scholarly journals Gallbladder perforation: management in a tertiary care centre

2018 ◽  
Vol 5 (10) ◽  
pp. 3346
Author(s):  
Prashant Tubachi ◽  
K. Sphurti Kamath ◽  
Mallikarjun Desai ◽  
Harsha Kodliwadmath
Keyword(s):  
Surgical Treatment ◽  
Acute Cholecystitis ◽  
Computerized Tomography ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
Gallbladder Perforation ◽  
Type I ◽  
Tertiary Care Centre ◽  
Intravenous Antibiotics

Background: Retrospective study in the management of perforated gallbladder and clinical outcome in a tertiary care centre.Methods: Total of 583 patients underwent laparoscopic or open cholecystectomy between 2015 to 2017. Out of these eleven patients had perforated gallbladder (1.9%). Niemeier’ classification used for gallbladder perforation. Both Ultrasonography and Abdominal computerized tomography was used in this study. The parameters like age, gender, method of management, diagnostic procedures, time between date of admission to time of surgery, surgical treatment, duration of hospital stay and post-operative morbidity were evaluated.Results: Out of the eleven cases, eight patients were male and three were female. Nine patients were above the age of fifty years. According to Niemer classification, seven patients had type I perforation, three patients had type II perforation and one had type one perforation. Out of the eleven cases, eight were clinically diagnosed to be acute cholecystitis and three were clinically diagnosed to have peritonitis. The cases diagnosed to have peritonitis- underwent immediate intervention. The remaining eight cases were initially managed conservatively with intravenous antibiotics, imaging and workup was done, following which intervention was done.Conclusions: Early diagnosis and emergency surgical treatment of gallbladder perforation with peritonitis is of crucial importance. If the patient is stable then intervention after optimising has better outcome. Abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation. 

scholarly journals Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre

2021 ◽  
Vol 2 (2) ◽  
pp. 82-86
Author(s):  
Uttam Laudari ◽  
Rosi Pradhan ◽  
Dibesh Shrestha ◽  
Bibek Timilsina ◽  
Suhail Sapkota ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Analysis ◽  
Infection Prevention ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Biliary Colic ◽  
Tertiary Care Centre ◽  
Duration Of Hospitalization

INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.  

scholarly journals A STUDY OF HISTOCYTOLOGICAL FINDINGS OF LUNG LESIONS IN IMAGE GUIDED FNAC AND BIOPSY IN TERTIARY CARE CENTRE

2020 ◽  
pp. 1-3
Author(s):  
Renuka Gahine ◽  
Shashikala Kosam ◽  
Vivek Patre ◽  
Kiranlata Bhagat
Keyword(s):  
Cell Carcinoma ◽  
Predictive Value ◽  
Tertiary Care ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Lung Lesion ◽  
Tertiary Care Centre ◽  
Predisposing Factor ◽  
Lung Lesions ◽  
Tertiary Referral Center

Aims and Objectives: To study the cytological and histological findings of lung masses and correlate findings with clinical and radiological findings. Material and methods: The study was an observational study, comprised of two years of prospective from December 2017 to September 2019 and five years of retrospective study between October 2012 to November 2017, conducted in Histopathology & Cytology laboratory, Department of Pathology, Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital, Raipur, (C.G.), a tertiary referral center. Result: Total 104 cases were studied . Out of 104 lung lesions 74 (71.2%) were males and 30 (28.8%) were females with M:F of 2.46:1. Majority of lung lesions were seen in the age group of 61-70 years i.e. 35 (33.66%) and 51-60 years i.e. 30 (28.85%) followed by 41-50 years 17 (16.35%). Mean age of the patients in our study was 56.4 years. Smoking was the most common predisposing factor for lung carcinoma observed in 58 (55.77%) cases followed by tobacco chewing. Clinically the most common complaint was cough in 65 (62.5%) cases, followed by weight loss. 10 cases were diagnosed as benign and 94 cases as malignant. Among benign lesions most common lung lesions were non-specific inflammatory lesions reported in 6 (5.77%) cases followed by granulomatous lesion in 3 (2.89%), hydatid cyst in 2 (1.93%) and aspergilloma in 1 (0.97%) case. Adenocarcinoma was the most common malignant lung lesion found in 52 (50%) cases followed by Squamous cell carcinoma 20 (24%), Small cell carcinoma 12 (13.04%) and Poorly differentiated carcinoma 6 (5.77%) cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of our study was 97.83%, 66.67%, 95.74%, 80.0% and 94.23% respectively. Conclusion: Guided FNAC and biopsy are safe, simple, less invasive, cost effective, well accepted and accurate diagnostic procedures with minimal complications and low morbidity rates.

scholarly journals A prospective study of endometriosis and its outcome at tertiary care centre

2019 ◽  
Vol 8 (12) ◽  
pp. 4847
Author(s):  
Shilpa Ninama ◽  
Bijal D. Rami
Keyword(s):  
Surgical Treatment ◽  
Prospective Study ◽  
Clinical Features ◽  
Tertiary Care ◽  
Pelvic Endometriosis ◽  
Tertiary Care Centre ◽  
Gnrh Analogues ◽  
Oral Contraceptive Pills ◽  
Presenting Symptoms ◽  
American Fertility Society

Background: This study was conducted to detect various presenting clinical features, type and severity of pelvic endometriosis according to revised American fertility society classification. Objective of this study was to assess outcome of endometriosis after medical and surgical treatment in form of pregnancy, reduction of symptoms like dysmenorrhoea, dyspareunia and others.Methods: This prospective study conducted at one of tertiary care teaching institutes for period of 3 years from January 2011 to December 2013. A total number of 100 patients of pelvic endometriosis were examined and divided according to Revised American Fertility Society Classification on bases of severity, type and clinical features and laparoscopic findings. After 1 year of follow up, outcome assessed after completion of medical and surgical treatment in form of pregnancy, reduction of dysmenorrhoea and dyspareunia and other symptoms.Results: This study showed most affected patients (46%) belongs to 26-30 years of age group, dysmenorrhoea was the most common presenting symptoms in 76% patients. Most common site affected (52%) was ovaries. Laparoscopy was done in 86% patients. Most patients (44%) were benefited with fulguration of endometriotic nodules. 62% of patients were given oral contraceptive pills or progesterone pills after definitive surgery as freely available in Governmental setup and fewer side effects as compared to Danazol and GnRH analogues. 40 patients became pregnant after medical and surgical treatment, where 60 patients had reduced dysmenorrhoea and 20 patients had reduced dyspareunia.Conclusions: Laparoscopy is gold standard diagnostic as well as therapeutic tool in pelvic endometriosis as it can rule out other causes of infertility without interfering normal anatomy.

Perfil clínico de pacientes pediátricos con diagnóstico de hepatitis autoinmune en un centro de alta complejidad del suroccidente colombiano

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Carolina Aristizábal-Henao ◽  
Laura Torres-Canchala ◽  
Eliana Manzi ◽  
Verónica Botero-Osorio
Keyword(s):  
Acute Hepatitis ◽  
Autoimmune Hepatitis ◽  
Tertiary Care ◽  
World Population ◽  
Type I ◽  
Tertiary Care Centre ◽  
Paediatric Patients ◽  
Clinical Responses ◽  
Few Data

Introduction. Autoimmune hepatitis is a progressive inflammatory liver disease that is rare in children, characterized by inflammation in liver histology, the presence of autoantibodies and high levels of immunoglobulin G. There are few data in children and in some studies performed in Latin America, but limited in Colombia. The aim of this study is to describe the demographic, clinical, paraclinical and therapeutic data as well as, the outcome of paediatric patients diagnosed with autoimmune hepatitis in a tertiary care centre in south-western Colombia. Methods. This is a descriptive study of a retrospective cohort of paediatric patients (≤ 18 years) with a diagnosis of autoimmune hepatitis, attended in a third-level hospital in Colombia between 2011 and 2019. Statistical analyses were performed using the program Stata 14.0. Results. A total of 40 patients were included, 57.5% were female, with a median age of 10.5 years (IQR 4-13). The 62.5% presented with acute hepatitis, 20% had liver failure, a 27.5% with cirrhosis at diagnosis; 75% presented compatible liver biopsy, and 82.5% were classified as type 1 autoimmune hepatitis. All patients received a steroid plus immunomodulator; presenting biochemical remission in 75% relapse in the 22.5%. Four of the patients required liver transplantation. Conclusions. Autoimmune hepatitis is an infrequent entity, although not negligible, in children in our environment. A higher prevalence of type I autoimmune hepatitis was found. Most patients were female and presented with symptoms of acute hepatitis at the initial diagnosis. The characteristics and clinical responses, in this cohort, are similar to those described in different series in the world population.

scholarly journals Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

2018 ◽  
Vol 4 (3) ◽  
pp. 789
Author(s):  
Arvinder Singh Sood ◽  
Pooja Pal ◽  
Anshul Singla
Keyword(s):  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Type I ◽  
Graft Material ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Tertiary Care Centre ◽  
Fascia Graft ◽  
Uptake Rates

<p class="abstract"><strong>Background:</strong> Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.</p><p class="abstract"><strong>Methods:</strong> This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared.  </p><p class="abstract"><strong>Results:</strong> The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.</p><p class="abstract"><strong>Conclusions:</strong> Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.</p><p class="abstract"> </p>

scholarly journals Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre

2021 ◽  
Author(s):  
Nithya T. ◽  
S. Rajagopalan
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Tertiary Care Centre ◽  
Numerical Rating ◽  
Management Method

Background: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used.Methods: A prospective observational study for a period of 15 months from March 2019 to May 2020 in 140 patients who underwent elective laparotomies from the department of general surgery Rajarajeswari medical college and hospital (tertiary care center).Results: A total of 140 patients were included among which 58 (41.4%) were female and 82 (58.6%) were male patients. The 20 different types of surgeries were recorded. In our study the most common surgery performed was open appendectomy followed by open cholecystectomy. Most common mode of analgesia used was combined analgesia. Opioids, NSAIDS (non-steroidal anti-inflammatory drugs), epidural and transdermal patch was used. NRS (numerical rating scale) score was recorded for all 140 patients on postoperative days 1, 2 and 3.Conclusions: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

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