Comparative Evaluation of Stapled Hemorrhoidectomy versus Open Hemorrhoidectomy

Background: Hemorrhoid is one of the most common diseases encountered by a surgeon on daily basis. The choice of method of treatment for hemorrhoids depends on the severity and the type of symptoms, on the degree of prolapse and on the expertise of the surgeon and available equipment. Aim of this study is to compare stapled hemorrhoidectomy with conventional Milligan-Morgan hemorrhoidectomy in terms of surgical outcomes.Materials and Methods: Out of total of 50 patients selected, 25 underwent open and 25 stapled hemorrhoidectomy. Inclusion criteria for selection of the patients were large grade II, III and IV hemorrhoids and externo-internal hemorrhoids with well-developed external hemorrhoids.Results: Out of 50 patients included in our study, 15 were female and 35 male. The youngest was of 25 years of age and eldest 59 years. In group A, mean operative time was 29.8 min as against 51.32 min in group B with p value <0.001. All patients of group A were virtually pain free 7 days postoperatively, while mean pain of 1.04 was still recorded at 7 days in group B patients.Conclusion: Early functional and symptomatic outcomes have been found satisfactory and comparatively better with stapled hemorrhoidectomy. However, long-term follow-up in respect of so many factors is yet to be seen and further studies are required for this

Comparison of open versus laparoscopic appendectomy

Background: Although laparoscopic cholecystectomy has now considered the gold standard for the management of gall stone disease, laparoscopic appendectomy has not attained the same degree of popularity and acceptance. Aim of this study is to assess and compare the role of laparoscopic appendectomy with open appendectomy in acute appendicitis as well as in the patients planned for interval appendectomy.Methods: Total number of fifty cases over the age of 12 years were studied prospectively. Out of 50 number of total cases, 20 cases were those who have been operated laparoscopically while 30 cases were of open appendectomy group. The two groups were compared with respect to operative time, length of hospital stay, post-operative pain and nausea, complication rate and time to return to normal activity.Results: The mean age was 22.8±2(6.83) and 26.7±2(9.22) years in the laparoscopic and open groups respectively, with the range of 14 to 42 in the laparoscopic group and 13 to 50 years in the open group. The Average operating time was more in the laparoscopic appendectomy as compared to the time taken in performing open appendectomy. However, this was not statistically significant with p<0,05. Overall, there was no significant difference in the incidence of complications between open and laparoscopic groups.Conclusions: The laparoscopic appendectomy is safe, simple and efficient technique for treatment of acute appendicitis with result comparable to the open appendectomy, if not better

Squash Smear Technique in Rapid Intraoperative Diagnosis of Non-neoplastic and Cystic Lesions of CNS

In neurosurgical practice, a rapid intraoperative diagnosis helps the neurosurgeon to monitor and modify the approach at surgery. Smears and frozen sections are the two rapid tissue preparations that may be used by neuropathologists for giving opinion on intraoperative biopsy specimens of suspected lesions. The smear technique, which could be either squash/crush smears or impression smears, has been applied in neurosurgical units worldwide. This method plays a very important role in the analysis of sample from craniotomies and the small specimens obtained from stereotactic biopsies.Squash smear technique is a very rapid technique and the study was designed to assess the accuracy of squash smear in the rapid intraoperative diagnosis of non-neoplastic and cystic lesions of CNS and to document the cytomorphology of these lesions. A total of 23 cases were studied. The tissue was removedat craniotomy or by burr hole biopsy.In all the cases clinicoradiological correlation was done with smear diagnosis. Smears were stained with 1% Toluidine blue and H&E. In all cases, results were compared with the paraffin section prepared from the tissue remaining after the squash smears. Immunohistochemistry was done in one case. Special stainswere used as required.Amongst non-neoplastic lesions, tuberculous lesions comprised the maximum number of cases (n=9), two cases of PML, one case of fungal lesion, one case of non-specific abscess, one case of infarct, only reactive changes in one and normal cortex and white matter in one. In cystic lesions of the CNS, there was one case of Rathke’s Cleft cyst, four cases of Epidermoid cyst and two cases of arachnoid cyst. Cases of PML and Rathke’s cleft cyst could not be identified on smears. In all the cases, smear diagnosis was compared with histopathological diagnosis

ENVIRONMENTAL CHEMISTRY: MONITORING AND REMEDIATION OF POLLUTANTS IN AIR, WATER, AND SOIL

The purpose of this study is to determine pollutants present in air, water, and soil. Highlighting the impacts of these pollutants and ways to monitor and control these pollutants are other objectives of this research. Further, air pollution, water pollution, and soil pollution are illustrated as a part of environmental pollutio

Comparison of open versus laparoscopic appendectomy

Background: Although laparoscopic cholecystectomy has now considered the gold standard for the management of gall stone disease, laparoscopic appendectomy has not attained the same degree of popularity and acceptance. Aim of this study is to assess and compare the role of laparoscopic appendectomy with open appendectomy in acute appendicitis as well as in the patients planned for interval appendectomy.Methods: Total number of fifty cases over the age of 12 years were studied prospectively. Out of 50 number of total cases, 20 cases were those who have been operated laparoscopically while 30 cases were of open appendectomy group. The two groups were compared with respect to operative time, length of hospital stay, post-operative pain and nausea, complication rate and time to return to normal activity.Results: The mean age was 22.8±2(6.83) and 26.7±2(9.22) years in the laparoscopic and open groups respectively, with the range of 14 to 42 in the laparoscopic group and 13 to 50 years in the open group. The Average operating time was more in the laparoscopic appendectomy as compared to the time taken in performing open appendectomy. However, this was not statistically significant with p&lt;0,05. Overall, there was no significant difference in the incidence of complications between open and laparoscopic groups.Conclusions: The laparoscopic appendectomy is safe, simple and efficient technique for treatment of acute appendicitis with result comparable to the open appendectomy, if not better

Impact of Medicaid Expansion on Liver-Related Mortality

The Affordable Care Act provided the opportunity for states to expand Medicaid for low-income individuals. Not all states adopted Medicaid expansion, and the timing of adoption among expansion states varied. Prior studies have shown that Medicaid expansion improved mortality rates for several chronic conditions. Although there are data on the association between Medicaid expansion on insurance type among patients waitlisted for a liver transplant, there are no published data to date on its impact on liver disease-related mortality in the broader population. We therefore sought to evaluate the association between Medicaid expansion and state-level liver disease–related mortality using a quasi-experimental study design. We evaluated age-adjusted, state-level, liver disease–related mortality rates using the Centers for Disease Control and Prevention data. We fit multivariable linear regression models that accounted for sociodemographic, clinical, and access-to-care variables at the state level, and a difference-in-difference estimator to evaluate the association between Medicaid expansion and liver disease–related mortality. In multivariable linear regression models, there was a significant association between Medicaid expansion and liver disease–related mortality (P = .02). Medicaid expansion was associated with 8.3 (95% CI, 1.6–15.1) fewer deaths from liver disease per 1,000,000 adult residents per year after Medicaid expansion compared with what would have been expected to occur if those states followed the same trajectory as nonexpansion states. The impact of Medicaid expansion translated to 870 fewer liver-related deaths per year in expansion states (4350 in the postexpansion study period from 2014 to 2018). These data support the contention that Medicaid expansion has been associated with significantly decreased liver disease–related mortality. Universal Medicaid expansion could further decrease liver disease–related mortality in the United States