iosr-JDMS   Volume-18 ~ Issue-12 ~ December-2019

Abstract: Aim:To study the preoperative serum albumin and body mass index as predictors of post operative morbidity and mortality in elective and emergency major surgeries. Methods: Details of the cases are recorded including history , clinical examination , investigations done and intraoperative findings. Anthropometry – height and weight recorded pre-operatively. BMI – weight [kg] / height [m2] . Serum albumin measured preoperatively. The patients are to be followed up after surgery and watched for complications such as wound gaping , seroma formation , wound infection , flap necrosis , fistula formation and death during the post operative period. Results:For all major operations , patients with low serum albumin level and abnormal BMI had faced post op complications.The increase in morbidity seems to be exponential as the level of albumin level decreases from a level of approximately 3.5 gm/dL. Thus coming to the conclusion that Albumin level is the strongest predictor in both mortality and morbidity for all major operations .

[1]. Macfie J. Nutrition and fluid therapy. Bailey and Love, Short Practice of Surgery 25th edition. CRC Press. USA. 2013: 223.
[2]. Lai CC, You JF, Yeh CY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26(4):473–81.[PubMed]
[3]. Bhamidipati CM, LaPar DJ, Mehta GS, et al. Albumin is a better predictor of outcomes than body mass index following coronary artery bypass grafting. Surgery. 2011;150(4):626–34. [PMC free article] [PubMed]
[4]. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36–42. [PubMed]
[5]. Clark RAF. Wound repair. In Clark RAF (ed): The molecular and cellular biology of wound repair, 2nd ed, New York, Plenum Press; 1996: 31. Bhamidipati CM, Lapar DJ, Mehta GS, Kern JA, Upchurch GR, Kron IL, Ailawadi G. Albumin is a better predictor of outcomes than body mass index following coronary artery bypass grafting. Surgery. 2011;150(4):626-34.

Abstract: Wilson's disease is a rare autosomal recessive condition involving abnormal copper accumulation in the body due to a defect in the ATP7B gene, which encodes a membrane bound copper binding protein. It presents with hepatic, neurological, and behavioural manifestations. The authors report a case of a 14 years old female who presented catatonic symptoms and was later diagnosed with Wilson's disease. Though uncommon, a diagnosis of Wilson's disease should be considered in the evaluation of adolescents and young adults presenting with psychiatric manifestations and/or neurological features..

Keywords: Catatonia, Wilson's disease, adolescents

[1]. Bull PC, Thomas GR, Rommens JM, Forbes JR, Cox DW, Nat Genet. The Wilson disease gene is a putative copper transporting P-type ATPase similar to the Menkes gene: Nat Gennet. 1993;5(4):327-37.
[2]. Akil M, Brewer GJ. Psychiatric and behavioral abnormalities in Wilson's disease. Adv Neurol. 1995;65:171-8.
[3]. Zimbrean PC, Schilsky ML. Psychiatric aspects of Wilson disease: a review. Gen Hosp Psychiatry. 2014;36(1):53-62.
[4]. Walshe JM. Cause of death in Wilson disease. Mov Disord. 2007;22(15):2216–20.
[5]. Walshe JM, Yealland M. Wilson's disease: The problem of delayed diagnosis. J Neurol Neurosurg Psychiatry 1992;55:692-6.

Abstract: Gallstones are present in 10 to 15% of the general population and asymptomatic in the majority (>80%). • In India it is estimated to be around 4%........

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Abstract: Background:- Oral squamous cell carcinoma (OSCC) is the sixth most common human cancer that encompasses at least 90% of all oral malignancies. Serum LDH may be used as a tumor marker for diagnostic and prognostic implication in OSCC. Settings and Design:- Tertiary care hospital, Interventional study Conclusion:- The serum LDH level was significantly (p=0.001) higher among the cases compared to controls at pre-op. There was significant rise in serum LDH level at pre-op which decreased at post-op. The mean change (37.77±358.90) in the serum LDH from pre-op to post-op was statistically insignificant..

[1]. Pereira S. Pereira T, Shetty S. Estimation of serum lactate dehydrogenase level in patients with oral premalignant lesions/ conditions and oral squamous cell carcinoma: A clinicopathological study. J Can Res Ther 2015;11:78-82.
[2]. Baskar AA, Manoharan S, Manivasagam T, Subramanian P. Circadian rhythmicity of plasma lipid peroxidation and antioxidants in oral squamous cell carcinoma. Singapore Med J 2005;46:184-8.
[3]. Liu L, Satish K, Sedghizadeh PP, et al. Oral squamous cell carcinoma incidence by sub site among diverse racial and ethnic populations in California. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:470-80.
[4]. Berlin NI. Tumor markers in cancer prevention and detection. Cancer 1981;47 5 Suppl: 1151-3.
[5]. Denny P, Ho CM, Li Y, Montemagno C, Qi F, Shi W, et al. The Oral Fluid Mems/Nems Chip (OFMNC): Diagnostic and translational applications. Adv Dent Res 2005;18:3-5..

Abstract: The synchronous malignancy of kidney and biliary originis rare. Here We report 63yrs old male patient with history of pain abdomen in left lumbar region, who was admitted for evaluation. Ultrasound examination revealed a well-defined heterogeneous predominately hypo echoic lesion with few cystic areas within measuring 5.7 * 5.8cm noted in lower pole of left kidney. Multiple well defined heterogeneous predominately hyper echoic lesion noted in left lobe of liver(1.7*1.3cm). Repeated FNAC of liver lesion was inconclusive. The histopathology report showed clear cell renal cell carcinoma of kidney. The biopsy from liver lesion taken intraoperativecame as metastatic mucin secreting adenocarcinoma. In summary, the existence of both kidney and metastasis to liver from other source occurs more in elderly patients

Key renal cell carcinoma , primary biliary cholangiocarcinoma

[1]. Hu NC, Hsieh SC, Chen TJ, Chang JY (2009) Multiple primary malignancies including colon, stomach, lung, breast, and liver can- cer: a case report and literature review. Chin Med J 122:3091–3093
[2]. Alexakis N, Bosonnet L, Connor S, Ellis I, Sutton R, Campbell F, Hughes M, Garvey C, Neoptolemos JP: Double resection for patients with pancreatic cancer and a second primary renal cell cancer. Dig Surg 2003;20:428–432.
[3]. Ismail TO, Janane A, Hajji F, Dekkak Y, Bekkali S, Sossa J, Chafiki J, Eloundou J, Lahrech Y, Qamous O, Qarro A, Jira H, Ghadouane M, Ameur A, Albouzidi A, Abbar M: Synchronous primary tumors of the kidney and pancreas: case report. Afr J Urol 2010;16:128–131.
[4]. Müller SA, Pahernik S, Hinz U, Martin DJ, Wente MN, Hackert T, Leowardi C, Haferkamp A, Büchler MW, Schmied BM: Renal tumors and second primary pancreatic tumors: a relationship with clinical impact? Patient SafSurg 2012;6:18.
[5]. Rabbani F, Reuter VE, Katz J, Russo P: Second primary malignancies associated with renal cell carcinoma: influence of histologic type. Urology 2000;6:399–403

Abstract: The Prostate specific antigen is elevated in majority of prostate cancer patients. Its estimation in the blood is used as one of the diagnostics as well as prognostic tool. However,PSA level ranging from 4.0 to 10.0 ng/mlis an area of grey zone and of diagnostic uncertainty. Additional factors such as intravesical prostatic protrusion, PSA density can increase the detection rate of prostate cancer in these particular grey zone areas. In our study the predictive accuracy of IPP(≤7mm)and PSAD (>0.15) was higher than that of tPSA, indicating that IPP would be a valid predictor of PCa when the patient had the PSA of 4.0–10.0 ng/ml..

Keywords: prostate cancer, psa level, total psa, ipp, intravesical prostatic protrusion, psa density

[1]. Stephan C, Jung K, Lein M, Diamandis EP (2007) PSA and other tissue kallikreins for prostate cancer detection. Eur J Cancer 43(13): 1918–1926.doi:10.1016/j.ejca.2007.06.006
[2]. Tchetgen MB, Oesterling JE (1997) The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigenconcentration. Urol Clin North Am 24(2):283–291
[3]. Schroder FH, Roobol MJ (2009) Defining the optimal prostatespecific antigen threshold for the diagnosis of prostate cancer. CurrOpinUrol19(3):227–231. doi:10.1097/MOU.0b013e328329a2d0
[4]. Lee JW, Ryu JH, Yoo TK, Byun SS, Jeong YJ, Jung TY (2012) Relationship between Intravesical prostatic protrusion andpostoperativeoutcomesinpatientswithbenignprostatichyperplasia. Korean J Urol 53(7):478–482. doi:10.4111/kju.2012.53.7.478
[5]. Lim KB, Ho H, Foo KT, Wong MY, Fook-Chong S (2006) Comparison of intravesical prostatic protrusion, prostate volume and serum prostaticspecific antigen in the evaluation of bladder outlet obstruction. Int J Urol 13(12):1509–1513. doi:10.1111/j. 1442-2042.2006.01611.x

Abstract: Thyroid nodule is one of the most common finding on neck ultrasound examinations. It is a common term which includes a variety of pathological types under it, ranging from benign to malignant. A solitary thyroid nodule is seen with high suspicion and patients are subjected to further imaging and pathological analysis. Sonography is a safe, non-invasive modality to visualize these nodules and their characterization can be done based on their morphological features. Distinguishing benign from malignant lesions is a desirable outcome of ultrasonographic examinations that allows early diagnosis and timely management of malignant lesions, also avoids unnecessary procedural burden in case of benign lesions. Thyroid nodules are assessed by not one but a combination of morphological.......

[1]. Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Archives of Internal Medicine. 1996; 156(19):2165-2172.
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[3]. Polyzos SA, Kita M, Efstathiadou Z, Goulis DG, Benos A, Flaris N, et al. The use of demographic, ultrasonographic and scintigraphic data in the diagnostic approach of thyroid nodules. Exp Clin Endocrinol Diabetes. 2009 Apr; 117(4):159–64.
[4]. Morris LF, Ragavendra N, Yeh MW. Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg. 2008 Jul; 32(7):1253–63.
[5]. Popli MB, Rastogi A, Bhalla P, Solanki Y. Utility of gray-scale ultrasound to differentiate benign from malignant thyroid nodules. Indian J Radiol Imaging. 2012 Jan; 22(1):63–8.

Abstract: Introduction Infection is a dreaded complication in orthopaedic surgery. Post operative surgical site infection following orthopaedic implantation leads to need for resurgery, prolonged antibiotic usage and antibiotic resistance. It poses economic burden as well as prolonged morbidity to the patient. After the introduction of laminar flow ventilation it has widely become accepted as the standard during orthopaedic procedures such as joint arthroplasty1. Laminar flow ventilation systems were pioneered by Sir John Charnley , when used in conjunction with other strategies to reduce sepsis, reported marked decline in post-operative wound infection. The practice became widely adopted in orthopaedic theatres after a series of trials that showed a significant decrease in infections from laminar........

[1]. Current Evidence for the Use of Laminar Flow in Reducing Infection Rates in Total Joint Arthroplasty M James, W.S Khan, M.R Nannaparaju, J.S Bhamra,* and R Morgan-Jones ,Open Orthop J. 2015; 9: 495–498. [2]. Lidwell O.M., Lowbury E.J., Whyte W., Blowers R., Stanley S.J., Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br. Med. J. (Clin. Res. Ed.) 1982;285(6334):10–14. doi: 10.1136/bmj.285.6334.10.
[3]. Prevalence of Surgical Site Infection in Orthopedic Surgery: A 5-year Analysis Fahad A. Al-Mulhim1, Mohammed A. Baragbah2, Mir Sadat-Ali1, Abdallah S. Alomran1, Md Q. Azam1 Int Surg 2014;99:264–268 DOI: 10.9738/INTSURG-D-13-00251.1
[4]. Diab-Elschahawi M., Berger J., Blacky A., Kimberger O., Oguz R., Kuelpmann R., Kramer A., Assadian O. Impact of different-sized laminar air flow versus no laminar air flow on bacterial counts in the operating room during orthopedic surgery. Am. J. Infect. Control. 2011;39(7):e25–e29. doi: 10.1016/j.ajic.2010.10.035.
[5]. Holton J., Ridgway G.L. Commissioning operating theatres. J. Hosp. Infect. 1993;23(2):153–160. doi: 10.1016/0195-6701(93)90019-V.

Abstract: This is prospective study on clinical features, staging, investigations and management of colorectal carcinoma. In this study we tried to determine that what will be the common clinical manifestation while presenting here at our institute and patient would be having which stage and various methods of investigations to investigate carcinoma properly and to give appropriate stage and to manage these patient accordingly. This randomized observational prospective cohort study has been carried out in 25 cases of colorectal carcinoma, admitted to department of general surgery in pdu medical college&hospital, Rajkot from october2017 to till april 2019. All patients were examined clinically and their history and examinations and neccesory imaging and blood investigations were done.....

[1]. Schwartz's principles of surgery 10th edition, risk factors for adenocarcinoma of colon rectum (chapter 29, page no:1203).
[2]. Halligan S, Altman D, Taylor S, Mallett S, Deeks J, Bartram C, Atkin W. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis and proposed minimum data set for study level reporting. Radiology.2005;237(3):893–904.
[3]. Principles of surgery 10th edition Schwartz's, pathogenesis of colorectal carcinoma (chapter 29, page no:1204).
[4]. Fisher B, Wolmark N, Rockette H, Redmond C. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. Journal of the National Cancer Institute.1988;80(1):21–29.
[5]. Akasu T, Moriya Y, Ohashi Y, Yoshida S. Adjuvant Chemotherapy with uracil-tegafur for pathological stage III rectal cancer after mesorectal excision with selective lateral pelvic lymphadenectomy: a multicentre randomised controlled trial. Japanese Journal of Clinical Oncology.2006;36(4):237–244.

Abstract: Surgery for spontaneous hemorrhage (SICH) is debated as early trials for surgery could not prove better outcome than conservative medical management. However, removal of the mass effect of the hematoma should logically reduce secondary brain injury. Meanwhile, use of minimally invasive surgery for intracerebral hematoma is becoming popular with claim for better outcome. We speculate that preoperative stabilization along with better patient selection in accordance with the findings of earlier trials could improve patient outcome.

Keywords: Spontaneous intracerebral hemorrhage, surgical outcome

[1]. Hemphill JC 3rd, Greenberg SM, Anderson CS,Becker K, Bendok BR, Cushman M etal. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2015; 46:2032-60
[2]. Sindelar BD, Patel V, Chowdhury S et al. (July 13, 2018). A case report in hemorrhagic stroke: A complex disease process and requirement for a multimodal treatment approach.Cureus 10(7): e2976. DOI 10.7759/cureus. 2976
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Abstract: Fractures of the proximal femur are amongst the most often encountered fractures by an orthopedic surgeon. Many treatment techniques are described in the literature, but the internal fixation with Dynamic Hip Screw is the treatment of choice. This study analyzes the outcome of the treatment of inter-trochanteric fractures with Dynamic Hip Screw. Between December 2017and June 2018, 45 patients with an intertrochanteric fracture who got admitted to Narayana Medical College and Hospital, Nellore, in the department of Orthopaedics were subjected to internal fixation with Dynamic Hip Screw and the results were evaluated. The average age incidence in the present study was 69.91 years. The male-female ratio was almost equal to 51:49. All the fractures occurred after a fall. Evan's stable fractures were more common. Out of the 41 cases, functional outcome evaluated using Harris Hip Sore scoring at their last follow-up:18 cases (44%) had excellent, 11 cases(27%) good, 12 cases (29%) fair. CONCLUSION: Internal fixation with Dynamic Hip Screw is the treatment of choice for the treatment of stable intertrochanteric fractures.

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Abstract: During the period of February 2015 to January 2017 total 11 cases of gastrointestinal duplication presented in various ways in the department of pediatric surgery in a tertiary care hospital, Kolkata. Which include Gastric, Duodenal, Jejunal, Ileal, Sigmoid& Rectal Duplication Cysts. Preoperativly diagnosed by various types of imaging modalities & treated accordingly. In most of our cases diagnosis were confirmed only during or after operation..

Key Words: Pediatric, gastrointestinal tract, duplications

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Abstract: The present procurement rates of surgical grade corneas are insufficient to meet the ever increasingcorneal transplantationneeds in India, posing a major challenge in eliminating corneal blindness. The major reasons for this arethe lack of proper knowledge and motivation in the masses.This cross sectional study was conducted to assess the awareness and knowledge of eye donation amongstpatientsand their attendants in a tertiary care hospital of Western India and to use this information to identify the possible interventions to increase the rates of eye donation.Two hundred and eighty two literate health care seekers were selected to answer a pretested semi-structured questionnaire in local language, during the National Eye donation Fortnight 2018. Questions were based on the socio-demographic details and assessment of the awareness and knowledge of.......

Key Words: corneal blindness, eye donation awareness, knowledge, health care seekers, strategies,motivation

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Abstract: PURPOSE: Extent of ocular toxicity and clinical findings due to Holi colors. A three years study 2017 to 2019. Methods: A three consecutive years, retrospective study involving the patients presenting with holi colors related toxicity in holi festival years 2017 to 2019. Results: In 2017 year; out of total 22 patients, 17 (77.27%) were mild, 3 (13.63%) were moderate and 2 (9.09%) were severe injuries seen. In 2018 year; out of total 16 patients, 10 (62.5%) were mild, 4 (25%) were moderate and 2 (12.5%) severe injuries seen.....

Key Words: Holi colors, ocular toxicity or injuries

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