Background:Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia.Aims:The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated.Materials and Methods:In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study.Results:The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia.Conclusions:The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.
Purpose:To determine the magnitude and pattern of refractive errors among patients attending the ophthalmology department of a new medical college in North-East India.Materials and Methods:A prospective study of the new patients (age ≥5 years), who were phakic and whose unaided visual acuities were worse than 20/20 but improved with pinhole, was done. Complete ophthalmic examination and refraction with appropriate cycloplegia for age were done for the 4582 eligible patients. Spherical equivalents (SE) of refractive errors of the right eyes were used for analysis.Results:Of the 4582 eligible patients, 2546 patients had refractive errors (55.56%). The proportion of emmetropia (SE − 0.50–+0.50 diopter sphere [DS]), myopia (SE <−0.50 DS), high myopia (SE >−5.0 DS), and hypermetropia (>+0.50 DS for adults and >+2.0 DS for children) were 53.1%, 27.4%, 2.6%, and 16.9%, respectively. The proportion of hyperopia increased till 59 years and then decreased with age (P = 0.000). The proportion of myopia and high myopia decreased significantly with age after 39 years (P = 0.000 and P = 0.004, respectively). Of the 1510 patients with astigmatism, 17% had with-the-rule (WTR), 23.4% had against-the-rule (ATR), and 19% had oblique astigmatisms. The proportion of WTR and ATR astigmatisms significantly decreased (P = 0.000) and increased (P = 0.000) with age, respectively.Conclusions:This study has provided the magnitude and pattern of refractive errors in the study population. It will serve as the initial step for conducting community-based studies on the prevalence of refractive errors in this part of the country since such data are lacking from this region. Moreover, this study will help the primary care physicians to have an overview of the magnitude and pattern of refractive errors presenting to a health-care center as refractive error is an established and significant public health problem worldwide.
Introduction: Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period.
Introduction: Gall bladder (GB) retrieval is an important cause for postoperative pain after laparoscopic cholecystectomy (LC). GB is usually extracted either from the epigastric or the umbilical port and there are limited data to decide the superiority of one over other in terms of postoperative pain. This study was designed to determine whether GB retrieval from the umbilical port was associated with less pain as compared to epigastric port in adult patients undergoing four ports elective LC. Material and Methods: A total of 100 patients took part in the study and were randomly allocated into 2 groups. Postoperatively, port-site pain score was assessed at 1, 6, 12, and 24 h by visual analog scale (VAS) score both for the epigastric and umbilical ports in all the patients and the collected data were analyzed by using SPSS version 22. Result: VAS score for postoperative pain at epigastric port at 1, 6, 12, and 24 h found to be higher as compared to umbilical port (6.640 ± 1.494 vs. 5.500 ± 1.176, 6.620 ± 1.549 vs. 5.320 ± 1.188, 6.100 ± 1.549 vs. 4.660 ± 1.232, 5.250 ± 1.459 vs. 3.970 ± 1.274, respectively) which was statistically significant ( P value 0.001). But the time taken for retrieval of GB was significantly longer in the umbilical group (4.94 ± 1.56 vs. 3.24 ± 1.29). Conclusion: Umbilical port is better as compared to epigastric port for GB retrieval in patient undergoing elective four port LC in terms of postoperative port-site pain but it takes relatively longer time for the extraction.
Diclofenac is a very commonly used analgesic medication. Diclofenac is a non-steroidal anti-inflammatory drug and acts by inhibiting COX (cyclo-oxygenase) 1 and 2. It has both analgesic and anti-pyretic effects. It can be administered both orally and parentarelly. Among the many side effects of diclofencac, extensive ganrene of the extremities is never reported as one of the probable complications. Extensive PubMed and other literature searches did not reveal any previously reported case reports, hence the reporting of this case.
Aim of the study: To study the effect of topical phenytoin in healing of grade I and II diabetic foot ulcers. Background: Diabetic foot ulcers entail a lot of financial burden both to the patients and also to the treating hospitals. These are estimated to affect 15% of all diabetic individuals during their lifetime. These precede almost 85% of amputations. In India, prevalence of diabetic foot ulcer in clinical population is 3.61%. Increase in the prevalence of foot complications in India is attributed to socio-cultural practices such as bare foot walking, religious practices like walking on fire, use of improper foot wear and lack of knowledge regarding foot care. The three etiological mechanisms involved in formation of diabetic foot ulcer are-ischemia, neuropathy and infection.Phenytoin has been used by some workers and the possible mechanisms of its action in ulcer healing have been described as-increase in the proliferation of fibroblasts, increase in the deposition of collagen, neovascularisation, enhanced granulation tissue formation, decrease in the action of collagenase, decrease in bacterial contamination by removing Staphylococcus aureus, Escherichia coli, Klebsiella species, and Pseudomonas from the wound. Material and methods: A total of one hundred patients (66 males and 34 females) were enrolled in the study half of which were dressed with crushed phenytoin tablet powder (Group 1) and the remaining half was dressed with normal saline (Group 2). Statistical analysis was done using using the SPSS version 22 for Windows, Inc Chicago II.Descriptive statistics was used to find the mean± standard deviation.Mann Whitney test was done to find the difference between the various variables in the two groups. Results: Phenytoin was found to help in early healing of diabetic foot ulcers with the mean epithelisation time was found to be significantly lower in the phenytoin group. Conclusion: Topical phenytoin enhances healing of diabetic foot ulcers and is a cheap and effective modality of treating these patients.
Intrauterine contraceptive devices have been in use for a long time as family planning measures, one of its complications of perforating the uterus and migrating into the peritoneal cavity is also well known. Retrieval in such cases depends on the location of the migrated intrauterine devices and involves laparotomy or laparoscopy. We present here such a case that migrated partially into the lumen of the rectosigmoid and was successfully removed using a colonoscope.
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