Background: Laparoscopic cholecystectomy (LC) can be the easiest or the most difficult laparoscopic operation. Conversion to open surgery has been a traditional marker of difficult LC. Recent studies have shown that C-reactive protein (CRP) may be helpful to surgeon in knowing the pathological condition of gall bladder before removal. Aim of this study was to evaluate the role of CRP as a predictor of difficult LC or its conversion.Methods: This study was done from 1 march 2016 to may 2017 in department of general surgery, SMS hospital Jaipur, under single unit. All patients with cholelithiasis admitted in single unit of SMS hospital undergoing LC were included in this study. Exclusion criteria were high BMI (>35), proven congenital anomaly of gall bladder, previous abdominal surgery, any conditions increasing CRP and immunocompromised patients. CRP was done for each patient.Results: Mean age of our 148 patients was 50.41 years. Female to male ratio was 4.28:1. Mean CRP was 22.2±18.2 mg/dl for simple cholecystectomy, 46.5±32.0 mg/dl for difficult cholecystectomy and 83.6±22.4 mg/dl for laparoscopic converted to open cholecystectomy, which was statistically significant (p value 0.0002).Conclusions: CRP is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high CRP have higher chance of complication intraoperative and high chances of conversion to open.
Background: Tetanus is an acute neurological fatal disorder caused by anaerobic spore forming bacillus Clostridium tetani, which produced an exotoxin (Tetanospasmin) in a wound. Purpose of this study was to find out the clinico-epidemiological factors of tetanus and how we can modify or minimize the outcome of this disease.Methods: This prospective, observational study was conducted in isolation ward in department of general surgery, SMS hospital Jaipur (Rajasthan) from 1 March 2016 to October 2017. Two hundred patients with clinical diagnosis of tetanus, who were admitted in single unit of SMS hospital, recruited in this study. Patients with age less than 1 yr were excluded. After admission, patient’s detailed history and thorough clinical examination done. The day to day progress of the cases was followed till the time of their discharge from the hospital. Outcome variables were age, gender, geographical area, causes of tetanus and site of injury, precipitating factors, role of baclofen, morbidity, cured and mortality.Results: In this study, mean age of patients were 17 years and male to female ratio was 2.44:1. Most of patients were from rural backgrounds with rural to urban ratio of 6.14:1. Overall mortality in present study was 16.5%. The severity of disease directly related with mortality. The mortality for mild, moderate and severe tetanus was 0%, 1.9% and 68.1% respectively.Conclusions: Though tetanus is a vaccine preventable illness, its prevalence is high in our country. The incidence of tetanus can be reduced by: strengthening of primary immunization programme; proper wound management and giving prophylactic tetanus immune globulins along with tetanus vaccine.
Metaplastic breast carcinoma is very rare neoplasm. Authors report a case of metaplastic breast carcinoma containing characteristic features of infiltrating ductal carcinoma and chondrosarcoma. A 62-year-old female presented with complaint of a lump in the right breast for the last 2 years. FNAC was suggestive of mucinous tumour. Tru-cut biopsy had been performed outside the institution, which was suggestive of a Ductal carcinoma with mucinous component. Modified radical mastectomy of the right breast was performed and histopathology was suggestive of infiltrating ductal carcinoma and chondrosarcoma of the right breast. All resected lymph nodes were free of metastasis. Immunohistochemistry was suggestive of a metaplastic carcinoma with components of ductal carcinoma and chondrosarcoma with moderately positive ER, negative PR, positive Pancytokeratin in ductal carcinoma component, positive S-100 and KI-67.
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