Archive for the ‘ surgery ’ Category

ORAL ATROPINE PREMEDICATION IN INFANTS ATTENUATES CARDIOVASCULAR DEPRESSION DURING HALOTHANE ANAESTHESIA

ABSTRACT
Objectives:
To evaluate the effect of oral atropine premedication in infants attenuates cardiovascular depression during halothane anaesthesia.
Methodology Design and setting:Tertiary care teaching hospital.Subjects:A double blind study was conducted on 60 patients of paediatric age group of ASA Grade I were divided into Group A(4-9 months) & Group B(10-15 months). Patients of both the groups were randomly placed into premedication subgroups: subgroup I (Placebo), subgroup II (Lo Dose, 0.02mg/kg), subgroup III (Hi Dose, 0.04mg/kg) with 10 patients in each group.
Results:Oral atropine given one hour before the induction of anaesthesia in the doses of 0.02mg/kg and 0.04mg/kg is effective in attenuating cardiovascular depression caused by halothane which is the most commonly used inhalational anaesthetic agent in paediatric patients.
Conclusion:Oral atropine given one hour before the induction of anaesthesia was effective in attenuating cardiovascular depression caused by halothane which was the most commonly used inhalational anaesthetic agent in paediatric patients.
Key words: Oral atropine, Premedication, Halothane Anaesthesia, Cardiovascular depression.

A RARE PRESENTATION OF UNUSUAL BENIGN MULTICYSTIC THYROID SWELLING IN THE LATERAL PART OF NECK

ABSTRACT
Thyroid swellings rarely present as cystic masses in neck laterally. Mostly cystic neck masses appearing in neck are usually benign. However, they may occasionally have a sinister origin and should be investigated rigrously. Thyroid cysts most often result from cystic degeneration in an adenomatous nodule. ² Brachial Cysts, dermoid cysts and epidermoid cysts are the most common benign neck cysts. Presentation of thyroid tissue as a cystic mass in the lateral side of the neck is rare . We present a rare case of multicystic swelling in left supra-clavicular region of neck with no other thyrotoxic or pressure features . The swelling appeared to be malignant during surgery on gross examination, but turned to be a benign thyroid cyst by histopathological examination.
Keywords: multicystic, thyroid cyst, cystic degeneration

PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM IN COMMON BILE DUCT STONE PATIENTS

ABSTRACT
Subclinical thyroid dysfunction is a common laboratory diagnosis characterized by an abnormal high serum thyrotropin (TSH) concentration with normal free triiodothyronine (T3) and thyroxine (T4) levels. Refinements in serum thyrotropin measurements during the past few decades have resulted in a sharp increase in the diagnosis of thyroid dysfunction, mirroring the tendency towards early diagnosis of many other conditions such as hyper lipidemia for which early treatment appears beneficial. Various studies have been done regarding subclinical thyroid dysfunction and its clinical relevance in common bile duct (CBD) stone patients. This study of subclinical hypothyroidism was done on 30 common bile duct stone patients, admitted in Department of General Surgery. The aim of the study was to find out the prevalence of subclinical hypothyroidism in common bile duct stone patients.
Key words: subclinical hypothyroidism, common bile duct stone, thyroid dysfunction

MEASUREMENT OF INTRA-ABDOMINAL PRESSURE AS AN INDICATOR OF MORBIDITY AND MORTALITY IN CRITICALLY ILL SURGICAL PATIENTS

ABSTRACT
Intra abdominal pressure (IAP) is defined as the pressure in the peritoneal cavity and an acute rise in this pressure can result in adverse physiological consequences termed Abdominal Compartment Syndrome (ACS). This increase in abdominal pressure can affect multiple organ systems and once a certain stage has been passed, the effects are no longer reversible by decompression. So challenge is to be aware of the condition and act sufficiently early to reverse the effects.
Aims: 1) To assess whether intra abdominal pressure is an independent predictor of morbidity and mortality for patients undergoing emergency exploratory laparotomy. 2) To identify the hidden causes of abdominal compartment syndrome.
Settings and Design : this was a randomised controlled trial involving 50 patients, who were admitted and
underwent emergency laparotomy.
Methods and Material:50 patients who underwent emergency laparotomy due to various indications ,were included in the study. Intra abdominal pressure was measured through urinary bladder with Foley’s catheter, which was connected to saline manometer. Readings were taken preoperatively and then post operatively at 0, 6, 24 and 72 hours. Grading of intra abdominal hypertension (IAH) was done as per the pressure. ACS was labelled if IAH was associated with at least one newly developed organ system dysfunction.

Results: Pre operative IAH was seen in 62% of the patients. Raised IAP at 6 hours and 24 hours is significant predictor of morbidity (p =0.031 and p = 0.004 respectively) whereas, raised IAP at 48 hours is a significant predictor of mortality. Similarly, raised IAP at 6 hours is also a significant predictor for longer hospital stay (p=0.031).
Conclusions : IAP is a significant indicator of morbidity and mortality in the patients undergoing emergency laparotomy. Thus a thorough monitoring and early decompression can decrease the morbidity and mortality rate.

A RARE CASE OF INCIDENTALOMA – ADRENAL TUMOUR, Khalilur Rahman.A, Shruthi Kamal. V, Rajesh

ABSTRACT: Adrenal myelolipoma is a rare benign neoplasm composed of mature adipose tissue and a variable amount of haemopoetic elements. Most lesions are small and asymptomatic discovered incidentally. Herein we are reporting a case of right adrenal myelolipoma incidentally discovered in a 48 year  old women presented with intermittent, dull aching, vague abdominal pain for the past one year. She underwent total thyroidectomy seven years back for multinodulargoiter and was on Tablet thyroxine 100µg once daily (OD). The Physical examination was unremarkable. Ultrasound abdomen revealed right adrenal mass lesion. Routine investigation were normal and MRI suggested right adrenal myelolipoma(8.6 X 7 X 6.2 cm). Laboratory investigations revealed the non-functioning nature of adrenalmass.The patient underwent open right adernalectomy with a smooth post-operative recovery. Histopathology revealed adrenal myelolipoma.

Urachal cyst in adult presenting as abdominal pain – Case Report – khalilur Rahman 1, Rajesh 2, Shruthi Kamal3, Dinesh kumar 4,

Abstract – Introduction Urachal cyst is very rarely seen in adults. They are normally obliterated in early infancy. Urachal abnormalities are more common in children. - Case presentation -We describe a case of a 35 years South Indian male who presented with intermittent lower abdominal pain. He also had a history of discharge from umbilicus which subsided on treatment with antibiotics. No mass was palpable per abdomen. CT scan abdomen was done which showed a cystic lesion 1.3 x 1 cm about 4 cm inferior to the umbilicus which was suggestive of urachal cyst. Exploratory laparotomy was performed. Urachal cyst excised. The distal urachal ligament was obliterated and fibrous. No communication was found to the bladder. Histopathology confirmed it to be urachal cyst. Postoperative period was uneventful. Patient was relieved of abdominal pain on outpatient follow-up after 3 months - Conclusion -Urachal abnormalities are rare in adults. Clinical presentation was as chronic intermittent abdominal pain which was nonspecific. A high index of suspicion required to arrive at the diagnosis. The investigation modalities didn’t offer conclusive diagnosis.  Excision relieved the abdominal pain.

Case report – Uncommon cause of abdominal lymphadenopathy – Castleman disease, Godwin Devadhas Packiaraj 1 , P B Sudarshan 2 , Sridevi Manian 3-

Abstract: No doubt it is rightly said that abdomen is a temple of surprises. The case presented here is one of the uncommon entity which a surgeon encounters . Abdominal  mass always presents a diagnostic dilemma to the treating surgeon because of various structures from which it can arise. Mesentric mass in particular is one such aspect which always poses a difficullty to surgeon because of the extension of the mesentry right across the abdomen from right iliac fossa to left hypochondrium. The mass of the mesentry ranges from cystic mass to solid mass. The case that follows is a solid mass which is an uncommon variety of lymph node neoplasm- Castleman disease.

Case Report -Disastrous Sequelae of Untreated Femoral Hernia Godwin Devadhas Packiaraj1 , B.S.Sundaravadanan2

Keywords: Femoral hernia, peritonitis

Case Report- Primary calcium oxalate enterolith masquerading as gall stone ileus – Prem Chand, Manish Yadav ,AdarshpalKaur, RachanLalSingla, Bimaljot Singh, Ashwani Kumar

ABSTRACT We report a case of 65 year female with 7 days history of pain in abdomen, vomiting, constipation and abdominal distension. X-Rays abdomen showed multiple air fluid levels and dilated small bowel loops. Ultrasound abdomen showed dilated gut loops and stone in the gall bladder.Exploratory laparotomy was done and a single 4×3 cm round stone with smooth surface was found in terminal ileum.

Suprahepatic anteriorly placed gall bladder with chronic Buddchiari syndrome – PremChand , BimaljotSingh , RachanLalSingla, AdarshpalKaur , Ashwani Kumar

Abstract Congenital anomalies of the gall bladderinclude its complete absence, hypoplasia and atresia, duplication, excessive mobility and ectopias, but they are very rare.Suprahepaticanteriorly placed gall bladder with chronic budd chiari syndrome is an extremely rare congenital anomaly. We report incidental radiological findings associated with a 66 yr old male, with no past history of related symptoms,who was admitted for evaluation after a history of assault. Imaging by computed tomographydemonstrated suprahepatic anteriorly placed gall bladder and portal vein with chronic budd chiari syndrome.

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