A CLINICAL STUDY ON VARIOUS MODES OF PRESENTATION OF PANCREATOBILIARY MALIGNANCIES

2021 ◽  
pp. 62-64
Author(s):  
Ashwini Sheorain ◽  
Nibedita Sen ◽  
Swapnil Sen ◽  
Sushpa Das
Keyword(s):  
Early Diagnosis ◽  
Obstructive Jaundice ◽  
Tertiary Care ◽  
Experimental Studies ◽  
High Morbidity ◽  
Malignant Obstructive Jaundice ◽  
Palpable Mass ◽  
Diagnosis And Management ◽  
Modes Of Presentation ◽  
Loss Of Weight

Obstructive Jaundice is an important surgical problem that occurs when there is an obstruction to the passage of conjugated bilirubin from liver cells to intestine. It is among the most challenging conditions managed by general surgeons and results in high morbidity and mortality. Hence, early diagnosis of the cause of obstruction is very important especially in malignant cases, as resection is only possible at an early stage. Signicant 3 advances have been made over the past 30 years in understanding pathophysiology, diagnosis and management of obstructive jaundice. Biliary obstruction effects the bile ducts and leads to disturbed liver function and widespread systemic effects. Jaundice patients are at high risk for developing hepatic and renal dysfunction, cardiovascular problems, nutritional deciencies, bleeding problems, infections, and wound 4 complications, and higher perioperative mortality. There is usually an overlap of features among different obstructive pathologies, for example uctuating icterus is present in both common bile duct stone and periampullary carcinoma. AIM:To study the clinical spectrum of the patient with malignant obstructive jaundice. MATERIALS AND METHODS: The study has been carried out on 48 patients with clinical presentation of suspected malignant obstructive jaundice over a period of 13 months who were seen in general surgery department of a tertiary care centre of Eastern India. A detailed history and relevant information were collected from the patient and relatives like mode of onset, duration, progression, loss of weight and substance abuse. Besides, information like place of residence, family history, personal history, drug intake etc. were recorded. RESULTS: The mean age (mean ± s.d.) of the patients was 66.27±5.85 years with range 52 - 78 years and the median age was 67.0 years. 81.3% of patients had signicant loss of weight which was signicant. 75.0% of patients had palpable mass abdomen and it was signicant. There was neither any signicant association between habit of alcohol intake nor the habit of smoking with cancer of the patients. CONCLUSION: The descriptive study on malignant obstructive jaundice patients demonstrated the various modes of presentation. Obstructive jaundice is a multi spectrum disease, in terms of organ involvement, local spread and resectability. Analytical and experimental studies done for each of the etiologies separately will throw more light on the possible evolution of early diagnosis and management.

A STUDY FOR EVALUATION OF CLINICAL, BIOCHEMICAL, TUMOR MARKERS AND RADIOLOGICALPARAMETERS IN PATIENTS OF OBSTRUCTIVE JAUNDICE

2021 ◽  
pp. 59-61
Author(s):  
Sangamesh S K ◽  
S R Ghosh ◽  
Debarshi Jana
Keyword(s):  
Obstructive Jaundice ◽  
Tumor Markers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
Care Hospital ◽  
Malignant Obstructive Jaundice ◽  
Purposive Sampling ◽  
Radiological Parameters ◽  
Ca 19.9

Study was conducted in Command Hospital (Eastern Command) Kolkata - ATertiary Care Hospital with the following Aims and Objectives. Study and co relate clinical, biochemical, radiological parameters in obstructive jaundice. MATERIAL AND METHODS: Study was conducted in Command Hospital (Eastern Command) Kolkata - A tertiary care hospital. All adult patients who was diagnosed as case of obstructive jaundice based on clinical, radiological and pathological criteria. Study duration 3 Years. Purposive sampling, 50 in each group,100. RESULT AND ANALYSIS: BENIGN OBSTRUCTIVE JAUNDICE, 6(12.0%) patients had FEVER. In MALIGNANT OBSTRUCTIVE JAUNDICE, 2(4.0%) patients had FEVER. Association of FEVER vs FINAL DIAGNOSIS was not statistically signicant (p=0.1403). In BENIGN OBSTRUCTIVE JAUNDICE, 4(8.0%) patients had PRURITIS. In MALIGNANT OBSTRUCTIVE JAUNDICE, 37(74.0%) patients had PRURITIS. Association of PRURITIS vs FINAL DIAGNOSIS was statistically signicant (p<0.0001). CONCLUSION: AST and ALP were higher in malignant obstructive jaundice compared to benign obstructive jaundice which were statistically signicant. Mean GGT was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically signicant. It was found that mean CA 19.9 was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically signicant.

scholarly journals The Challenges of Managing Ovarian Cancer in the Developing World

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Olivier Mulisya ◽  
Franck K. Sikakulya ◽  
Mbusa Mastaki ◽  
Tambavira Gertrude ◽  
Mathe Jeff
Keyword(s):  
Ovarian Cancer ◽  
Relative Survival ◽  
High Morbidity ◽  
Ovarian Mass ◽  
Cancer Awareness ◽  
Cancer Treatments ◽  
Palpable Mass ◽  
Relative Survival Rate ◽  
Loss Of Weight ◽  
One Year

Ovarian cancer has high morbidity and mortality rates among cancers of the reproductive system. The disease typically presents at late stage when the 5-year relative survival rate is only 29%. Similarly, access to prevention, early diagnosis, treatment, and palliative care for cancer-related disease is insufficient. The availability of cancer treatments in Africa is especially poor. Case. A 17-year-old lady, nulliparous, was admitted with complaint of abdominal swelling and loss of weight and a huge left ovarian cyst revealed by ultrasound scan. Laparotomy was done, and a mass which resembled a hemorrhagic solid tumor was found. Grossly, the left ovarian mass measured 15.0×20.0×8.0 cm and a left salpingectomy was performed. Two months later, she came back with lower limb swelling progressively increased in a week with vulvar edema, with a palpable mass. She was discharged on request by her relatives for traditional medicine. One year later, she passed on in an unrevealed picture. The management of ovarian cancer is too challenging in low-resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, policies, and planning focus to be coordinated in a rational way.

scholarly journals Profile and pattern of obstructive jaundice cases from a tertiary care teaching hospital of Uttar Pradesh

2017 ◽  
Vol 4 (2) ◽  
pp. 743
Author(s):  
Ashok Kumar Gupta ◽  
Abhishek Singh ◽  
Shwetank Goel ◽  
Rakesh Tank
Keyword(s):  
Obstructive Jaundice ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Madhya Pradesh ◽  
Modes Of Presentation ◽  
Benign Biliary Strictures ◽  
Common Causes ◽  
Study Population ◽  
One Year ◽  
Loss Of Appetite

Background: The common etiologies of obstructive jaundice have been reported to vary from one centre to another and from one individual to another. Only a very few studies have been conducted on this topic and none from the state of Madhya Pradesh, India. The present study was planned to study the profile and pattern of obstructive jaundice cases in the region of Madhya Pradesh, India.Methods: A retrospective cohort of patients with obstructive jaundice admitted to SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India during past one year i.e. January to December 2014 formed the study population. In this study, all the eligible patients positively diagnosed as extrahepatic obstructive jaundice were included in this study. Study tools were records of the patients such as information/records from MRD department and clinical case sheets.Results: Malignant causes (63.89%) were more frequent than benign causes (36.11%). More than 50% cases were in the age group of 55-75 years. Sex wise males outnumbered females. Among the malignant causes of obstructive jaundice, cancer head of pancreas (60.87%) and cholangiocarcinoma (17.39%) were common causes whereas among the benign causes of obstructive jaundice, choledocholithiasis (76.92%) and benign biliary strictures (15.38%) were common causes.Conclusions: Jaundice (91.67%), loss of appetite (77.78%) and pain abdomen (75%) were three most common modes of presentation of obstructive jaundice cases.

scholarly journals THE STUDY OF DETECTION OF DENGUE CASES BY NS1 ANTIGEN AND IGM ANTIBODY IN RIMS, ADILABAD, INDIA.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Tanajee Zade ◽  
Dr. K. Srinivas ◽  
Dr. Akshay Berad
Keyword(s):  
Early Diagnosis ◽  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
High Morbidity ◽  
Care Hospital ◽  
Serum Samples ◽  
Igg Antibody ◽  
Igm Antibody ◽  
Ns1 Antigen

Dengue fever is an acute febrile arboviral disease affecting tropical & subtropical regions of the world. Dengue infection produces a spectrum of clinical illness, ranging from an asymptomatic to its most severe form like dengue haemorrhagic fever and dengue shock syndrome. In view of high morbidity and mortality, it is imperative to have a rapid and sensitive laboratory assay for early detection of the dengue infection. The newer parameter NS1 antigen has gained a lot of interest for early diagnosis of the disease. Detection of non-structural antigen (NS1 Ag), IgM and IgG antibody may help in the early diagnosis. The present study was conducted in a RIMS Adilabad, tertiary care hospital & medical college in the Department of  General Medicine. A total of 100 serum samples were processed from suspected cases of dengue fever by using dengue test for detection of NS1 antigen and IgG antibodies. Platelet counts of all these cases were noted. . Of these 100 subjects 85 were serologically proved to have dengue illness, 57 patients were NS1 antigen positive, 28 patients were IgM antibody positive patients. As the NS1 antigen is detectable in blood from day one after onset of fever, its assay is an effective tool for early diagnosis of dengue infection so as to avoid complications. Key words:  Dengue, NS1 Antigen, IgM antibody, Platelet

scholarly journals A clinical study of ectopic pregnancy at a tertiary care centre in Telangana, India

2020 ◽  
Vol 9 (2) ◽  
pp. 682
Author(s):  
Subha Ranjan Samantaray ◽  
Ipsita Mohapatra ◽  
Achanta Vivekanada
Keyword(s):  
Risk Factors ◽  
Early Diagnosis ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
High Morbidity ◽  
Tertiary Care Centre ◽  
Life Threatening ◽  
History Of

Background: Ectopic pregnancy (EP) is a life-threatening obstetrics emergency in early trimester, associated with a high morbidity and mortality if not timely intervened.  High index of clinical suspicion is required for early diagnosis, specifically in women presenting with amenorrhoea, pain abdomen and vaginal bleeding. Aim of this study is to determine the incidence, risk factors, clinical presentation, management and outcome of ectopic pregnancy.Methods: This retrospective observational study was conducted in the department of obstetrics and gynaecology, at Prathima institute of medical sciences, Telangana from July 2012 to June 2019, for a period of 7 years. A total of 53 cases of ectopic pregnancy were analyzed for parameters like age, gravidity, gestational age, risk factors, clinical presentation, management and morbidity.Results: Incidence of ectopic pregnancy was 5.3 per thousand deliveries. Majority of cases were in age group of 20 to 25 years (52.8%) and were gravida 3 and above (68%). The commonest risk factors identified were history of previous pelvic surgeries (37.7%) followed by history of abortion (18.8%). Commonest symptoms were abdominal pain (90.6%), amenorrhoea (75.5%) and vaginal bleeding (47.2%). Only 41.5 % of cases had triad of symptoms. Fallopian tube (92.4%), specifically ampulla (62.3%) was the most frequent site affected. About 73.6% cases presented with ruptured tube. Surgery (94.3%) was the mainstay of therapy.Conclusions: ectopic pregnancy is a life-threatening emergency, early diagnosis and treatment will improve the prognosis.

Examination of level of knowledge in Italian general practitioners attending an education session on diagnosis and management of the early stage of Alzheimer's disease: pass or fail?

2016 ◽  
Vol 28 (7) ◽  
pp. 1111-1124 ◽  
Author(s):  
Federica Veneziani ◽  
Francesco Panza ◽  
Vincenzo Solfrizzi ◽  
Rosa Capozzo ◽  
Maria Rosaria Barulli ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Early Diagnosis ◽  
General Practitioners ◽  
Tertiary Care ◽  
Two Dimensions ◽  
Screening Tests ◽  
General Level ◽  
Diagnosis And Management ◽  
Level Of Knowledge

ABSTRACTBackground:We detected the general level of knowledge about the early diagnosis of Alzheimer's disease (AD) and subsequent care in general practitioners (GPs) from Southern Italy. We explored also the GP perception about their knowledge and training on diagnosis and management of AD.Methods:On a sample of 131 GPs, we administered two questionnaires: the GP-Knowledge, evaluating GPs’ expertise about AD epidemiology, differential diagnosis, and available treatments, and the GP-QUestionnaire on Awareness of Dementia (GP-QUAD), assessing the GPs’ attitudes, awareness, and practice regarding early diagnosis of dementia.Results:Specific screening tests or protocols to diagnose and manage dementia were not used by 53% of our GPs. The training on the recognition of early AD signs and symptoms was considered inadequate by 55% of the participants. Females were more likely to consider their training insufficient (58%) compared to males (53%). Female GPs were less likely to prescribe antipsychotic drugs to control neuropsychiatric symptoms (NPS) and suggest specialist advice in late stage of cognitive impairment. Multiple Correspondence Analysis (MCA) performed only on GP-QUAD suggested two dimensions explaining 26.1% (“GP attitude”) and 20.1% (“GP knowledge”) of the inertia for a total of 46.2%,Conclusion:In our survey on GP clinical practice, several problems in properly recognizing early AD symptoms and subsequently screening patients to be referred to secondary/tertiary care centers for diagnosis confirmation have emerged. In the future, specific training programs and educational projects for GPs should be implemented also in Italy to improve detection rates and management of dementia in primary care.

scholarly journals A Prospective Study of Evaluation and Management of Obstructive Jaundice in a Tertiary Care Hospital, North Coastal Andhra Pradesh

2021 ◽  
Vol 8 (21) ◽  
pp. 1717-1721
Author(s):  
Janni Laxman ◽  
Patnala Mohan Patro
Keyword(s):  
Obstructive Jaundice ◽  
Analytical Study ◽  
Tertiary Care ◽  
Average Diameter ◽  
P Value ◽  
Care Hospital ◽  
Medical Sciences ◽  
Malignant Obstructive Jaundice ◽  
Painless Jaundice ◽  
A Prospective Study

BACKGROUND Obstructive jaundice is defined as a condition occurring due to block in pathway between the site of conjugation of bile in liver cells and entry of bile into duodenum through the ampulla. This block may be intraheptic or extraheptic in the duct. Evaluation and management of obstructive jaundice is a challenging task to the surgeon owing the varied etiology and wide management option. Common bile duct (CBD) varies in length from 5 to 15 cm with average diameter of 6 mm. CBD can be divided in to four portions: supra duodenal, retro duodenal, intra duodenal and intramural portion. The purpose of this study was to evaluate the pattern of aetiology of obstructive jaundice in these parts and compare the clinical and laboratory presentations with obstructive jaundice between benign and malignant cases. METHODS This is a prospective analytical study. Patients with obstructive jaundice who attended the outpatient department of Surgery, GITAM Institute of Medical Sciences and Research, Visakhapatnam over a period of 24 months from November 2017 to October 2019 were admitted and taken up for the study. A total of 60 cases were studied. RESULTS Abdominal pain was a presenting symptom in 48 patients (80 %). Ninety five percent of patients of benign and 50 % of patients of malignant aetiology presented with this symptom. P value was found to be statistically significant for this symptom. This means that jaundice with pain in abdomen is more common in benign conditions while malignant conditions cause painless jaundice. CONCLUSIONS Malignant obstructive jaundice is most commonly seen in males while benign conditions are more common in females. Benign conditions causing obstructive jaundice is most common under 40 years of age while malignant obstructive jaundice is commonly seen between 50 and 60 years of age. KEYWORDS Cholestasis, Extraheptic, Obstructive Jaundice

scholarly journals Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

2018 ◽  
Vol 5 (3) ◽  
pp. 946
Author(s):  
Hemant K. Nautiyal ◽  
Ayush Agarwal ◽  
Gurvansh Singh Sachdev ◽  
P. K. Sachan
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Tertiary Care ◽  
Clinical Signs ◽  
High Morbidity ◽  
Soft Tissue Infections ◽  
Tertiary Care Centre ◽  
Systemic Involvement ◽  
Significant Difference ◽  
Chi Square Analysis

Background: Many times, it is difficult to differentiate between Necrotizing soft tissue infections (NSTI) and Non NSTI based on symptoms, signs and investigations. Only early diagnosis and debridement can prevent high morbidity associated with it.Methods: This prospective observational, study was conducted in the department of General Surgery, over a period of 1 year on consecutive 100 admitted patients. Clinical signs, symptoms and vital parameters of NSTI group and Non NSTI group were compared. Biochemical investigations, systemic involvement and treatment received was also evaluated. Chi-square analysis was performed to compare categorical variables.Results: A 77.8% of the NSTI and 54.7% of the Non NSTI infections occurred in males. Significant difference was found in mean age in patients with NSTI (50.9±13.1) and Non NSTI (41.1±15). Type II DM (38.9%) and hypertension (8.3%) were more commonly associated with NSTI patients. Mean pulse rate, respiratory rate and body temperature were significantly more in NSTI group. Patients with NSTI had significantly less hemoglobin and increased creatinine as compared to Non NSTI group. In NSTI group, 83% of patients had necrotizing fasciitis along with myonecrosis followed by Fournier’s gangrene (13.8%). Among Non NSTI group perianal abscess and subcutaneous abscess constituted 45.31% of patients. Methicillin sensitive staphylococcus aureus was found in 43.8% and 38.9% of Non NSTI and NSTI groups respectively.Conclusions: Classical symptoms and signs of NSTI are not reliable and often investigations also fail to differentiate between NSTI and Non NSTI. Type 2 diabetes mellitus patients are more prone to it. High level of clinical suspicion is required for early diagnosis. Timely and adequate debridement of NSTI is necessary to decrease morbidity and mortality.

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