Pilonidal disease is a very common anorectal problem that most often arises in the hair follicles of the natal cleft of the sacrococcygeal area. Successful management depends on adherence to well-described surgical principles based on knowledge of pathogenesis and the patient's presentation. Considerable morbidity from prolonged wound Care can be avoided in these typically healthy patients when their disease is cured at initial presentation.
Background: Gall bladder stones are one of the commonest abdominal disorder requiring hospitalization and surgery in India. In Europian countries more than 10% prevalence of gall bladder stone has been recorded. Different studies suggested that sluggish movement of bile during hypothyroidism may induce formation of stone in gall bladder. Moreover, use of thyroxine for dissolving gall bladder stone has been suggested in studies. However, relation of thyroid hormones and gall bladder stone is still unclear. Therefore, present study was designed to assess if there is any relation between thyroid hormones disorders and gall bladder stones. Methods: It was cross sectional type of study which was conducted in departments of general surgery of TMMC & RC, Moradabad. This study was carried out from April 2017 to December 2017. Study population included 100 patients of cholelithiasis undergoing for cholecystectomy. Surgical profile along with full history including name, age, sex etc was recorded in the study. Similarly, full history of control group subjects was taken. Thyroid hormones in serum total tri iodothyronine (T3), free thyroxine (FT4), and TSH were measured by Enzyme Linked Immunosorbent Assay (ELISA) method. Results: Gall bladder stone were more common in female patients (60) in comparison of male patients (40). Hypothyroid disorder was found in 20% male gall bladder patients. Whereas, 7.5% hyperthyroid disease in male cholelethiais patients. Euthyroid status was observed in 72.5% male gall bladder patients. Hypothyroid disorder was found in 14% female gall bladder patients. Whereas, 7% hyperthyroid disease in female cholelethiais patients. Euthyroid status was observed in 65% female gall bladder patients. Conclusion: Findings of the current study suggest that female population suffers more in comparison of male population. Further, prevalence of gall bladder stones were more in 51 to 60 years age group population. Further, no definite relation was observed between thyroid hormones disorders either hypothyroid or hyperthyroid and gall bladder stones. However, more studies of on larger populations are required to assess if there is any relation between thyroid disorders and gall bladder stones.
Bezoars are persistent ingested concretions of human or vegetable fibers or concretions of foreign material that accumulate in the gastrointestinal tract mainly the stomach. Long term prognosis is good with proper psychological counselling and long term follow up. Fluoxetine or other SSRI'S have shown good results in treatment of trichotillomania. Parental counselling and education is important part of treatment.
Background: The objective of the present study was to observe prevalence of anatomical variations of cystic artery in patients with the aim of avoiding accidental damage during laparoscopic cholecystectomy.Methods: Patients (n=600) who underwent elective laparoscopic cholecystectomy after written and informed consent between October 2015 to October 2018 at Teerthankar Mahaveer Medical College and Research Centre, Moradabad were followed prospectively. Laparoscopic cholecystectomies were performed with 04 port technique with patients under anesthesia. Cystic artery’s anatomical variations with reference to triangle of calot in each patient undergoing the surgery was visualized through laparoscope and recorded.Results: Several anatomic variations of cystic artery were seen under laparoscope. Our experience with 600 cholecystectomies revealed that in majority of patients (85.67%; n=514), cystic artery was present in the boundaries of triangle of Calot, followed by outside the triangle of Calot seen in 13.33% (n=80) patients, while compound type was found in only 1% patients (n=6).Conclusions: Variations in the anatomy of cystic artery with reference to triangle of calot is seen very often. Knowledge of these variations helps in prevention of accidental hemorrhage during laparoscopic cholecystectomy. Cystic artery is present inside the triangle of calot in majority of cases. We found that classification suggested by You-Ming et al is very useful.
Background: Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.Methods: A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.Results: Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.Conclusions: This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.
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