Background: In many studies it was noticed that following a laparoscopic cholecystectomy (LC), liver function parameters were disturbed. The carbon dioxide pneumoperitoneum causes changes in the splanchnic microcirculation and can affect cardiac, pulmonary, liver and kidney physiology. Alterations in intracranial pressure, blood acid- base control and the immune system have also been seen. This study was done to know the effects of carbon dioxide pneumoperitoneum on liver function tests in LC. Aim of the study was to study the significance of alterations in Liver function tests and procedure’s safetyMethods: Blood samples of 100 patients who underwent laparoscopic cholecystectomy preoperatively once and post operatively after 24 hours were collected. These blood samples were tested for LFT. The pre op and post op levels of these liver function test values were compared.Results: The level of serum AST, ALT, bilirubin (total) and ALP were increased significantly during the first 24 hrs. Postoperatively after laparoscopic cholecystectomy as compared to baseline values and the levels of serum albumin and total proteins were decreased.Conclusions: There may be a transient elevation of hepatic enzymes after LC and the major causative factor seemed to be CO2 pneumoperitoneum.
Background: One of the independent risk factor for erectile dysfunction is diabetes mellitus. The present study planned to determine the prevalence and factors associated with ED in DM.Methods: A one year cross-sectional study on a total of 208 patients with type 1 or 2 diabetes. National Institutes of Health (NIH) approved questionnaire for International Index of Erectile Function (IIEF) was used to interview each patient to assess for ED.Results: In this study 12.98% of patients had ED score between 13 to 18 suggestive of mild to moderate ED and 9.62% with 19 to 24 scores suggestive of mild degree. The prevalence of erectile dysfunction was 32.21%. The mean age in patients with erectile dysfunction was significantly high (58.40±10.96 years) compared to those without erectile dysfunction (51.00±11.16 years) (p<0.001) Of the 119 patients with duration of diabetes between one to five years 42.02% had ED and of the 3 patients with duration of more than five years 66.67% had ED (p<0.001). Prevalence of ED was higher in patients with HbA1c levels between 7.0 to 8.5 (32.76%) and >8.5 (37.07%). Prevalence of erectile dysfunction was higher in patients with history of smoking (63.64%) (p<0.001) and alcohol intake (51.85%) (p<0.001). The prevalence of erectile dysfunction was also significantly high in patients with history of hypertension (59.7%) (p<0.001).Conclusions: The ED in patients with diabetes mellitus was significantly prevalent with age, duration of diabetes, history of hypertension, cardiovascular disease, glycemic control and hypertriglyceridemia.
CONTEXTEarly postoperative pain is common and predominant complaint which results in prolonged hospital stay. AIMSThe present study explores effectiveness of intraperitoneal instillation of tramadol on postoperative pain relief and emergence of adverse effects following laparoscopic appendectomy. SETTINGS AND DESIGNThe present one year double blinded randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, from January 2014 to December 2014. METHODS AND MATERIALA total of 60 patients undergoing elective laparoscopic appendectomy were enrolled. The selected patients were divided into two groups of 30 each as group A and B based on the drugs that is intraperitoneal tramadol 150 mg (Diluted in 40 mL of normal saline) and 40 mL of intraperitoneal normal saline respectively. STATISTICAL ANALYSIS USEDThe categorical data was expressed as rates, ratios and percentages and comparison was done using Fisher's exact test and chisquare test. Continuous data was expressed as mean±standard deviation and the comparison was done using independent sample 't' test. A probability ('p' value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant. RESULTSIn group A, 53.33% of the patients were males compared and 46.67% in group B (p=0.606). The mean age in group A (26.13±9.96 years) and group B (31.43±14.81 years) were comparable (p=0.110). Both the groups were comparable in terms of demographic characteristics, clinical presentation and vitals (p>0.050). The mean VAS scores at beginning were significantly low in group A (1.53±0.94) compared to group B (2.93±1.17) and similar trend was noted at all the durations through the post-operative period (p<0.001). Most of the patients in group A did not request for the post-operative analgesia (56.67% vs 6.67%; p=0.011). In group A, significantly lower numbers of mean doses were administered (0.57±0.82 vs 2.20±0.92; p<0.001). The frequency of postoperative rescue analgesia significantly low in group A at 15 minutes, 30 minutes, 6 hours and 12 hours as compared to group B (p<0.050). Adverse events were noted in 23.33% of the patients with group A compared to 10% in group B (p=0.166). The mean hospital stay in group A was significantly low (p=0.017). CONCLUSIONSIntraperitoneal instillation of tramadol offers effective post-operative visceral pain relief in laparoscopic appendectomy and incidence of adverse effects is well acceptable. KEYWORDSIntraperitoneal Instillation; Laparoscopic Appendectomy; Post-Operative Pain; Tramadol. HOW TO CITE THIS ARTICLE:Pratap V, Bellad AP. Analgesic efficacy of intraperitoneal tramadol vs. placebo for postoperative pain relief following laparoscopic appendicectomy: a double blinded one year randomized control trial: single centric, hospital based study.
INTRODUCTION : Diabetes mellitus is a common metabolic disorder, prevalence steadily increasing over the past few decades. The complications associated with it , hence , has also increased. Diabetic foot ulcer is one of the most serious complications , utilizing resources, significantly contributing to the morbidity of the patient. There is hence, a need to correctly identify the severity of the diabetic foot ulcer so as to plan the appropriate management and to help in counselling of such patients. AIM : To assess severity in diabetic foot ulcer using diabetic ulcer severity score. MATERIAL AND METHODOLOGY : This is a hospital based longitudinal study , conducted on 93 study subjects admitted with diabetic foot ulcers. Diabetic ulcer severity score was calculated for each patient . The score was calculated by adding scores of the respective parameters constituting site of ulcer, number of ulcers, presence/absence of pedal pulsations, presence/ absence of bone involvement. Each patient was followed up for a period of 6 months , or earlier in case of patient undergoing minor/major amputation. After the study was conducted , analysis was done by calculating various percentages of healing /amputation with respect to the score. RESULTS : Out of the total 93 study subjects , 74.2% were males. The mean age was calculated to be 59.6 years with maximum number of subjects being in 55-60 years of age group range. Majority of them had diabetic ulcer severity score of 2 (42%). Out of the total study subjects , 58% had a complete healing , 28% underwent minor amputation whereas 14% underwent major amputation. 100% of the study participants with score 0 had healing of ulcer which decreased to 85% for score 1 , 53.8% for score 2 , 6.25% for score 3 and 0% for score 4. This was suggestive of poorer chances of healing as the diabetic ulcer severity score increases. CONCLUSION : With the increasing incidence of patients diagnosed with diabetes mellitus , the rate of complications of diabetes has also increased over the past few decades including the risk and occurence of diabetic foot ulcers There is an increasing need for diabetic foot ulcer prognostication systems and universal use of the same. Thus ,we recommend the use of diabetic ulcer severity score as a prognostic tool to assess the severity of the diabetic foot which will further enhance communication and counselling of the patient and will help in providing the appropriate treatment to such patients.
Background: Several surgical wound closure techniques are used including conventional sutures and skin adhesive compounds. However, tissue adhesives have evolved as an improved alternative to sutures. Few data are available on the tissue adhesives in the closure of inguinal hernia skin incisions. The aim of this study was to determine the effectiveness of tissue adhesive in the closure of inguinal hernia skin incisions compared to conventional sutures.Methods: A 1-year randomized controlled trial was conducted including 60 patients with inguinal hernia. Based on closed envelope method, patients were randomly allocated into two groups: group A and B. Patients of group A underwent skin closure with cyanoacrylate glue and that of group B underwent skin closure with conventional sutures. Demographics and clinical characteristics of the patients were recorded. On postoperative day 3, the patients were evaluated for swelling, fever, redness and discharge from the wound. SPSS 20 was used to analyze the data. Chi-square test, Fisher’s exact test, and independent sample t-test were employed in the analysis of data.Results: All the patients included in the present study were men. The age of the patients ranged between 18 and 50 years in both the groups. All patients had chief complaint of swelling in the inguinal area. The clinical characteristics of the study population including sex, mean age, weight, pulse rate, systolic blood pressure, and diastolic blood pressure were comparable in group A and group B (P>0.050). The mean duration of surgery was significantly lower in group A (66.67±4.61 min) compared to group B (71.21±6.90 min; P=0.004). On Postoperative day 3, very few patients in group B had swelling (6.67% vs. 16.67%; P = 0.228), fever (6.67% vs. 16.67%; P = 0.228), discharge (6.67% vs. 16.67%; P = 0.228), and redness (6.67% vs. 10.00%; P = 0.640) than in group A.Conclusions: Tissue adhesive is superior and equally safe as compared to conventional suture in terms of duration of surgery and postoperative surgical complications. However, large studies should be conducted focusing on infection, follow-up period, and cosmesis as the outcomes.
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