Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.
Background: Diabetes mellitus is a common problem and stress hyperglycemia occurring in patients undergoing surgery without history of diabetes mellitus has been shown to have a poorer clinical outcome. Effective glycemic control in the perioperative period results in marked improvement in clinical outcome.Methods: This prospective study was conducted among 100 cases of the pancreatobiliary postoperative patients admitted in General Surgery Department, Government Medical College Kottayam during November 2015 to November 2016. The post-operative blood sugar values, age, sex, BMI, family history of diabetes mellitus, anemia, hypoproteinemia, intraoperative blood loss, intraoperative blood transfusion, duration of surgery, and type of surgery were studied with respect to occurrence of stress hyperglycemia.Results: The total incidence was 35%. The incidence in pancreatic surgery (87.5%), other biliary surgeries (77.8%), open cholecystectomy (31.2%) and laparoscopic cholecystectomy (18%). Significant association was found in malnourished and obese persons, anemia, hypoalbuminemia, duration of surgery more than 3 hours, intraoperative blood loss of more than 500 ml and intraoperative blood transfusion and pancreatic surgery. Independent predictors of stress hyperglycemia were found to anemia, hypoproteinemia, duration of surgery more than 3 hours and underweight and obese individuals.Conclusions: Stress hyperglycemia incidence in pancreatobiliary postoperative patients was found to be 35%. Independent predictors of stress hyperglycemia were anemia, hypoproteinemia, duration of surgery more than 3 hours and BMI <18.5 and >30. Hence correction of anemia, improving the nutritional status preoperatively and minimising the duration of surgery will improve the clinical outcome.
Background: Fine needle aspiration cytology (FNAC) is regarded as the gold standard investigation in the diagnosis of thyroid swellings. But often unsatisfactory specimen, especially mixed with blood, poses an obstacle in proper cytological interpretation. To overcome this problem, an alternative method of fine needle non aspiration cytology (FNNAC) technique was developed which, relies on the capillary pressure only to suck the cells inside the needle bore.Methods: Patients presenting with thyroid swellings from July 2008 to January 2009 were included in the study. 91 patients treated for thyroid lesions entered a prospective comparative evaluation of fine needle cytology with aspiration and non-aspiration techniques in thyroid. The thyroid swelling in every patient was sampled by both the aspiration as well as the non-aspiration technique by a single operator. Both procedures were done using 23G needles. Aspiration was done using a 10ml syringe. Both dry and wet smears were made and stained. All smears were interpreted by a cytologist without knowledge of the technique employed. Apart from the diagnosis, comments were made on the quality of the slides and three qualitative categories are created as unsuitable specimens, diagnostically adequate and diagnostically superior.Results: Non-neoplastic lesions accounted for 92.3%. They comprised mainly of nodular colloid goiter 53.84%, colloid nodules 29.6%, thyroiditis 8.79%, and one case of suppurative lesion. Out of the 7 neoplasms, 2 were follicular neoplasms, 1 was papillary carcinoma, 2 cases of Hurthle cell neoplasm and 1 cellular nodule in an MNG. Diagnostically superior material was obtained in 42 cases (46.15%) of the non-aspiration samples, as compared with 18 cases (19.78%) of aspiration samples which was statistically significant.Conclusions: The FNNAC produces better results in the form of a better quality of the cellularity and less field obscurity by blood. This technique should be used alone or in tandem with FNAC for better diagnostic yield.
INTRODUCTIONAppendicitis is considered as the most common cause of acute abdomen in our surgical casualty and appendicectomy is the most common emergency surgery performed. The definite treatment of acute appendicitis is appendicectomy to avoid complications.1 If timely appendicectomy is not done due to any reason 2-6% of the patients develop a mass as one of the early complications.2-4 On the third day (rarely sooner) commencement of acute appendicitis, a tender mass can frequently be felt in right iliac fossa. An appendicular mass is the end result of a walled-off appendicular perforation and represents a pathological spectrum ranging from phlegmon to abscess. 2,3 This mass is composed of omentum, edematous caecal wall and edematous loop of ileum. In its natural course from 5th to l0th day, the mass either becomes larger and an ABSTRACT Background: Appendicular mass is one sequelae in unoperated cases of acute appendicitis which are managed conservatively followed by interval appendicectomy (IA). Currently the need for IA has been questioned due to low risk of recurrence. Methods: Data of all AM patients from 2005 to 2010 were collected and revised the following parameters: age, sex, length of hospital stay, symptoms and signs, total leucocyte count and USG. Those who developed similar pain and those who underwent emergency appendicectomy were considered as recurrence. Patients were grouped as: 1-patients who developed RIF pain,2-asymptomatic patients,3-patients who developed recurrent a/c appendicitis,4-patients who did not developed recurrent a/c appendicitis. Results: Of the 93 patients, 12 patients underwent IA. Average duration between mass resolution and recurrence is 4.16 months. 14.8% patients had recurrent similar abdominal pain, and only 7.4% patients had recurrent acute appendicitis. Length of hospital stay had a statistically significant correlation with recurrence. The mean TC in the group with recurrent acute appendicitis was 12,500 and asymptomatic group who had a mean TC of 10678.28 which was statistically significant. Conclusions: Conservative treatment is successful for majority of appendicular masses. A routine IA seems unnecessary. Asymptomatic patients can be followed up without IA. Most of the recurrences occur within the first 3 to 6 months. Length of hospital stay and total leucocyte count influenced the recurrence. IA may be considered in those who are prone for recurrence.
Background: Acute pancreatitis is a pestilent disease with severity ranging from mild and self-limiting to a rapidly progressive illness leading to multi organ failure. Mild acute pancreatitis is inflammation of the pancreas with minimal remote organ involvement. Since the disturbance in the homeostasis is minimal, the treatment aims at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate nutritional supplementation. Gut barrier damage in the early phase of acute pancreatitis accounts for the bacterial translocation, initiation of sepsis, infected pancreatic necrosis and SIRS. Aim of the study was to determine the feasibility, advantages and disadvantages of early enteral nutrition in mild acute pancreatitis.Methods: 40 patients taken consecutively from units which start enteral feeds before 48 hours (study group) were compared against 40 patients taken consecutively from units where patients will be kept fasting for 48 hours (control group) to determine whether early enteral feeding is better in determining the recovery in terms of duration of hospital stay, reduction in abdominal symptoms and use of analgesics.Results: There was significant reduction in the duration of hospital stay (p=0.011), intensity and duration of abdominal pain, need for analgesics, and risk of oral food intolerance in the study group.Conclusions: Patients with mild acute pancreatitis can safely be started on early enteral feeds. It reduces gastro intestinal adverse effects, abdominal pain and need for analgesics and improves oral food tolerance causing shorter hospital stay.
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