LC can be performed safely even in non-teaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure. It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.
Ultrasound-guided ethanol ablation is a safe, highly effective, relatively rapid treatment modality that is both patient and surgeon friendly and should be considered as the treatment of choice for benign cystic thyroid nodules.
This study was undertaken in order to evaluate the feasibility and safety of performing laparoscopic orchidectomy (LO) in men for unilateral impalpable testis in non-teaching rural hospitals in a developing country. We also investigated the possibility of reducing the cost and length of stay in hospital for patients undergoing LO. This is a prospective analysis of patients with impalpable testis undergoing LO in three non-teaching rural hospitals in the Kashmir Valley from January 2001 to March 2007. The cohort represented men requiring LO aged 15 to 62 (mean 36.2) years. The main outcome parameters assessed included mortality, conversion to an open procedure, complications, reduction in the costs and the length of the hospital stay. Forty-eight men with unilateral undescended testis on physical examination were studied. During laparoscopy the testis was identified near the deep ring in 30 patients, intra-abdominally in 16, and two had blind-ending vas and spermatic vessels near the deep ring. In 46 patients orchidectomy was performed. There were no deaths and none of the patients required conversion to an open procedure. Using reusable instruments, 00 degrees polyglactin sutures and self-made extraction bags, about US$ 300/patient was saved. There was no case of malignancy of the testis on histopathology examination. LO is one of the most satisfactory methods for the management of men with impalpable testis, having both a diagnostic and a therapeutic role especially for patients in the underdeveloped countries. These simple methods can reduce the cost and the length of the hospital stay.
To assess the ligamentization of the hamstring graft after arthroscopic anatomic single bundle anterior cruciate ligament (ACL) reconstruction using MRI at one year postoperatively. Patients and Methods: 25 patients (22 males and 03 females) underwent arthroscopic anatomic single bundle ACL reconstruction using hamstring tendon autograft. After ACL reconstruction, the ligamentization of the hamstring graft at one year postoperatively was evaluated on MRI by assessing the signal intensity of the graft and the integration of the graft on the tibial side. The graft integration at the level of the tibial tunnel was evaluated by the presence or absence of synovial fluid at the tunnel-graft interface. Results: MRI signal intensity of the ACL grafts was low in 13 (52%) cases, intermediate in 10 (40%) cases, and high in 1 (4%) case. Presence of synovial fluid at the graft interface was observed in 3 (12%) cases. The graft ligamentization was present in 23 (92%) cases, as indicated by the Figueroa score of 3-5. Conclusion:The phenomenon of ligamentization of ACL grafts after anatomical ACL reconstruction occurs within 1 year after surgery. MRI is a good tool to evaluate graft integration and graft ligamentization after ACL reconstruction.
I In nt tr ro od du uc ct ti io on n T he "gold standard" for management of symptomatic cholelithiasis is a laparoscopic cholecystectomy (LC). [1][2][3] Compared with an open cholecystectomy, an LC causes less postoperative pain and postoperative pulmonary dysfunction and allows for earlier discharge from the hospital, shortened recovery periods, and improved cosmesis. 1,[4][5][6][7][8] In the literature, large series of LCs have been reported with few complications, 6,9-12 and most surgeons and patients now prefer an LC to an open cholecystectomy.Minimal access surgery is limited in this region. Since 1995, only two teaching hospitals offer this service to a population of nearly 6 million. Due to an absence of trained laparoscopic surgeons and the A A 6 6--y ye ea ar r P Pr ro os sp pe ec ct ti iv ve e C Cl li in ni ic ca al l S St tu ud dy y o of f L La ap pa ar ro os sc co op pi ic c C Ch ho ol le ec cy ys st te ec ct to om mi ie es s i in n K Ka as sh hm mi ir r V Va al ll le ey y, , I In nd di ia a A Ab bs st tr ra ac ct t O Ob bj je ec ct ti iv ve e: : T To o e ev va al lu ua at te e t th he e f fe ea as si ib bi il li it ty y o of f r re ed du uc ci in ng g h ho os sp pi it ta al l s st ta ay y l le en ng gt th h a an nd d t th he e c co os st t o of f l la ap pa ar ro os sc co op pi ic c c ch ho ol le ec cy ys st te ec ct to om mi ie es s ( (L LC Cs s) ) i in n a a d de ev ve el lo op pi in ng g c co ou un nt tr ry y. . S St tu ud dy y D De es si ig gn n: : A A c cl li in ni ic ca al l s st tu ud dy y o of f p pa at ti ie en nt ts s w wi it th h s sy ym mp pt to om ma at ti ic c c ch ho ol le el li it th hi ia as si is s u un nd de er rg go oi in ng g a an n L LC C i in n G Go ou us si ia a H Ho os sp pi it ta al l, , D Di is st tr ri ic ct t H Ho os sp pi it ta al l B Ba ar ra am mu ul ll la a, , M Mo od de er rn n H Ho os sp pi it ta al l, , a an nd d A Ah hm me ed d H Ho os sp pi it ta al l o of f K Ka as sh hm mi ir r f fr ro om m J Ja an nu ua ar ry y 2 20 00 01 1 t to o M Ma ar rc ch h 2 20 00 07 7. . T Th he e m ma ai in n p pa ar ra am me et te er rs s e ev va al lu ua at te ed d w we er re e m mo or rt ta al li it ty y, , c co on nv ve er rs si io on n, , c co om mp pl li ic ca at ti io on ns s, , r re e--o op pe er r--a at ti io on n, , r re ed du uc ct ti io on n i in n h ho os sp pi it ta al l s st ta ay y l le en ng gt th h, , a an nd d c co os st t. . R Re es su ul lt ts s: : O On ne e t th ho ou us sa an nd d, , t th hr re ee e h hu un nd dr re ed d, , a an nd d t th hi ir rt ty y--f fi iv ve e p pa at ti ie en nt ts s, , 1 10 02 24 4 f fe em ma al le es s a an nd d 3 31 11 1 m ma al le es s, , p pr re es se en nt te ed d f fo or r L LC Cs s. . T Th he er re e w wa as s n no o m mo or rt ta al li it ty y i in n t th he e 3 30 0 p po os st to op pe er ra at ti iv ve e d da ay ys s. . T Tw we en nt ty y--f fi iv ve e c ca as se es s w we er re e c co on nv ve er rt te ed d t to o o op pe en n p pr ro oc ce ed du ur re es s, , w wh hi il le e o on ne e p pa at ti ie en nt t h ha ad d c co om ...
: Fine needle aspiration cytology has been the gold standard of diagnosis in case of thyroid neoplasm. However ultrasonography of thyroid neoplasm is a useful guide for an operating thyroid surgeon. We in our study evaluated patients of thyroid neoplasm with USG thyroid& studied its role in the therapeutic management of neoplasm. In our study of 10 patients of thyroid neoplasm we found USG of the thyroid neoplasm as a valuable guide in management.
This study evaluates the feasibility of performing laparoscopic cholecystectomy in order to reduce the expenditure in a 28-bed sub-district hospital in Kashmir, India. We report on a prospective clinical trail involving patients with gall bladder disease reported to the hospital from June 2005 till May 2007.
This study was aimed to determine the accuracy of arthroscopic anatomic single bundle anterior cruciate ligament (ACL) reconstruction using MRI at one year postoperatively. Patients and Methods: This prospective study included 40 patients (34 males and 06 females) who underwent arthroscopic anatomic single bundle ACL reconstruction with hamstring tendon autograft using medial portal technique. The patients were evaluated at one year postoperatively by clinical examination and MRI. The MR images were evaluated for graft location, tunnel location, graft signal intensity, graft quality, and graft ligamentization. Results: The ACL was found to be anatomically reconstructed in 37 (92.5%) cases. The mean sagittal inclination angle of ACL graft was 54 degrees (range 48.6 ○ -60 ○ ). The mean coronal inclination angle of ACL graft was 70.5 degrees. The mean center of tibial tunnel was found to be at 42.6% of AP diameter of tibia (range 35-51%). The mean femoral graft angle (FGA) was 50.5 degrees (range 43.5 ○ -57 ○ ). The graft ligamentization was present in 38 (95%) cases. Conclusion: Single bundle ACL reconstruction using medial portal technique results in anatomical location of the graft. MRI is an excellent tool to evaluate the graft and bone tunnel location, graft signal intensity, and graft ligamentization.
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