No abstract

Acute appendicitis is a common surgical emergency condition with difficulty in accurate diagnosis. Alvarado scoring system is useful tool for early diagnosis. Aim of this study: This study is to evaluation of Alvarado score system in the early diagnosis of acute appendicitis: a prospective study. Materials and Methods: All consecutive patients with diagnosis of acute appendicitis admitted and evaluated by scoring system described by Alvarado. Patient who had undergone surgery, the diagnosis of appendicitis was confirmed by histo-pathological examination and compared with previous clinical diagnosis on the basis of Alvarado score. Results: Accuracy of diagnosis in male patients was more sensitive then female patient in child bearing age.

Introduction: Glomus tumor is a benign and rare vascular tumor arising from the glomus body, commonly found in the hand particularly in subungal region. These tumors present usually as bluish discolouration of nail plate with classical triad of excruciating pain, localized tenderness and sensitivity to cold. It's etiology remains unknown but several hypothesis explain the excruciating pain. Different clinical test including Love's pin test, Hildreth's test and trans-illumination test are often helpful in diagnosis. MRI (Magnetic Resonance Imaging) is an excellent imaging modality in the diagnosis of these lesions. Diagnosis of tumor is delayed because of subtle clinical signs and also surgeons often miss advising MRI to patients due to its high cost. There are two main approaches for excision of glomus tumor-transungual and periungual. Selection of approach depends upon surgeon's choice and anatomical location of the tumor. Complete surgical excision of the tumor reduces chance of recurrence. The aim of this study is to review the time from onset of symptoms to the diagnosis, management of problem and recurrence retrospectively. Material and methods: This study was done retrospectively between May 2017 to May 2019 at tertiary care center of eastern India. All patients with histopathologic ally confirmed subungual glomus tumor of distal phalanx of hand were included in this study. Patients with Reynolds disease were excluded from this study. MRI was done preoperatively and histopathological analysis of the excised specimen was done postoperatively to confirm the diagnosis. Patients were followed-up after every 3 month for 1 year to see any complication and recurrence. Results: It was found that the patients had clinical symptoms for an average of 2.3 years. All patients were women with mean age of 34.2 years. Out of 5 patients, 2 patients developed nail deformity. Recurrence was not found till last follow-up period. All patients were returned to their normal routine work and regained their full function of the hand.

Introduction: Acute peritonitis by perforation is the most common type and almost 80% cases results from necrosis of digestive conduit, such as typhoid fever, duodenal ulcer perforation, tubercular perforation and mesenteric ischemia secondary to the intestinal obstruction. So it is very important to seek urgent evaluation and treatment that can prevent fatal complications. This prospective study was conducted at tertiary care center to know the range of perforation in terms of etiology, presentation ,site of perforation, treatment options, postoperative complications and mortality so that we can improve its outcome in this region. Methods: This was a prospective study conducted by the department of general surgery from September 2017 to March 2018. 39 consecutive patients of perforation peritonitis admitted to surgical emergency were included in this study. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy, cause of perforation was identified and managed accordingly. Results: The mean age of patients was 34.9 years (range 15-75 years).The majority of patients were male (76%). Perforated duodenal ulcer due to acid-peptic disease and small bowel perforation due to typhoid were the most common cause of perforation peritonitis. Tubercular perforation was second most common cause of small bowel perforation. Post-operative complications included wound infection (31%), anastomotic leak (8%),burst abdomen (13%) ,Pneumonia( 25%),septicemia (8%),Acute renal failure (6%) and abdominal collection in (9%) . Conclusion: Peritonitis due to perforation is still a terrible and alarming condition encounter to general surgeon in emergency. Early arrival of patients to hospital and adequate Resuscitation before surgery improves outcome of disease. Avoidance of extensive emergency surgery contributes to low mortality.

No abstract