BACKGROUND The Modified Alvarado Scoring System (MASS) has been shown to be easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis. However, its application and usefulness has not been evaluated in the current study settings in the diagnosis of acute appendicitis. Hence, this study was conducted. Objectives-1. To evaluate the specificity and sensitivity of Modified Alvarado Scoring System in the diagnosis of Acute Appendicitis. 2. To assess the rate of negative laparotomies. MATERIALS AND METHODS A cross-sectional study was conducted for a period of 18 months among 107 patients presenting at the surgery OPD, Sri Siddhartha Medical College Hospital and Research Centre, Tumkur, with complaints of pain in right iliac fossa with suspected features of acute appendicitis. The informed consent was taken. After considering the inclusion and exclusion criteriae, study subjects were categorised based on modified Alvarado scoring system. The subjects with ≥ 7 were made to undergo appendicectomy and those with score < 7 were re-scored after conservative management. The pre-operative diagnostic accuracy was evaluated. RESULTS The mean age of the study participants was 26.54 ± 10.46 yrs. and majority were males. Most frequent complaint was nausea and/or vomiting. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were 97.4%, 79.3%, 92.7%, 92.0%, 92.5% respectively. Negative appendicectomy rate was 7.3%. CONCLUSION MASS score of ≥ 7 is found to be having high sensitivity, PPV, NPV and good specificity, hence can be used as diagnostic indicator of acute appendicitis in the low resource setting.
Background and Aims: Chronic anal fissure (CAF) is usually managed with surgical modalities but it imposes huge cost with recurrence rates. Hence, topical therapies are preferred is such cases which has a good patient acceptability rate. The present study aims to compare the topical metronidazole (MTZ), diltiazem (DTZ), and glyceryl trinitrate (GTN) in terms of healing rate and pain reduction in CAF patients. Methods: This was a randomized and prospective study conducted on 90 patients with CAF. The patients were grouped as follows (n=30), Group 1; 1% MTZ gel, Group 2; 0.2% Nitroglycerin ointment, and Group 3 (n=30): 2% DTZ ointment. The patients were evaluated at 2, 4, and 6 weeks for pain using visual analogue score (VAS) and healing rate. The results were compared and p<0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p>0.05), however the VAS scores where markedly reduced within the group at 6 weeks. The healing rate was higher in MTZ group (90%) as compared to GTN (83.3%) and DTZ group (83.3%) but it was not significant. Regarding side effect, burning sensation was observed in MTZ and GTN, DTZ groups were devoid of side effects. Conclusion: The MTZ was more effective with good healing rate but with few side effects. Regarding the pain reduction, all the groups displayed equivocal effects. Thus topical MTZ is a suitable agent for the faster healing of CAF and thus avoids the requirement of surgical options.
Introduction: Proper positioning of the acetabular cup is pivotal in any total hip arthroplasty. Cases of DDH have shallow acetabulum which is deformed and oblong and the femur head corresponds to it. Identifying the correct centre of hip rotation is difficult. In this study we highlight the easy technique of "Medial protrusion technique" for cup placement. Materials and Methods: Skeletally mature patients with developmental dysplasia of hip showing clinical and radiological hip arthritis were included. Total of ten hips with DDH and hip arthritis underwent THA using this technique. Radiological evaluation with X ray and CT was done and the Harris hip score was calculated preoperatively and subsequently in all follow ups. Results: The average follow up period was 5.5 ± 1.3 years. The mean Harris hip score in these patients was 86.5 ± 1.4. Two patients out of 10 patients had excellent results, while 8 patients were rated as having good results. The average pain score was 41.6. The x-rays demonstrated good overall alignment and fixation of the acetabular cup. All cups were integrated well. Conclusion:Our study confirms that this technique is simple safe and easily reproducible and time reliable technique providing superior outcomes in uncemented THA in DDH cases.
Background: Open appendectomy is one of the most common surgeries done in an emergency operation theatre even after three decades of introduction of laparoscopic surgeries. The previous studies done on laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared primary outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power.Methods: A pre-study power analysis suggested that 200 randomized patients would yield 80% power to show a mean decrease of 1.3 days hospitalization. One hundred ninety-eight patients with a preoperative diagnosis of acute appendicitis were randomized prospectively to laparoscopic or open appendectomy. The primary outcomes measured were duration of operative time, postoperative pain and analgesia, length of hospital stay and cosmetic advantages.Results: It was found that mean operation time was 33±5.8 minute and 37± 7.5 minute in OA and LA respectively. Duration of post-operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusions: Present study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stays and less requirement of narcotic analgesic.
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