Modified Hasson technique: a quick and safe entry of first port into the abdomen

Background: Laparoscopy is the standard technique for abdominal surgeries. There has been a debate over the safest laparoscopic entry technique over the past two decades. But, no technique has been regarded as the best, leading to numerable techniques. We use a modified Hasson technique to enter the peritoneal cavity. Hence, we conducted a study to evaluate the efficacy of our modified Hasson technique.Methods: A retrospective study was conducted in the Department of General Surgery, Al Azhar Medical College Hospital from January 2013 to December 2018.Results: A total of 156 patients were studied. Inguinal hernia repair was the most common indication. The mean entry time was 2±0.7 minutes. The postoperative complications included port site seroma [1 (0.6%)] and port site infection [1 (0.6%)]. Both the complications were found at the umbilical port and all following surgery for appendicular perforation. There was no incidence of preperitoneal placement of port, intraabdominal injury, port site hematoma or port site hernia. There was no mortality in the study group.Conclusions: Modified Hasson technique is a safe and quick technique to enter the abdomen.

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Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience

Journal of Surgical Sciences ◽

10.3329/jss.v22i2.44075 ◽

2020 ◽

Vol 22 (2) ◽

pp. 110-117

Author(s):

Md Mahmudul Islam ◽

Khondkar AK Azad ◽

Md Aminul Islam ◽

Rivu Raj Chakraborty

Keyword(s):

Road Traffic Accident ◽

Traffic Accident ◽

Chest Trauma ◽

Road Traffic ◽

Tube Thoracostomy ◽

Rib Fracture ◽

Medical College Hospital ◽

College Hospital ◽

Medical College ◽

The Mean

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days. Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent. Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117

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Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.6309 ◽

2021 ◽

Vol 28 (03) ◽

pp. 277-281

Author(s):

Bushra Shaikh ◽

Imamuddin Baloch ◽

Azhar Ali Shah ◽

Abdul Sami Mirani ◽

Parkash Lal Lund ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Wound Infection ◽

Port Site ◽

Site Infection ◽

College Hospital ◽

Medical College ◽

Duration Of Surgery ◽

Group A ◽

Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

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Prevalence of Pre-Existing Corneal Astigmatism in Age Related Cataract Patient

Faridpur Medical College Journal ◽

10.3329/fmcj.v8i1.16887 ◽

2013 ◽

Vol 8 (1) ◽

pp. 02-04

Author(s):

Md Abdur Rashid ◽

KH Anowar Hossain ◽

AKM Rafiqul Islam

Keyword(s):

Prospective Study ◽

Cataract Surgery ◽

Visual Outcome ◽

Corneal Astigmatism ◽

Normal Vision ◽

College Hospital ◽

Medical College ◽

Cataract Patient ◽

Age Related ◽

The Mean

Cataract surgery is no more a blind rehabilitation surgery, it absolutely gives normal vision. In the era of modern cataract surgery patients expectations are also high about visual outcome. This prospective study was carried out to investigate the magnitude and pattern of pre-existing corneal astigmatism in age related cataract patient at Faridpur Medical College Hospital, Faridpur and Agha Yusuf Adhunik Hospital, Kustia, from July 2009 to June 2012. We examined 850 eyes of 730 patients who underwent cataract surgery. The mean age at the time of surgery was 61.9±8.1 (40 to 70) years. Corneal astigmatism was measured by Auto Refracto Keratometer at least two times for each patient. Astigmatism was calculated from diopteric difference of vertical reading from horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian at 90°± 20°. Against the rule (ATR) astigmatism was considered when steep meridian at 180°±20°. Astigmatism is in other direction is defined as oblique. On keratometry, when vertical reading (k1) was found greater than horizontal (k2) was considered WTR astigmatism and the reverse reading for ATR astigmatism. The percentage of corneal astigmatism was 1D or less was 69.6%, more than 1D and less than 1.5D, 27.6% and more than 1.5D and less then 2D 2.8%. Prevalence of ATR astigmatism was more than WTR astigmatism and prevalence of ATR astigmatism increases significantly with age. Approximately two third of pre-operative patient had 1D or less astigmatism and one third had more than 1D corneal astigmatism. DOI: http://dx.doi.org/10.3329/fmcj.v8i1.16887 Faridpur Med. Coll. J. 2013;8(1): 02-04

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Socio-demographic Characteristics of Vesico-vaginal fistula (VVF) patients attended at a tertiary Care Hospital in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50766 ◽

2020 ◽

Vol 6 (2) ◽

pp. 114-117

Author(s):

Shimul Akter ◽

Naznin Rashid Shewly ◽

Kashefa Khatun ◽

Rokshana Parvin Nupur ◽

Kamrun Nahar ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Demographic Characteristics ◽

Medical College Hospital ◽

Care Hospital ◽

Vaginal Fistula ◽

College Hospital ◽

Medical College ◽

The Mean ◽

Vesico Vaginal Fistula

Background: Vesico-vaginal fistula can occur in different women with varied socio-economic condition. Objectives: The purpose of the present study was to see the socio-demographic characteristics of vesico-vaginal fistula (VVF) patients attended at a tertiary care hospital in Bangladesh. Methodology: This cross-sectional study was carried out from July 2013 to December 2013 for a period of 6 months in the National Fistula Centre in the Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. All patients who underwent surgical repair for iatrogenic VVF in National Fistula Centre of the department of Obstetrics and Gynaecology of Dhaka Medical College Hospital were included in this study. Patients who got themselves admitted to Obstetrics & Gynaecology department of DMCH with the complaints of fistula. The entire selected patients were interviewed for detailed socio-demographic characteristics. Result: A total number of 51 cases of VVF were recruited for this study. The mean age was 46.02 (±SD 6.104) years. Most of the respondents were illiterate (55.0%) and one-third patients had primary level education. The number of highly educated patients was scarce (12.0%). It was evident that average age at marriage of the patients was 15.8(±4.74) years. Some females were forced to accept marriage at the age of 10 years. The mean interval between initiation of menstruation and the marriage was only 4.72 years. Mothers were on an average 17.48 years old at the time of first delivery. Conclusion: In conclusion middle age illiterate women are most commonly suffering from VVF. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 114-117

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Primary Retroperitoneal Ganglioneuroma: A Retrospective Cohort Study of 32 Patients

Frontiers in Surgery ◽

10.3389/fsurg.2021.642451 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jianchun Xiao ◽

Zixuan Zhao ◽

Binglu Li ◽

Taiping Zhang

Keyword(s):

Growth Pattern ◽

Clinical Manifestations ◽

Incomplete Resection ◽

Radiological Imaging ◽

College Hospital ◽

Laboratory Findings ◽

Female Ratio ◽

Medical College ◽

The Mean ◽

The Masses

Purpose: To investigate the clinical characteristics, diagnosis, differential diagnosis, therapy options, and outcomes of retroperitoneal ganglioneuroma.Methods: In this retrospective study, we collected and analyzed the clinical data of 32 patients diagnosed with retroperitoneal ganglioneuroma and admitted to Peking Union Medical College Hospital from October 2012 to August 2019.Results: Among our 32 cases with retroperitoneal ganglioneuroma, the male-to-female ratio was 1:3 and the mean age was 35. Only 25% of the cases presented with abdominal pain while more than 65% had no specific symptoms. The masses could be found through physical examination in only five patients. Most of the tumors are located near the renal area. They were usually single and displayed an embedded growth pattern with diameters <10 cm, clear borders, and soft texture. For radiological imaging, the majority of tumors demonstrated soft tissue density with mild-to-moderate enhancement on CT imaging and showed hypoecho with moderate blood flow signals in ultrasound. No significantly abnormal laboratory examinations were found in most patients. Of all the 32 patients, 2 chose surveillance after biopsy due to difficulties in operation, while others chose surgical resection. The mean follow-up time was 15.8 months among 26 patients. The tumor remained stable in the surveillance cases. Residual tumors were found in four cases receiving operations with no progress and discomfort. No recurrence was seen in all patients.Conclusions: The retroperitoneal ganglioneuroma is a benign tumor without specific clinical manifestations or significant laboratory findings. Typically, it is shown as low density with a clear border and an embedded growth pattern in radiological imaging. The overall prognosis is good. Surgery is an effective approach with possible severe complications. Incomplete resection or surveillance can be considered for some cases where complete resection is difficult to achieve.

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Laparoscopic Cholecystectomy for Acute Cholecystitis: Indication, Risk, and Outcome

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v8i06.010 ◽

2021 ◽

Vol 8 (06) ◽

pp. 5508-5513

Author(s):

Dr. Shiladitya Shil ◽

Dr. Ashutosh Deb Sarma ◽

Dr. Md. Alomgir Islam ◽

Dr. Md. Abdullah-Hel-Baki Abdul ◽

Dr.Monira Begum

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Prospective Observational Study ◽

The Other ◽

Surgical Indication ◽

College Hospital ◽

Female Ratio ◽

Medical College ◽

The Mean ◽

Good Treatment Option

Background: A laparoscopic cholecystectomy is a fundamental approach to treating acute cholecystitis, and the timing of performing this given treatment is associated with clinical outcomes. It is unknown whether surgical indication, risk, and consequences of laparoscopic cholecystectomy for acute cholecystitis differ from those for the chronic form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Objective: This study aimed to evaluate surgical indication, risk, and outcomes of laparoscopic cholecystectomy for acute cholecystitis. Methods: This prospective observational study was carried out at Bangladesh Medical College Hospital (Uttara Campus) from July 2006 to November 2008. A total of 103 acute cholecystitis patients were observed to evaluate the safety, risk, and outcomes (includes hospital stay, joining to routine daily works) of laparoscopic cholecystectomy. Result: Male and female ratio is 1:4, and the mean age in our series is 47 years. Acute calculas cholecystitis ultra-sonogram feature shows the highest percentage (85.4%) compare to the other four parts. The study also confirmations around 69% did not get any complications, and bleeding was the most frequently observed (16%) complication. The overall outcomes in this research were observed around 75% of total operated patients did not experience any difficulty and said they fit entirely. The other 19% who had some complications include Pain, RTI, Seroma, Jaundice, Cholangitis, Wound infection). Conclusion: Regarding bile duct injury and prolonged complications, laparoscopic surgery is not a very good treatment option for acute cholecystitis.

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A STUDY OF HYPERURICACIDEMIA AND THE PRESENCE AND SEVERITY OF ACUTE CORONARY SYNDROME IN INDEX MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTER, INDORE ( M.P.)

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2029 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

B. Khanam ◽

M. Imran Khan ◽

Ajay Kumar Singh ◽

Sumit Solanki ◽

S.M. Holkar

Keyword(s):

Acute Coronary Syndrome ◽

Control Group ◽

Case Group ◽

College Hospital ◽

Medical College ◽

Coronary Syndrome ◽

Luminal Stenosis ◽

Angiographic Evidence ◽

The Mean ◽

High Uric Acid

Background: Few studies have assessed the relation of hyperuricacidemia with the acute coronary syndrome (ACS). This study investigated the association between high uric acid levels with the presence and severity of ACS. Methods: Three hundred and seventy patients having angiographic evidence of atherosclerosis (CAD + case group) compared to 170 patients with no luminal stenosis (n=110) or with <50% luminal stenosis (n=60) at coronary angiography (CAD – control group). Results: The mean age of the patients was 60 ± 10 years (317 men, 58.7%). Hyperuricacidemia was more likely associated with a trend toward higher vessel scores, indicating a more severe CAD (adjusted OR=1.51, 95% CI=1.09-2.09; P=0.005) in the whole population. A comparison of sex-specific values showed a significant association existed only in men. Conclusions: Asymptomatic hyperuricacidemia may be associated with the presence and severity of ACS. Keywords: Hyperuricacidemia, Severity & Acute Coronary Syndrome.

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Marital Satisfaction Among Spouses of Male Patients with Alcohol Dependence Syndrome

INDIAN JOURNAL OF MENTAL HEALTH AND NEUROSCIENCES ◽

10.32746/10.32746/ijmhns.2019.v2.i2.19 ◽

2019 ◽

Vol 2 (02) ◽

pp. 8-13

Author(s):

Humayoon Akbar ◽

Sudhakar S. ◽

Shanthi B. ◽

Khadeja Bi ◽

Jayaseelan R. ◽

...

Keyword(s):

Marital Satisfaction ◽

Alcohol Dependence ◽

Rural Areas ◽

Tertiary Care ◽

College Hospital ◽

Medical College ◽

Alcohol Dependence Syndrome ◽

Male Patients ◽

The Mean ◽

Alcohol Dependent

BACKGROUND One third of Indians consume alcohol and there is an alarming annual increase in alcohol consumption. Majority of spouses of alcohol dependent males are also the primary care-takers of their husbands and are at risk of domestic violence. Marital dissatisfaction could reduce their involvement in getting their spouses treated for alcohol dependence. Our aim was to study the marital satisfaction among the spouses of patients with alcohol dependence. METHODOLOGY This study was conducted on spouses of male patients with alcohol dependence syndrome attending the psychiatry department of a tertiary care medical college hospital in Kanchipuram District in Tamilnadu. 200 consecutive male patients with alcohol dependence syndrome using the ICD 10 criteria were recruited. Severity of alcohol dependence was assessed using Short Alcohol Dependence Data (SADD). Marital satisfaction among the spouses was assessed using ENRICH Marital Satisfaction (EMS) Scale. Analysis of the data was done using Statistical Package for the Social Sciences (SPSS) version 22.0. RESULTS The mean age of alcohol dependent men and their spouses were 43.05±9.39 and 37.58±8.86 years respectively. Most of the spouses (83.5%) had done their primary education only and 50% were house-wives (unemployed). Majority of men earned between Rs.5000 to 10,000 and most of them were unskilled workers belonging to the lower socio-economic group in the rural areas. The mean SADD and EMS scores were 25.05 ± 8.891 and 31.76 ± 14.45 respectively. 74% of men in our study population were highly dependent on alcohol. Amongst the spouses of men with severe dependence 68.9% reported moderate and 28.3% reported low marital satisfaction. DISCUSSION and CONCLUSION Majority of alcohol dependent men suffered from severe dependence. An inverse relationship between marital satisfaction scores and severity of alcohol dependence was observed. Alcohol dependence and its severity was noted to have an adverse impact on marital satisfaction among spouses of the dependent patients.

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Functional Status of Maternal Thyroid Gland in Eclampsia

TAJ Journal of Teachers Association ◽

10.3329/taj.v31i1.41567 ◽

2019 ◽

Vol 31 (1) ◽

pp. 9-14

Author(s):

M Hafizur Rahman ◽

Mahbub Ara Chowdhury ◽

Shahin Mahmuda

Keyword(s):

Pregnant Women ◽

Normal Pregnancy ◽

Hormonal Changes ◽

Free Triiodothyronine ◽

College Hospital ◽

Medical College ◽

The Mean ◽

Maternal Thyroid ◽

Complicated Pregnancy ◽

In Pregnancy

Marked changes in maternal thyroid activity occur in pregnancy. During pregnancy bodily hormonal changes and metabolic demands result in complex alteration in the bio-chemical parameters of thyroid activities. Besides these, thyroid enlargement, increased thyroid capability for iodine uptake and increase in basal metabolic rate are evidential though these findings are not usually associated with symptoms of hyperthyroidism in pregnancy. Serum concentration of thyroid hormone thyroxine and triiodothyronine in complicated pregnancy like eclamptic toxemia is another field of controversy. To evaluate the changes in thyroid function in normal pregnancy and eclamptic toxemia, a study was undertaken in Rajshahi Medical College Hospital. We collected serum specimens from non pregnant but married women, normal 3rd trimester pregnant women and patients with eclampsia at 3rd trimester of pregnancy and measured serum concentrations of total and free thyroxine (TT4 & FT4) and total and free triiodothyronine (TT3 & FT3 ) by using RIA. Among the study subjects, 10 women were married but non pregnant, 12 women were in their 3rd trimester of normal pregnancy and 32 patients of eclamptic toxemia with 3rd trimester of pregnancy. In normal pregnancy, FT4 and FT3 levels remained normal while TT4 and TT3 levels were elevated. In patients with toxemia of pregnancy, the mean serum TT3 concentration was significantly lower than that of normal pregnancy and the serum FT3 concentrations were below the normal pregnancy range. The mean serum TT4 and FT4 concentrations in patients with eclampsia were however, significantly higher than those in normal pregnant women. TAJ 2018; 31(1): 9-14

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Ossiculoplasty: study of hearing results in 50 patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20170427 ◽

2017 ◽

Vol 3 (2) ◽

pp. 216

Author(s):

Reshma P. Chavan ◽

Shivraj M. Ingole ◽

Santosh Na. Birajdar

Keyword(s):

Conductive Hearing Loss ◽

Normal Mucosa ◽

Hearing Improvement ◽

College Hospital ◽

Middle Ear Mucosa ◽

Hearing Results ◽

Medical College ◽

Reconstruction Methods ◽

The Mean ◽

Conductive Hearing

Background: Ossiculoplasty improves conductive hearing loss. Various reconstruction methods and techniques are developed with use of different graft materials over period of time. Results of ossiculoplasty can be predetermined with consideration of prognostic factors. Methods: The present study is retrospective study of 50 patients who underwent ossiculoplasty in the medical college hospital over the period of 3 years i.e. from January 2013 to December 2016. The pre-operative and post-operative audiometric findings were documented and analyzed to study the hearing improvement with the use of auto graft malleus and incus for ossiculoplasty. The results of ossiculoplasty were also compared with other studies done for ossiculoplasty. Predictors of ossiculoplasty results such as ossicular status and middle ear mucosa were also studied. Results: The average post-operative air bone gap was 12.92 dB. The mean post-operative ABG was within 20 dB in both primary and revision cases. Average air-bone closure in patients with normal mucosa was 32.1 dB and that of adhesive mucosa was 18 dB. Significant improvement in post-operative air-bone closure (p <0.01) was observed in patients with auto graft incus than malleus head as ossiculoplast. Conclusions: 84% ossiculopasty patients were having post-operative air bone gap within 20 dB. The ossiculoplasty using auto graft ossicle is physiological, biocompatible, stable and has low complication rate.

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