Background: Chronic calculous cholecystitis is the benign disease affecting the gallbladder, frequently female population of middle age. This study was done with the objective of study the composition of gall stones, microbiological spectrum and their association in chronic calculous cholecystitis patients.Methods: This is a prospective study done on 131 cases of chronic calculous cholecystitis admitted in the department of General Surgery (DNB), K.K. Hospital, Lucknow for cholecystectomy during January 2018 to January 2019. 31 patients were excluded from the study based on exclusion criteria. USG of abdomen was done in all 100 cases. All patients underwent either open cholecystectomy (OC) or laparoscopic cholecystectomy (LC).During cholecystectomy bile was aspirated and was sent to laboratory for culture. Gallstone retrieved from the specimen and was classified based on morphology.Results: Out of 100 cases, 76 cases underwent LC and 24 cases were done with OC. Female dominance was seen in the study (69%). The predominant type of gall stone in present study was cholesterol (68%). The bile culture test was positive in 20% of cases. The most common isolated microorganism was E. coli (50%). No significant association was observed between composition/type of gall stone and isolated microorganisms in bile (p=0.126).Conclusions: The result concluded that chronic calculous cholecystitis was more common in females of middle age group. Bile culture was positive in 20% cases and E. coli was the common organism isolated. Identification of the type of organism is crucial for early management of the disease condition.
Background: Corrosive substances can cause serious injuries of the upper gastrointestinal tract and may lead to death. Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are mostly used as household agents and are ingested accidentally or suicidal intentionally. The objectives of the present study were to evaluate and compare the medium term outcomes of the multi modal treatment used for patients presenting with corrosive upper gastrointestinal strictures and to study the demographic and clinico- pathological profile of the patients of corrosive upper gastro intestinal tract strictures.Methods: A combined retrospective and prospective study was carried out on departmental database and patient presenting with corrosive upper gastrointestinal stricture from December 2010 to July 2019 in the Department of Surgical Gastroenterology at King George's Medical University for a period of 9 years.Results: Corrosive ingestion was found to be more prevalent in age group of 15-65 years with higher incidence to be found in females compared to males. Majority of ingestion of corrosive substances are found to be suicidal by adults.Conclusions: India has high incidence of corrosive ingestion mainly suicidal and homicidal indent. Endoscopic dilatation of esophageal strictures is safe and effective therapy and should be first line therapy in patients with esophageal strictures and surgery should be considered only in patients who have technical and clinical failure on endoscopic dilatation.
Background and objectives Pulmonary hypertension (PH) is an independent risk factor for increased mortality, especially in patients undergoing hemodialysis (HD), but the mechanism of its development is unknown. This study aimed at evaluating volume overload and inflammation as potential variables to cause its development in patients undergoing maintenance hemodialysis. Materials and methods This was an observational cross-sectional study conducted on patients undergoing hemodialysis at a tertiary hospital in northern India. Patients of end-stage renal disease, aged 18 years or more, on maintenance hemodialysis for over two months were included in the study. The patients were divided into two groups based on the presence or absence of PH, determined by measuring systolic pulmonary arterial pressure (SPAP). The severity of PH was defined as: mild (SPAP 35-45 mmHg), moderate (SPAP 46-55 mmHg), and severe (SPAP> 55mmHg). The two groups were evaluated for demographic variables, type of vascular access, biochemical parameters, and markers of inflammation and fluid overload. Data between the two groups were compared statistically. Results This study included a total of 82 patients showing the prevalence of PH to be 25.6% with a men-to-women ratio of 2:1. Out of 21 cases of PH, mild PH was found in seven (33.3%) cases, moderate in 14 (66.7%), and cases with severe PH were none. The two groups differed significantly in ejection fraction and markers of inflammation and volume status. Laboratory data associated with PH were alpha-1-acid glycoprotein (p<0.05) and pro-b-type natriuretic peptide (p <0.05). Conclusion The present study showed higher levels of inflammatory markers alpha-1-acid glycoprotein and pro-b-type natriuretic peptide and lower levels of ejection fraction in patients undergoing HD, indicating a significant association with PH.
Background: Acute pancreatitis is one of the leading causes of hospitalization amongst all gastrointestinal disorders with high burden of morbidity and mortality. Predicting the progression of AP in terms of course and outcome to determine suitable management strategy and level of care is challenging. A number of predictor models are developed to predict the severity of acute pancreatitis but they vary in their definitions of severity. HAPS have been proposed as a simple scoring tool for assessment of severity and prognosis of acute pancreatitis. Thus, the aim of present study was to investigate the usefulness of HAPS predictor model against APACHE II model.Methods: Current investigation was a hospital based prospective study conducted on 80 proven cases of acute pancreatitis at K. K. hospital, Uttar Pradesh. The serum amylase and lipase levels of all enrolled patients, were tested and measured at admission, and at 48 and 72 hours post admission. The pancreatitis-specific clinical investigations like; HAPS, APACHE II were calculated and assessed statistically in terms of sensitivity, specificity, positive and negative predictive values and accuracy.Results: The findings of present investigation revealed that amongst the two scoring systems, APACHE II was superior predictor model in terms of sensitivity and specificity for various outcomes like severe acute pancreatitis, hospital stay >7 days and in-hospital mortality. However, HAPS exhibited high specificity for all the outcomes.Conclusions: HAPS can be recommended as a useful tool for early evaluation of acute pancreatitis in patients specifically in primary care settings of developing countries like India.
Background: Gall stone disease is the commonest gastro intestinal disease requiring surgical intervention, laparoscopic cholecystectomy (LC) which has replaced open cholecystectomy (OC). LC has more advantages over OC but has few drawback such as CO2 pneumoperitoneum leading to altered liver functions. The study was done with the aim to compare liver function tests in patients undergoing LC & OC and to compare these values in two groups preoperatively and postoperatively at 24 hrs, 48 hrs, 72 hrs.Methods: A total of 151 patients were admitted with cholelithiasis, out of which 72 patients underwent surgery between January 2018 to January 2019. Patients were selected by block randomization method into 2 groups containing 28 in each (Group 1- OC and Group 2- LC). SGPT, SGOT, LDH, TB, DB, IB, ALP and S. amylase were studied pre-operatively and at intervals of 24 hrs, 48 hrs, 72 hrs postoperatively. Comparison was made between both groups.Results: Pre and postoperatively stage, the level of LFT in Group 1 and Group 2 were similar except IB, which was significantly high in Group 1. At 24 hrs the difference in TB, DB, SGPT and S. amylase were statistically significant (p<0.05) between the groups. At 48 hrs difference between Group 1 and Group 2 in TB, DB, SGOT and SGPT were statistically significant (p<0.05). At 72 hrs difference between Group 1 and Group 2 in only SGPT was statistically significant (p<0.05).Conclusions: Cholecystectomy (OC and LC) lead to transient but reversible significant hepatic enzymes alterations. These alterations are self limited and return to reference values within 10 days of operation. The cause of alteration might be liver tractions, electrocoagulation’s and manipulation of duct.
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