The actual prevalence of hydatid disease in northern part of India is found more than usually interpreted. The present study has been done on 25 patients suffering from hydatid disease of various sites and treated during June 2009 to November 2011 at JLN Medical College and Hospital, Ajmer, with the aim of studying the clinical manifestations of hydatid disease of different sites and/or organ system and of analysing the morbidity and mortality of hydatid disease. The age, sex, h/o dog contact, duration of hospital stay, clinical presentation, treatment advised, findings and difficulties encountered during operation, and postoperative management of patients as well as morbidity and mortality were recorded and analysed. We observed that the mean age was 40 years. The sex incidence revealed female preponderance in the study (M : F: 1 : 2). Duration of illness in the present study varied from 1 month to 6 years in case of liver hydatid disease. Majority of patients were from rural areas (21) and the remaining (4) from urban areas. Swelling was the most common presenting feature. Incidence of hydatid disease at unusual sites in India is higher than in other parts of the world.
The practice of laparoscopic appendectomy as an ambulatory surgery is uncommon even in apex institutes, more so in developing countries, despite proven feasibility. To promote this practice in the developing countries like ours, we attempted to find the safety and cost effectiveness in such institutions which have limited resources. Thirty cases of symptomatic appendicitis were tried for same day discharge after laparoscopic appendectomies. The results were encouraging with 87% patients discharged on the same day and 13% on the next day in the early morning. Among the next day discharged cases, only 03% stayed for medical reasons (nausea, vomiting, and pain) while 10% stayed as their attendants declined to leave (social reasons), even though they were medically eligible for discharge from the hospital. There were no significant postoperative complications except tolerable pain in all patients and mild to moderate nausea/vomiting in 80%. There was no readmission. The mean length of hospital stay was 11.20 hrs. At the time of discharge all patients were highly satisfied. We concluded that routine same day discharge is safe and feasible after appendectomies in developing countries, with social decline as the main hurdle which can be improved by proper communication.
Negative topical pressure, the general category to which the trademarked VAC therapy belongs, is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum-assisted closure therapy, vacuum pack therapy, and sealing aspirative therapy. The VAC therapy system is trademarked by Kinetic Concepts, Inc., or KCI. It was first reported in 1997. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. Negative-pressure therapy for the closure of wounds accelerates secondary wound healing. High cost is still a hindrance in its use in developing nations. Many modifications were tried, but their efficacy is yet to be proved. In reality, this method is quite cost effective. It is only the lack of understanding and adequate setup which makes this method hard to use. The main objective of this paper is to focus on the cost effectiveness of VAC and its modifications. We want to emphasize the importance of homemade NPT and the use of simple suction devices.
The most difficult problems that follow surgery for pilonidal disease are persistent unhealed midline wound and recurrence. Various innovations were proposed to deal with these problems. The adipocutaneous flap of Karydakis was devised to shift the natal cleft, while Z-plasty involves fasciocutaneous flap. The present prospective randomized trial was conducted on 50 cases of symptomatic or recurrent pilonidal sinuses divided randomly into two equal groups undergoing Karydakis procedure and Z-plasty. The duration of hospitalization for Karydakis procedure was found significantly lesser than that for double Z-plasty (P < 0.001). Similar observations are obtained for duration of wound healing (P < 0.001), work off period (P < 0.001), and the duration of presence of significant pain postoperatively (P < 0.001). The overall complications were more in double Z-plasty. Recurrence developed in 32% of the cases in double Z-plasty group comparable to no recurrence seen in Karydakis procedure. Thus, Karydakis flap was found superior to double Z-plasty having less seroma formation, no local hematoma, and no flap necrosis. Statistically, this comparison was highly significant (P < 0.001). Karydakis flap has some added advantages over double Z-plasty technique like keeping scar away from the midline and flattening of the natal cleft, thus reducing local recurrence rates.
Ropivacaine is an alternative to epidural bupivacaine, with greater selectivity for sensory fibres than motor fibres, thus producing less motor blockade as compared to bupivacaine. The purpose of this study was to evaluate the efficacy of Ropivacaine 0.1% when administered epidurally for the relief of labour pain and to compare it with 0.1% bupivacaine, conducted at Rajindra Hospital Patiala, Baba Farid University of Health and Sciences, on 20 parturients after ethical approval from the institutional review board and obtaining written informed consent. Participants were randomly allocated to the two groups (bupivacaine 0.1% (Sensorcaine) + fentanyl 20 g versus ropivacaine 0.1% (Ropin) + fentanyl 20 g). It was observed that ropivacaine 0.1% and bupivacaine 0.1%, with fentanyl 20 g/mL, produced equivalent analgesia for labour. There were no statistically significant differences in the amount of local anaesthetic used, pain scores, sensory levels, motor blockade, labour duration, mode of delivery, and side effects or patient satisfaction amongst the two local anaesthetics using the intermittent top-up technique. We conclude that the combinations of ropivacaine or bupivacaine with fentanyl achieve equally effective and excellent labour analgesia with no motor blockade and without jeopardizing the safety of the mother and foetus and, hence, are recommended for labour analgesia.
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