Gunjan JINDAL, Samita SINGAL, Birinder NAGI, Amit MITTAL, Shallini MITTAL and Rikki SINGAL

ABSTRACT

Objectives: Clinically or sonographically suspected gallbladder carcinoma was evaluated on multidetector computed tomography. Based on the spectrum of multidetector computed tomography findings, staging of gallbladder carcinoma was done. Multidetector computed tomography diagnosis was compared with pathological diagnosis.
Material and Methods: This is a prospective study carried out in 100 patients at a rural Indian center between May 2012 and June 2015. Multidetector computed tomography was performed in all the cases and the findings were observed. Based on the radiological spectrum, staging of gallbladder carcinoma was done. The diagnosis was confirmed by ultrasound guided fine needle aspiration cytology/histopathological examination of surgical specimens.
Results: The most common multidetector computed tomography findings noted by us were mass replacing gallbladder, followed by diffuse/focal gallbladder wall thickening and polypoidal mass. Other findings noted were cholelithiasis, liver infiltration, intra hepatic biliary dilatation, liver metastases, portal vein invasion, antroduodenal and hepatic flexure involvement. Ultrasonography guided fine needle aspiration cytology done in all cases was positive in 92 cases and inconclusive in eight cases. Surgery was performed in only 22 patients, and histopathological findings were correlated with multidetector computed tomography findings.
Conclusion: Multidetector computed tomography is also reliable in detection of extension of tumor and lymph nodes. multidetector computed tomography plays a major role in evaluating and staging of carcinoma gallbladder. It also guides the surgeons for operatibility and resectability of tumour.
Keywords: gallbladder, carcinoma, multidetector computed tomography, fine needle aspiration cytology, surgery.

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Rikki SINGAL, Muzzafar ZAMAN, Amit MITTAL and Samita SINGAL

ABSTRACT

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. There are lot of advances in closure of cystic duct and artery (clip ligation, suture ligation), but it remains an enigma regarding efficacy, safety and postoperative complications for using non-absorbable suture material or Liga clip for the operating surgeon in laparoscopic cholecystectomy.
Objectives: Our study aimed to evaluate the efficacy, safety and complications of non-absorbable sutures ligation versus clips application in laparoscopic cholecystectomy, and to compare the operative time and cost effectiveness of the two surgical approaches in laparoscopic cholecystectomy.
Methods: This prospective study was performed between August 2014 and February 2015 in M. M. Institute of Medical Science and Research, in a rural center, Mullana, India. The study included 160 patients who were diagnosed with chronic cholecystitis in a single unit. Subjects were divided into two groups and all cases were operated by a single surgeon. The cystic pedicle was tied with non-absorbable material (silk 2-0) in group A and with Titanium clips using a clip applicator in group B.
Results: The application of silk and clips for cystic duct and artery ligation in laparoscopic cholecystectomy can be safely used. The mean time for ligation of cystic duct was 2.50 (SD ±0.25) in group A and 1.50 min (SD ±1.85) in group B, with P<0.001, which was significant. Similarly, the mean time for ligation of cystic artery was 1.50 min (SD±0.20) in group A and 1.36 min (SD ±0.11) in group B, with P>0.001. There were no postoperative complications, such as wound infection or bile leakage, in any of the two methods. The cost of material for silk suture (40-60 Rupees or 0.62–0.92 $) is definitely much lower than that for Liga clips (790-1000 Rupees or 12.28–15.55 $). For the use of clips, a clip applicator is required, but in case of silk ligation no special instrument is required and silk is also easily available.
Conclusion: In laparoscopic cholecystectomy, ligation of cystic duct and cystic artery with clips takes less time than by silk suture. We conclude that both ligation techniques can be safely and effectively used. Training for junior surgeons is necessary to avoid potential complications.
Keywords: cholecystectomy, surgical training, intracorporeal ligation, bile leakage, bleeding.

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Ranjan KUMAR, Raj KUMAR AIRON, Amit MITTAL, Rikki SINGAL, Kamal SHARMA and Samita SINGAL

ABSTRACT

Aims and Objectives: (1) To study the role of multidetector computed tomography in patients with haematuria. (2) To correlate multidetector computed tomography findings with clinical outcome/laboratory findings/FNAC and/or operative findings (wherever performed).
Materials and Methods: The present study was carried out in the Department of Radiodiagnosis, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from April 2014 to 2016. Fifty patients with complaint of haematuria, referred from various wards and outpatient departments of this institution, were included. Multidetector computed tomography was performed in ultrasonography positive cases, in symptomatic patients with negative ultrasonography scans and in those with suboptimal ultrasonography scans. The equipment used in our study was a HD 11 XE (Philips medical systems) ultrasound unit with convex and linear probes and a 128 slice Multidetector CT (Philips Ingenuity).
Results: Maximum number of patients (30%) in the 51-60 years age group with a male preponderance. The prevalence of malignancy in patients with haematuria in this study was 28% which included bladder urothelial carcinoma (18%), renal cell carcinoma (6%), UTUC (4%), prostatic carcinoma (2%) and one case of TCC which turned out to be non-Hodgkin’s lymphoma on histopathology. Calculi were more prevalent in the younger age group and overall constituted 20% of the causes of haematuria. Other causes of haematuria detected on multidetector computed tomography were pyelonephritis, renal trauma (grade V renal injury), bladder diverticulum, benign prostatic hyperplasia and cystitis.
Conclusion: Multidetector computed tomography by using its multiplanar and 3D capabilities is highly accurate and specific in detecting the causes of haematuria. It can demonstrate the exact site of involvement in very high percent of cases. In addition to haematuria, multidetector computed tomography can detect various associated and incidental findings which may not be suspected clinically.

Keywords: haematuria, tumours, ultrasonography, computed tomography.

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