Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single center in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirementMethods: It was a  prospective comparative study conducted  in the department of surgery Skims Medical college Srinagar, India from July 2015 to March 2017. The study was performed on all adult patients with ultrasound documented cholelithiasis and gall bladder Polyposis. The total number of patients studied was 100 which were divided into two groups of 50 each.Results: The average operative time in three port group was 29.2 minutes (range, 15-37) compared to 30.66 minutes (range, 15-42) in four port group, which was statistically insignificant. The final visual analog scores for pain in the postoperative period was 2.30 vs 2.86 in three port and four port group respectively, with a P value=0.008, which was statistically significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less pain and less analgesic requirement and better cosmetic results

Outcome of albendazole therapy in the management of hepatic hydatid disease

Background: The treatment modalities for managing patients with hepatic hydatidosis include surgical treatment and non-surgical treatments. The non-surgical methods include albendazole therapy and percutaneous management. Use of albendazole as an adjuvant therapy to surgery has been found to significantly reduce the viability of daughter cyst and recurrence of hydatid disease. The aim of the study was to understand the effect of albendazole therapy on the viability of protoscoleces and recurrence rate of hydatid disease of liver.Methods: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences and Medical College, Srinagar, Kashmir India, from March 2010 to February 2012 with further follow up of 3-4 years and the total of 64 patients were studied. ; Patients were divided into two groups, Group A and Group B, each comprising of 32 patients. In group A, patients were given albendazole for 12 weeks preoperatively followed by further postoperative course for 12 weeks. In group B, patients were first taken for surgery followed by postoperative course of albendazole for 12 weeks. The two main outcome measures studied and compared during present study were the viability of the hydatid cysts and the recurrence rate in two groups.Results: Out of those, patients who received preoperative albendazole, 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who received only postoperative albendazole therapy, recurrence rate was 18.75% while as there was no recurrence was in patients who received both preoperative and postoperative albendazole therapy.Conclusions: Study concludes that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Papillary carcinoma thyroid with metastasis to ectopic cervical thymus

Papillary carcinoma of thyroid is the most common type of thyroid neoplasm which is usually confined to the thyroid and tends to metastasize to regional lymph nodes. Distant metastasis occur in up to 15% of cases. Thymic metastasis from any malignant carcinoma is extremely rare with only four cases reported in medical literature. We report a case of papillary carcinoma of thyroid metastasizing to ectopic cervical thymus which has not been previously reported

Atypical Localizations of Hydatid Disease: Experience from a Single Institute

Introduction: The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepaticopulmonary hydatid cysts are rare and only a few sporadic cases have been reported. Materials and Methods: Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7%) patients had isolated involvement of the atypical sites, while six (2.4%) also had a primary involvement of liver. Results: The cysts were present in gall bladder (0.4%), peritoneum (1.6%), spleen (1.6%), ovary (0.4%), subcutaneous (0.8%), seminal vesicle (0.4%), spinal (0.4%), pancreas (0.4%), kidney (0.4%), mediastinal (0.4%), muscle (0.4%), and brain (0.8%). Discussion and Conclusions: Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.Keywords: Atypical locations, hydatid, echinococcosisNigerian Journal of Surgery, Jan-Jun 2012 | Volume 18 | Issue

Breast Gangrene

<p>Abstract</p> <p>Background</p> <p>Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene.</p> <p>Methods</p> <p>A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed</p> <p>Results</p> <p>All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area.</p> <p>Conclusion</p> <p>Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement.</p

Pathogenic variability in Exserohilum turcicum and identification of resistant sources to turcicum leaf blight of maize (Zea mays L.)

Turcicum leaf blight of maize incited by Exserohilum turcicum (Pass.) Leonard and Suggs is the major limiting factor of maize production in temperate agro-ecologies. Disease management through host plant resistance is the most effective strategy. In the present study among 26 maize genotypes which were initially screened for resistance against E. turcicum under field conditions, 8 genotypes viz., PS 39, CML 451, CML 470, CML 472, VL 1030, VL 1018140, VL1018527 and SMI178-1 were found resistant when screened against twelve isolates of E. turcicum under artificial epiphytotic conditions. Eight genotypes viz., PS45, CML165, CML459, VL1249, VL0536, SMC-5, SMC-3 and KDL 211 were found moderately resistant with disease grade ranged from 2.1-2.5. These maize genotypes possess resistance to turcicum leaf blight can be used successfully in developing high yielding early maturing varieties for high altitude temperate agro-ecologies. The fungus E. turcicum is highly variable in nature. Variability studies on pathogenicity were conducted on twelve isolates of E. turcicum on eleven putative differential maize lines. During the present study a wide pathogenic variation was observed among the twelve isolates of E. turcicum. Cluster analysis on the basis of similarity or dissimilarity in reaction types exhibited by the differential hosts, clustered the isolates into 6 pathogenic groups. The isolates belonged to higher altitudes (Kti 10, Kti11, Kti5) were found to be more aggressive as compared to the isolates of low altitude areas

Regional mitochondrial DNA and cell-type changes in post-mortem brains of non-diabetic Alzheimer’s disease are not present in diabetic Alzheimer’s disease

Background: Mitochondrial dysfunction is implicated in both diabetes and Alzheimer’s disease (AD), and diabetes also increases the risk of AD, however the combined impact of AD and diabetes on brain mitochondria is unknown. The purpose of this study was to test the hypothesis that the combination of both diabetes and AD exacerbates mitochondrial dysfunction. Methods: Post-mortem human brains (n=74), were used to determine mitochondrial DNA (mtDNA) content of cerebellum, frontal cortex and parietal cortex by quantifying absolute mtDNA copy number/cell using real time qPCR. mtDNA content was compared between diabetic and non-diabetic cases representing non-cognitively impaired controls (NCI), mildly cognitively impaired (MCI) and AD. A subset of parietal cortex samples was used to quantify mRNAs corresponding to cell types and mitochondrial function. Immune-staining of parietal cortex sections followed by semi-automated stereological assessment was performed to assess cell types. Results. Using mtDNA as an indicator of mitochondrial content, we observed significant regional variation, being highest in the parietal cortex, and lowest in the cerebellum. In the absence of diabetes, AD cases had decreased parietal cortex mtDNA, reduced MAP2 (neuronal) mRNA and increased GFAP (astrocyte) mRNA, relative to NCI. However, in the presence of both diabetes and AD, we did not observe these changes in the parietal cortex. Irrespective of cognitive status, all 3 brain regions in diabetic cases had significantly higher mtDNA than the non-diabetic cases. Conclusion. Our data show that the parietal cortex has the highest mitochondrial content but is also the most vulnerable to changes in AD, as shown by reduced mtDNA and neurones in this region. In contrast, when patients have both diabetes and AD, the AD associated parietal cortex changes are no longer seen, suggesting that the pathology observed in diabetic AD may be different to that seen in non-diabetic AD. The lack of clear functional changes in mitochondrial parameters in diabetic AD suggest that there may be different mechanisms contributing to cognitive impairment in diabetes and their impact on the respective disease neuro-pathologies remain to be fully understood

Surgical management of complicated hydatid cysts of the liver

AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver