scholarly journals Reconstruction of pressure ulcers with flaps in a tertiary care centre

2021 ◽  
Vol 8 (2) ◽  
pp. 647
Author(s):  
Ravikumar Gopalakrishnan ◽  
Manoharan Rajalingam ◽  
Balamuralee Rajagunasekaran ◽  
Ramya Esakimuthu
Keyword(s):  
Pressure Ulcers ◽  
Tertiary Care ◽  
Stage Iv ◽  
Stage Iii ◽  
Duration Of Treatment ◽  
Tertiary Care Centre ◽  
Operative Complications ◽  
Developed Pressure ◽  
Flap Cover ◽  
Post Operative Complications

Background: Patients with pressure ulcers have multiple risk factors and develop various post- operative complications. The purpose of the study is to analyse the outcome of management of pressure ulcers with different flaps.Methods: This is a retrospective study done in a series of patients who underwent flap reconstruction of pressure ulcers between 2016 and 2019 in the Department of Plastic and Reconstructive Surgery, Thanjavur medical college, Tamilnadu, India. Totally twenty-eight patients were operated for stage III and stage IV pressure ulcers with various types of flaps depending upon the site of pressure ulcers. Post operatively flaps were monitored for viability and post-operative complications. Results: Total 22 males, 5 females and 1 male child had undergone surgery for pressure ulcers. The age group ranged from 3years to 62 years with an average of 37 years. The sites of the pressure ulcers were as follows: 14 (50%) sacral; 10 (35.7%) ischial; 3 (10.7%) trochanteric and 1 (3.6%) multiple pressure ulcers. Most of the patients (60.7%) had traumatic paraplegia and developed pressure ulcers. 18 patients with stage III and 10 patients with stage IV pressure sores were operated with different flaps. Duration of treatment ranged from 29 to 118 days. The mean hospitalization was 78 days.  Conclusions: Effort is needed to prevent the development of pressure ulcers through the early identification of risk and early implementation of preventive measures. Flap cover is ideal to prevent recurrence. Post-operative follow- up with physiotherapy and rehabilitation are very important.

scholarly journals Clinical Outcomes of Management of Traumatic Cataract in a Tertiary Care Centre

2020 ◽  
pp. 20-23
Author(s):  
anuradha bharati ◽  
pallavi sharma ◽  
sachit mahajan ◽  
Bhavani Raina ◽  
Sanjay Kai
Keyword(s):  
Visual Acuity ◽  
Tertiary Care ◽  
Final Visual Acuity ◽  
Posterior Capsular Opacification ◽  
Care Centre ◽  
Traumatic Cataract ◽  
Tertiary Care Centre ◽  
Visual Outcomes ◽  
Operative Complications ◽  
Post Operative Complications

Background and Objectives : Ocular trauma can lead to development of cataract when natural lens is damaged by either blunt or penetrating injury. The management of traumatic cataract follows the same principle as for senile cataract but associated damage to ocular tissues and several post-operative complications may lead to suboptimal visual outcome. This study was conceptualized to evaluate the visual outcomes following management of traumatic cataracts. Material and Methods : This prospective, longitudinal study was conducted on 80 patients with traumatic cataract in tertiary care centre. Patients were managed surgically and were followed up for a period of six months. Visual acuity was measured at every follow-up visit and any post-operative complications were noted and managed, accordingly. Final visual acuity was assessed at the end of six months. Results: Maximum cases of traumatic cataract (53.75%) were observed in age group of <20 years with male to female ratio of 2.63:1. Maximum patients (92.15%) were implanted posterior chamber intraocular lens, either as a primary or secondary procedure. Uveitis and posterior capsular opacification were most common post-operative complications (30%) and 68.75% cases achieved a final visual acuity of 6/6-6/ 18 at the end of six months. Conclusions Traumatic cataract is an important cause of ocular morbidity specially in young patients. Surgery in cases of traumatic cataract can yield good visual outcomes if posterior segment is not involved and if post-operative complications are managed efficiently.

scholarly journals IMMEDIATE AND EARLY POST OPERATIVE COMPLICATIONS OF TRABECULECTOMY IN A TERTIARY CARE CENTRE

2015 ◽  
Vol 2 (12) ◽  
pp. 1836-1844
Author(s):  
Suresh H H ◽  
Vidyadevi M ◽  
Alka Varghese ◽  
Krishnaprasad A H ◽  
Reddy S P
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Operative Complications ◽  
Post Operative Complications

scholarly journals Intestinal obstruction in a tertiary care centre in India: are the differences with the Western experience becoming less?

2021 ◽  
Author(s):  
Suvendu Sekhar Jena ◽  
Ravi Chandra Reddy Obili ◽  
Sri Aurobindo Prasad Das ◽  
Ruchir Bhavsar ◽  
Sanket Solanki ◽  
...  
Keyword(s):  
Developing Countries ◽  
Intestinal Obstruction ◽  
Demographic Data ◽  
Tertiary Care ◽  
Developed Countries ◽  
Western World ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background: Patients with intestinal obstruction consist of a major proportion of emergency room visits and the complication is associated with significant morbidity and mortality. It has a diverse etiology and varies from region to country. In developed countries it is mainly due to adhesions and in developing countries due to obstructed hernias. Although there are numerous studies from the western world there have been few recent publications from the developing world. Method: We retrospectively analyzed all the patients admitted for intestinal obstruction to our department from January 1996 to December 2019. Their demographic data, duration of symptoms before presenting to the hospital and duration of stay before surgery in the hospital were noted along with cause and level of obstruction. The type of procedure, any post-operative complications, mortality or re-exploration were also noted. Post-operative complications were graded as per Clavien Dindo classification. Results: A total of 986 patients presented with intestinal obstruction during this period out of which 743 patients underwent surgery. There were 429 (57.74%) males 314 (42.26%) females who had a mean age of 50.1 years (range 11 to 96 years). The commonest cause of obstruction was adhesions in 273 (36.7%) followed by carcinoma [130(17.5%)], tuberculosis [111(14.9%)], stricture [94(12.7%)] and hernia (5.4%) patients. Colorectal surgery was the most common previous procedure in the adhesive group [85(31.1%)]. Colon cancer was the common cause in carcinoma group. Ileum was the most common site of obstruction [329(44.3%)]. The overall operative mortality was 41 (5.5%). Conclusion: Postoperative adhesions are now the commonest cause of intestinal obstruction in our referral center with a comparable mortality rate with western reports. Though the etiology of intestinal obstruction is shifting towards the western pattern, tuberculosis, obstructed inguinal hernia still consists a major chunk of patients in developing countries.

scholarly journals EP.WE.385A retrospective audit reviewing current practice on managing the incidence of anaemia and iron deficiency in pre-operative oesophagogastric resection patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sumbal Bhatti ◽  
Laith Evans
Keyword(s):  
Tertiary Care ◽  
Iron Therapy ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Operative Complication ◽  
Operative Outcomes ◽  
Retrospective Audit ◽  
Increased Risk ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Aims NICE guidelines state patients with anaemia should be offered iron therapy before and after surgery. An audit was undertaken at a tertiary care centre to assess compliance in patients undergoing oesophagogastric resection. Methods Retrospective audit looking at oesophagogastric resections over a period 12 months at a tertiary care centre. Data is being gathered from ORSOS and ICE to record pre, peri and post-operative haemoglobin and MCV, amongst other metrics, including whether iron therapy was prescribed. Data is also being gathered on post-operative outcomes. An intervention aiming to increase pre-operative haemoglobin levels will be implemented and then a repeat audit cycle will be carried out. Results Preliminary results from cycle 1 suggest that despite 71% of patients undergoing oesophagogastric resection having a haemoglobin&lt;130g/l in men and &lt;120g/l in women, only 6.7% are receiving preoperative iron therapy of any kind (i.e. oral or intravenous). 42.8% of all patients included suffered a post-operative complication. We predict implementation of changes in pre-operatively will reduce the post-operative complication rate. Conclusions The majority of patients undergoing oesophagogastric resection are not receiving adequate iron therapy prior to surgery and are being put at an increased risk of post-operative complications. Ongoing auditing will highlight the scope of the problem and reduce the risk of post-operative complications. Data is preliminary at this stage but due to the novelty of the audit (only one relevant paper was returned upon completing a structured literature search) we are submitting this abstract now as we believe it to be of clinical significance.

Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?

2012 ◽  
Vol 126 (7) ◽  
pp. 701-705 ◽  
Author(s):  
C Pierret ◽  
J-P Tourtier ◽  
Y Pons ◽  
S Merat ◽  
V Duverger ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Multiple Organ ◽  
Antithyroid Drugs ◽  
Tertiary Care Centre ◽  
Term Outcome ◽  
Operative Complications ◽  
Post Operative Complications

AbstractObjective:Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients’ post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.Study design:Prospective case series.Setting:Tertiary care centre.Subjects and methods:We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.Results:Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).Conclusion:In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

scholarly journals Clinicopathological profile of squamous cell carcinoma presenting in Tertiary Care Hospital, Karachi.

2020 ◽  
Vol 27 (05) ◽  
pp. 939-943
Author(s):  
Sameera Asif ◽  
Summera Kanwal ◽  
Tahera Ayub ◽  
Zafar Abbas ◽  
Batool Vazir ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Buccal Mucosa ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Care Hospital

Objectives: Oral Squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity. The study was done with the aim to determine the clinical pattern of OSCC seen in tertiary care hospital of Karachi, Pakistan. The frequency of neck metastasis in different staging of squamous cell carcinoma was also recorded. Study Design: Retrospective study. Setting: Department of Oral & Maxillofacial Surgery Liaquat College of Medicine and Dentistry. Period: June 2013- July 2016. Material & Methods: It included 35 males and 25 females which presented with different sites and stage of squamous cell carcinoma. Clinically patients were staged as stage I, stage II, stage III and stage IV and comprised of 3, 8, 30 & 19 patients respectively. Patients presented with cancer of buccal mucosa (31 patients), retromolar region (12 patients), maxillary alveolus (8 patients), tongue (2 patients), floor of mouth (4 patients) & lip (3 patients). Right side was most common, 48 patients as compare to left side, 12 patients while lip cancers was in upper lip in all patients including commissure. Results: Total 60 patients were included in the study with the male to female ratio of 1.4:1. No significant association was seen between age and gender of the patient (p-value 0.933). Majority of patients were male involving buccal mucosa (51.67%) as the most frequently involved site followed by retromolar area (20%) and tongue (13.3%). Mean age of patients included in the study was 50.87 ± 5.53. Conclusion: Most of the cases of OSCC were seen in older patients with increased number of cases involving buccal mucosa as their primary site. Majority of the tumors were classified as stage III followed by Stage IV, Stage II and stage 1 respectively.

scholarly journals Prevalence of hypomagnesemia in patients undergoing gynecological oncology surgery in tertiary care cancer institute of India

2017 ◽  
Vol 6 (10) ◽  
pp. 4355 ◽  
Author(s):  
Bikram Bhardwaj ◽  
Ava Dipan Desai ◽  
Bijal Manish Patel ◽  
Chetna Deepal Parekh ◽  
Shilpa Mukesh Patel
Keyword(s):  
Serum Magnesium ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Gynecologic Malignancy ◽  
Gynecological Malignancy ◽  
Entire Cohort ◽  
Post Operative Period ◽  
Operative Complications ◽  
Post Operative Complications

Background: Hypomagnesemia is an important but unknown risk factor for post-operative complications in patients undergoing surgery for presumed gynecological malignancy. This study aims to evaluate the prevalence of hypomagnesemia in patients undergoing surgery for presumed gynecological cancers referred to our tertiary care Cancer Institute.Methods: This is a prospective observational study of 100 patients admitted with provisional diagnosis of malignancy. They underwent surgery in one of the Gynecologic Oncology units at The Gujarat Cancer Research Institute, Ahmedabad from October 2016 to April 2017. Hypomagnesemia was defined a serum magnesium levels less than 1.8mg/dl.Results: The incidence of pre-operative hypomagnesemia in the entire cohort was 35%. Sixty three percent patients had normal pre-operative magnesium levels and hypermagnesemia was seen in 2% of study population. Patients with benign disease had 29.6% pre-operative hypomagnesemia compared with 39.6% in patients with gynecologic malignancy. Pre-operative hypomagnesemia and even falling levels in post-operative period are an important predictive marker for post-operative complications like increased post-operative pain, post-operative ileus, hypertension and even post-operative hypokalemia. Age, body mass index, hematocrit, surgical indication and length of hospital stay were not associated with hypomagnesemia. Patients undergoing neo-adjuvant chemotherapy before surgery had significant incidence of hypomagnesemia both pre-operatively and post-operatively.Conclusions: Hypomagnesemia is quite prevalent in patients of gynecologic-oncology undergoing surgery. Pre-operative hypomagnesemia and even falling levels in post-operative period have a bearing on the final surgical outcome. Hence pre-operative and post-operative magnesium levels may be included as a valuable marker in all patients undergoing surgery for gynecologic malignancy.

scholarly journals Current scenario of tracheostomy: our experience

2020 ◽  
Vol 6 (7) ◽  
pp. 1336
Author(s):  
Kavita Sachdeva ◽  
Rashmi Hansdah
Keyword(s):  
Tertiary Care ◽  
Central India ◽  
Neck Surgery ◽  
Care Hospital ◽  
Operative Complications ◽  
Current Scenario ◽  
Indications And Complications ◽  
Stoma Stenosis ◽  
Lower Morbidity ◽  
Post Operative Complications

<p class="abstract"><strong>Background:</strong> Tracheostomy is an important surgical procedure done by ENT surgeons. In this study we have assessed the indications and complications encountered during tracheostomy and decannulation.</p><p class="abstract"><strong>Methods:</strong> 100 patients undergoing tracheostomy by the Department of Otolaryngology and Head and Neck Surgery between 1st January and 31st December 2015 in a tertiary care hospital in Central India were included in the study. The various indications of tracheostomy along with the complications encountered and decannulation following tracheostomy were studied.   </p><p class="abstract"><strong>Results:</strong> In this study, most   commonly (22%) tracheostomies were performed in young (31-40) years, male (73%) patients. This included 79% elective and 21% emergency tracheostomies. The indications of tracheostomy were retained secretions 61%, laryngopharyngeal obstruction 21%, and respiratory insufficiency 19%. 21 intra-operative complications included bleeding (18% cases) and apnoea (3% cases). Wound infection 19%; subcutaneous emphysema 10%; tube block 6% and   haemorrhage 2% constituted 37 immediate post-operative complications. 17 late post-operative complications included stoma stenosis 9%; granuloma formation 4% and trachea-oesophageal fistula and aspiration 2% each. 33% of total patients were decannulated easily.</p><p class="abstract"><strong>Conclusions:</strong> In conclusion we found that elective tracheostomy is associated with lower morbidity and mortality and strapping of tracheostomy site is an easy, safe and effective method   of tracheostomy closure in properly selected patients.</p>

Clinical characteristics and outcome of metaplastic breast cancer: A retrospective tertiary care center experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1095-1095
Author(s):  
Bicky Thapa ◽  
Salome Arobelidze ◽  
Xuefei Jia ◽  
Hassan Awada ◽  
Tariq Zuheir Kewan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Tertiary Care ◽  
Stage Iv ◽  
Nuclear Grade ◽  
Stage Iii ◽  
Univariable Analysis ◽  
Metaplastic Breast Cancer ◽  
Risk Of Death ◽  
Anthracycline Chemotherapy

1095 Background: Metaplastic breast cancer (MBC) is a rare neoplasm which accounts for less than 1% of all breast cancers. MBC is associated with worse prognosis and there is a paucity of literature on management. We evaluated the clinical characteristic and outcomes of MBC patients at our institution. Methods: After IRB approval, 136 patients diagnosed with MBC were reviewed from the Cleveland Clinic tumor registry from 2000-2017. Patients were evaluated for overall survival (OS) and progression free survival (PFS) using univariable analysis. Time to event variables were estimated by Kaplan-Meier method. Results: A total of 136 pathologically proven MBC patients were included in the study. Median age at diagnosis was 60 years (27-92). Eighty two percent (n = 112) had nuclear grade III, 7% (n = 10) had high grade dysplasia, 2% (n = 3) had nuclear grade I, and 4% (n = 5) had nuclear grade II; 60% (n = 82) patients were diagnosed at stage II, 21% (n = 28) at stage I, 14% (n = 19) at stage III, and 5% (n = 7) at stage IV. Estrogen receptor, progesterone receptor and Her2 expression were positive in 16% (n = 22), 9% (n = 12), and 10% (n = 14) respectively. Only 37% (n = 50) patient had lumpectomy, 18% (n = 25) received hormonal therapy, 56% (n = 76) received radiation, 51% (n = 70) received anthracycline chemotherapy and 26% (n = 36) received non-anthracycline chemotherapy; 37% (n = 50) had chemotherapy after 4 weeks of surgery and 35% (n = 48) patients had chemotherapy within 4 weeks of surgery. On univariable analysis, the 5-year OS for stage III was 30% (14% - 64%), hazard ration (HR) of 4.53 (95% CI, 1.71 - 12.01) (p = 0.002), for stage IV HR of 43.26 (95% CI, 12.34 - 151.64) (p = 0.001); chemotherapy within 4 weeks of surgery was associated with a higher risk of death, HR of 0.30 (95% CI, 0.12 - 0.74) (p = 0.009). Hormonal therapy, radiation therapy, surgery and type of chemotherapy was not associated with significant change in OS and PFS. In our cohort, 2-year OS was 79 % (73 % - 87 %) and 5-year OS was 69 % (61 % - 77 %); 2-year PFS was 61 % (52 % - 70 %) and 5-year PFS was 72 % (65 % - 81 %). Conclusions: Stage of MBC and chemotherapy within 4 weeks of surgery was associated with statistically significant OS and PFS on univariable analysis. Randomized clinical trials are warranted to improve outcomes in MBC patients.

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