Mesh inguinal hernioplasty is one of the most commonly performed surgery by general surgeons. One of the significant problems following hernia repair is recurrence. Prosthetic materials like polypropylene mesh has been used for inguinal hernia repair and has many advantages like low recurrence rates, less postoperative pain, decreased hospital stay and fewer complications. MATERIALS AND METHODS: In this prospective study, 432 open Lichenstein tension-free inguinal mesh hernioplasty was performed between June 2004 and May 2014. Various parameters regarding postoperative complications were studied. RESULTS: In 432 cases, inguinal hernia was indirect in 59.03% of cases (255 cases), direct in 36.57% (158 cases) and of the pantaloon (mixed) type in 4.39% (18 cases). Mean age of patients was 50.8 years (range 19-92). The median follow-up period was 2.1 years (range 1 month-5 years). Seroma and hematoma formation requiring drainage was observed in 9 and 11 patients, respectively, while transient testicular swelling occurred in 28 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). There was one recurrence of the hernia. Residual neuralgia was observed in 3 patients. CONCLUSION: Lichtenstein Tension-free mesh hernioplasty has many advantages of being simple, effective, low recurrence rate, early return to daily activities and good patient compliance and satisfaction. This technique is preferable for hernia repair in our setting.
To evaluate the feasibility and safety of inguinal hernioplasty under local anesthesia in elderly patients with significant comorbidity. METHODS: A prospective study of 68 patients requiring inguinal mesh hernioplasty for inguinal hernia was carried. One group comprising 34 patients under 60 years of age underwent inguinal mesh hernioplasty while the other group comprising 34 patients over 60 years of age. The comorbid conditions and complications were compared between both groups. RESULTS: Inguinal mesh hernioplasty in elderly patients is more likely associated with comorbid conditions than younger patients in terms of hypertension, chronic obstructive pulmonary disease, cardiovascular diseases, benign prostatic hyperplasia etc. CONCLUSION: Elective inguinal mesh hernioplasty under local anesthesia has good results in elderly patients with significant comorbidities. Inguinal mesh hernioplasty under local anesthesia is safe and results in good success rate in elderly patients with significant comorbidities.
Breast abscess is defined as an acute soft tissue infection which is characterized by localized pain, swelling and redness associated with a mass that may or may not be fluctuant. [1,2] Most breast abscesses develop as a complication of lactational mastitis. OBJECTIVES OF STUDYTo assess the feasibility and effectiveness of percutaneous needle aspiration of breast abscesses as a day care procedure. METHOD AND METHODOLOGYThis prospective study was conducted in patients with breast abscess attending the surgical OPD of a tertiary centre. A total of 100 patients with breast abscess giving consent to participate in study were included in the study. Percutaneous needle aspiration of pus under local anaesthesia was done with 18/16G needle. Empirical antibiotic therapy with amoxicillin+clavulanic acid was started. Aspirated pus was sent for bacteriological study. The antibiotics were changed in accordance to sensitivity report if needed. RESULTSThe mean age of the patients was 28.11 years and youngest patient was of 17 years married female. Most of the patients were lactating female in age group of 25-30 years followed by age group of 20-25 years. Topographically, most breast abscess were located in upper outer quadrant in 38 patients followed by 32 patients having abscess in central region. The mean volume of pus on ultrasonography was 57.32 mL and mean volume of pus on aspiration was 45.75 mL. The mean number of aspiration was 2.18. All of the aspirated pus was sent for culture and sensitivity. Among these, 12 samples of pus were sterile and 88 samples showed growth of organism. CONCLUSIONWith appreciable cure rate by repeated needle aspiration, this method can be preferred as treatment of breast abscess in selected patients.
To compare the effectiveness of mixture of local anesthesia versus spinal anesthesia in lateral sphincterotomy for the treatment of anal fissures. METHODS: A prospective study of 54 patients requiring lateral sphincterotomy for anal fissures. One group comprising 27 patients underwent lateral sphincterotomy under spinal anesthesia while the other group had topical lignocaine (2%) jelly applied followed by local infiltration of lignocaine (2%). RESULTS: There were no significant differences between the 2 groups in terms of operating time, per operative pain, postoperative pain, nausea or vomiting, post-operative requirement of analgesia and patient's acceptability/ satisfaction with method of anesthesia. CONCLUSION: A mixture of topical and local anesthesia can be used effectively for lateral sphincterotomy for treatment of anal fissure and is good alternative to spinal anesthesia.
Gastrointestinal stromal tumor is biologically heterogeneous in both morphological appearance and clinical behavior. Immunohistochemical analysis and literature review was done to explore the necessity of mutation study. We present a case study of a 40 year old male presented with upper abdominal lump, exploratory laprotomy done and a large cystic mass involving transverse colon, omentum, stomach along with gross hemoperitoneum was found. Ruptured large cystic tumor mass measuring 19X16 cms was received for histopathological examination. Grossely the cystic mass show variegated outer nodular surface with attached piece of stomach and a segment of colon. Bright field microscopy show striking perivascular arrangement of tumor cells and geographical necrosis and the report signed out as undifferentiated carcinoma stomach. Battery of immunohistochemical markers was done. Tumor cells displayed diffuse positivity for CD117, DOG1, and pan-CK along with more than focal positivity for CD34 and negative for SMA, desmin, S-100, synaptophysin, chromogranin, Bcl-2, Ki-67. Tumor turned out to be Cytokeratin positive epithelioid gastric GIST. Cytokeratins may be expressed in high grade GISTs rarely and CK positive GISTs must be differentiated from carcinomas, melanomas and a range of CK-positive sarcomas. A panel of immunohistochemistry markers is required for diagnosis and prognostication of the tumor.
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