The kidney is the most common genitourinary organ injured from external trauma, occurring in 1% to 5% of all injuries. Non operative management of renal injuries with renal salvage as the primary aim has gained much support in the past decades; though paediatric data is limited. Here we present a case of unilateral complete transection managed conservatively and the renal salvage was possible with retaining normal function.
Introduction: Central line associated blood stream infection (CLABSI) is a primary blood stream infection in a patient that had a central line within the 48-hour period before the development of bacteraemia and is not related to an infection at another site. It is often associated with serious infectious complications resulting in significant morbidity, increased duration of hospitalization and additional medical costs. Objective: We aimed to study the course of infection, microbiology of CLABSI, & to identify the degrees of severity of sepsis associated with CLABSI. Materials & Methods: Patients admitted in Intensive care units who fulfilled the inclusion criteria were enrolled. Various demographic, microbial and patients characteristics were noted along with outcome using a prestructured proforma. Results: We studied 58 patients in ICU in which males were common, Sepsis seen in 43% of patients, 37% had Staph. Aureus, and the mortality was 24.1%. Conclusion: CLABSI infection is best prevented rather than cured. It has mortality as high as 24.13%. It can manifest with varying degrees of severity of sepsis. Organ Dysfunction, multi organ involvement, TLC abnormalities, Oliguria, altered mental status, Hypotension are all markers of poor prognosis. More scientific data on the subject is required to formulate guidelines and protocols for prevention and treatment of CLABSI.
Background: The aim of this study is to present their initial 5-year experience in the treatment of fistula-in-ano by means of VAAFT (Video-Assisted Anal Fistula Treatment).Methods: 76 patients were competent for the VAAFT procedure. Patients were subjected to routine diagnostic tests. 20 patients had classical fistula surgery. In the remaining 56 patient full procedure i.e. diagnostic fistuloscopy, closing the internal ostium, and coagulation of the fistula canal was done. The mean observation period was 23 months.Results: Majority of the cases, inter-sphincter fistula and multiple branching was observed during the diagnostic fistuloscopy. Nine patients had additional fluid compartments. In 56 patients subjected to the full VAAFT procedure the internal ostium was closed using a linear stapler. A recurrence of fistula was observed in one, while non-healing was seen in two patients. Major complications like stool and gas control deterioration (based on the FISI scoring) were not observed in VAAFT operated patients.Conclusions: The VAAFT method preserves sphincter competency, no major intraoperative and postoperative complications were observed. The recovery rate is observed to be comparable with other techniques without the risk of incontinence. It is one of the best method enabling intraoperative visualisation and identification of the internal ostium and fistula canal. Initial optimistic results require further investigations on a larger group of patients.
BACKGROUND During the Covid19 pandemic, the potential spread of the SARS-CoV-2 virus during surgeries, especially in laparoscopic surgeries, is a key concern. Surgical smoke released during laparoscopic surgeries may cause viral transmission. Therefore, the risk and benefits of viral transmission during laparoscopic surgery needs to be carefully evaluated. For the safety of healthcare professionals are adapted from the previous pandemics/epidemics, the preventive measures especially applicable to laparoscopic surgeries include care during CO2 insufflation/desufflation, minimal use of energy sources, personal protection measures are recommended. OBJECTIVE The aim of this article is to review the contemporary literature pertaining to the risk of conducting laparoscopic surgeries during the Covid-19 pandemic. In addition, we summarize the relevant safety protocols for the patients, surgical team, anesthetists, and the operation room staff. METHODS A systematic literature search was performed using the key words: Covid-19 laparoscopy, Surgical smoke, Covid safety in operation rooms, Laparoscopic surgeries and Covid safety, prevention, Aerosol transmission, Laparoscopic surgery, Covid-19’ Search articles were considered from the aims of the articles, nature, safety protocols, and risk mentioned in the literature. RESULTS Although the initial guidelines advocated by various organizations stated that Laparoscopy generally should not be used as it is considered to carry some risks of aerosol-type formation and infection and considerable caution is advised. Though some reports have suggested the use of Laparoscopy in selected cases where clinical benefit to the patient substantially exceeds the risk of potential viral transmission to the surgical team. CONCLUSIONS Based on this review of the current scientific knowledge, no scientific evidence was found to support the use of open surgery over laparoscopy to reduce viral transmission of COVID-19 if the advocated Covid-19 guidelines are followed strictly; however, there is still much to discover about the viral transmission.
Background: Spleen is one of the most commonly injured intra-abdominal solid organs. If undiagnosed in earlier stage patient may even present with shock. Even though management depend on grade on splenic injury, primary goal remains stabilizing the patient. The operative interventions are done by open or laparoscopic technique which may be splenorrhaphy or splenectomy.Methods: A prospective observational study on 52 patients with splenic injury was performed. The study period was 27 months. Patients with clinical and radiological signs of splenic trauma were categorised and operative/ non-operative treatment was given as per protocol. The surgical and nonsurgical outcomes were evaluated during inpatient stay and follow-up was kept.Results: Fifty-Two patients were analysed comprising 36 male and 16 females. Most common mode of injury was road traffic accident followed by falls. Grade III injury was commonest, while rib fracture was commonest associated injury. Pneumonia was a frequent complication postoperatively.Conclusions: Splenic injury is a real threat after blunt abdominal trauma in young population. Vaccination and equalae of OPSI (Overwhelming post splenectomy infection) must be kept always in mind after splenectomy. Splenic trauma diagnosed early and treated immediately can save the patient’s life.
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