Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.
Chest pain is one of the most common presenting complaints in the emergency department. Interpreting a 12-lead electrocardiography (ECG) for evidence of ischemia is always challenging. Frank ECG changes such as ST-segment elevation and ST-segment depression can be easily identified by emergency physicians. However, identifying subtle or early features of ACS in the 12-lead ECG is essential in preventing significant mortality and morbidity from ACS. In the following case series, we describe five of the subtle/early ECG changes of ACS, namely (1) T-wave inversion in lead aVL; (2) terminal QRS distortion; (3) hyperacute T-waves; (4) negative U-waves in precordial leads; and (5) loss of precordial T-wave balance. In all these cases, the initial 12-lead ECG showed only subtle/early ECG changes which were followed up with serial ECGs which progressed to STEMI.
Pancreatic cancer remains one of the most aggressive neoplastic processes, and most of the cases are detected late with vascular invasion and metastasis. Inspite of progress in the diagnosis and treatment of malignancies, the resectability and 5-year survival rates for pancreatic ABSTRACT Background: Pancreatic cancer is one of the most aggressive neoplastic processes. Inspite of progress in the diagnosis and treatment of malignancies, the resectability and survival rates for pancreatic cancer are very poor. This study aims to determine the accuracy of computerised tomography in assessing the resectability of carcinoma pancreas. Methods: 66 patients with carcinoma pancreas, who were judged fit for surgery were studied. All cases had undergone preoperative contrast enhanced triphasic computed tomography (CT) for assessing the resectability. Radiological data was compared with per operative findings for assessments regarding vascular invasion and resectability. Results: Of the 66 cases, resectability reported by CT was 59 (89.4%). The rest of 7 (10.6%) cases were reported as unresectable. Per operatively vascular involvement was found in 14 (21.2%) cases and with no vascular invasion in 52 (78.8%) cases. All the unresectable cases reported in CT (7 cases) turned out to be unresectable. Out of 59 cases reported as resectable, 43 (65.2%) cases under went Whipples procedure, while rest of the 23 (34.8%) cases underwent palliative procedures. Out of these 23 cases, 14 (21.2%) cases were unresectable due to vascular involvement.
Conclusions:The study has shown that CT does assess the operability in carcinoma pancreas, assessing mainly unresectability though less effective in assessing resectability. The role of endoscopic ultrasound and laparoscopic ultrasound in aiding CT in further assessment of resectable and borderline resectable cases are to be considered for further research.
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