scholarly journals TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Khaled Noureldin ◽  
Mohamed Elkhouly ◽  
Heer Shah ◽  
AliAsgar HatimAli ◽  
Bolu Ayantunde ◽  
...  

Abstract Introduction Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort. Patients and Methods Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC). Results 372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%. NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC. Conclusion NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
A Ayantunde ◽  
M Elkholy ◽  
H S Shah Heer Shah ◽  
A Hatim

Abstract Introduction Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort. Method Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC >11000/mm3, elevated CPR >5 mg/L. Results 372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR. Conclusions NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.


2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.


Author(s):  
Vijayan Peettakkandy ◽  
Bijukrishnan Rajagopalawarrier ◽  
Sreenath Kuniyil ◽  
Jithin Veliyath Thankaraj

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.


2019 ◽  
Vol 10 (4) ◽  
pp. 3356-3368
Author(s):  
Kussay M. Abbas Zwain ◽  
Samer M. Mohamed Al-Hakkak ◽  
Alaa A. Al-Wadees ◽  
Zainab Mahdi Majeed

β-thalassemia major is a chronic, inherited hematological disease that leads to chronic anemia in the affected children. One of the options of treatment in such patients was splenectomy; however, it is not without risk of many complications; one of them is the thrombotic events. A prospective study of 55 patients with β-thalassemia inscribes in this study. 14 patients (25.5%) had a normal thrombocyte count and 41 patients (74.5%) have an abnormally high thrombocytes count which was significantly associated with PVT (P. Value <0.001), Regarding the WBC count, it extended between 4000 to more than 30,000, in both genders with non-statistically significant differences between both genders, (P>0.05). Regarding the serum ferritin, the mean level was 2908.5 ± 1024.3 ng/ml. In males, the mean S. Ferritin was relatively higher than that of females, 3167.6 ± 1841.3 mg/dl, and 2573.8 ± 1150.6 ng/ml. The weight of the spleen was up to 1500 grams in 25 (80.6%) of males and 20 (83.3 %) of females while it was more than 1500 grams in the remaining and females and males, without a significant difference statistically in the spleen weight of, (P>0.05). The most frequent presenting symptom was abdominal pain. It was founded in 46 patients (83.6%), followed by fever in 76.4%, diarrhea in 58.2%, and Nausea and vomiting in 31 (56.4%). 3 patients out of the 55 (5.5%) developed portal vein thrombosis in their follow up period. Post splenectomy PVT in thalassemia the patient is relatively frequent (5.5%) complication that require a high degree of doubt for diagnosis early, especially in patients with postoperative pain of the abdomen within 2 months after surgery, Female gender, Large spleen and postoperative increase number of platelets are risk factors for PVT so one can initiate surveillance by Doppler ultrasound postoperatively and start antiplatelet prophylactic therapy immediately for such patients. 


2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Shahtaj Khan ◽  
Hamzullah Khan ◽  
Saba Khan ◽  
Mansoor Akhtar

Objectives: To determine the variation of d-dimers in COVID-19. To determine the contribution of demographic factors (age and gender) toward an elevated d-dimers values. To determine the probability of surviving in different age groups in COVID-19, with d-dimer > 0.5 µg/ml. Methodology:  A total of 193 patients were enrolled from COVID-19 isolation units, Hayatabad medical complex Peshawar, whose d-dimer levels were performed as per instructions of the treating physician and were followed. Relevant information’s were recorded on a pre-designed performa prepared in accordance with the objectives of the study. Results: Out of total 193 patients 152(78.8%) were males and 41(21.2%) females. 94(48.7%) patients were in the age range 35-55 y while 76(39.4%) patients had age more than 55 y. Regarding d-dimer readings, 162(83.9%) had d-dimer levels more than 0.5 µg/ml. The mean with standard deviation of age of the patients was 52 ± 13 y. The mean with standard deviation of d-dimer values of the patients was 4.9 ± 13.3 µg/ml. It was observed that, the relative risk of deranged values of d-dimers was 1.18 (rr = 1.18) in patients with age > 55 y. Similarly in female gender the relative risk of higher values of d-dimers above normal was 1.26 (rr = 1.26) without reaching a statistically significant p-value (p = 0.48). The probability of worse outcome in term of death was 2.06 times more in patients with d dimers > 0.5 µg/ml (OR = 2.06). Furthermore the probability of surviving was 90-100% by age < 50 y, 80% in age range 51-60 y, 45% in age range 61-70 y and 30% at age  > 80 y. Conclusion: The deranged d-dimer levels were noted in 84% of the COVID-19 patients. Age > 55 y and female gender are at higher risk of deranged d-dimers and further consequences. Survival rate of patients with deranged d-dimers drops to 30% in patients with age > 80 y, 45% at age < 70 y. Key word: COVID-19, D-dimers, survival rate, prognostic values Anaesth. pain intensive care 2020;24(5): Received: 20 June 2020, Reviewed: 24, 28 June 2020, Accepted: 1 July 2020


2014 ◽  
Vol 120 (6) ◽  
pp. 1484-1495 ◽  
Author(s):  
Paulo Roberto Lacerda Leal ◽  
Charlotte Barbier ◽  
Marc Hermier ◽  
Miguel Angelo Souza ◽  
Gerardo Cristino-Filho ◽  
...  

Object The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Methods Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22–79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. Results The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm3) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm3 and 89.09 ± 14.72 mm3, respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm2) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm2 and 5.64 ± 0.85 mm2, respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05. Conclusions Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.


Author(s):  
L. Cunha ◽  
A. Gonçalves ◽  
M. Dinis ◽  
C. Oliveira ◽  
M. Ferro ◽  
...  

ABSTRACT:We analysed the clinical features of 82 patients with dominantly inherited ataxia in a cohort survey. All patients fulfilled the diagnostic criteria for Machado-Joseph disease. The mean age of onset of symptoms was 39.8 (± 12.5) years and the duration of the disease was 9.2 (± 6.7) years. Ataxia, peripheral neuropathy, and fasciculation scores correlated with age of onset and duration of disease. Upper motor neuron scores failed to correlate with age of onset. In a follow-up study we analysed the clinical data of 46 patients two years after the first examination. A paired ttest was used to compare differences between observations. The results are in agreement with those of the cross-section in time, suggesting a deterioration of the symptoms with the evolution of the disease. We conclude that dynamic definition of the disease according to age of onset and duration of symptoms is preferable to subdivision into classical types.


Author(s):  
Vinod Shinde ◽  
Tejal Sonar ◽  
Shikha Shah ◽  
Ashutosh Kumar ◽  
Anuja Satav

<p class="abstract"><strong>Background:</strong> A tympanoplasty is a surgical procedure to close a tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly after chronic otitis media and trauma.</p><p class="abstract"><strong>Methods:</strong> 50 patients were divided into 2 groups and underwent type-1 tympanoplasty using temporalis fascia versus sliced tragal cartilage. The patient was placed in supine position. Antiseptic painting and draping was done. All cases were operated under local anaesthesia. Post aural approach with post aural Wilde’s incision with 15 number blade, the incision was made 5-10 mm posterior to post aural groove. Temporalis fascia graft was harvested. Tragal cartilage, incision was taken over the under surface of the tragus and tragal cartilage was sliced.  </p><p class="abstract"><strong>Results:</strong> The mean duration of symptoms was 12.72 and 15.84 months in group A and B respectively. Reduced hearing was noted in 21 and 24 patients, ear discharge in 21 each and giddiness in 2 and 4 patients respectively in group A and B. The difference was non-significant when the symptoms were evaluated. Improvement in AB gap was significantly better in group B with a p value of 0.042. The mean improvement was 14.2 dB and 17 dB respectively.</p><p class="abstract"><strong>Conclusions:</strong> Type-1 tympanoplasty using the sliced tragal cartilage may be associated with better improvement in AB gap and can be regularly employed compared to temporalis fascia method.</p>


2021 ◽  
Vol 15 (6) ◽  
pp. 1340-1344
Author(s):  
Q. Yusaf ◽  
A. Qayyum ◽  
E. U. Haq, Javaria ◽  
A. Yasir ◽  
H. A. Qayyum

Background: It has been noted that there is an increased prevalence and serious clinical implications of stroke in women. However, local studies focused on stroke among female gender are still scarce. Aim: To find frequency of female patients with ischemic stroke and to compare the sub-types of ischemic stroke, mean NIHSS score and mean MRS scores among both genders. Methodology: This descriptive case series was conducted in indoor and outdoor department of Neurology at Mayo Hospital, Lahore for six months [Feb 6, 2018 till August 6, 2018]. After taking demographics and clinical characteristics of patients, the severity of stroke was taken using National Institute of Health Stroke Scale (NIHSS) at admission in hospital. The functional outcome was measured using Modified Rankin Scale (MRS). Subtype of acute ischemic stroke was assigned using Oxfordshire classification for acute ischemic stroke. All data was taken on a structured proforma and was entered and analyzed using SPSS version 21. Results: The mean age of cases was 53.58 ± 9.42 years with 73(60.83%) male and 47(39.17%) female cases. Among TACS, there were 15(50%) female cases whereas 9(34.6%) female case were found in PACS and 10(33.3%) female cases were found in LACS. The frequency of gender in all subtypes was statistically same in both groups, p-value > 0.05. The mean modified Rankin scale in male and female cases was 2.93 ± 1.58 and 4.30 ±1.50 respectively with significantly higher mean MMR score in females than male cases, p-value < 0.05. Conclusion: This study concludes that females make up a considerable percentage of patients with ischemic stroke. Though, no statistically significant difference could be found in terms of subtypes of ischemic stroke, the mean NIHSS score and mean MRS were statistically higher among females compared to male cases. Keywords: Stroke, subtypes, severity, ischemia, gender difference, NIHSS, MRS


2017 ◽  
Vol 24 (01) ◽  
pp. 51-56
Author(s):  
Jabeen Atta ◽  
Abdul Ghafoor Dalwani ◽  
Zubair Ahmed Yousfani ◽  
M. Siddique Khurram ◽  
Roohi Bano ◽  
...  

Objectives: To determine the frequency, clinical presentation and managementstrategies for carcinoma of caecum among pathologies in right iliac fossa excludinggynaecological disorders at Liaquat university hospital Hyderabad / Jamshoro. Study Design:Cross sectional multi-disciplinary study. Period: Thirty months. Setting: Liaquat UniversityHospital Hyderabad / Jamshoro. Patients and Methods: All the patients presented with GIsymptoms, intestinal obstruction, and appendicitis or had mass in the right iliac fossa wereselected and recruited and further evaluated for existence of carcinoma of caecum andpreceded for management strategies. The data was analyzed in SPSS 16 and the frequencyand percentage was calculated and the level of significance was p-value ≤0.05. Results: Total50 patients were diagnosed as caecum cancer during thirty months study period. The cancerof caecum was common in older age group. The mean age ± SD for whole population andmale as well as female gender was 67.53±6.98, 66.32±8.75 and 65.34±5.96 and of fifty cases,thirty two (64%) were males and eighteen (36%) were females respectively. The commonpresentation identified was mass in right iliac fossa in 28 patients (p=0.03) while the commonoperative procedure performed was ileotransverse anastomosis with right hemicolectomy in 34patients which is non-significant in relation to age (p=0.7) whereas it was significant in contextto gender (p=0.04) respectively. Conclusion: The common presentations for carcinoma ofcaecum detected was right iliac fossa mass while the predominant age, gender and operativeprocedure performed were seventy plus years, male gender population and Ileotransverseanastamosis with right hemicolectomy.


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