Introduction: Appendicitis is the inflammation of vermiform appendix, one of the most frequent diagnoses for emergency department visits, resulting in hospitalization. Accurate and prompt diagnosis of acute appendicitis may reduce the incidence of morbidity and mortality resulting from perforation and other gravid complications. Aims:To evaluate the effectiveness of Alvarado scoring system in preoperative diagnosis of acute appendicitis. Methods: The study of 100 patients attending to Nepalgunj Medical College and Hospital during the year August 2021 to July 2022, with symptoms of acute appendicitis were included. The Alvarado score for each patient was evaluated. All the subjects included were scheduled for open appendicectomy and the specimens were subjected for histopathological evaluation. Patients with score less than 7 were categorized as Group A, whereas greater than 7 were categorized as Group B. Results: Among 100 patients, there were 58 males and 42 females. Symptoms like pain in right iliac fossa (97%), nausea and vomiting (85%) and anorexia (41%) were common. Positive signs were tenderness in right iliac fossa (92%) and fever (53.5%) with leukocytosis (73%) and neutrophilia in 62 cases (88%). Of 100 patients 27 belonged to Group A, whereas 73 belonged to Group B. 17 patients out of 27 in Group A were diagnosed with acute appendicitis on histology, whereas, 10 showed negative results. 69 out of 73 subjects in Group B were diagnosed with acute appendicitis on histology, whereas 4 showed negative results on histology. The rate of negative appendectomy was significantly higher in group A than group B. The overall sensitivity, specificity, positive predictive value, negative predictive value were 80.20%, 71.42%, 84.52% and 37.03% respectively. Conclusion: The Alvarado score when more than 7 enables risk determination in patients presenting with abdominal pain, linking the probability of appendicitis.
Introduction: Almost all ureteric stone migrates from kidney. The drugs commonly used to assist in the passage of bigger calculi include alpha-blockers, calcium channel antagonists, phosphodiesterase inhibitors, corticosteroids. Tamsulosin is an alpha-1 adrenergic receptor antagonist known to augment the stone expulsion rate. Aims: To evaluate the efficacy of Tamsulosin versus fluid therapy in management of urolithiasis. Methods: The study was carried out on 100 patients (divided into 2 groups) at Nepalgunj Medical college Hospital Nepalgunj from May 2020 to April 2021,between 18-50 years of age of either sex, presenting with a symptomatic urinary calculus as demonstrated on imaging. Group 1 received 0.4mg of tablet tamsulosin once daily for 4 weeks, whereas Group 2 fluid therapy for a period of 4 weeks or until expulsion of stone. Results: Group A reflected 88% (40 patients) expulsion rate, whereas Group B reflected 72.0% (36 patients) expulsion rate. There was a statistically significant difference in the expulsion rate amongst both the groups. 92.0% (46 patients) subjects in Group A demonstrated stone expulsion within 4 weeks, mean time being 8 days. In comparison only 70.0% (35 patients) subjects in Group B demonstrated stone expulsion within 4 weeks, mean time being 14 days.Use of tablet diclofenec 100mg was lower in Group A in comparison to Group B. Conclusion: Tamsulosin is a safe and effective pharmacological agent in management of ureteric stones as it known to increase overall stone expulsion rate, reduced stone expulsion time, decrease acute attacks by acting as a spasmolytic, and fewer pain episodes. It may be considered as a conservative therapeutic option before more invasive procedures like ureteroscopic removal or Extracorporeal shock wave lithotripsy.
Introduction: Appendicitis is very common surgical emergency and incidence of appendicular lump is about 2-6%.There are different approaches for management of appendicular lump among which most common and widely accepted approach is managing lump conservatively with interval appendicectomy 6 weeks after resolution of inflammation. The aim of the study is to evaluate the efficacy of the conservative management in appendicular lump. Materials and methods: Retrospective study of the 43 patients admitted with a diagnosis of appendicular lump from March 2015 to February 2016 at Nepalgunj medical college, Nepalgunj were carried out. Result: Out of 204 patients of appendicitis 43(21.07%) patients were found to have appendicular lump. Age ranged from 6 to 81yrs old. Appendicitis was found to be common at the age range of 21 to 30 years (44.18%).patient reported after 3 to 8 days of Onset of symptoms but most of the patients reported at 5 to 6 days of onset of symptoms. Among 43 patients, 40 patients (93.01%) managed successfully with conservative management. Only three patients (6.97%) developed complications. Out of these conservatively managed, 18(41.86%) underwent interval appendicectomy, 19(44.18%) patients lost to follow up,3(6.97%) had recurrent appendicitis. Conclusion: Our study concluded that most of the appendicular lumps can be managed conservatively with few complications, which can be managed with immediate intervention.
Introduction: Intestinal anastomosis is a surgical procedure executed to ascertain communication between two segments of the intestine, after the removal of pathology affecting the bowel. It depends on factors like anastomosis site, bowel capability and the type of the pathogenesis. Aims: To compare single versus double layer method in terms of time taken for anastomosis, hospital stay, post-operative leak and cost effectiveness. Methods: This is a comparative hospital based study carried out at the department of surgery Nepalgunj Medical College from September 2017 to August 2020. Patients requiring emergency laparotomy with resection and anastomosis of small bowel were included. Patients requiring colonic anastomosis, diversion stoma and multiple anastomoses were excluded. Patients were divided in to two groups- single layer and double layer group. Each group was compared for outcome measures like time taken to construct the anastomosis, hospital stay, post-operative leak and cost of surgery. Results: The total number of patients was 50. The mean age was 45.57±17.42 years for single layer and 48.67±18.16 years for double layer group. Time taken for intestinal anostomosis in single and double layer were 18.28±5.08 and 25.27±6.18 respectively which was statistically significant (p - <0.012). Hospital stay was 10.9±1.43 in single layer and 11.2±1.87 which was statistically not significant (p - >0.342). Similarly, the anastomosis leak was seen in 2 patients in single layer and 3 in double layer. Which was statistically not significant (p - >0.318). While comparing the cost effectiveness single layer technique was cost effective. Conclusion: The single layer anastomosis is a preferable, safe and economic technique in comparison to the conventional double layered anastomosis.
Background: Anal fissure is a common benign condition presenting as severe pain, constipations and bleeding per rectum. It is defined as longitudinal tear or defect in anal canal skin. Surgical treatment of this conditions requires hospital admission and complications, like bleeding, infection and to its severe extent continence disturbances. That warrants a new treatment modality as pharmacological sphincterotomy i. e topical GTN (glycerine trinitrate) whose effects are reversible, cost effective and simple. Objective: The objective is to compare the effectiveness of topical GTN over lateral sphincterotomy in terms of pain management and healing of fissure. Method: This was a comparative study carried out in the department of Surgery at Nepalgunj Medical College, Teaching Hospital. Two groups were created and 25 patients in each group were put randomly. First group (Group 1) used topical GTN whereas second group(Group 2) underwent lateral sphincterotomy for treatment of fissure. The two groups were reassessed at 4 and 8 weeks for pain and fissure healing. Result: Total number of patients was 50. Each group consisted of 25 patients. The male to female ratio in group 1 was 1:1.5 and in group 2 it was 1: 1.8. In group 1 patients after 4 weeks of application of GTN pain reduced from the mean of 80±15 at the time of presentation to 50±9.27. When these patients were seen after 8 weeks, the pain reduction on VAS was nil in 21 patients out of 25. In group 2 the mean score fell from 75±15 to 20±10 after 4 weeks and at 8weeks 23 out of 25 patients didn't have any pain. It was observed that the pain reduction and healing were faster in group 2 patients when evaluated after 4 weeks (p=0.0029). but at the end of 8 weeks both group patients were similar in terms of pain reduction and healing of fissure (p=.28). Conclusion: According to study local GTN application is as effective as lateral sphincterotomy with cost effectiveness, simple with tolerable side effect and no continence disturbances.
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