Muzzafar ZAMAN, Aliya SHAH, Rikki SINGAL, Altaf KIRMANI, Abdul Rashid BHAT and Rajinder Pal SINGAL

ABSTRACT

Objectives: Osteoporosis is a skeletal disorder characterized by a decrease in bone mass, with accompanying microarchitectural damage that increases the risk of bone fracture. The aim of this study is to evaluate various risk factors for osteoporosis and the role of DEXA scan in diagnosing the problem in an earlier stage.
Materials and methods: About 100 patients who presented with complaint of low back pain in our outpatient department were studied and subjected to a DEXA scan.
Results: The age range of patients included in this study was between 35 and 70 years. Of all subjects, 85.10% (n=57) were females and 78.80% (n=26) males. The number of those with significant medical or surgical history was 31% (n=31). The anthropometric characteristics of the studied group included weight, height, and also BMI in kg/m2, which was 20.23, 21.06 in male subjects and 19.343, 20.42 in female ones.
Regarding DEXA measurements, the bone mineral density was 0.97±0.27 (0.48, 1.96) for males and 0.83±0.21(0.01, 1.60) for females, with a total of 0.88±0.24 (0.01, 1.96).
Conclusion: Low back pain is highly prevalent in postmenopausal women. DEXA is a widely accepted radiological tool used to detect osteoporotic changes in bones earlier, with a higher accuracy than plain radiographs of skeletal system. It is relatively cheap, needs no special preparation and involves less radiation hazard.
Keywords: osteoporosis, DEXA scan, fracture, low back pain

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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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Nidhi GUPTA, Gautam MENDIRATTA, Rikki SINGAL and N.S SHARMA

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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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Rikki SINGAL, Muzzafar ZAMAN and Bhanu Pratap SHARMA

ABSTRACT

Background: Abdomen is considered a magic box or a Pandora box where you will get different, unexpected pathologies along with rare entities. Appendicitis is the commonest emergency in surgery which presents challenges to surgeons because of a myriad list of differential diagnosis including both medical and gynaecological pathologies. Preoperative imaging plays an important role in diagnosis and management.
Aims and objectives: To study the rare atypical anatomical and surgical presentations of appendix in patients with clinical features of appendicitis. We focus on the clinical features and the role of investigations for the radiological part and management.
Material and methods: This study was done in M.M. Institute of Medical Sciences and Research, Mullana, Ambala, from November 2014 to July 2016. This was a retrospective study. We found 168 cases with the diagnosis of appendicitis, out of which 19 were with rare entities.
Results: Subjects of both genders were aged between 20 and 60 years. Out of 19, 15 were males and 4 females. Four patients were operated for inguinal hernia but incidentally we found appendix in the hernial sac termed as Amyand’s hernia. Another patient presented with obstruction and appendix was forming a band diagnosed as torsion of appendix. Two most interesting cases were diagnosed as appendicular neuralgia and relieved by appendectomy. Out of 19 cases, 7 cases were operated for appendicitis diagnosed as appendicolith. In all the cases appendectomy was done without encountering any complications. Symptom free patients were operated for appendicular neuralgia. No malignancy was found in mucocele appendix at follow up. There were no complications by the 6-month follow-up.
Conclusion: As we came across with different entities of appendix presented with appendicitis, patients should be investigated before proceeding for surgery. In our study, there were incidental findings for which surgeons were not aware of the diagnosis and even for the patient. In inguinal hernia, ultrasonography was not done, diagnosis being made on clinical basis. Clinical and radiological investigations play an important part in early diagnosis and management.
Keywords: appendix, perforation, inflammation, torsion, hernia, mucocele, neuralgia.

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Usha DALAL, Ashwani Kumar DALAL and Rikki SINGAL

ABSTRACT

Objective: Over the world, hydatidosis is endemic in many countries. It is more prevalent in Turkey. We came across with concomitant hydatidosis of the lung and liver and reviewed the management.
Material and Methods: This is a prospective study that was carried out in the Government Medical College and Hospital, sector-32, Chandigarh, India, between 2004 and 2010, in the Department of Surgery. A total of five patients diagnosed with concomitant liver and pulmonary hydatid disease underwent surgery. They were operated by thoracotomy and laparotomy in the same sitting.
Results: Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. Excessive biliary drainage occurred in one patient who was managed successfully.
Conclusions: We believe that simultaneous management of pulmonary and hepatic cysts through the thoracic route and by laparotomy is convenient and should be encouraged in patients because this approach decreased morbidity and mortality by deferring second operation. Needle aspiration can be applied only for liver cysts but it is absolutely contraindicated in lung hydatid cysts.

Keywords: lung, liver, hydatid cyst, single-stage surgery

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Rikki SINGAL, Siddharth DHAR, Muzzafar ZAMAN, Bir SINGH, Varsha SINGH and Sheena SETHI

ABSTRACT

Aim: To investigate the efficacy of super-oxidized solution (SOS) over normal saline in peritonitis cases.
Our objectives are to present the potential clinical impact of intraperitoneal lavage with solutions for early recovery of the patient by reducing the infection rate.
Material and methods: A double-blind random clinical trial was performed in 240 cases diagnosed as peritonitis at MM Institute of Medical Sciences and Research, Mullana, Ambala, India, from December 2013 to November 2015. Subjects were categorized into 2 groups, i.e. 120 cases in the group I and 120 cases in the group II. Both the groups underwent peritoneal lavage; the group I underwent normal saline lavage and group II received SOS. The effectiveness of both the solutions was compared.
Results: In both the groups majority of the patients (50.0%) were in the 21 – 40 years of age. The mean age in our study was 45.28 years, median was 45 and the standard deviation was 14.07. The bacterial load was higher in the group II as compared to the group I after the lavage with SOS solution. The superficial wound infection rate was higher in the group II (48 cases) compared to the group I (32). These data was significant with p value (0.040). Wound pain was found in 59 cases in group II as compared to 42 in group I. This difference was found to be statistically significant with p value 0.036. Post-operatively the morbidity and mortality was less in the group I as compared to group II.
Conclusion: SOS significantly reduced the wound pain and infection hence resulting in early recovery. SOS is a high level disinfectant, non-flammable and no special training is required to handle it.
Keywords: Peritonitis; peritoneal lavage; solutions; normal saline; infection

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