IntroductionMeckel’s Diverticulum is the most common congenital disease and seen in 2% of population. It is difficult to diagnose preoperative, mostly seen during operation with its various presentation.Material and Methods This is a retrospective study in which all the cases diagnosed as Meckel’s diverticulum with its complication diagnosed while doing operation were included. Demographic data, clinical presentation, preoperative diagnosis, intraoperative findings, surgical procedure performed, histopathological report and postoperative follow up of patients were recorded and statistically analyzed. The aim of this study was to assess various presentation of Meckel’s diverticulum in 8 years of duration in college of medical sciences, Bharatpur Nepal. ResultsOut of 32 cases, there were 20 male and 12 female with M:F ratio1.66:1. The mean age was 8.34 ± 3.98 years. All together sixteen (50%) patients had features intestinal obstruction. Perforation was seen in 28.1% patients, intussusception in 21.8%, diverticulitis in 15.6%, small bowel volvulus around fibrous band in 18.8%, internal herniation in 9.4% and massive bleeding in 6.3% patients. The average distance from ileocecal junction was 40-60 cm. All cases underwent emergency laparotomy, presence of Meckel’s diverticulum was incidental intraoperative finding. Three cases had superficial wound infection. Small intestine mucosa followed by gastric, pancreatic and colonic mucosa were most common histological finding. The average duration of hospital stay was 5 to 8 days.ConclusionMeckel's Diverticulum is a true diverticular anomaly that may remain clinically silent for lifetime, or it may have life-threatening complications. Due to nonspecific features in case of acute abdomen, Meckel’s diverticulum and its complications should be kept as an important differential diagnosis.Keywords: intestinal obstruction; meckel’s diverticulum; volvulus.
Introduction: Nasal obstruction is the most common symptom of deviated nasal septum. Septoplasty is a surgical procedure that corrects deformity of the nasal septum. Sinonasal outcome test 22 is a subjective questionnaire tool that include various nasal symptoms which is useful to measure patient`s symptoms outcome after septoplasty. Aims: To determine the symptomatologic outcome in patients with deviated nasal septum following septoplasty using Sinonasal outcome test 22. Methods: This prospective longitudinal study was done atNepalgunj Medical College and Teaching Hospital, Kohalpur including 60 patients of symptomatic deviated nasal septum who underwent septoplasty. Details of patient symptoms as per Sinonasal outcome test - 22 were graded from zero to five preoperatively and were compared one month following surgery. Results: Patients who underwent septoplasty were commonly in the age group 20-45 years and least in the age group 46-60 years with a mean age of 25.48. In the present study, the male to female ratio was 1.4:1. Deviated nasal septum was more common on the left side (53.3%). The mean preoperative sinonasal outcome test -22 score was 24.42 (range 14-40), and the mean postoperative sinonasal outcome test-22 score was 12.93 (range 8-23) and the difference was 11.49. Conclusion: Sinonasal outcome test 22 is a subjective questionnaire tool used in patients with deviated nasal septum. In our study with the use of this questionnaire tool there was improvement in nasal symptoms on comparing preoperative and postoperative symptoms following septoplasty.
Introduction: Tympanoplasty is the procedure of choice for surgical correction of tympanic membrane perforation triggered by either chronic otitis media or trauma. Various types of autologous grafts have been used to close tympanic membrane perforations among which temporalis fascia and tragal cartilage are preferred, due to their anatomic proximity, ease of harvesting and suppleness. Aims: To compare clinical and audiological outcomes of type 1 tympanoplasty where temporalis fascia and tragal cartilage were used as the graft material. Methods: A prospective study was conducted on 50 patients of ages ranging from 10 to 50 years with Chronic Otitis Media - Mucosal. All the patients underwent type 1 tympanoplasty and were categorized into Group-A (Temporalis fascia graft) and Group-B (Cartilage graft), each group comprising of 25 patients. Graft uptake rate, hearing gain and air bone gap closure were compared between the groups in 4 and 8 weeks after surgery. Results: Out of total 50 patients, 20 were male and 30 were female. The average age of the patients was 28.20 years. The total hearing gain in the whole series was 14.94 dB while the total air bone gap closure was 14.78 dB respectively. The difference between pre and post-operative hearing was statistically significant for both air bone gap and air conduction, (P<0.05) in the whole series. There was 15.56 dB improvement in mean hearing threshold and 15.64 dB mean air bone gap closure in the fascia group, compared to 14.32 dB improvement in mean hearing and 13.92 dB mean air bone gap closure in the cartilage group. Graft uptake rate in the temporalis fascia group was 84% and the cartilage group was 92 % with significant difference in the graft uptake rate between the groups. Conclusion: The graft uptake rate and hearing results of tragal cartilage are comparable to those of temporalis fascia. Cartilage tympanoplasty has a higher graft uptake rate with low failure rate and also shows a high degree of reliability in high risk cases. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome post-operatively. Thus, cartilage tympanoplasty is recommended as an alternative option.
Introduction: Chronic otitis media is chronic inflammation of middle ear cleft followed by permanent abnormality of tympanic membrane. As mastoid a part of temporal bone is in close relation to middle ear; its pneumatization plays an important role in pathogenesis and prognosis of chronic otitis media. Aims: To study the pneumatization pattern of mastoid in unilateral chronic otitis media and its relationship with contralateral mastoid, diseased side tympanic membrane and ossicular status. Methods: Forty patients of 10-65 year of age diagnosed as unilateral chronic otitis media squamous type were selected. They were otoscopically evaluated for retraction and perforation of tympanic membrane and were subjected to high-resolution computed tomography of temporal bone. High resolution computed tomographies were analyzed for mastoid status of bilateral ear and ossicular involvement. During mastoidectomy ossicular status was noted and correlated with high resolution computed tomography. Results: Forty cases were enrolled in the study. Age ranged from10-65 years. On radiological analysis of temporal bones, 21(52.5%) mastoids were sclerotic, 15(37.5 %) mastoid diploic and 4(10%) were pneumatized in the diseased sides. Contralateral side showed pneumatization in 23(57.5%), diploic in 11(27.5%) and sclerotic in 6(15%) Amongst 21 sclerotic mastoid, 11(52.3%) patient had retraction in pars tensa and 9(42.8 %) had retraction of pars flaccida. In total 15 diploic mastoids retraction of pars tensa was in 8(53.3%) and pars flaccid retraction in 8(53.3%) All three ossicles were involved in 8(38%), Malleus and incus were eroded in 3(14%), incus were eroded in 7(33.3%), malleus were eroded in 3(14%) and ossicles were intact in 3(14%)of 21 sclerosed mastoids on high resolution computed tomography. In remaining 19 non sclerotic mastoids all 3 ossicles were eroded in 4 (21%), malleus plus incus eroded in 8 (16%), incus were eroded in 5(26.3%) andossicular chain was intact in 2(10%). Conclusion: Mastoid pneumatization pattern not only effect to the pressure of middle ear leading to chronic otitis media but also alter the pathogenesis and outcome of chronicotitismedia. Contralateral mastoid pneumatization is not altered in unilateral Chronic otitis media.
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