Background: In spite of the advances in surgical techniques and antimicrobial molecules, gastrointestinal perforations still remain highly fatal. Delay in diagnosis as well as referral is often attributed to be the cause behind the high mortality caused by this condition. The aim of the study was to elucidate the etiological factors of gastro intestinal perforation as well as postoperative outcome among patients undergoing treatment at a tertiary care centre.Methods: This was a Descriptive study of patients admitted with gastro intestinal perforation in the General Surgical wards of Government Medical College, Trivandrum from March 2014 to February 2015. The demographic, clinical, operative and post-operative findings were entered into a structured performa and analyzed statistically.Results: Atraumatic perforation was found to predominate over traumatic perforations. Most of the atraumatic perforations belong to the age groups between 21 and 30. Also, there is a high male predominance among these patients. Proximal gastrointestinal tract injuries predominate much more than distal ones. Increased morbidity is seen if there are associated co morbidities and risk factors including smoking and alcohol abuse. Mortality rate is highest in traumatic injuries involving colon and rectums.Conclusions: Mortality due to perforation peritonitis is still a challenge to the surgeon and burden to the society. Early diagnosis and treatment will positively alter the outcome of a gastrointestinal perforation and can be ensured only by timely arrival of the patients to hospital and subsequently by early intervention. This in turn depends mostly on strengthening the primary care and referral services.
Background: Mass iodization of table salt was introduced by the Government of India to treat as well as prevent iodine deficiency problems including goitres. However, even after so many years of introduction of iodized salt, the number of patients reporting with multi nodular goiter to the hospitals in Kerala seems to be high. The coastal districts of Trivandrum and Kollam report especially high prevalence of goitres and subsequently thyroidectomies. The aim of this study was to find the prevalence of iodine deficiency among patients with multi nodular goiter in South Kerala.Methods: This was a cross sectional study of 300 patients admitted with multinodular goitre in the general surgical wards of Government Medical College Trivandrum, Kerala, India. From June 2013 to June 2014, these patients were evaluated clinically and with the investigatory facilities available at this institution. Their urine spot iodine excretion levels were measured at the laboratory of state iodine deficiency control cell, Trivandrum, Kerala, India.Results: Out of the 300 cases, 6 patients were found to have mild iodine deficiency. Mean iodine level was normal at 170 microgram per decilitre. The prevalence of iodine deficiency in multinodular goiter cases studied was found to be 2%.Conclusions: The high prevalence of multinodular goiter cases in Kerala cannot be sited per se as due to iodine deficiency as only 2% of the total number of cases studied had low urine iodine levels. This raises a question whether the salt iodization programme needs to be re-analyzed and possibly re-structured for the state of Kerala.
Background: Thyroid diseases are highly prevalent in India, especially in the southern states. Evaluation of thyroid pathologies revolves mainly on imaging and cytology. Recent advances in thyroid imaging have greatly improved the diagnosis, treatment and follow-up in thyroid diseases. Though there are advanced modalities including Computed Tomography and Magnetic Resonance Imaging, Ultrasonography remains the cornerstone for the evaluation of thyroid gland, due to its ubiquitous availability and cost-effectiveness. The objectives of the study were to find out the diagnostic accuracy of ultrasonography in thyroid swellings and to find out the most reliable diagnostic feature of thyroid malignancy in ultrasonography.Methods: This was an observational study, conducted on 71 patients admitted to the General surgical wards of Government Medical College, Trivandrum, with thyroid swellings, for a period of 18 months. For all these patients, ultrasound scan of the thyroid gland was done on an ultrasound machine with a 17/5 MHz linear transducer, by experienced faculty.Results: Ultrasonography was found to have a sensitivity of 87.2% and a specificity of 79.2% in diagnosing thyroid pathologies. The most common malignancy of thyroid found in the study was papillary carcinoma and the most reliable ultrasound finding suggestive of malignancy was microcalcification.Conclusions: As per the present study, it is concluded that high resolution ultrasonography is very useful in diagnosing the nature of thyroid swellings, with an accuracy rate of 84.5%. Ultrasonography is a valuable diagnostic tool in the evaluation of thyroid diseases and is the imaging modality of choice.
Background: Hashimoto's disease is a chronic, autoimmune form of thyroiditis and is one of the most common causes for hypothyroidism. Many studies have found an association between Hashimoto's thyroiditis and various other thyroid pathologies, including cancers. The objectives of the study were to look for any association between Hashimoto's thyroiditis and other forms of thyroid diseases and to analyse the pattern of patients treated with Hashimoto's thyroiditis. Methods: This was a retrospective study conducted at a tertiary care centre from December 2008 to January 2014. Patients with Hashimoto's thyroiditis confirmed by histology were selected as the cases. Their clinical and biochemical data and post-operative histopathological reports were collected and analysed. Results: 300 patients who underwent thyroidectomy were found to have a diagnosis of Hashimoto's thyroiditis. 97.33% of the patients were females. Maximum patients belonged to the 31-40 age group. Of the 300 patients, 61.67% had other associated pathologies. The maximum association was with colloid goiters, followed by adenomas and malignancies. Among the malignancies, 80.65% were papillary cancers while the rest were follicular cancers. There were no cases of other malignancies associated with Hashimoto's thyroiditis. Conclusions: Hashimoto's thyroiditis is fairly common in the studied population, mostly among females. It is associated with other thyroid pathologies including differentiated cancers. Lymphoma is not found to be associated with Hashimoto's disease in our population. Hashimoto's thyroiditis thus forms a major share of goiters leading to thyroidectomy in Indian population. However, the decision to operate should be primarily governed by the associated cytology.
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