Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome.

BACKGROUND: Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile. MATERIALS AND METHODS: Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed. RESULTS: Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78. DISCUSSION: P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients.

A Prospective Randomized Trial of Open Wound Treatment vs Occlusive Dressings in Elective Surgical Cases with Respect to Surgical Site Infections.

BACKGROUND: Surgical wounds heal by primary intention in all the elective and emergency surgical procedures. Current practice is to place dressing over the closed wound before the patient leaves the sterile environment of the operating theatre. Dressing is a material applied to protect a wound and favour its healing. However, to leave wound open in direct contact to environment following any procedure by just applying some ointment on it, the so called open wound treatment is still controversial one. In the present study we have compared open wound treatment vs occlusive dressings in elective surgical cases with respect to surgical site infections. MATERIALS AND METHODS: The present study was conducted on 100 patients admitted for elective general surgery after taking written informed consent. Patients were divided randomly in to two equal groups each comprising of 50 patients. In Group A, patients had occlusive dressing till removal of stitches and in Group B, patients wounds were kept exposed to environment after the surgical procedure. RESULTS: In present study we observed total 7% of postoperative wounds were infected of all the clean and clean contaminated wounds we studied. In Group A, patients had occlusive dressing and these patients had 8% infection rate whereas in Group B patients, wounds were kept exposed to environment and these patients had 6% infection rate. CONCLUSION: It is hereby concluded that in the elective surgical cases there is no harm in leaving the wounds open postoperatively. This method not only helps in arresting the infective pathology at a lesser stage but also saves surgeon's time and patient's money.

A comparitive study to evaluate the role of serum lipid levels in aetiology of carcinoma breast.

INTRODUCTION: Breast cancer is the most common occurring cancer in women worldwide. Various factors that have lead to change in lifestyle are thought to be associated with increase in breast cancer incidence in Asian countries. Several clinical studies suggest the prognostic significance of serum lipid levels in breast cancer. Present study was planned to confirm the association of lipids levels with breast cancer. MATERIALS AND METHODS: Lipid analyses was carried out on serum samples from 100 breast cancer patients and 100 control women, with a age group of 25 y and above. The case & control group included 50 premenopausal women and 50 postmenopausal women. RESULTS: Patients of study group had high Low density lipoproteins (LDL) (p-value - 0.00), Triglycerides (TG) (p-value -0.001) and Total cholesterol (TC) (p-value -0.00) as compared to control group. There was no association of VLDL (p-value -0.436) and HDL (p-value -0.797) among study group and control group. There was no association of lipid levels in different grades of carcinoma. CONCLUSION: High levels of LDL, TG and TC were associated with breast cancer. However, no association was there in different grades of carcinoma. So it may be concluded that, LDL, TG and TC may be having some role in aetiology of breast cancer. Therefore, early detection and control of these factors may help in reducing the incidence of breast cancer and ultimately social and economic burden on society.

Isolated cystic duct lymph node tuberculosis.

Tuberculosis of the cystic duct lymph node without involvement of gall bladder is exceedingly rare. Cholelithiasis is a usual accompaniment. A case of 65-year-old woman was diagnosed to have cholelithiasis. Laparoscopic cholecystectomy was performed and a prominent cystic lymph node was excised for biopsy. Histopathology surprisingly reported tuberculosis of cystic duct lymph node without affecting the gall bladder. Thereupon, she was treated with antituberculous chemotherapy.

Mid-arm approach to basilic and cephalic vein cannulation using ultrasound guidance.

Central venous lines are often used when there is difficulty obtaining peripheral venous access. The basilic and cephalic veins in the mid-arm region, although difficult to see or palpate, can be imaged longitudinally and cannulated using real-time ultrasonography, providing an easy alternative. These techniques are described, with reports of four typical cases.

Necrotising soft tissue infections as a complication of chickenpox.

Varicella gangrenosum, in which a necrotising soft tissue infection complicates the vesicular eruption of chickenpox, is rare. The condition may have devastating sequelae including disseminated intravascular coagulation and death. Survival is dependent on early diagnosis, adequate antibiotic coverage and, particularly, early surgical debridement. Three cases of varying severity are presented here together with a review of the available literature.

Mortality profile in trauma victims.

To assess the mortality incidence among trauma victims a one year prospective study was conducted on all patients admitted with physical trauma. The causes of death amongst trauma victims comprised road traffic accident (44.71%), thermal injuries (19.71%), domestic causes (11.54%), agriculture related injury and criminal violence (9.61% each), fall of construction workers (2.4%), collapse of buildings and train accidents (0.96% each) and industrial injury (0.48%). Mortality was highest among victims with multiple injuries (41.35%). The mortality rate increased in direct proportion to increase in transportation time and injury severity score.

Mortality profile in trauma victims.

To assess the mortality incidence among trauma victims, one year prospective study comprising all patients admitted in Rajendra Hospital, Patiala, Punjab with physical trauma was undertaken. Road traffic accidents were the commonest cause of trauma-death followed closely by thermal injury. Mortality was highest among victims of multiple injuries. The mortality rate increased in direct proportion to increase in transportation time and Injury Severity Score (ISS). We advocate some simple preventive and regulatory steps to lower the mortality incidence in trauma cases.

Acute omental infarction--a report of six cases.

Six cases of acute omental infarction, a rare entity, are reported. Four of them are secondary to torsion and two are cases of primary infarction. Appendicitis is the most common mode of presentation of this condition. Except for one patient who was obese, no predisposing factors were discernible in these patients. The aetiology and pathogenetic mechanisms of this disease were reviewed.