Biliary ductal variations and its clinical implications: a cadaveric study

Background: Biliary ductal region being frequently abnormal has been the subject of research since long time for anatomists, surgeons and radiologists as well.Methods: The present study was carried out in the department of Anatomy at PGIMS, Rohtak on 50 specimens of liver taken unblock with associated structures.Results: Accessory hepatic and accessory cystic ducts were observed in 4% cases each.  2% cases exhibited abnormal low fusion of cystic duct with common hepatic duct.Conclusions: These anomalies may add to postoperative complications if ignored. Present study is a step in the direction of creating awareness about these variations among the clinicians

CAM5.2 Expression in Metastatic Tumours of CNS: A Diagnostic Tool

Introduction: Secondary tumours or metastases account for more than half of all brain tumours in adults. Central nervous system is most commonly a target of metastatic dissemination. The judicious use of  selected immunostains is unquestionably helpful in diagnostically challenging cases. CAM 5.2 being highly specific, is emerging as a specific marker to diagnose metastatic carcinoma.Presentation of case: Total six metastatic tumours were studied using CAM5.2. Histopathological sections of brain tissue were stained by routine hematoxylin and eosin (HE) as per standard technique. Representative sections were subjected to immunohistochemical staining with CAM 5.2. Skin biopsy act as a positive control for cytokeratin.All of the 6 cases showed positivity for CAM 5.2. CAM5.2 expression in metastatic tumours was statistically significant (sensitivity 100% 100% specificity).Conclusion: We conclude in our study that CAM5.2 was significantly associated with metastatic tumours, as they were positive using this specific marker

Pattern of meniscal tear in patients with anterior cruciate ligament injury at a rural tertiary care center of Central India: A prospective study

Background: Various studies have reported the incidence of meniscal injuries in anterior cruciate ligament (ACL)-deficient knee. It is responsible for the development and progression of knee osteoarthritis (OA) in patients with ACL injury and concomitant meniscal tear. Objective: The objective of this study is to find out an occurrence of meniscal tear and its pattern in patients with ACL injury. Materials and Methods: We studied 124 patients diagnosed with ACL injury by arthroscopy at a rural tertiary care center of Central India region. The study was conducted from July 2016 to June 2018. Standard protocol was used to collect information for sociodemographic characteristics. Condition of the injury was assessed at the time of arthroscopic procedure and noted. Data were collected and analyzed by Epi Info software. Results: We diagnosed 124 patients with ACL injury, out of which 106 (85.5) were male and 18 were female (14.5). The mean age of the patients was found to be 28.7 years (±10.7), with a range of 14-59 years. The present study observed the incidence of medial meniscus tear in 30 (24.2) and lateral meniscal tear in 18 (14.5) study participants. Conclusion: The present study showed a substantial number of cases with meniscal damage. Hence, it is imperative to screen patients with ACL tear clinically and radiologically and even during arthroscopic procedure so that chances of OA association can be minimized by early intervention

Thyroid Abscess After Fine Needle Aspiration with Spontaneous Rupture into the Trachea : A Case Report

Fine needle aspiration (FNA) of the thyroid is a well-tolerated minimally invasive procedure. Thyroid abscess, as a complication of FNA in an immune-competent adult, is extremely rare. Diagnosis requires a high index of suspicion, for which treatment is intravenous antibiotics, drainage, and sometimes surgery. Here we present a case of thyroid abscess in an otherwise healthy man who presented with neck pain, rapidly increasing neck swelling, difficulty in swallowing, and hoarseness of the voice that developed two weeks after diagnostic FNA of a thyroid nodule which had been present for ten months. Despite antibiotic treatment, the abscess ruptured into the trachea, requiring surgical intervention. This highlights the importance of maintaining asepsis during FNA of the thyroid. Timely diagnosis of a thyroid abscess is essential to avoid life-threatening airway complications

Caustic ingestion management : world society of emergency surgery preliminary survey of expert opinion

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.Peer reviewe

The management of intra-abdominal infections from a global perspective : 2017 WSES guidelines for management of intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.Peer reviewe

The role of the open abdomen procedure in managing severe abdominal sepsis : WSES position paper

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.Peer reviewe

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe

World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS)

Non peer reviewe