Background: Indwelling ureteric stents produce varying degrees of complication and discomforts ranging from frequency and urgency to haematuria or infection and signicantly impacts quality of life. Aim: assess the effectiveness of Tamsulosin and tolterodine in improving the lower urinary tract symptoms of patients with indwelling double –J- ureteric stents following ureterorenoscopy Methods: The study was conducted in randomized, double-blind manner in department of general surgery , NMCH ,Patna from 1st January 2014 to 10th June 2015. In total, 40 patients with double J stent were randomly divided into two groups (group A, n: 20, group B, n: 20 ). Each patient randomly received one pack of drug in different colours of the content to take Tamsulosin 0.4 mg before sleep, Tolterodine 4 mg once a day : group A received Tolterodine , group 2 Tamsulosin a for 1 month in a double-blind manner. Ureteral stent-related morbidity indices which analysed included urinary symptom, pain, general health, quality of work and sex scores were measured by Ureteral Symptom Score Questionnaire for rst and fourth weeks after drug consumption and the rst week after double J stent removal. Results: No signicant change in various domains of USSQ like urinary symptoms , body pain, general health , work performance , sexual matters. Conclusions: Both drugs minimise the symptoms however a larger well-designed study needs to be conducted to conrm the ndings.
Background: Primary closure of common bile duct following choledocholithotomy is now being considered as other possibility to the traditional method. This study is designed to analyse the outcome of primary common bile duct repair in terms of mean operation time, duration of hospital stays and post-operative morbidity. The objective of the study was to assess feasibility of safe primary closure in order to achieve early discharge and define case selection for this purpose.Methods: Study was conducted in Sikkim Manipal institute of medical sciences, gangtok on patients operated between January 2017 and April 2018. Primary closure was performed in 16 patients and choledochotomy with T-tube drainage was performed in 16. The primary endpoints were morbidity, the bile drainage quantity, operative time, post-operative stay, time until return to work and postoperative complications and hospital expenses were recorded for each group.Results: Mean total duration of the surgery was 132.44 minutes in primary closure group while it was 146.31 minutes in T-tube group and this difference of around 14 minutes between two groups was statistically significant. Patients were discharged on the 9th day at average in the primary closure group, while in the T-tube they were discharged on the 13th day on average. This difference was statically significant.Conclusions: Primary choledochorraphy is a safe option in selected patients undergoing choledocholithotomy, provided common bile duct patency and clearance can be confirmed intra-operatively.
Introduction: Even though Laparoscopic Cholecystectomy (LC) is far less traumatic compared to open cholecystectomy, it is still associated with considerable postoperative pain. Apart from routine analgesics, several attempts have been made to establish intraperitoneal analgesia as a useful perioperative pain relief modality. Aim: To determine the optimal concentration (or dilution) and volume of intraperitoneal lignocaine among three preparations of 100 mg lignocaine for postoperative analgesia after LC. Materials and Methods: Study was designed as a randomised controlled, double blinded study. Patients undergoing elective LC for symptomatic cholelithiasis were included in the study. Patients (n=105) were randomised into three groups. Group A received 5 mL 2% lignocaine in 5 mL normal saline (100 mg/10 mL=10 mL solution of 1% lignocaine). Group B received 5 mL 2% lignocaine in 100 mL of normal saline (100 mg/100 mL=100 mL solution of 0.1% lignocaine). Group C received 5 mL 2% lignocaine in 500 mL normal saline (100 mg/500 mL=500 mL solution of 0.02% lignocaine). Three groups were compared for postoperative pain using Visual Analog Score (VAS), requirement of rescue analgesia, nausea and vomiting, vital parameters (heart rate, respiratory rate, mean arterial pressure, transcutaneous saturation) and hospital stay. Analysis of Variance (ANOVA) was used to compare mean and χ2 test was used to compare categorical data. Results: The mean VAS of group B (100 mg lignocaine in 100 mL of normal saline) was significantly lower than the overall mean VAS at different postoperative time intervals, and consistently lower than those of groups A and C. The study found a consistent (r=0.15 to 0.33) and significant (p<0.05 at all-time intervals) positive correlation between pain and duration of surgery. Demand for rescue analgesia was significantly higher in group A. Pulse rate was least in all postoperative time and significantly lower at 4th hour. The difference in mean arterial pressures, respiratory rate and transcutaneous saturation among the three groups was not significant statistically. Nausea and vomiting were uncommon. Conclusion: The study concluded that for a total dose of 100 mg lignocaine, 100 mL solution is more effective compared to 10 mL or 500 mL solution.
Background: The physiological obstruction of the bile flow associated with appendicular pathology leads to hyperbilirubinemia, which can be used as a predictive factor of appendicular perforation. Objective/Aim : Primary objective of this study was 1. To evaluate hyper-bilirubinemia associated with appendicular pathology. Secondary objectives of this study were 1. To evaluate elevated bilirubin level as an additional diagnostic marker for severity of acute appendicitis. 2. To evaluate whether elevated bilirubin levels have a predictive potential for the diagnosis of appendicular perforation. Methods: The study was conducted in the department of Surgery, Central Referral Hospital, associated to Sikkim Manipal Institute of Medical Sciences, Gangtok. The study was designed as a prospective observational study spanning over a time of 12 months, with enrolment of patients from 12.05.2016 to 11.05.2017. A total of 52 patients with clinical diagnosis of features of acute appendicitis or appendicular perforation admitted in the surgical ward were included. Results: Patients with appendicular perforation (n=14) were divided based on location of perforation:9(64.3%) had perforation at apex, 2(14.3%) at base and 3 (21.4%) had perforation at the body of appendix. Patient who had perforation at the apex of appendix had a mean total bilirubin of 1.84 mg/dl, 7 (77.8%) of these patients had elevated total bilirubin while an equal number had elevated direct bilirubin. Two (22.2%) had normal total bilirubin and value. Patients having perforation at base had a mean total bilirubin of 1.11 mg/dl and direct bilirubin of 0.56 mg/dl. Though one of these had elevated total bilirubin the other had normal value. On the other hand, both had elevated direct bilirubin. The patients having perforation on the body of appendix had mean total bilirubin and direct bilirubin 1.51 mg/dl and 0.57 mg/dl respectively. Both these patients had elevated total bilirubin and direct bilirubin. It was found that both total and direct bilirubin increased in cases having perforation of appendix, but these elevations was not statistically significant. Conclusions: Based on the data obtained, the bilirubin levels cannot be used as an indicator for: a) Severity of acute appendicitis b) appendicular perforation.
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