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Introduction Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer-related death in the world. The etiology of gastric cancer includes Helicobacter pylori infection, diet, lifestyle, tobacco, alcohol, and genetic susceptibility. Upper gastrointestinal endoscopy (UGIE) is the most effective method for examining the upper gastrointestinal tract as compared to the other examination tools. Objective To study the histopathological finding of upper gastrointestinal endoscopic biopsies and its association with H. pylori in cases of carcinoma stomach. Materials and methods This was a hospital-based observational study carried out in the Department of Surgery, at Maharaja Krushna Chandra Gajapati Medical College, Berhampur, a tertiary care hospital in Eastern India. Study population consisted of 106 patients for a period of 2 years from July 2019 to June 2021, after due consideration of the inclusion and exclusion criteria. Endoscopic location and pathological types of the gastric lesion were noted, and all biopsy specimens were investigated to see the presence of H. pylori by rapid urease test (RUT) and histological examination in the form of Giemsa and H&E stain. Results In the present study of 106 cases, 62 cases (58.49%) were found to be positive for H. Pylori by RUT and 72 cases (67.92%) were positive for H. pylori by smear staining. In histopathological study, 72 cases (67.92%) were of intestinal type of carcinoma and 34 cases (32.07%) were of diffuse type of carcinoma. Smear for H . pylori was positive in 56 cases (77.78%) among the 72 cases of intestinal type of carcinoma stomach. Whereas only 16 cases (47.05%) were found to be smear-positive for H. pylori among the 34 cases of diffuse type of lesion. Irrespective of histological type, H. pylori was positive in 67.92% of patients with carcinoma stomach. This association was statistically significant (p<0.001) and indicates its role in intestinal type of gastric carcinoma. Conclusion There is a high frequency of H. pylori infection in cases of stomach cancer. This study confirmed the higher association of H. pylori infection with gastric cancer. Its association with the intestinal histological variety of stomach cancer is more common than diffuse type. The prevalence of H. pylori infection in distal stomach carcinoma is higher than proximal.
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Background Right iliac fossa mass is one of the most common clinical scenarios a surgeon encounters during their surgical practice. It poses a critical diagnostic dilemma for surgeons and requires considerable diagnostic skills. Its clinical diagnosis becomes difficult in the presence of comorbidities, such as severe obesity and guarding, as in these cases, the mass becomes palpable only upon the administration of a relaxant. Methods A total of 108 patients admitted to Bhima Bhoi Medical College & Hospital, exhibiting signs and symptoms of mass in the right iliac fossa upon cross-examination, were included in the study. We recorded their detailed clinical history and performed physical examinations, including erect abdomen, chest (post-anterior view), and contrast x-rays, ultrasonogram; and CT scans. Results In this study, patients with appendicular masses, appendicular abscesses, ileocecal tuberculosis, cecum carcinoma, ovarian tumors, and parietal lipoma accounted for 45.3%, 17.5%, 12.9%, 7.4%, 6.4%, and 4.6% of the total cases, respectively, whereas patients with retroperitoneal tumors, parietal abscesses, and ileocecal lymphadenopathy accounted for 1.8% each.
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Introduction Acute appendicitis happens to be increasingly common in school-going children and early part of adult life, peak incidence reaching in the teens and early twenties. Luminal obstruction of the vermiform appendix is thought to be essential for the development of appendicular ischemia, gangrene, and perforation. The treatment of choice in acute appendicitis is emergency appendectomy. Appendicitis particularly puts the surgeon in a dilemma whenever the patient presents late by around four to seven days. In case of delay in presentation, complications like appendicular lump formation occur. The factors that make the clinical presentation inconsistent which in turn makes the diagnosis challenging in the case of acute appendicitis are the variable position of the appendix, the degree/grade of inflammation, and the age of the patient. At present, the standard treatment is the Ochsner-Sherren regimen universalized by Oschner and has been mostly practised over many decades as the standard care for the appendicular lump. Conservative regimen does not work in a few cases where urgent surgical exploration is necessary. This study was conducted to compare early appendectomy versus conservative management followed by interval appendectomy in case of appendicular mass and to make a better strategy for effective management of patients with complicated appendicitis. Methods A total of 112 patients were diagnosed as having an appendicular lump as per the available records between June 2018 and June 2021. The total study population was divided into two comparative groups depending upon the treatment they received. The patients in group-1 received medical treatment and those in group-2 had undergone surgical management. The patients in group-1 were treated according to the Ochsner-Sherren regimen. The patients in group-2 were the patients in whom emergency appendectomy was done. If the general condition of the patient did not improve, pain and tenderness didn't subside, the size of phlegmon or abscess was increasing and other features of the acute abdomen were persistent, then it was regarded as a failure of medical treatment and the patient was prepared for surgery on an emergency basis. Results Out of 1192 cases of acute appendicitis admitted between June 2018 and June 2021, a total of 112 patients were diagnosed with an appendicular lump. As per the record, 64 patients were managed conventionally as per the Ochsner-Sherren regimen followed by elective interval appendectomy (group-1) and 48 cases were managed with an emergency surgical procedure (group-2). In group-1, out of 64 patients, non-operative treatment was successful in 58 patients (90.62%). Among the remaining patients, there was a failure of non-operative treatment in six patients and they were subjected to emergency surgical exploration (9.37%). So a total of 58 patients underwent interval appendectomy after six weeks. Out of 54 patients who had undergone emergency appendectomy in both groups, the per-operative finding was an appendicular lump in 55.5% of patients while a total of 44 patients in group-2, were discharged from the hospital within six days (91.66%). But in group-1, only 16 patients were discharged from the hospital within six days (25%), rest were discharged from the hospital after more than seven days of stay. Conclusion Early appendectomy in appendicular mass is safe due to the improvements in surgical techniques and better postoperative care.
