IJSS Journal of Surgery

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https://imsear.searo.who.int/handle/123456789/157948

Editor: Dr Mahesh M Pukar
ISSN: 2395-1893

Frequency: Once in two months

Language: English

Open Access Peer-reviewed journal

Web site: https://surgeryijss.com/

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Now showing 1 - 20 of 165

Goldenhar Syndrome: Case Report.
(2015-01) Patil, Nandini A; Patil, Anil B
Goldenhar syndrome or fascio-auriculo-vertebral dysplasia or oculo-auriculo-vertebral syndrome is a sporadic or autosomal dominant inherited genetic rare syndrome characterized by mandibular hypoplasia, facial asymmetry, low set ear or atresia of ear canal, preauricular skin tags, hemi vertebra in cervical region, epibulbar dermoid, coloboma of upper eyelid, limb dermoids, cardiac abnormalities and other systemic abnormalities includes facial involvement, predisposing to the right side or there may be a more complex phenotypic abnormality with the skeletal, cardiac, renal and pulmonary systems. Central nervous system involvement are common with these patients, particularly there are higher chances with ophthalmologic anomalies. 50% of the patients with Goldenhar would have either conductive and/or sensorineural hearing loss. This case report describes a typical 40-year-old female patient who presented to the hospital with auricular abnormality and diminished hearing and was found to have the fascioauriculo-vertebral dysplasia spectrum of this syndrome and hypothyroidism. Diagnosis was based principally on clinical aspects. Radiology, laboratory fi ndings, otorhinolaryngologic evaluations were important in reaching a defi nitive diagnosis. Management depends on the patient’s age and systemic clinical manifestations, with a multidisciplinary approach often being required.
Role of Ileostomy in Enteric Perforation.
(2015-01) Shah, Shashikant; Gandhi, Jenit P
Introduction: Enteric perforations have been seen as a common problem in tropical countries. Over a period the trend of enteric perforations has changed, its treatment, disease progression and prognosis. Methods: The studies of 25 cases of ileal perforations treated and underwent an ileostomy as a treatment modality between the periods of May 2010-August 2012 were included. Traumatic ileal perforations and ileal perforation without an ileostomy were excluded from the study. Results: In a study conducted commonest cause was Enteric fever in nonspecifi c ileal perforations. Perforation commonly occurred in second and third decade of life with 48% of patients belongs to the age group between 11 and 30. The mean age of the patients in the study was 33 years. Male preponderance with male to female ratio 5:1 was observed. Pneumoperitoneum in chest and erect abdominal X-ray was seen in 84% of the patients. Time between onset of pain and surgical intervention (Lag period) was between 10 and 96 h with the mean of 43.44 h. Single ileal perforations were seen in 84% of the cases with 72% being located within 30 cm from ileocecal junction (ICJ). Majority were located within 60 cm from ICJ (96%). Conclusions: A non-specifi c enteric perforation (60%) was the most common cause of ileal perforation. Ileostomy as a treatment modality carried a mortality rate of 4%. Ileostomy closure an overall complication rate of 24%. Wound infection, small bowel obstruction and enterocutaneous fi stula were commonly seen complications. 12% cases had small bowel obstruction managed conservatively.
Analytic Study of Chest Injury.
(2015-01) Shah, Jigar V; Solanki, Mehul I
Background: Trauma is one of the leading causes of morbidity and mortality worldwide. Chest trauma constitutes about 10-15% of all cases and is responsible for 25% of deaths as a result of trauma. It is a major problem for India, where there is a very high incidence of vehicular accidents (6% of global vehicular accidents), along with crime and riots. In spite of that very few studies have been documented that assess the prevalence and management of these events. Hence, this retrospective study was carried out to determine the magnitude and management of patients with chest trauma in rural setup. Methods: A study of 100 cases of chest trauma admitted in Dhiraj Hospital, from May 2010 to September 2012 was carried out. The data collected included the patient’s demographic profi le; mode, type and severity of chest injuries, management scheme and outcome. Results: Of 100 patients who sustain chest trauma, 76% of cases were due to vehicular accident. Of 100 patients 64% had rib fractures, 17% had fl ail chest, 12% had pneumothorax, 24% had hemothorax, and 5% had hemopneumothorax and 24% had extra-thoracic injury. In 33% water seal intercostals tube insertion was done and 17% of patients having fl ail chest were treated with intermittent positive pressure ventilation. Conclusions: The present study reveals that the trauma commonly seen in young males was motor vehicle accident. The outcome and prognosis for the majority of patients of blunt chest trauma are excellent. Most require no invasive therapy or, at most intercostals chest drainage tube insertion.
Basal Cell Carcinoma: A Case Report.
(2015-01) Madhura, Killedar M; Honeypalsinh, Maharaul H; Rinkan, Virani A
Basal cell carcinoma (BCC) is one of the most common skin cancers, which causes disfi gurement and destruction by invasion in surrounding tissue. However, it rarely metastasizes to distant tissue and cause death. It is a locally invasive tumor. The present case is of a BCC in a 62-year-old female presenting with non-healing ulcer above right eyelid. The patient had no history of arsenic intake, irradiation, herb medication, or exposure to chemical gases. No signifi cant past, personal and family history were observed. Histopathology revealed BCC. The patient was managed with wide excision of the lesion and then full thickness skin graft. At present, the patient is stable.
Post-Approval, Observational Study with Garenoxacin a Newer des-fl uoroquinolone in Uncomplicated Urinary Tract Infections in Vadodara, India.
(2015-01) Pukar, M; Hajare, A; Krishnaprasad, K; Bhargava, A
Background: Urinary tract infection (UTI) is one of the most important global health issues, which has raised the morbidity and mortality rates in both the genders. Strategies that are proposed in the management of UTIs include use of empirical antibiotics with a broad spectrum of coverage. Urine specimen culture plays a pivot role to evaluate the organism responsible for the pathogenesis. Methods: This observational study was conducted at Vadodara comprised of 50 patients suffering from UTI. All the patients that included in the study were examined for side-effects during the entire period of the drug therapy. Clinical response was judged by subjective assessment for control of presenting symptoms. Results: Data were obtained from 50 patients. Garenoxacin was prescribed as a fi rst-line therapy to the patients with UTI. Four patients received the drug for 5 days and 44 patients received the drug for 7 days. Escherichia coli was the most common organism obtained from the urine culture, followed by Staphylococcus saprophyticus and Enterobacter species. Clinical cure/improved was established in 98% of cases. One case of therapy failure was reported. Negligible side-effects such as nausea, vomiting, and abdominal pain were reported. Conclusions: Garenoxacin with its superior yet differentiated pharmacodynamic and pharmacokinetic profi le involving low minimum inhibitory concentrations with high target site tissue concentrations defi nitely fi nds a merit for further evaluation. With superior safety profi le, excellent antimicrobial coverage and a convenient once a day dosing garenoxacin appears to improve the patient compliance.
Bilateral Extradural Hematoma: A Case Report.
(2015-01) Patil, Anil B; Patil, Nandini A
The occurrence of bilateral extradural hematomas is an uncommon consequence of cranio-cerebral trauma. In the literature bilateral, extradural hematomas have rarely been reported. This article is about a case of 45-year-old female who was admitted in our hospital with a history of road traffi c accident. On admission, she was conscious but irritable having Glasgow coma scale 14/15. In stable condition, she was found to have visual agnosia for left eye. Her computed tomography scan showed a bilateral symmetrical site with asymmetrical dimensions. Patient underwent left occipito-posterio-parietal craniotomy with complete removal of extradural hematoma was done. Right occipital extradural hematoma was not removed.
Lymphangioma of Tongue a Rare Entity: A Case Report.
(2015-02) Gupta, Sagar; Vegad, Kaushal
Lymphangioma is relatively rare congenital malformations of lymphatic vessels that are fi lled with a clear protein-rich fl uid with a few lymph cells. They result due to abnormal development of the lymphatic system with an obstruction to lymph drainage from the affected area. This is an interesting case of lymphangioma of the tongue in a 2-year-female child. Oral lymphangioma is uncommon lesions that tend to involve the dorsal surface of the tongue. Conservative surgical excision is preferred in superfi cial, localized lesions and hence an insight of this condition of prime importance in its diagnosis and management. Oral lymphangioma is relatively uncommon lesions occurring at the dorsal region of the tongue. Superfi cial and localized lesions should be treated by conservative surgical excision with low relapse rates.
Emergency Esthetic Closure of Scalp in a Rural Setup: A Case Report.
(2015-03) Akheel, Mohammad; Tomar, Suryapratap Singh; Bumb, Swapnil S
Road traffic accidents are a major havoc in present day life. The injuries caused by them are extremely dangerous and is always a threat to a normal routine of the patient. Every patient desire to have an esthetic appearance of the head and neck region no matter how devastating is the injury. Surgical esthetic primary closure of soft tissues is always a challenge for oral and maxillofacial surgeon. We present a case report of a 15 year old girl with 12 cm scalp laceration who had an esthetic closure in a rural primary Health Care Centre in a Medical Teaching Hospital in Andhra Pradesh.
Functional Outcome of Surgically Treated Sanders Types II, III, IV Calcaneal Fractures: An Observational Study.
(2015-03) Joshi, Johny; Gupta, Anshul; Menon, Hari; Patel, Manish; Lakhani, Dhairya
Background: Management of calcaneal fractures has always been in controversy. Many treatment techniques have been described, but specific indications are vague. In this prospective study, we studied the functional outcome of surgically treated intra-articular calcaneal fracture. Aim and Objective: To study the outcomes in terms of mechanism of injury, intra-operative difficulties, post-operative complication, infection, the range of motion in the surgically managed calcaneal fracture. Materials and Methods: A total of 32 Patients with 34 calcaneal fractures operated in NCH Surat from September 2012 to December 2014 were included in the study. Pre-op computed tomography (CT) scan carried out in all patients. Maryland foot score was used to evaluate to assess the functional outcome. Results: Incidence is much more common in males (90.6%), most of the patients being in their 3rd decade of life. The spinal fracture was the most common associated injury (30%). Results according to Maryland foot score were excellent in 26.4%, good in 61.64%, and none of the patients had poor results. Complications include synovitis, broadening and superficial infection. Pre-op CT scan is very useful tool in calcaneal fractures. Conclusion: Open reduction internal fixation is the ideal treatment for Sanders type 2/3/4. Even Sanders Type IV (which was thought to be associated with poor results) had a good outcome in short-term follow-up. Use of proper surgical timing/technique/asepsis can lead to good or excellent results in more than 90% of patients and avoiding the majority of the complications. Use of beta-tricalcium phosphate is not a cost effective measure as results are similar in all patients. Earlier mobilization, early return to work, good cosmesis, better subtalar motion are all advantages of surgery.
Management of Hydatid Disease: A Prospective Observational Study.
(2015-03) Pukar, Mahesh M; Virani, Rinkan
Background: Hydatid disease also known as Arterius (9-79 AD) and Galen (130-200 AD). It was known at that time as “water tumor of the chest” and “liver full of water.” Reddi (1664), Hartmann (1683) and Tyson (1691) first suspected cystic disease of the liver in animals. Materials and Methods: Hydatid disease is still a major health problem in the infested areas of the world. Surgery is the mainstay of treatment. A disease with a recurrence rate of 10-12% makes it mandatory to have a high diagnostic accuracy of investigations, a full proof treatment regimen and better preventive methods aiming at control and eradication of this age-old disease. Results: Hydatid disease commonly affects liver followed by lung other less common organs are the spleen, kidney, pancreas, and muscle. Surgery is the treatment of choice. Ultrasonography and computed tomography scan having tremendous value in the diagnosis of hydatid disease. Conclusion: Liver is the most common organ involved followed by lung, spleen and kidney. Females are more affected than male. Enucleation is the treatment of choice.
Rapunzel Syndrome: Trichobezoar in a 15-Year-Old Female Patient: A Case Report.
(2015-03) Patil, Nandini; Patil, Anil; Fegade, Snehal; Patil, Kiran
Rapunzel syndrome is a type of trichobezoar, a very rare to find in clinical settings, wherein the hairball tail extends in small bowel. Patient may present with varying signs ranging from vague abdominal pain to signs of intestinal obstruction. This case describes averagely built, averagely nourished young female of 15 years of age, no e/o anemia, jaundice, lymphadenopathy; per abdominal examination revealed an elliptical lump in epigastric region extending to umbilical region, lump was not freely mobile and non-tender. Early gastroscopy is indicated in patients with long history of vague abdominal pain, weight loss and hair loss in young females.
Stabilization of Ulnar Stump with Extensor Carpi Ulnaris: A Case Report.
(2015-03) Patel, Ravish; Chaudhary, Nitin; Menon, Hari
Giant cell tumor (GCT) involving distal ulna being rare with reported rate of 0.45-3% of all GCT cases; the literature has only sporadic cases reported. Various treatment options have been proposed, and dilemma exist whether to do resection alone or resection combined with stabilization or reconstruction. Also, there is no conclusive evidence regarding the method of stabilization or reconstruction. A case of GCT of lower end ulna treated with excision of the distal end of ulna and stabilization of stump with extensor carpi ulnaris tendon slip in a 41-year-old female. The patient had an excellent functional outcome and no evidence of recurrence at 2 years of follow-up. Resection of ulna proximal to the insertion of pronator quadratus could lead to instability in the form of radio-ulnar convergence and winging of the ulnar stump and result in limitation of forearm rotation and weakness in grasping. Stabilization of the ulnar stump after resection for a GCT gave excellent results.
A Massive Left Ovarian Mucinous Cystadenoma: A Case Report.
(2015-03) Nichat, P D; Desai, Hridaynath; Siddiqui, M; Chandrakant, G
We report the occurrence of a rare case of a huge ovarian tumor in Saint George’s Hospital in Mumbai, India. Our patient was a middle-aged woman presented with marked abdominal distension and discomfort at the emergency surgical department. The data were documented through history, clinical examination, laboratory investigations, ultrasound examination, and by computed tomography scan abdomen and pelvis. The case was found to be as a rare massive ovarian mucinous cystadenoma. This case report emphasizes the significance of thorough evaluation of all women presented with vague abdominal pain. Although the condition that is extremely rare, it is a potential danger in its massive form, if timely diagnosis and management are not done. With the increasing awareness about such conditions, more cases are detected and reported.
Intravesical Foreign Body: A Rare Case Report and Review of Literature.
(2015-03) Janu, V H; Sadhwani, M A; Modi, H H; Patel, G R
Foreign bodies related to urogenital tract represent a relatively rare pathology and are most commonly found in the urinary bladder. Foreign body of the urinary bladder may occur by migration from surrounding organs or by self-insertion via urethra. Vesicovaginal fistula (VVF) is commonly caused by obstructed labor, gynecological surgeries, occasionally due to malignancy, but rarely by the foreign body; in most cases being ring pessaries. A 25-year-old female presented in our clinic with urinary incontinence and irritative lower urinary tract symptoms. Radiological investigation revealed intravesical foreign body (wooden abortion stick) with VVF. It was removed via suprapubic cystostomy and fistula managed conservatively.
Undiagnosed Chronic Abdominal Pain and Colonic Perforation: A Rare Cause: Gossypiboma.
(2015-05) Pukar, Mahesh M; Chaudhary, Jigar
The term gossypiboma is used to describe as a mass due to retained surgical sponge after surgery. It is rare, but serious complication that is seldom reported because of the legal implications. The present study was carried out at the tertiary health center from January 2013 to April 2015. Five cases were studied prospectively. Gossypiboma usually has a varied and a vague presentation that makes it difficult to detect on radiological investigations. Sometimes, it can remain quiescent and could even present years after the operation. Though rare, gossypiboma should be kept in mind as a differential diagnosis in post-operative cases presenting as vague pain or recurrent chronic abdominal pain or long term foul smelling sinus discharge even years after the operation. Four out of five cases had colonic perforation, which was managed by primary closure. Fecal diversion was not required in any of the patient. Gossypiboma is avoidable, but serious rare post-operative complication. It is usually asymptomatic and has non-specific radiological findings. Hence, the diagnosis is often delayed. Gossypiboma can cause wide variety of complications like perforation and adhesion to the adjacent structures.
Pleomorphic Adenoma of Palate: A Case Report.
(2015-05) Vuppalapati, Hima Bindu; Balasankula, Bhavya; Kosuri, Pavan Kumar; Banoth, Veeranna
Pleomorphic adenoma (PA) is the most common tumor of salivary glands, which is a benign neoplasm consisting of cells exhibiting the ability to differentiate to epithelial (ductal and non-ductal) cells and mesenchymal (chondroid, myxoid and osseous) cells. The parotid gland is the most common site (90%). Approximately, 8% of PA involves the minor salivary glands; the palate is the most common site (60-75%) of minor salivary gland involvement followed by lips and other sites. Palatal PA presents clinically as a painless, slow-growing mass found on the junction of the hard and soft palate which extend in posterolateral direction. The aim of the article is to present a case of palatal PA, with a focus on the differential diagnosis and various aids of diagnosis and its successful treatment by surgical excision.
Significance of Expression of PSP94 Isoforms in Etiology of Benign Prostatic Hyperplasia and Prostate Cancer.
(2015-05) Mhatre, Deepa R; Mahale, Smita D; Dhabalia, Jayesh V; Tongaonkar, Hemant B; Fernandes, Gwendolyn C; Dandekar, Sucheta P; Varadkar, Anand M
Background: Prostate Secretory Protein of 94 Amino Acids (PSP94) level is known to increase in benign prostatic hyperplasia (BPH) and decrease in prostate cancer (PCa). However, there has not been a consensus on the abundance and significance of the different isoforms of PSP94 during the development of BPH and PCa. Methods: Benign and malignant prostate tissue was ascertained histologically. Biplex polymerase chain reaction (PCR) and real-time PCR were employed to quantitate the two isoforms, PSP94 (MSMB1) and PSP57 (MSMB2). Results: Higher abundance of both MSMB1 and MSMB2 transcripts was observed in BPH as compared to PCa. Further, there was a strong positive correlation between the transcript levels of these isoforms, MSMB1 and MSMB2, in samples from both BPH and PCa patients. Conclusions: PSP57 (MSMB2) transcript may not be involved in the development of BPH or PCa and could have a physiological role in prostate cells.
Migrating Helical Tack Causing Chronic Discharging Sinus Following Laparoscopic Ventral Hernia Repair: A Case Report.
(2015-05) Ghosh, Sumanta Kumar
Choice of prosthetic mesh and secure anchorage to its bed is key to successful laparoscopic repair of a ventral hernia. Transfascial suture and tack are two commonly used techniques for mesh fixation. While transfascial suture causes more post-operative pain, tack’s anchorage is a suspect. Spiral tacks are inert and cause less tissue reaction. Though isolated case reports are available regarding pain and intestinal complications arising from the use of tacks, the incidence of tack migration through the fascial layer and causing discharging chronic sinus mimicking mesh infection has been reported only once. Surgeons should be aware and cautious about using new technologies to provide correct management strategy in individual cases of complications arising from them, rather than treating them empirically. As complications can arise even after years of primary surgery, a longer period of follow-up is essential for comparative evaluation of different techniques.
Peripheral Ameloblastoma of Mandible: A Rare Case Report.
(2015-05) Thanuja, R; Ahuja, Puneet; Kohli, Moulshree; Dutta, Jahnobi; Sareen, Chanchal
Peripheral ameloblastoma (PA) is a rare, benign, extraosseous neoplasm of the odontogenic epithelium. It is an exophytic growth which is localized to the soft tissues overlying the tooth-bearing areas of maxilla and mandible. In most cases, there is no radiological evidence of bone involvement, except for cupping or saucerization of the underlying bone. Histologically, the PA consists of proliferating odontogenic epithelium that exhibits the same histomorphological cell types and patterns as seen in the intraosseous ameloblastoma. The PA is a slow growing and non-invasive, and recurrence is uncommon following excision, in contrast to central ameloblastoma which is locally invasive and can destroy large segments of the jaw. We report here a case of the plexiform type of PA.
Outcome of Heliotherapy and Modified Parkland’s Formula for Fluid Resuscitation in Management of Moderate Degree of Burns: A Single Centre Observational Study.
(2015-05) Pukar, Mahesh; Rajshakha, Aakash; Mewada, Sohank; Lakhani, Dhairya
Background: Acute resuscitation is one of the most challenging aspects of caring for burned patients. Although the Parkland formula is still the most common employed resuscitation formula worldwide, it is far from a perfect solution. Materials and Methods: This is a prospective observational study, which was carried out over a period of 3 years. A total of 50 patients were enrolled. Modified Parkland formula and heliotherapy were used in the management of moderate degree burns. Result: Out of 50 patients with Moderate degree of burns 47 survived (mortality rate: 6%). One of the deaths in occurred during the period of resuscitation (day 2). While the other two deaths were related to septic shock. Urine Output (ml/kg/h) of 0.72 ± 0.06 and 0.92 ± 0.05 was noted on day 1 and 2, respectively. Conclusion: Modified Parkland formula and heliotherapy proved to be effective in our set-up in comparison to the conventional Parkland formula and protocol for management of burns, as reflected in the published literature, thus, we recommend multicentric trials to test the efficacy of this technique, in management of burns.

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