scholarly journals AUDIT OF MANAGEMENT OF ADULT CHOLEDOCHAL CYSTS

2021 ◽  
Vol 71 (6) ◽  
pp. 1997-2000
Author(s):  
Ammad Ud Din Nasir ◽  
Muhammad Shoaib Khan ◽  
Anas Bin Saif ◽  
Qasim Butt ◽  
Hanif Abbasi
Keyword(s):  
Choledochal Cyst ◽  
Operative Procedure ◽  
Tertiary Care ◽  
Case Series ◽  
Military Hospital ◽  
Type I ◽  
Care Hospital ◽  
Choledochal Cysts ◽  
Cyst Excision

Objective: To analyze the complexity and diversity of type, surgical management and complications in adult choledochal cysts presenting to a Hepatobiliary unit of a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2019. Methodology: All the patients diagnosed with choledochal cyst and underwent surgical procedure between Jan 2017 to June 2019 were analyzed. The clinical features, types, operative procedure and outcomes of the patients in terms of post-operative morbidity and mortality were assessed. Calvin Dindo classification was used to assess complications. Results: A total of 17 patients were studied, out of which, 13 were females (76.5%) and 4 were males (23.5%) with mean age of 37.41 ± 16.96 years. There were 13 type I (76.5%), 2 type IVa (11.8%) and 1 type II (5.9%) choledochal cysts according to Todani’s classification. Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on all 17 patients. There was no mortality in the series. Post-operative complications occurred in 4 (23.5%) patients, 2 were grade II, 1 was grade I and 1 grade III according to Clavin Dindo scale. Long-term follow up revealed recurrent cholangitis in 3 (17.6%) patients which settled on antibiotic regime. The median follow up time was 1.5 years. Conclusion: The total extra-hepatic excision with Roux-en-Y hepaticojejunostomy is the treatment of choice for adult choledochal cyst. The procedure has low morbidity and very low mortality.

scholarly journals Rhino Orbital Cerebral Mucormycosis in settings of Covid-19 infection: A Case Series of Thirteen Patients

2022 ◽  
Author(s):  
Rajesh Verma ◽  
Rajarshi Chakraborty ◽  
Keerthiraj DB ◽  
Kingzang Wangda ◽  
Veerendra Verma ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Public Awareness ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Imaging Features ◽  
Initial State ◽  
Northern India ◽  
History Of

Abstract Background Rhino-Orbital-Cerebral Mucormycosis (ROCM) is an important infectious disease encountered in huge number in this recent post-covid 19 era. An alteration in defence immune system during covid-19 illness, in the presence of uncontrolled hyperglycaemia has led to the new epidemic of ROCM especially in developing nations like India. Method This case series of thirteen patients illustrates the various clinical presentation, laboratorical parameters, imaging features and outcome of patients of ROCM admitted in a tertiary care hospital in Northern India. Result In our case series, a total of 13 newly diagnosed cases of Rhino-Orbital-Cerebral Mucormycosis were studied. History of covid-19 illness was observed in 7 cases (53.8%), use of steroid during Covid-19 illness was seen in 5 cases (38.5%), oxygen therapy was given in 4 cases (30.8%). Co-morbid state in the form of diabetes mellitus was present in 12 cases (92.3%) with mean duration 16.69 months with an important finding of 6 cases (46.2%) having new-onset diabetes; hypertension in present in 3 cases (23.1%). Magnetic resonance imaging of paranasal sinuses showed involvement of multiple sinuses in all the 13 cases(100%), including maxillary and ethmoidal sinuses, with frontal in 12 cases (92.3%), sphenoidal in 11 cases (84.6%), symmetric in 9 cases (69.2%), mastoiditis in 4 cases (30.8%), maxillary space involvement in 4 cases (30.8%), palatal involvement in 1 case (7.7%). Multi-speciality approach treatment was given in the liposomal amphotericin B therapy in all the patients along with thorough endo-nasal debridement done in all cases, transcutaneous retrobulbar amphotericin B in 6 cases (46.2%) with exenteration done in 7 patients (53.9%). At 3 months of follow-up, there was substantial clinical improvement in all the cases. Conclusion There should be definite emphasis on high suspicion of mucor clinically for early diagnosis and aggressive management at initial state of diagnosis for better outcome. The need for sustained proper glycemic control during covid 19 era along with judicious use of steroid and public awareness for early symptoms and manifestations of mucor can curb the magnitude of such potentially opportunistic epidemic to a substantial rate. The longer the infection remains undetected, the greater the devastation ROCM can impose, of which blindness is an important hazard.

scholarly journals Tympanoplasty Type-I using tragal perichondrium graft: Our experience

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Fazali Wahid ◽  
Sajid Rashid Nagra
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Pure Tone Audiometry ◽  
Neck Surgery ◽  
Tympanic Membrane Perforation ◽  
P Value ◽  
Type I ◽  
Care Hospital ◽  
Female Ratio ◽  
Case Series Study

Objective: To determine the efficacy of tragal perichondrium graft used in tympanoplasty Type-I at a tertiary care hospital. Methods: This descriptive case-series study was performed at the department of E.N.T, Head and Neck Surgery, Medical Teaching Institution/Lady Reading Hospital (MTI/LRH), Peshawar, Pakistan from June 2017 to May 2018. After approved from IREB, a well informed consent was taken. Pure Tone Audiometry (PTA) was performed before surgery and post-operatively at three and six months interval. The mean ± SD Air-Bone Gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). Chi-square (X2) test of significance was used taking confidence interval at 95%. The p-value ≤0.05 was considered significant. Results: Total patients were 36; male 21 (58.3%), female 15(41.7%) with male: female ratio of 1.4:1. Mean ± SD age was 27.14 ± 7.49 years (Range 15 – 50Years). Tympanic membrane perforation was commonly found on right side 22 (61.1%), predominantly involving anterioinferior site 19 (52.8%) and medium sized perforation outnumbered 22 (61.1%). Mean pre-operative air-conduction of 49.72 dB was significantly reduced to 18.27 dB with pvalue of <0.05. Similarly the pre-operative mean air bone gap on PTA of 45.63 ± 8.35dB was also reduced to statistically significant level of 7.41 ± 3.51 dB on post-operative PTA with p-value of <.05. Graft was taken up well in 34 cases (94.4%). Conclusion: Tragal perichondrial graft is an effective grafting material used for tympanoplasty due to its possessing qualities. doi: https://doi.org/10.12669/pjms.35.4.421 How to cite this:Wahid FI, Nagra SR. Tympanoplasty type I using tragal perichondrium graft: Our experience. Pak J Med Sci. 2019;35(4):---------.  doi: https://doi.org/10.12669/pjms.35.4.421 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Management of Choledochal Cysts at a Tertiary Care Centre: A Nine-Year Experience from India

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Pranav Honnavara Srinivasan ◽  
Amudhan Anbalagan ◽  
Rajendran Shanmugasundaram ◽  
Naganathbabu Obla Lakshmanamoorthy
Keyword(s):  
Preoperative Evaluation ◽  
Tertiary Care ◽  
Late Complications ◽  
Common Symptom ◽  
Type I ◽  
Choledochal Cysts ◽  
Tertiary Care Centre ◽  
Cyst Excision ◽  
Management Of Complications ◽  
Long Term Follow Up

Background. Although choledochal cyst disease is seen predominantly in childhood, it is becomingly increasingly diagnosed in adult patients. Methods. Data of 36 patients with choledochal cysts managed in our institute between January 2010 and December 2018 were retrospectively analyzed. Results. Median age at presentation was 37 years (range: 13–72 years). Female-to-male ratio was 3.5 : 1. All patients were symptomatic, and abdominal pain was the most common symptom. 72.2% had other associated conditions. There was a considerable delay from the onset of symptoms to referral, median duration being 348 days. There were 28 cases of type I (77.8%), 5 cases of type IVA (13.9%), and 3 cases of type IVB (8.3%). Cyst excision with Roux-en-Y hepaticojejunostomy was performed in 29 (80.55%) cases. This procedure was combined with a left lateral sectionectomy, left hepatectomy, and radical cholecystectomy in 1, 2, and 1 cases, respectively. Lilly’s technique was used in 2 cases, and cyst excision with hepaticoduodenostomy was performed in 1 case. Early complications were seen in 21 patients (58.3%), and late complications were seen in 5 patients (13.8%). 2 patients were found to have associated malignancies. One patient was detected to have cholangiocarcinoma in the resected liver incidentally, and another patient was diagnosed to have gall bladder cancer intraoperatively. Conclusion. Choledochal cysts should be considered in the differential diagnosis of adults presenting with epigastric or right hypochondrium pain or jaundice. A thorough preoperative evaluation is required. Cyst excision with Roux-en-Y hepaticojejunostomy forms the standard treatment in most cases. Long-term follow-up is essential for management of complications and early detection of malignant change.

scholarly journals SPECTRUM OF SUBTYPES OF SACROCOCCYGEAL TERATOMA: A CASE SERIES STUDY IN A TERTIARY CARE HOSPITAL IN CENTRAL INDIA: A SURGEON'S AND A RADIOLOGIST'S PERSPECTIVE

2021 ◽  
pp. 1-3
Author(s):  
Sanjib Kumar Jena ◽  
Prajwaleet Gour ◽  
Kamalkant Khidtta ◽  
Debraj Saha
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Central India ◽  
Surgical Excision ◽  
Ct Scans ◽  
Sacrococcygeal Teratoma ◽  
Type I ◽  
Care Hospital ◽  
Complete Surgical Excision ◽  
Case Series Study

OBJECTIVE: 1.To demonstrate the clinical presentation, radiological features, management and histopathological features of sacrococcygeal tumors in neonates. Material And Methods: Between 1st March 2020 and 1st December 2020, 5 cases(4 male, 1 female) of sacrococcygeal teratomas(SCT) were diagnosed in Government Medical College Nagpur using ultrasonography(USG) and Computed tomography(CT) scans. In each case, tumor size, its content, mass effect, and classication according to the Altman's criteria were determined and compared with other features. Then the patients underwent surgery and samples were sent for histopathological correlation. Results: Among the 5 patients, 3 were of Type I type and 2 were of type II type. In histopathological reports, 4 were of mature type and 1 was of immature type. Conclusion: USG and CT scans are effective in diagnosing and localizing the extent and involvement of SCT. SCT appear to be entirely benign during the neonatal period. Complete surgical excision remains the mainstay of treatment.

scholarly journals Experiences in the Management of Choledochal Cyst in Pediatric Patients in a Tertiary Care Center of Bangladesh Armed Forces

2016 ◽  
Vol 12 (2) ◽  
pp. 117-121
Author(s):  
Meherun Nessa ◽  
Shams ud Din Elias Khan
Keyword(s):  
Surgical Treatment ◽  
Choledochal Cyst ◽  
Tertiary Care ◽  
Armed Forces ◽  
Reconstruction Technique ◽  
Anastomotic Site ◽  
Type I ◽  
Paediatric Surgery ◽  
Cyst Excision ◽  
Initial Symptoms

Introduction: Choledochal cyst (CC) is a rare congenital abnormality of the biliary tract, for which there is no standardized surgical treatment. If left untreated it may cause bile duct (BD) obstruction to cholangiocarcinoma. For the commonest type of Choledochal cyst (Type I and IV) the treatment is surgery, although, the reconstruction technique of the BD has no gold standard. Objective: To assess the outcome of surgical treatment of choledochal cyst in pediatric cases in 8 years period in CMH Dhaka, a tertiary referral hospital of Bangladesh Armed Forces. Materials and Methods: This cross sectional study was carried out in the department of Paediatric Surgery at CMH Dhaka on 20 children of under 10 years having choledocal cysts. The study period was from March 2006 to February 2014. Results: Total of twenty patients aged 3 years to 10 years was included in the study. Out of them 14(70%) were females and 6(30%) were males. Fifteen (75%) patients presented with recurrent abdominal pain, 14(70%) with recurrent jaundice, 4(20%) patients with abdominal mass as initial symptoms. Twelve (60%) patients were diagnosed by Ultrasonogram (USG), rests were by Contrast Enhanced Computed Tomography (CECT) and Magnetic Resonance Cholangiopancreatography (MRCP). Eighteen patients presented with type 1 choledochal cyst and 2 of them had type IV choledochal cyst. All the patients were submitted to cyst excision and Roux-en-Y hepaticojejunostomy. Among them one patient required refashioning of anastomotic site to treat bile leakage. Conclusion: Early diagnosis and referral is essential to prevent complications and grave consequences and prognosis of these cases after surgery is good. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 117-121

scholarly journals Gallbladder Volvulus in a Patient with Type I Choledochal Cyst: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
George Younan ◽  
Max Schumm ◽  
Fadwa Ali ◽  
Kathleen K. Christians
Keyword(s):  
Choledochal Cyst ◽  
Biliary Tree ◽  
Type I ◽  
Review Of The Literature ◽  
Choledochal Cysts ◽  
Elderly Female ◽  
Management Algorithm ◽  
First Case ◽  
Prompt Diagnosis

Introduction.Gallbladder volvulus is a rare, potentially fatal condition unless diagnosed and treated early. Choledochal cysts are rare congenital malformations of the biliary tree predisposing to different pathologies and posing the risk of degradation into cholangiocarcinoma and gallbladder cancer. Dealing with both diseases at once has not been published yet in the literature.Presentation of Case.We report a case of gallbladder volvulus in an elderly female who happened to have a concomitant type I choledochal cyst. Treatment was achieved with a cholecystectomy and observation and follow-up of the choledochal cyst.Discussion.Prompt diagnosis and surgical management of gallbladder volvulus is important to avoid the morbidity and mortality of gangrenous cholecystitis and biliary peritonitis in a frail old population of patients. Precise clinical diagnosis, supplemented with specific imaging clues, helps in the diagnosis. Management of choledochal cysts is also surgical; however the timing of surgery is still a matter of debate.Conclusion.We describe in this report the first case of gallbladder volvulus in a patient with a choledochal cyst and propose a management algorithm of a very rare biliary tree pathology combination.

scholarly journals Comparison between hepaticojejunostomy and hepaticoduodenostomy after excision of choledochal cyst in children: a cohort study

2019 ◽  
Vol 2 (2) ◽  
pp. e000029
Author(s):  
Johann Paulo Suico Guzman ◽  
Leandro L Resurreccion III ◽  
Marcus Lester R Suntay ◽  
Renato G Bernaldez
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Choledochal Cyst ◽  
Operative Time ◽  
Type I ◽  
Biliary Reconstruction ◽  
Female Ratio ◽  
Cyst Excision ◽  
Significant Difference

ObjectiveHepaticojejunostomy (HJ) and hepaticoduodenostomy (HD) are commonly used biliary reconstruction techniques after choledochal cyst excision. HD has been suggested to be a more physiologic alternative during reconstruction. The objective of this study is to compare operative time, hospital stay, morbidity (leak, cholangitis, ileus, and obstruction), and mortality between HJ and HD after cyst excision.MethodsThis is a 14-year retrospective cohort study of pediatric patients (≤18 years old) who underwent choledochal cyst excision and subsequent biliary reconstruction at the Philippine Children’s Medical Center. Data were taken from inpatient charts, operative technique, OPD logbook, readmission, and OPD charts.ResultsThere were 122 patients: 56% HD and 44% HJ. Majority were female (72%), with 1:2.6 male to female ratio. The average age was 36.1 months, with a mean follow-up of 32.8 months (range 6 months–14 years). The most common cyst was type I (87%). Operative time was longer for HJ compared with HD (321.3 vs 203.6 min; p=0.000). Hospital stay was longer with HJ compared with HD (7.7 vs 6.8 days; p=0.002). Mortality rate was low at 1.6% while morbidity was at 13.9% in both groups. Although morbidity was higher among those who underwent HD, there was no significant difference between the two procedures. Anastomotic leak (4%) and cholangitis (7.4%) were observed in HD, and ileus (7.4%) was observed in the HJ group.ConclusionsIn our series, HD provided less operative time and hospital stay than with HJ. We did not observe bile gastritis after HD as compared with others. It is suggested that longer follow-up is needed to confirm such findings.

scholarly journals Wies procedure for correcting involutional entropion of the lower lid in geriatrics

2021 ◽  
Vol 3 (1) ◽  
pp. 21-29
Author(s):  
Erum Shahid ◽  
Uzma Fasih ◽  
Arshad Shaikh
Keyword(s):  
Recurrence Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Successful Outcome ◽  
Care Hospital ◽  
Retrospective Case ◽  
Geriatric Population ◽  
Involutional Entropion ◽  
Anatomic Results

Objective: To evaluate the anatomic outcome and recurrence rate of the Wies procedure for treating involutional entropion of the lower lid in geriatrics. Materials and methods: This retrospective case series was conducted in the Ophthalmology department of a tertiary care hospital from January 1, 2016 to December 31, 2017. Geriatric patients (≥ 65 years) who had undergone the Wies procedure, i.e., transverse lid split and everting sutures for correction of involutional entropion of the lower lid were included. All the surgeries were done under local anaesthesia by a single ophthalmologist. The follow-up period was 12 months. A successful outcome was defined as restoration of lid margin to its position with no lash touching the cornea and no recurrence within 12 months. Results: Eighteen eyes of 13 patients with a mean age of 67.6 ± 2.2 SD years were included. There were 11 males (61%) and 7 females (39%). Bilateral entropion correction was done in five patients. Nine right eyes and nine left eyes were included. Anatomical success was 94.4% at 12 months. Recurrence was seen in one (5.6%) patient at 12 months. Conclusion: The Wies procedure for correction of involutional entropion with horizontal lid laxity in the geriatric population provided good anatomic results in our study. The recurrence rate was minimal within 1 year. The recurrence rate can be reduced by an accurate initial entropion assessment.

scholarly journals Neutralizing Antibody Response and Associated Factors in Coronavirus-19 Disease (COVID-19) up to One Month: A Case-Series of 129 Hospitalized Patients

2021 ◽  
Author(s):  
Aliye Bastug ◽  
Hurrem Bodur ◽  
Urartu Ozgur Safak ◽  
Nazlican Filazi ◽  
Omer Aydos ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Case Series ◽  
Neutralizing Antibody ◽  
Potential Effect ◽  
Care Hospital ◽  
Igg Antibody ◽  
Factors Affecting

Abstract Purpose Little is known about the characteristics of neutralizing antibody(NAb) response in patients recovered COVID - 19. We aimed to elucidate the factors affecting presence and titers of in an early phase of infection up to 30 days.Methods A total of 129 laboratory-confirmed COVID-19 patients in a tertiary-care hospital were enrolled. Clinical and laboratory data were obtained retrospectively. SARS-CoV-2 specific NAb, IgM, and IgG antibody responses were analyzed. NAb-positive and negative patients were compared, to examine potential associations between clinical, demographical, and laboratory characteristics and the presence/titers of NAb.Results SARS-CoV-2 specific NAb, IgM and IgG were detected at the time of hospital discharge in 60.5%, 30.2%, and 51.9% of the patients, respectively. The presence of antibodies was 42.4%(NAb), 20.3%(IgM) and 44.1%(IgG) among patients within 5-9 days since onset; increased to 79.5%(NAb), 34.1%(IgM) and 47.7%(IgG) by 10-14 days; and detected in 66.7%(NAb), 50%(IgM), 83.3%(IgG) at/after day-15, following symptom onset. The median titer of neutralizing antibody(SN 50) was significantly higher in severe patients(25 versus 7.5, p= 0.009). Of the 23 severe patients, 52.2%(n=12) had higher NAb titers (i.e., SN 50 ≥ 1:25) when compared to that in non-severe patients(p= 0.021; OR = 2.89; 95%CI= 1.15 – 7.28), yet, potential effect of follow-up time on NAb status and titers could not be ruled out.Conclusion Presence and higher titers of NAb were detected more in severe patients compared to their non-severe counterparts. Survival analysis suggested that this difference could at least be partially explained by the length of follow-up after symptoms’ onset.

scholarly journals Is Video-Assited Thoracoscopic Surgery Superior to Limited Axillary Thoracotomy in the Management of Spontaneous Pneumothorax?

2001 ◽  
Vol 8 (5) ◽  
pp. 339-343 ◽  
Author(s):  
Meaghen J Hyland ◽  
Ahmad S Ashrafi ◽  
André Crépeau ◽  
Reza J Mehran
Keyword(s):  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Tertiary Care ◽  
Operating Time ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Tube Length ◽  
Care Hospital ◽  
Retrospective Case

OBJECTIVE: To evaluate bullectomy and pleurectomy in the treatment of spontaneous pneumothorax (PNO) using video-assisted thoracoscopic surgery (VATS), and to compare the outcome with that of the same procedure performed using limited axillary thoracotomy (LAT).DESIGN: A retrospective case series with patient follow-up.SETTING: A Canadian tertiary care hospital.PATIENTS: The medical records of all patients with a spontaneous PNO treated by either VATS or LAT at the Ottawa Hospital - General Campus, Ottawa, Ontario, between April 1993 and August 1999 were reviewed, and the patients were subsequently interviewed.MAIN OUTCOME MEASURES: Operative details (length of operation, operative complications); postoperative details (duration of chest tube, length of hospital stay, duration of analgesia, pain, time missed from work, complications, recurrence rate); and cost (hospital and operative, socioeconomic [time missed from work]).RESULTS: Fifty patients were identified who had had surgical treatment of a spontaneous PNO. Twenty-eight patients were treated by LAT and 22 underwent VATS. The median length of follow-up was 44.6 months (range four to 81.5 months). Three patients developed a recurrent PNO - two patients after LAT and one patient after VATS. No difference was found between the two groups in the operating time or in the amount of pain experienced immediately after surgery. However, patients who underwent VATS had a shorter length of stay (P=0.002) and a shorter requirement for analgesics postoperatively (P=0.03). Overall, the total cost of VATS was no different than that for LAT; however, in terms of socioeconomic costs, patients in the VATS group missed significantly less time from work postoperatively (P=0.02).CONCLUSIONS: VATS offers a cost effective and better tolerated procedure for the management of spontaneous PNO than the time-honoured open technique.

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