scholarly journals A COMPARATIVE STUDY BETWEEN EARLY EXPLORATIONS VERSUS CONSERVATIVE MANAGEMENT IN MANAGEMENT OF APPENDICULAR LUMP

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Sanjay Patidar ◽  
Kritika Kamal ◽  
Jaydip Sinh Kathota ◽  
Sudhanshu Tiwari ◽  
Prashant Nakrani
Keyword(s):  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Conservative Management ◽  
Research Centre ◽  
Age Group ◽  
Surgical Exploration ◽  
Hospitalization Time ◽  
Group I ◽  
Group Ii ◽  
Adhesive Intestinal Obstruction

Background: Acute Appendicitis is one of the most common acute surgical conditions of the abdomen and appendicular lump is formed if treatment is delayed. Appendicular mass is one of its early complications developing in   2-6% cases within48 hours of attack. The traditional treatment of appendicular lump is conservative followed by delayed appendectomy. During conservative treatment 10-20% is not resolved and leads to gangrene or perforation followed by localized abscess or generalized peritonitis requiring early surgical intervention. Aim and Objective: To evaluate the outcome of early surgical exploration and its complications in respect to conservative management of appendicular lump. Material and Methods: Total of 48 patients admitted with diagnosis of appendicular lump were included in our study. This prospective study was conducted in Department of General Surgery of Index Medical College, Hospital and Research Centre, Indore, M.P over period of 2 years [August 2019 to July 2021] in all age group and both sexes. All cases were divided randomly into two groups. Group I, early surgical exploration and Group II, conservative approach with OCHSNER SHERREN REGIME followed by interval appendectomy after 6 weeks. Results: Total 471 patients admitted to hospital with diagnosis of acute appendicitis, out of which total 48 patients were having Appendicular lump suggestive of incidence of 9.81%. Maximum patients were found in age group 21-30 years. Average duration of symptoms was 2 days. Two methods were adopted for the management of appendicular lump. The first group included 24 patients who were operated immediately after investigations and second group of 24 patients were managed conservatively followed by delayed appendectomy. In the first group mean hospitalization time was 4 days. Residual abscess, adhesive intestinal obstruction, failure of treatment and readmission were not found. In the group II, mean hospitalization time 10 days, more chances of residual abscess, adhesive intestinal obstruction, failure of treatment and readmissions were noted. Conclusion: In our study, it can be concluded that early surgical exploration confirms diagnosis and cures the problem, reduce the cost of management, shortens the convalescence and hospital stay with reasonably satisfactory outcome. Key-Words: Appendicular Lump, Ochsner-Sherren Regime Appendectomy.

scholarly journals APPENDICULAR MASS

2010 ◽  
Vol 17 (02) ◽  
pp. 180-184
Author(s):  
SARDAR ALI ◽  
HAFIZ MUHAMMED RAFIQUE
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Cost Effective ◽  
Female Ratio ◽  
Surgical Exploration ◽  
Group I ◽  
Variable Extent ◽  
Group Ii ◽  
Adhesive Intestinal Obstruction ◽  
Appendicular Mass

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 to November 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying studentChi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.

scholarly journals APPENDICULAR MASS

2010 ◽  
Vol 17 (02) ◽  
pp. 180-184
Author(s):  
SARDAR ALI ◽  
HAFIZ MUHAMMED RAFIQUE
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Cost Effective ◽  
Chi Square ◽  
Female Ratio ◽  
Surgical Exploration ◽  
Group I ◽  
Group Ii ◽  
Adhesive Intestinal Obstruction ◽  
Appendicular Mass

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 toNovember 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying student Chi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.

A PROSPECTIVE COMPARATIVE STUDY BETWEEN EARLY AND INTERVAL APPENDICECTOMY FOR APPENDICULAR MASS

2021 ◽  
pp. 34-37
Author(s):  
Janni Laxman ◽  
R S Teja Reddy ◽  
Sivasai Krishnaprasad K
Keyword(s):  
Acute Appendicitis ◽  
Comparative Study ◽  
Intestinal Obstruction ◽  
Hospital Stay ◽  
Wound Infection ◽  
Group I ◽  
Interval Appendicectomy ◽  
Simple Mass ◽  
Group Ii ◽  
Appendicular Mass

Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Patients presenting late in acute appendicitis are complicated by the development of an inammatory mass in the right iliac fossa. The treatment of appendicular mass is controversial. However, 1 there are several other management options for appendicular mass. Traditionally, these patients are managed conservatively, followed by interval appendicectomy 4-6 weeks later. Advocates of the initial conservative approach claim a lower rate of complications compared to the early 2 operative approach. Objective: To study the safety and feasibility of emergency appendicectomy for appendicular mass by comparing the complications, morbidity and mortality with conservatively treated patients. Materials & Methods: This is a prospective and comparative study conducted at Gitam Institute of Medical Sciences and Research, Visakhapatnam, from January 2018 to December 2019. A total of 60 patients with appendicular mass were divided into two groups of 30 each. Group I included patients who underwent emergency appendicectomy, while Group II consisted of patients who were managed conservatively. Results:In this study, patients' mean age was 27.58 yrs with a male to female ratio of 2.66:1. Intraoperative ndings in Group I - 20(70%) cases had simple mass, 8(26.66%) had adhesions and loculated pus in 2(6%). In Group II, 14(53.84%) patients had normal ndings, 4(15.38%) cases had simple mass, 6(23%) had adhesions, 1(3.84%) had loculated pus and adhesive intestinal obstruction. Postoperatively, In Group I, 3(10%) patients had wound infection, and 1(3.33%) patient developed fecal stula, which was managed conservatively. In Group II, 2(6.66) patients had wound infection, 4(13.33%) had failure of conservative treatment, four had lost follow-up, 3 had respiratory tract infection, and one patient developed intestinal obstruction due to adhesions. Mean length of hospital stay was 5.3 days in Group I and 8.5 days in Group II. Fewer complications, reduced number of days of parenteral medication, and reduced duration of total hospital stay were noted in Group I compared to Group II, indicating that emergency appendicectomy is a safe and feasible method of managing patients with appendicular mass.

Axial Rotation Test for Trapeziometacarpal Joint Hypermobility in the Normal Population

2018 ◽  
Vol 23 (03) ◽  
pp. 351-355
Author(s):  
Ryan A. Odgers ◽  
Ghazi M. Rayan
Keyword(s):  
Older Women ◽  
Normal Population ◽  
Axial Rotation ◽  
Joint Hypermobility ◽  
Age Group ◽  
Rotational Laxity ◽  
Trapeziometacarpal Joint ◽  
Rotation Test ◽  
Group I ◽  
Group Ii

Background: The objective was to quantify joint laxity in healthy volunteers by measuring the passive axial rotation of the trapeziometacarpal joint using the axial rotation test. Methods: Eighty volunteers (34 men and 46 women) were subjected to the axial rotation shear test and the degree of total rotational motion (TRM) was assessed. Volunteers were divided into Group I with a range of 18–50 years old and Group II for 51 years and older. Statistical analysis was performed. Results: The average TRM in Group I was 32.3 mm for women, and 27.4 mm, for men (p = 0.04). The average TRM in women of Groups I and II, was 32.3 and 21.6 mm respectively, (p < 0.001). The average TRM in men of Groups I and II, was 27.4 and 19.4 mm (p < 0.001). In Group II the average TRM of women was 21.6 mm, and for men was 19.4 mm, which was not significantly different. Conclusions: Young women have greater degree of rotational laxity in the TM joint compared to men of the same age group and to older women. The axial rotation test can quantify the degree of rotational laxity of the TM joint.

Do prostaglandins modulate renal haemodynamic effects of endothelin-1 in conscious lambs?

2010 ◽  
Vol 88 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Kumar Kesavarao Ebenezar ◽  
Fatemah Ghane Sharbaf ◽  
Wei Qi ◽  
Francine Gabriel Smith
Keyword(s):  
Marked Decrease ◽  
Haemodynamic Effects ◽  
Initial Increase ◽  
Age Group ◽  
Vascular Conductance ◽  
Postnatal Maturation ◽  
Endothelin 1 ◽  
Group I ◽  
Group Ii ◽  
Renal Vascular

To test the hypothesis that vasodilatory prostaglandins buffer the renal vasoconstrictor effects of endothelin-1 (ET-1) early in life, renal haemodynamic responses to ET-1 were measured in 2 groups of conscious, chronically instrumented lambs at 1–2 weeks of age (group I, n = 11) and 6 weeks of age (group II, n = 10). Lambs were pretreated with vehicle or 1 mg·kg–1 indomethacin, a nonselective cyclooxygenase inhibitor, and renal haemodynamic effects were measured continuously for 1 min before (control) and 5 min after intra-arterial injection of 250 ng·kg–1 ET-1. In group II lambs, there was a marked decrease in renal blood flow (RBF) and renal vascular conductance (RVC) elicited by ET-1 administration, as we have previously described. This response was not altered by vehicle or indomethacin pretreatment. In group I lambs, there was an initial increase but no decrease in RBF and RVC elicited by ET-1 administration, as we have previously described, and this response was also not altered by either vehicle or indomethacin. These results suggest that endogenously produced prostaglandins do not appear to modulate the renal haemodynamic effects of ET-1 in conscious lambs during postnatal maturation.

Ventilation and thoracoabdominal asynchrony during halothane anesthesia in infants

1993 ◽  
Vol 74 (4) ◽  
pp. 1591-1596 ◽  
Author(s):  
M. Benameur ◽  
M. D. Goldman ◽  
C. Ecoffey ◽  
C. Gaultier
Keyword(s):  
Tidal Volume ◽  
Minute Ventilation ◽  
Statistical Significance ◽  
Age Group ◽  
Halothane Anesthesia ◽  
Minimal Alveolar Concentration ◽  
Group I ◽  
Wall Compliance ◽  
Group Ii ◽  
Thoracoabdominal Asynchrony

To evaluate the ventilatory consequences of high chest wall compliance during anesthesia in infants, we assessed the effects of halothane at different fractions of minimal alveolar concentration (0.75, 1.0, and 1.5 MAC) on ventilation and movements of the rib cage and abdomen in infants < or = 12 mo of age (group I) and children (group II) > or = 12 mo of age. Minute ventilation decreased in group I, (20.6%, 0.75 to 1.5 MAC), but the change in group II did not reach the level of statistical significance. Tidal volume decreased with halothane level between 0.75 and 1.5 MAC, and its fall was greater in group I (32.7 +/- 11.2 vs. 22.6 +/- 9.3% in group II, P < 0.05). Duty cycle, or ratio of inspiratory to total time (TI/TT), increased in group II with halothane level but did not change in group I, resulting in a decreased TI in group I at higher halothane levels. Thoracic paradox increased with halothane level in group I but not group II. The increase in thoracic paradox in association with the fall in tidal volume between 0.75 and 1.5 MAC was greater in group I than group II (P < 0.05). We conclude that smaller infants depend more on inspiratory intercostal muscle activity to stabilize the thorax, leading to a greater degree of depression of ventilation during halothane depression of inspiratory intercostal activity.

Fistulogram after Arteriovenous Dialysis Graft Thrombectomy Should be Mandatory

2008 ◽  
Vol 74 (12) ◽  
pp. 1154-1158
Author(s):  
Shakthi D. Kumar ◽  
Krishna M. Jain ◽  
Shikha Jain ◽  
John S. Munn ◽  
Mark C. Rummel
Keyword(s):  
Graft Patency ◽  
Clinical Findings ◽  
Primary Patency ◽  
Surgical Exploration ◽  
Significant Stenosis ◽  
Group I ◽  
Dialysis Graft ◽  
Group Ii ◽  
Significant Lesion

The purpose of this study was to determine if fistulogram after prosthetic arteriovenous dialysis graft thrombectomy would reveal underlying lesions, which need correction, and if revision would improve graft patency. One hundred and ninety-two open thrombectomy procedures in 61 patients from January 1, 2000 to July 31, 2005 were reviewed retrospectively. All of the study patients were divided into two groups: In Group I fistulogram was carried out and in Group II no fistulogram was performed. Based on the fistulogram or clinical findings, appropriate intervention was carried out. In Group I, of 99 thrombectomy procedures, a significant lesion was identified and revision was carried out in 77 cases (78%). In Group II, of 93 thrombectomy procedures, a significant lesion was identified and revised in 53 cases (57%). A significant abnormality was more likely to be encountered by routine fistulogram than surgical exploration alone, 78 per cent versus 57 per cent (P < 0.05). Assisted primary patency is significantly increased in Group I and II when revision was performed (4.84 months) compared with when no fistulogram and no revision was performed (2.9 months), P < 0.05. Routine fistulogram after thrombectomy of an arteriovenous dialysis graft increases the likelihood of identifying a significant stenosis. Revision of the graft increases the longevity. We recommend routine use of fistulogram during thrombectomy.

scholarly journals Study of Lipid Profile and Coronary Angiographic Pattern in Young Bangladeshi Patients with Acute Coronary Syndrome

1970 ◽  
Vol 1 (2) ◽  
pp. 183-188 ◽  
Author(s):  
AR Khan ◽  
AAS Majumder
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Lipid Profile ◽  
Older Age ◽  
Age Group ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
Group I ◽  
Younger Age ◽  
Group Ii

Background: Majority of the patients of coronary heart disease (CHD) in our country are above 40 years of age but a good number of patients belong to the age under 40, the most valuable and productive period of life during which they can devote themselves to uplift their family, society and country and can participate in nation building activities.3,4 The number of young individuals falling into the spectrum of CHD is increasing everywhere However, this age trend is peculiar in relation to the western age incidence.5 Our objective was to investigate the lipid profile and coronary angiographic pattern in young Bangladeshi patients with acute coronary syndrome and also to find out the relationship between dyslipidemia and coronary artery disease in this age group. Methods: This observational study was carried out in National Institute of Cardiovascular Diseases (NICVD) during the period of January 2000 to December 2000. A brief history was recorded on the date of admission and fasting lipid profile was done within 24 hours of admission. Other associated major risk factors were looked for and recorded accordingly. After stabilization oh the acute condition patient was prepared for coronary angiogram and informed consent was taken. Accordingly elective CAG was done. Among them total 64 patients of ACS, underwent coronary angiogram in the cath lab of NICVD, were selected randomly of which of which 32 patients were up to the age 40 years (Group- I) and 32 were above 40 years of age (Group-II). Patient of ACS of either sex having no age limitation were included without prior history of Percutaneous Coronary Intervention or Coronary Artery Bypass Graft surgery. The findings were reviewed and scrutinized carefully by two interventional cardiologists. In doubtful cases third expert reviewed the CD. If a consensus was not reached due to technical or visual error, the case wais discarded from the study. Details of CAG findings i.e. site and number of diseased vessels, location, morphology and pattern of lesion were studied and recorded accordingly. Results: The prevalence of dyslipidaemia and positive family history were more in group I than group II. Younger age group has less favorable lipid profile than older age group having raised total cholesterol in 31.3 percent cases, low HDL in 12.5 percent cases and raised LDL in 31.3 percent cases, while in older age group, it was 21.8, 25.0, 0 and 18.7 percent, respectively. CAG study of the patients showed that no vessel involvement was more common in group I than group II (21.9% vs 12.5%), but triple vessel disease was more common in group II (12.5% vs 21.8%). Single vessel and double vessel diseases were similar in both the groups. Involvement of LAD was slightly more in-group I than group II (68.8% vs 65.6%) and involvement of LCX and RCA were less in group I than group II (21.9% vs 34.3%, and 43.8% vs 78.1%, respectively). Diffuse LAD and RCA lesions were more in group II (36.4% vs 52.4% and 42.9% vs 48.0%, respectively), but diffuse LCX lesion was more in group I (42.9 vs 36.4%). Multiple irregular lesions are more common in older age group (53.1%) than younger age group (28.1%). Conclusion: The younger age group has less favorable lipid profile than older age group having raised total cholesterol, decreased HDL and raised LDL. CAG findings show that most of the lesions are present in LAD (having less impressive LVEF) as like as in older age group, but older age group has more multiple irregular lesions. Prevalence of >2 lesions in one coronary artery was more in group I (31 vs. 25%) but difference was not statistically significant. Keywords: Lipid profile, Coronary angiogram, Younger patients, Acute Coronary Syndrome. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8237 Cardiovasc. j. 2009; 1(2): 183-188

Changes in Teat Morphology (Doka Phenomenon) and Estrus Prediction in Riverine Buffaloes (Bubalus bubalis)

2019 ◽  
Author(s):  
S K Joshi ◽  
T K Mohanty ◽  
A Kumaresan ◽  
M Bhakat ◽  
S Sathapathy
Keyword(s):  
Morphological Changes ◽  
Bubalus Bubalis ◽  
North India ◽  
Research Centre ◽  
Murrah Buffaloes ◽  
Group I ◽  
Before And After ◽  
Group Ii ◽  
The Difference ◽  
The Relationship

The objective of the study was to characterize the term Doka and to capture morphological changes in teat to find out the relationship between Doka and onset of estrus in Murrah buffaloes (Bubalus bubalis). The Murrah buffaloes maintained at of Livestock Research Centre (LRC), ICAR-NDRI, Karnal were classified into two groups based on the lactation number for the study of Doka characteristics. In group I, twenty animals up to 3rd lactation were incorporated, whereas thirty animals from 4th to 5th lactation were included in group II. The period when buffaloes showed teat engorgement was called as Doka period, is the local term used by the farmers in North India that can be taken as a visual sign for prediction of estrus. The length and diameter of teats, before and after milking were measured, for both the groups during morning and evening milking and subsequently analyzed. The present study confirmed that the teat diameter (mm) before milking during Doka was significantly (plessthan0.05) higher as compared to pre Doka period in both the groups (group-I - 37.01 ±2.13 vs 28.42 ±1.64, group-II - 53.49 ±2.82 vs 41.096±2.16). The teat diameter (mm) during Doka period after milking was significantly (plessthan0.05) more in both the groups (group-I - 26.65 ±1.26 vs 24.44 ±1.16, group-II - 39.27 ±2.41 vs 35.31 ±2.17) as compared to pre Doka period. So, it can be concluded that the changes in teat diameter can safely be considered as a sign of Doka and the forthcoming heat in Murrah buffaloes. However, the difference in teat length between different stages of Doka was found to be non significant.

scholarly journals Evaluation of outcome of early appendectomy in appendicular lump

2020 ◽  
Vol 8 (1) ◽  
pp. 7
Author(s):  
A. S. M. Rezbanul Haque ◽  
Bablu Kumar Saha ◽  
M. Mahfuzul Haque ◽  
M. Abdus Sattar ◽  
Upendra Nath Ray ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Recovery Period ◽  
Medical College ◽  
Group I ◽  
Perforated Appendix ◽  
Early Exploration ◽  
The Mean ◽  
Group Ii ◽  
Surgery Department ◽  
The Cost

Background: Appendicular lump is a well-known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. This study aims to evaluate the outcome of early appendectomy in an appendicular lump.Methods: A total of 210 patients were admitted in surgery and pediatric surgery department of Rangpur medical college and hospital with the diagnosis of acute appendicitis and its sequalae over two years.Results: In this study, sixty patients were included who were presented with an appendicular lump. Maximum patients (50%) were found in the age group of 21-30 years. Males (66.67%) were more affected. Eighty percent of patients were coming from below-average socio-economic conditions. In group I, early appendicectomy had done and outcomes were satisfactory and favorable. In group II, eighteen patients were operated who were admitted at 6 to 8 days after an attack of acute appendicitis, and twelve patients were continued the conservative treatment. In group II, who had done surgery, among them, fourteen patients (77.78%) were found an appendicular abscess, and four patients (22.22%) were found perforated appendix per-operatively. In group I, the mean recovery period was less and they had minimum complications. In group II, the mean recovery period was more and they had more complications.Conclusions: Based on these findings, it can be concluded that early exploration in appendicular lump patients confirm the diagnosis, cures the problem, reduces the cost of management, and shortens the convalescence period and hospital stay with reasonably satisfactory outcomes.

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