Blood ordering and utilization in patients undergoing elective general surgery procedures in a tertiary care hospital: A prospective audit.

Background Blood ordering is commonly done for patients undergoing major elective surgery. Excessive order of the blood for elective surgery leads to wastage of resources, time and workforce. Auditing preoperative blood ordering decreases the cost of medical care by avoiding unnecessary cross-match without compromising patient safety. Methods For this hospital-based audit, we collected data prospectively from July 2017 to June 2018 regarding the transfusion and transfusion indices, namely cross-match-totransfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI) and maximum surgical blood ordering schedule (MSBOS) for elective surgeries done in the Department of Surgery. Results A total of 1151 patients were included in the study. A total of 160 units of blood were issued of which only 138 were transfused to 116 patients. Seventy-one procedures were included in the study. The C/T ratio was less than 2.5 for 16 procedures, T% was >50% for 9 procedures and MSBOS was more than 0.5 for 16 procedures. Conclusion Cross-matching is overused for elective surgical procedures. Only 16 of the 71 procedures had an ideal C/T ratio. Group and screen policy can be adopted for most of the commonly performed procedures, and cross-matching of blood may not be needed.

Abdominoscrotal Haematocele in an Adult and Its Successful Treatment.

Abdominoscrotal hydrocele (ASH) is a variant of hydrocele that rarely occurs in adults. ASH has two sacs, one in the scrotum and one in the abdomen connected through the inguinal canal. Abdominoscrotal haematocele is a rare complication of ASH. We report a 57-year-old male patient who presented to a tertiary care hospital in Puducherry, India, in 2019 with complaints of swelling in the scrotum for 15 years and abdominal pain for two months. Both the swellings were soft and cross fluctuation was present. Imaging confirmed the diagnosis of ASH. During a diagnostic laparoscopy, the abdominal sac was decompressed and found to have thick brownish fluid suggestive of haematocele. It was demonstrated that both sacs were connected. Due to difficulty in the dissection of the sac, the procedure was converted to an open procedure. Both the sacs were excised and Lytle's repair was done for the dilated internal ring. The patient recovered and no recurrence of any swelling in the abdomen or scrotum was found at the end of a one-year follow-up.

A Rare Case of Primary Anorectal Malignant Melanoma.

Malignant melanoma affecting the anorectum is very rare. We present a 63-year-old female who presented with features of bleeding per rectum and painful defecation. On examination, the patient had a palpable mass on the right side of the anorectum, with predominant exophytic growth and intraluminal extension. Biopsy and imaging studies were diagnostic of malignant melanoma. The patient was discussed on the tumor board and planned for abdominoperineal resection. Postoperatively, the patient was started on chemotherapy. The patient was followed up for two years, and there was no evidence of any recurrence.

Interns' anticipatory anxiety about cardiopulmonary resuscitation: reducing it while bolstering confidence with psychological skills training.

INTRODUCTION: Dealing with emergencies is a critical responsibility of physicians-in-training. Residents typically lead cardio-pulmonary resuscitation efforts in a teaching hospital. A 'Code Blue' is a situation that is highly challenging, time sensitive and very often highly anxiety-provoking. Recently, there is greater recognition of the need and value of integrating specific psychological performance skills training to better manage the stress of critical situations. In this study, we sought to evaluate the impact of including a psychological skills training program with BLS/ACLS training for performance and confidence optimization and mitigation of anxiety in 1 year residents related to participating in and leading emergency resuscitations. MATERIALS AND METHODS: First-year residents across six specialties underwent traditional BLS/ACLS training with the addition of a 3 h psychological skills training component (Code Calm) as part of their residency orientation. Anxiety and confidence-based questionnaires were used to evaluate the residents' perceptions of code-related stress and confidence to lead resuscitation efforts. RESULTS: Code-related anxiety scores demonstrated a statistically significant decrease post training (p < 0.0001); general confidence scores showed a statistically significant increase post-training (p < 0.001); confidence in leading resuscitation showed a statistically significant increase (p < 0.0001). DISCUSSION: The results of this study demonstrate that BLS/ACLS training can positively influence anxiety and confidence in residents related to their resuscitation skills, especially if combined with psychological skills training. Future studies should evaluate the incremental value of including psychological skills training with BLS/ACLS and its impact on enhancing physical performance skills.

Feasibility of Laparoscopic Closed Cystectomy for Hepatic Hydatid Cyst in Segments VI, VII, and VIII.

Background Laparoscopic closed cystectomy of the hepatic hydatid cyst (HHC) is increasingly being performed as it has improved postoperative recovery and reduced morbidity. However, laparoscopic closed cystectomy of HHC is difficult when located in segments VI, VII, and VIII. This study aimed to assess the laparoscopic closed cystectomy feasibility of the HHC when cysts are located at the difficult access site. Methodology Seven patients out of 13 patients of HHC treated laparoscopically in the surgery department from 2014 to 2018 were included. These patients had cysts located in segments VI, VII, and VIII of the liver. All patients received perioperative albendazole, underwent ultrasonography (USG) and contrast-enhanced computed tomography for diagnosis. We noted the demographic character of all the patients, cyst's location, cyst size, type of the cyst, mean operative time, intraoperative and postoperative complications, duration of the hospital stay, and recurrence of the cyst.  Results All patients underwent laparoscopic closed cystectomy of HHC. One patient had a conversion to open procedure, and one patient had an additional thoracoscopic approach added. The mean operative time was 191.86 minutes. There were no intraoperative complications. One patient had developed a surgical site infection, and three had a minor bile leak postoperatively. The hospital stay's mean duration was four days, and there was no recurrence in the 21 months follow-up. Conclusion The laparoscopic closed cystectomy of HHC located at segments VI, VII, and VIII is feasible, safe, and cost-effective. A thorough preoperative evaluation, preparation, and radiological planning of the procedure should be done.

Perforation of the Meckel's Diverticulum Following Blunt Trauma to the Abdomen.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Most of the patients are asymptomatic and very few develop symptoms. Hemorrhage, obstruction, perforation, and inflammation are the complications that can occur in an MD. Even though hollow viscus perforation is common, perforation of the MD following blunt abdominal trauma is rare. We report a case of perforation of the MD in a 60-year-old man following a blunt abdominal trauma due to a fall from a bike, which was diagnosed promptly and managed successfully by timely operative intervention.

Traumatic Acute Colonic Intramural Hematoma: A Rare Entity and Successful Expectant Approach.

Acute intramural hematoma in colon is a rare presentation following trauma. There are reports in literature of acute colonic hematoma following trauma, warfarin intake and in patient with coagulation disorders. In traumatic acute colonic intramural hematoma, most of the reported cases were managed surgically. Very few cases were successfully managed conservatively. We present a case of 28-year-old male who presented to the surgical emergency after two days of road traffic accident. After relevant investigations, he was found to have intramural hematoma of ascending colon, which was managed conservatively.

Spontaneous Pneumomediastinum in a Young Adult: A Rare Presentation.

Spontaneous pneumomediastinum (SPM) refers to the presence of air in the mediastinum without any obvious cause. It is an uncommon condition occurring due to alveolar rupture as a result of increased intrathoracic pressure. It is commonly seen in young males, patients with known asthmatic disorders and pulmonary diseases. We report a rare case of SPM in a young healthy male without any significant past history. The patient was managed conservatively and discharged.