Background: Traditionally, appendectomy has been the treatment of choice for acute appendicitis but many times diagnosis can be difficult. Clinicians are looking through different ways to come to the correct diagnosis to decrease negative appendectomy. The aim of this study was to determine relation between clinical pattern, laboratory and ultrasonography findings with histopathological report of appendectomy specimen and to evaluate the Alvarado scoring regarding its usefulness in the early diagnosis in our set up. Methods: Prospective cross-sectional study was carried out in Gandaki Medical College Teaching Hospital and Fewa City Hospital from Jan 1, 2016 to Dec 31, 2018 on consecutively admitted patients with clinical diagnosis of acute appendicitis with study variables as demography, Alvarado score, radiological/laboratory investigations, surgical management, histopathology, and clinical outcome. Results: Among 1021 patients (48.8% men, 51.2% women), patients with Alvarado score offive and more (967, 88.8%) had abdominal USG and some (134) with score of 5-6 (13.12%) had CT scan. On the basis which 818patients (151 patients with score 5-6 and 667 with score 7 to 10) underwent emergency appendectomy; 705 (86.19%) by open and 113 (13.81%) by laparoscopic technique. Appendicitis was suggestive per-operatively in 76.2% of patients with Alvarado score of 5-6 and 97.4% of patients with the score of 7-10. Histo-pathologically diagnosis was correct in 752 (91.9%), 91.2% in open appendectomy and 96.5% in laparoscopic appendectomy cases. Only two patients had infective complication and no mortality. Conclusion: Alvarado scoring in patients presenting with acute abdominal pain is reliable predicting tool for acute appendicitis.
Introduction: Incisional hernia is a common problem after abdominal surgery. Patients present with pain, swelling and intestinal obstruction. It may be repaired by either anatomical suturing or mesh repair. Methods:It is a prospective observational study conducted in Western Regional Hospital and Fewa City Hospital, Pokhara from 2013 to 2016. A total of consecutive 100 patients admitted in these hospitals during the study period were included.Results: Incisional hernia is more common in females (M : F = 1 : 3.8), and in 30 -50 years age group (60%). Major risk factors were wound infection (30%), overweight (25%), and postoperative cough (10%). It is found to be more associated with gynecological (65%), than gastrointestinal operations, and more so with lower abdominal midline incision (65%). It is found to occur mostly within one year (60%) of primary surgery than later. Even 24% of the patients had first symptom within six months. Mesh repair (92%) was the preferred standard surgical treatment for incisional hernia. Conclusion:Overweight females of age range between 30 -50 years with history of gynecological operations by lower abdominal midline incision are more prone to develop incisional hernia. This incidence increases when there is wound infection. Mesh repair is the choice of operation for incisional hernia. John L, ClarkMD.
Hand fractures are different from other fractures elsewhere in the body. Functional impairment of hand leads to a prominent issue to the patient. We have a common practice of treatment of hand fractures by using kirschner wire(s). The internal fixation using plates and screws for metacarpal fractures of the hand is technically demanding but it is beneficial to the patients as it permits early mobilization and better pain relief. We studied the outcome of this type of internal fixation of the metacarpal fractures at Nepal Medical College. We included 26 patients above 18years with isolated extraarticular, closed and open Swanson I metacarpal fractures of the hand. Fractures with rotation of the digit and unacceptable angulation, shortening and unstable fractures were included. Pain was evaluated by visual analogue scale and function using American Society for Surgery of hand Total Active Flexion (ASSHTAF) score. The mean pain score (VAS) was 0.27 at 12 weeks. The ASSHTAF score showed excellent results in 92.3% patients at 12 weeks. At the final follow up 92.3% patients had excellent results, 3.8% had good and 3.8% had poor results. Fracture union was seen in all patients at final follow up. The study shows that internal fixation of unstable metacarpal fractures gives significant pain relief to the patient and an excellent functional outcome.
Introduction: No age is immune for appendicitis and appendicectomy. Appendicectomy is one of the most common operations done all over the world. Emergency surgeries are more common than elective. Histopathological examination of every excised tissue is strongly recommended but trained manpower and laboratory for histopathological examination is not available in every hospital in our country. Methods: It is a prospective observational study of appendectomy performed at Bir Hospital, Kathmandu, Nepal country over a period of three years. Histopathological examination reports and preoperative findings were collected. Histopathological examination was performed by postgraduate pathologist at different hospitals and laboratory centres. Peroperatively appendices were categorized as non malignant looking appendix and suspicious malignant looking appendix by operating surgeons at different hospitals. Histopathological examination reports were compared with peroperative categorization. Results: Eight hundred and fifty five appendectomies performed during the study period were analysed. Eight hundred thirteen (95.1%) cases had non-malignant looking appendix and 42 (4.9%) cases had malignant looking appendix peroperatively. Seven (0.8%) cases were found malignant and 848 (99.2%) cases were found non-malignant on histopathology report. All seven (16.67%) malignant cases were from 42 suspicious malignant looking cases. Conclusion: Routine histopathology examination is mandatory for only peroperative suspicious malignant looking appendix.
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