Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI.

INTRODUCTION: Obesity is a well-established risk factor for cholelithiasis. But most of the studies have actually tried to establish the risk of cholelithiasis in overweight and obese people. Very few studies have addressed the issue of cholelithiasis in patients with otherwise normal Body Mass Index (BMI). In this study we have tried to establish if there is any relationship between increasing BMI and cholelithiasis. AIM: To establish a relationship between increasing BMI and risk of cholelithiasis. MATERIALS AND METHODS: Retrospective analysis was carried out after doing a prospective pilot study. Ten years data of patients admitted to surgery ward with complaints of pain abdomen was reviewed. Patients with cholelithiasis were segregated as cases and patients with some other diagnosis were selected as controls. Patients with incidental diagnosis of cholelithiasis were excluded. Appropriate analytical tools were used to draw the results using SPSS© 20. RESULTS: Over 11,000 patients data was reviewed and 7,182 patients were selected for inclusion into the study. Major exclusion was due to incomplete availability of data. Cholelithiasis group had 2,872 patients and rest of the patients served as controls against them. Female patients outnumbered their male counterparts in cholelithiasis group. Mean age of the gallstone patients was 37.09 years, almost 2 years younger than their controls. Mean BMI of all patients was 23.55 kg/m2 and in cholelithiasis and control group was 24.93 and 22.62, respectively (df=1, F>1635.395, p<0.001). Gender specific comparison also yielded a significant difference df=3, F=547.238, p<0.001). The difference in the way the patients were distributed among the ethnic groups (Nepalis, Bhutias, Lepchas and others) was also significant (df=3, F=34.234, p<0.001). Most important outcome was that the majority of the patients in the cholelithiasis group were within the normal BMI range. CONCLUSION: We concluded that it's not only the overweight or obese patients who develop symptomatic cholelithiasis but also the individuals with normal BMI. The risk of symptomatic cholelithiasis increases with every increase in BMI. Risk of symptomatic cholelithiasis also increases in women and as the age advances.

Neonatal gastric teratoma: a rare entity.

Gastric Teratoma is an extremely rare neoplasm seen in children. It is mostly benign and predominantly seen in males presenting with an abdominal mass. The lung and stomach are very unusual sites for teratoma. Gastric teratoma accounts for less than 1% of all teratomas, less than 100 cases are reported in literature. We report a case in a 20-day-old infant who presented with large abdominal mass; our case is an addition to the few limited known gastric teratomas reported in the world literature.

Neonatal Fournier's gangrene.

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier's gangrene in a 21 day old male neonate who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gives good results and probably in our setting, to some extent, it is a preventable condition.

Alvarado scoring in acute appendicitis-a clinicopathological correlation.

Acute appendicitis is a clinical diagnosis, so it's impossible to have a definitive diagnosis by gold standard (histopathology) pre operatively. The treatment being surgical, negative appendicectomy rates are high. Present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appendicitis and its co relation by histopathology. Retrospective study of consecutive patients admitted with suspected acute appendicitis during the period March 2005 to March 2007. The Alvarado scoring system was computed from admission notes and records and correlated with the histopathology reports. Out of 155 patients, 92 underwent appendicectomy with the intention to treat appendicitis and diagnosis was confirmed in 80 patients. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value. The normal appendicectomy frequency was 13% and positive predictive value was 86%. Alvarado scoring system is easy, simple, cheap, useful tool in pre operative diagnosis of acute appendicitis and can work effectively in routine practice.