Hemorrhoidectomy versus rubber band ligation in treatment of second and third degree hemorrhoids: a comparative study

Background: Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used Out patient treatment.Methods: We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. The diagnosis of hemorrhoids is primarily based on the proctoscopic  examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1 year from January 2017 to December 2017. It includes 50 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of Tertiary Care Hospital in Gujarat. These 50 patients were selected randomly and divided into two groups of 25 patients each (hemorrhoidectomy group and RBL group). Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed.Results: Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery.Conclusions: RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia

A rare complication of spontaneous rupture of incisional hernia: case report

Incisional hernia Complicates only 2%-10%. Spontaneous evisceration of content is very rare but whenever it occurs, it demands emergency surgery, to prevent further obstruction, strangulation of bowel and to cover its contents. The hernial contents can be covered primarily by mesh repair if the general condition of the patient and local condition of the operative site allows or can be covered by skin followed by delayed mesh repair. Authors report such rare case of spontaneous evisceration of omentum in 35 years old female patient who was known case of incisional hernia for 2 years. Neglect for early operative intervention or delay in seeking the treatment for an incisional hernia increases the risk of rupture

Technique and Role of Embolization using Ethylene Vinyl-Alcohol Copolymer before Carotid Body Tumor Resection.

A 45-year old female referred for a large carotid body tumor resection. The tumor was encasing the internal (ICA) and external carotid arteries (ECA). She underwent angiogram and embolization of the ascending pharyngeal artery and a distal branch of the ECA using ethylene vinyl-alcohol copolymer (EVOH). Two days later, surgical resection of the tumor with regional lymph node dissection was performed along with an interposition reversed vein graft anastomosis between the mid common carotid and distal ICA. Devascularization of carotid body tumor can be performed using EVOH delivered through trans-arterial and percutaneous routes. Embolization may facilitate surgical resection and decrease blood loss but does not decrease the rate of neurological complications. Embolization can be performed by the vascular surgeon before a large carotid body tumor resection with minimal migration and or stroke risk

Agreement of site and central readings of ileocolonoscopic scores in Crohn's disease: comparison using data from the EXTEND trial

Background and AimsCentralized endoscopic scoring may reduce variability, but evidence is lacking in patients with Crohn’s disease. We assessed the agreement of endoscopic scorings between site endoscopists and one central reader by using data from the adalimumab Crohn’s disease clinical trial EXTEND.MethodsAgreement between readers for Crohn’s Disease Endoscopic Index of Severity (CDEIS)–scored endoscopies from 6 sites and Simple Endoscopic Score for Crohn’s Disease (SES-CD)–scored endoscopies from 19 sites in EXTEND was evaluated at baseline and weeks 12 and 52. Agreement on total scores was calculated by using intraclass correlation coefficient (ICC). Kappa statistic or Spearman correlation coefficient measured the agreement between readers for each ileocolonic segment on CDEIS variables including deep ulceration, surface involved, and ulcerated surface and SES-CD variables including ulcerated surface, size of ulcers, and affected surface.ResultsICCs on mean scores at baseline and weeks 12 and 52 were 0.78, 0.92, and 0.86 (CDEIS), and 0.77, 0.86, and 0.82 (SES-CD), respectively. Site endoscopists consistently reported higher scores. High agreement was observed for most segments and all time points for CDEIS variables and SES-CD large ulcers. Weak agreement occurred for the right side of the colon at all time points for CDEIS deep ulceration and SES-CD large ulcers and at baseline and week 12 for CDEIS ulcerated surface. Fair/moderate agreement occurred for SES-CD ulcerated surface and moderate/high agreement for affected surface for all segments and time points.ConclusionsSite and central readers showed high agreement on total CDEIS and SES-CD scores overall, whereas variability for individual segments was observed. Weakest agreement occurred at baseline, with a greater difference for SES-CD than for CDEIS score. (Clinical trial registration number: NCT00348283.

Study of ectopic pregnancy in a tertiary care centre

Background: Ectopic pregnancy is a life threatening emergency leading to maternal death. Incidence of ectopic pregnancies has been increasing in last two to three decades with reduction in mortality. The presenting symptoms include abdominal pain, amenorrhoea and/or irregular vaginal bleeding. The present study was undertaken to study the clinical features of ectopic pregnancies in a tertiary care hospital.Methods: The present study on ectopic pregnancies was carried out in Department of Pathology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India from January 2010 to June 2014. All the cases of ectopic pregnancy managed surgically were included in the study.Results: Total 102 cases of ectopic pregnancy were studied. Proportion of ectopic pregnancy in the present study is 1 in 205 deliveries. Majority of the cases (37) (36.27%) were noted between 21 to 25 years of age group followed by the age group 26 to 30 years. Ectopic pregnancy was most commonly noted in nulliparous women (44/102) (43.14%). Majority of the cases (50/102) (49.02%) had no risk factors. Abortion was the most common risk factor identified, alone as well as in conjunction with other factors. Ampulla was the most common site for ectopic pregnancy. 55% of the cases were on the right side where as 45% on the left side. We had 2 cases of heterotropic pregnancy with tubal ectopic in both the cases. The typical triad of amenorrhoea, pain in abdomen and bleeding was observed in 21.57% cases.Conclusions: The incidence of ectopic pregnancies is on rise as evident in this study. In order to reduce the morbidity and mortality due to ectopic pregnancies, there is need for early diagnosis especially in high risk cases

Pathogenesis, diagnosis and management of diabetic foot ulcers: a systematic review

Diabetic foot ulcers lead to substantial morbidity and impair quality of life with high treatment costs and enormous economic losses. Diabetic foot ulcers readily become chronic; all too often these wounds do not heal primarily. Treatment of chronic wounds should be essentially directed against the main etiologic factors responsible for the wound. There are different treatment approaches for wound healing in diabetic foot ulcers. If treatment is based on the pathological cause, it may give better results and it must be cost effective too. Hydrogel dressing, platelet rich plasma, placenta extract gel, vacuum dressing are newer modalities in diabetic foot management

Exact Kohn-Sham versus Hartree-Fock in momentum-space: examples of two-fermion systems

The question of how density functional theory (DFT) compares with Hartree-Fock (HF) for the computation of momentum-space properties is addressed in relation to systems for which (near) exact Kohn-Sham (KS) and HF one-electron matrices are known. This makes it possible to objectively compare HF and exact KS and hence to assess the potential of DFT for momentum space studies. The systems considered are the Moshinsky atom, the Hooke's atom and light two-electron ions, for which expressions for correlated density-matrices or momentum densities have been derived in closed-form. The results obtained show that it is necessary to make a distinction between true and approximate DFT.Comment: 30 pages, accepted for publication in J. Chem. Phys. (2006

Spontaneous intravesical knotting of infant feeding tube: a rare case report

Infant Feeding tube is universally used in Paediatric Patients for many diagnostic as well as therapeutic purposes. Intravesical knotting of IFT is rare but having significant morbidity. We here present such a rare case report in 6 month old patient treated endoscopically. Sometimes it is very difficult to remove knotting with various techniques discussed later, but it may cause more trauma to urethra. There are only few reported cases worldwide about it in few journals. But Endoscopic removal being safe among all. In such Urological Emergency, always early Identification is most important to prevent further complications. As neonate and infant’s urethra is small compared to the available smallest Foley catheter (8Fr), a 5 Fr and 8 Fr feeding tubes are practical alternatives to drain urine from the bladder. Intravesical catheter knotting of small feeding tubes placed as urinary diversion from the bladder is rare. The first case of catheter knotting in a pediatric patient was reported in 1976

Parametric Study of Shapes of Pylon for Cable Stayed Bridge

Man's achievement in field of Structural Engineering is evident from world's largest bridge spans, tallest structures etc. In the recent years cable stayed bridges have received more attention than any other bridge mainly, in the United States, Japan and Europe as well as in third-world counties due to their ability to cover large spans. Cable-stayed can cross almost 1000m (Tatara Bridge, Japan, Normandy Bridge, France) A study is carried out to find the dynamic and aerostatic effect on different shapes of pylons of a cable stayed bridge. The different shapes of pylons considered here are H type, A type, Inverted Y type, Diamond type and Delta type. The central span of the cable stayed bridge is also varied as 100m, 200m, 300m, 400m to study the combined effects due to shape and span. The study is carried out by taking live load according to IRC 6:2000, IRC Class A and Class 70R vehicle load along with Aerostatic wind loads was undertaken. A Dynamic analysis in the form of Linear Time-history is also carried out using El-Centro ground motion and various response quantities such as Bending-moment, Shearforce, Torsion and Axial force are represented