIPANTS: 1900 currently married women in the age group of 15-49 years of age. SETTING: Rural households. METHODS: 1900 currently married women, aged 15-49 years, selected by multi-stage random sampling technique from three districts of Kashmir valley who were interviewed at home using a pretested oral questionnaire. The assessment of various socioeconomic and other variables made as per the available standard procedures and scales. ANALYSIS: Percentage, Chi square test and Bivariate analysis. RESULTS: Knowledge of the contraceptive methods was fairly good especially for terminal methods i.e. female sterilization (97.7 %). Main source of information on contraception was obtained from mass media (60.4 %). Contraceptive practice was significantly related to number of living children, literacy, socioeconomic status and type of family. CONCLUSION: What is needed is to promote and stress contraceptive methods and their advantages using mass media approach and to explore more and more participation of private sector.

Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; a randomized clinical trial.

Pilonidal sinus is a chronic intermittent disease, usually involving the sacrococcygeal area. This study was undertaken to compare the results of rhomboid excision followed by Limberg flap with that of excision and primary closure in patients with primary pilonidal sinus. A total of 120 patients with pilonidal disease were randomly divided into group A who underwent excision and primary closure (n = 60) and group B who underwent the rhomboid transposition flap procedure (n = 60). Length of hospital stay and postoperative complications in two groups were compared. Duration of hospital stay (P < 0.001) and time to resumption of work (P < 0.001) was less for group B, and postoperative complications were fewer in group B (P < 0.05). During follow-up of 2 years, no recurrence was detected in patients in group B, whereas five patients developed recurrence in group A (P = 0.02). Limberg flap procedure is better than the simple excision and primary closure for the management of sacrococcygeal pilonidal disease.

Spontaneous hepatic subcapsular biloma: Report of three cases with review of the literature.

A biloma is an encapsulated bile collection outside the biliary tree. Most cases are caused mainly by iatrogenic injury and trauma, and are usually located in the sub-hepatic space. Spontaneous biloma is an uncommon entity. We report three rare cases of spontaneous hepatic subcapsular biloma formation in association with choledocholithiasis in two patients and cholangiocarcinoma in one patient. All the patients presented with extrahepatic biliary obstruction with no previous history of abdominal surgery, instrumentation, or trauma. Ultrasound and computerized tomography of the abdomen documented hepatic subcapsular biloma. The patients were initially managed with antibiotics and radiologically guided pigtail drainage of the collections, followed by definitive treatment of their underlying cause.

Gallbladder ascariasis with uneventful worm migration back to the duodenum: A case report.

Ascariasis, a worldwide parasitic disease, is regarded by some authorities as the most common parasitic infection in humans. The causative organism is Ascaris lumbricoides, which normally lives in the lumen of the small intestine. From the intestine, the worm can invade the bile duct or pancreatic duct, but invasion into the gallbladder is quite rare because of the anatomical features of the cystic duct, which is narrow and tortuous. Once it enters the gallbladder, it is exceedingly rare for the worm to migrate back to the intestine. We report a case of gallbladder ascariasis with worm migration back into the intestine, in view of its rare presentation.

Transaxillary approach with use of traction suture for excision of breast fibroadenoma: a new technique and its results.

Avoiding a scar on the breast is an inherent feminine desire. We devised a new approach for breast fibroadenoma excision:Transaxillary approach with use of traction suture (TATS), in 50 patients with breast fibroadenoma. The swelling was present in the outer breast. The wound healed without noticeable scarring and the original shape of the breast was preserved. All the patients expressed their great satisfaction with the procedure.

Primary isolated echinococcal cyst of the seminal vesicle: A rare case.

Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography (abdominal and trans-rectal), and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole (10 mg/kg/day) for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

Surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion; a randomized controlled trial.

UNLABELLED: Ganglion is the most common benign soft tissue tumour of hand and represents about 60-70% of all such soft tissue tumours. Treatment options include observation, aspiration, intralesional steroids and surgical and arthroscopic excision. Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for its treatment but the operative treatment is the best method when considering the recurrence rate. OBJECTIVE: To compare the result of surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion. STUDY PERIOD: November 2007 to October 2009. PARTICIPANTS: 36 patients above 15 years of age, having the disease for first time, having no history of wrist injury and with no history of use of steroid or any allergy to it, were selected for the study. SETTING: The study was undertaken at SKIMS Medical College Hospital, Bemina Srinagar Kashmir. Patients were randomly allocated to undergo either surgical excision (group A, n = 18) or aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization (group B, n = 18) using table of random numbers. All the patients were operated under local anaesthesia. Fisher-exact-test, Chi-square test were used for statistics. The success rate of surgery was 94.4% and that of aspiration with triamcinolone acetonide injection plus wrist immobilization was 61.1%. The difference in success rate was statistically significant(p = 0.041). Surgery is the most successful form of treatment when considering the cure rate of dorsal wrist ganglion.

Surgical Treatment of Dupuytren's Contracture; Results and Complications of Surgery: Our Experience.

Dupuytren's disease is one of the fibro-proliferative conditions affecting the palmar and digital fascia. This disease has been known to surgeons and treated by them for at least 200 years. Dupuytren's disease is very common in Northern Europe and also in countries inhabited by immigrants from Northern Europe. Dupuytren's contracture is stated to be uncommon in Indian subcontinent and very little has been written about this disease in India. The authors have however come across 30 patients with Dupuytren's contracture and they are the subject of this paper, with special emphasis on its surgical correction and complications of surgical treatment. Patients were categorized into stages I, II and III as per the severity of disease. Regional fasciectomy was performed in 90% of the patients and extensive fasciectomy in 10% of patients. Most of wounds were closed by primary closure with z-plasty. In rest of the patients free skin grafts were used to close the wound, when primary closure was not possible. The patients were followed up regularly for 5 years and the results of surgical treatment were categorized into excellent, good, fair and poor. The results were excellent in 23 patients (76.66%), good in six patients (20%) and fair in one patient (3.33%). Post operative edema and some stiffness was seen in two patients. Wound infection was seen in one patient and haematoma in one patient. The correct surgical technique and meticulous post operative care is needed to achieve higher rates of correction and to limit the complications and recurrence.