A 52-year-old Indian male was presented to the surgical outpatient department with complaints of discomfort in lower abdomen and increased frequency of micturition, occasionally associated with urge incontinence. Patient was experiencing these symptoms, which were progressively increasing for a duration of six months. He did not complain of burning micturition, haematuria and other bowel symptoms. There was no significant past medical history. General physical examination, abdominal exam including per rectal examination were normal.
Osteitis fibrosa cystica, a manifestation of severe hyperpara thyroidism presenting with crippling bone deformities is a rare presentation these days. We report a case of 40yearold male patient who presented with generalized aches and pains and bony deformities. Radiographs showed diffuse osteopenia, brown tumors and pathological fractures of phalanges but common manifestations associated with hyperparathyroidism like pancreatic calcifications and nephrolithiasis were absent. Serum calcium and parathyroid hormone levels were elevated while ultrasound imaging of neck showed the presence of a left lower parathyroid adenoma and was confirmed by Tc99 sestamibi scan. Large parathyroid lesion along with high calcium levels and severely elevated PTH puts this patient in highrisk category for postoperative hungry bone syndrome leading to severe hypocalcemia postoperatively. Hypocalcemia usually results in neuromuscular irritability manifesting as paresthesia, Chvostek and Trousseau sign, carpopedal spasm and even convulsions in severe cases. However, our patient had none of the common manifestations, but developed hypocalcemic cardiac failure postoperatively. Case history and management of case is presented.
BACKGROUND Laparoscopy has been a new entry in the field of surgery with an active history of around just two decades. Today, it is in a position to challenge the conventional surgery which is in use since ages. It is making rapid inroads into various disciplines of surgery. Rapid improvements in optics, along with improvements in energy devices and mechanical stapling devices gave a fillip to acceptance of laparoscopy by the majority of surgeons. Also accumulating data and evidence has started influencing the sceptical, mobilising them to jump into the bandwagon. Barriers to adoption of new techniques, resistance to learning are common to human nature and it is necessary to have a systematic overview of the issues that might crop, so as to be prepared to overcome the problems of accepting laparoscopy into established centres of surgery. AIMS This publication is a reflection of our experience, our trials and tribulations in taking forward the laparoscopy program at our institution. This publication will give an overview of the steps involved in initiation of laparoscopy and aspires to be a source of answers, for day-today issues that crop during the process of learning laparoscopy. METHODS AND MATERIALS Just the way, executing laparoscopic surgery is a team effort, incorporating laparoscopy program in an institution is also a team effort where the members of team extend beyond the operating room. Involvement and cooperation of individuals across departments is a must along with benevolent seniors and a proactive administration. So we collated data by interviewing all the stakeholders of laparoscopy program, analysed observations of the faculty from the operating room and reviewed literature on the world wide web. Opinions of the administrators about their perceptions and the issues faced by the junior staff of the department were taken into consideration. Patients were interviewed before and after laparoscopic surgery. CONCLUSIONS Success at incorporation of the laparoscopy program in an established centre of surgery needs tact and social skills. Awareness of potential barriers can help preempt problems in execution. The surgeon will be the team leader and his mind-set, personality and leadership abilities will influence the success of the program. Patience and perseverance are important virtues of a successful laparoscopic surgeon. Having thoughtful and considerate seniors and generous administrators is an added advantage for facilitation of program, as experienced by us in our institution.
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