Predicting and grading liver injury in the absence of computed tomographic imaging.

Background: Even developed countries lack computed tomography (CT) scan in rural areas. Availability, affordability and accessibility of CT scan play an important role in the management of blunt hepatic trauma. Materials and Methods: A descriptive observational study among 56 hepatic blunt trauma patients as Group 1 and 56 non-hepatic blunt trauma patients as Group 2 enrolled retrospectively. Observational analysis of presence of liver trauma, grades of liver injury (I-VI) and clinical course with the liver function tests are done. Results: Aspartate transaminase (AST) (P = 0.02) and alanine transaminase (ALT) (P = 0.003) levels were significantly elevated among Group 1. Significantly elevated levels in Group 1 than Group 2 of AST [467.5 (22-5097) vs. 95 (23-1780); P < 0.001] and of ALT [422 (28-1548) vs. 69 (20-727); P < 0.001] noted. Significant elevation of AST and ALT levels, as the AAST (American Association for the Surgery of Trauma) CT grade of liver injury increases, noted (P = 0.001). Using the ROC curve analysis, the optimal cut-off values of AST and ALT were set at ≥467.5 U/L and ≥111.5 U/L, respectively. At this cut-off, AST had sensitivity 50%, specificity 91.7%, PPV 85%, NPV 66%, ALT had sensitivity 85.3%, specificity 86.1%, PPV 85.3% and NPV 86.1% for liver injury. Conclusion: ALT is more sensitive for liver injury. AST peak is seen in the immediate period. Combining clinical assessment, transaminase levels and Focused Assessment with Sonography in Trauma improves the sensitivity and specificity. Transaminase levels can vary with ethnicity and local epidemiological diseases; therefore, optimal cut-off levels should be established for local population. This would predict and grade the liver injury, helping in early decision-making and avoid wasting the golden hour in trauma.

Surgical Notes: To Play or Not to Play.

INTRODUCTION: Music is any sound that is perceived as pleasingly harmonious. The link between music and healthcare can be traced long back in the history of mankind. Thus, our study aimed at assessing the impact of different genre of music on the cognition functioning, memory and attention levels of the surgeons. MATERIALS AND METHODS: It was a single-arm interventional trial assessing 45 surgeons from different specialities. Each participant was expected to do 5 sets of tasks, one set each for the 5 music tracks played. Each task set further contained 5 different types of tasks, namely trail marking, jigsaw puzzle, backward counting, comprehension and memory game using cards. The 5 music tracks included ambient OR noise, music of personal preference, western classical, heavy metal and pop music. Scores were assigned for each task and compared. RESULTS: The total score for music of personal choice was much less (19.68) when compared to the other genre and that for pop was the highest (25.03). Memory card tests and backward counting (tests of short-term memory) were comparatively better with music of personal choice. However, trail marking (test of speed) and jigsaw puzzle and comprehension tests (tests of complex neurological functions) were least performed when music of personal choice was played. CONCLUSION: Music of choice may help in short-term memory recall, but an over-familiarity with the music played can serve as a distractor thus affecting the speed and accuracy.

A rare cause of massive lymphadenopathy.

Rosai Dorfman Disease is a rare disease presenting mainly as painless enlargement of cervical lymph nodes. It is a benign disorder showing unique histological features characterized by reactive proliferation of sinus histiocytes. In 40% of cases, extranodal sites may be involved. The condition has to be differentiated from certain types of B cell lymphoma showing similar features. We report here a 17 year old male presenting with nodal and extranodal involvement of Rosai Dorfman Disease.

Clinico-Microbiological Aspects of Necrotising Fasciitis in Type II Diabetes Mellitus.

Necrotising fasciitis is insidiously advancing soft tissue infection, characterized by widespread fascial necrosis. One of the most common conditions encountered in the clinical practice and which required clinical suspicion in patients who have less resistance to these infections. Especially in diabetic patients who are more prone for such infection due to low immunity and other reasons like early detection of these infections helps these patients to have a better recovery by aggressive surgical management and other measures required for the same. Literature has enough evidence on how serious this entity. Hence this study is designed in that aspect to help in early diagnosis and appropriate treatment. This study will help to determine the clinical presentation, the polymicrobial involved. The organisms most closely linked to necrotizing fasciitis are group A beta-hemolytic streptococci, although the disease may also be caused by other bacteria and their sensitivity patterns will help us to install appropriate antibiotics with the surgical management. And to compare our mortality rate with the other studies. A prospective descriptive study including all type II diabetic patients with necrotizing fasciitis over 3 years. Patients were evaluated in detail with respect to patient's history, examination, culture sensitivity and chart reviews and followed up using standard evaluation tools to measure the various outcomes. In 62 patients, the commonest clinical presentation was necrotic patch of skin and cellulites. The organisms cultured being beta hemolytic streptococci and E.Coli. The culture sensitivity pattern is to broad-spectrum antibiotics. The average stay in the hospital was about 13.74 days for the study group and the time delay in presentation is 6 days. Wagner's score is a useful tool for aiding the diagnosis. Patients without foot care had extensive lesions. And a mortality rate of 1.6 % in these patients. In an acutely swollen limb in a diabetic patient a high degree of suspicion of necrotizing fasciitis is required. A detailed foot care is warranted in these patients. An early extensive debridement is mandatory and key for a favorable outcome. And to start on broad- spectrum antibiotics is advisable. Wagner's scoring is helpful to predict the chances of a second surgery. With the above entities in mind the mortality rate of necrotizing fasciitis in type ii diabetes mellitus can be contained.

Peritonitis in patients over the age of 50 years: 98 cases managed surgically.

Generalized peritonitis in patients over the age of 50 years is a common surgical emergency. This is a retrospective analysis of 98 cases managed surgically. Duodenal ulcer perforations, necrotizing enteritis, acute cholecystitis with perforation and small bowel perforations were the common causes. Most of them presented late, and many had associated conditions. Re-look laparotomies had a definite role to play. While there is significant decrease in the number of typhoid and tubercular peritonitis, there appears to be an increase in the incidence of necrotizing enteritis and acute cholecystitis.