A clinical audit of thoracotomy done in a tertiary care center

Background: Sri Aurobindo Medical College and Post Graduate Institute is a tertiary care center in Indore. The surgical oncology department is performing various oncological surgeries. One subspeciality is thoracic surgery, where surgeries for benign as well as malignant cases are being done. Thoracotomy is done for various lung, pleural and mediastinal pathology. Open and VATS are two main modalities with each having their pros and cons.Methods: All thoracotomies done from 2016 to January 2018 were included in the study. Decortications, wide local excision, lobectomies, pneumonectomies, hilar lymph node dissections were done.Results: Total 30 cases were done in a span of 2 years. Of these 9 cases were done for a malignant origin, 4 for benign tumor, 3 for benign non-infective disease and rest 14 for infective origin. Posterolateral thoracotomies were done most often. Average duration of the procedure was 157 minutes. Average blood loss was approximately 340 ml. Mean duration of stay was 10.9 days.Conclusions: Thoracic oncologic procedures are less often done due to paucity of the cases. However, surgical oncologist being well versed with the anatomy, relations and oncologic concepts can perform both neoplastic as well as infected cases. With increasing number of cases, the standard of care is increasing, operating time is lessened, complications are brought down, and the results are better

A clinical study of intestinal stomas: its indications and complications

Background: Intestinal stoma is an opening for fecal diversion. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it.Methods: This is a prospective study was carried out in a surgical unit of Hamidia Hospital, Gandhi Medical College, Bhopal from January, 2012 to December,2012. Data was collected by meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases. The results were collected, analyzed and compared with other studies.Results: A total of 100 patients were evaluated age ranged between 12- 85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 97 were admitted in emergency while 3 in out-patient department. The most common type of stoma made was loop ileostomy (64%) followed by sigmoid colostomy (11%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (38%) followed by Koch’s abdomen (18%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (36%) was the most consistent complication followed by laparotomy wound infection (13%).Conclusions: Inspite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone

Intra peritoneal ascending colon in parastomal hernial sac

The rate of parastomal hernia reported varies from 5% to 80%. It forms when the abdominal wall defect is continually stretched by the tangential forces applied along the circumference of the abdominal wall opening. The presence of parastomal hernia along with intraperitoneal ascending colon, caecum and terminal ileum along with ileal perforation is a rare entity

An analysis of surgically treated cutaneous malignancies in central India

Background: Cutaneous malignancies constitute one of the most common human malignancies. Annually, more than 400,000 people are diagnosed to have skin cancer. The skin cancers are classified into melanomas and non-melanoma skin cancers (NMSC). In India, skin cancers constitute about 1-2% of all the diagnosed cancers. The present study was undertaken on 41 patients presented to tertiary health centre to measure the frequency of cutaneous malignancies in our set up, analyse the demographic profile of the patients, assess the associated morbidity and mortality, formulate the treatment protocols and collect actionable evidence base for evolving useful strategies to address this emerging public health issue.Methods: Present study was carried out in the Department of surgical oncology, Sri Aurobindo Institute of Medical Sciences (SAIMS), Central India during the period from Jan 2015 to Dec 2017. The patients included in this study fulfilled the inclusion criteria which was first who presented with cutaneous malignancy confirmed by histopathology and surgical intervention.Results: Out of a total of 41 patients with various cutaneous malignancies, 53.7% (n=22) were males while 46.3 % (n=19) were females. The mean age was 53.92 years. There were 24 cases of SCC, 4 cases of BCC, 5 cases of malignant melanoma, two cases of malignant fibrous histiocytoma, two cases of sebaceous and one case each of dermatofibrosarcoma protuberans, epithelioma, capillary haemangioma and poorly differentiated carcinoma respectively. Face was the most frequent site of involvement (n=17), followed by trunk (n=6), scalp (n=5), lower limb (n=5), genital (n=4), upper limb (n=3) and neck (n=1).Conclusions: Cutaneous malignancies are not uncommon in our set up. In our set up, SCC constitutes the leading type. Painless skin lesion of a relatively long duration is the usual presenting feature. There is intense need of mass awareness and to impart knowledge about the medical and socioeconomic implications of this emerging health issue. This will not only help to prevent the avoidable causes but also prompt early medical consultation in case an individual develops such skin lesions.

Trichobezoar Casing Gastric Perforation: A Case Report

Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Trichobezoars are usually diagnosed on CT scan or upper GI endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis, or obstruction, with a high rate of mortality. The treatment is endoscopic, laparoscopic, or surgical removal and usually followed by psychiatric opinion. Herein, we report a case of gastric trichobezoar presenting as gastric perforation in a patient of trichotillomania and trichophagia that was accidentally found on laparotomy. As the patient was in shock on admission, relevant history of trichophagia could not be elicited. Henceforth, she was operated for perforation peritonitis. Trichobezoar was discovered intraoperatively and removed. The perforation was repaired with Graham’s omental patch. Postoperatively, history of trichophagia was corroborated with scarring alopecia of scalp. Trichobezoars is usually seen in adolescent girls, often with an underlying psychiatric or social problem. Laparotomy is the gold standard treatment. Surgical treatment should be followed by behavioral and psychiatric treatment. The patient should be vigilantly monitored for this impulsive disorder, as recurrences are common

A clinical audit of thoracotomy done in a tertiary care center

Background: Sri Aurobindo Medical College and Post Graduate Institute is a tertiary care center in Indore. The surgical oncology department is performing various oncological surgeries. One subspeciality is thoracic surgery, where surgeries for benign as well as malignant cases are being done. Thoracotomy is done for various lung, pleural and mediastinal pathology. Open and VATS are two main modalities with each having their pros and cons.Methods: All thoracotomies done from 2016 to January 2018 were included in the study. Decortications, wide local excision, lobectomies, pneumonectomies, hilar lymph node dissections were done.Results: Total 30 cases were done in a span of 2 years. Of these 9 cases were done for a malignant origin, 4 for benign tumor, 3 for benign non-infective disease and rest 14 for infective origin. Posterolateral thoracotomies were done most often. Average duration of the procedure was 157 minutes. Average blood loss was approximately 340 ml. Mean duration of stay was 10.9 days.Conclusions: Thoracic oncologic procedures are less often done due to paucity of the cases. However, surgical oncologist being well versed with the anatomy, relations and oncologic concepts can perform both neoplastic as well as infected cases. With increasing number of cases, the standard of care is increasing, operating time is lessened, complications are brought down, and the results are better