Sudhir Bhamre , Sushma S. Chandak

Abstract

Background and Aims: Salmonella typhi causes an estimated 22 million cases of typhoid fever and 216000 deaths annually worldwide1 and in developing countries, typhoid bowel perforation is an important surgical problem. The surgeon is faced with number of challenges during the management of these patients. The aims of this study are 1. To study the clinical profile of typhoid perforation of bowel in a tertiary care centre. 2. To study post operative outcome in patients with typhoid ulcer perforation. Methods and Methodology: A total of 45 patients diagnosed as having typhoid bowel perforation were included for the study after fulfilling the inclusion/ exclusion criteria. Results: Majority of patients were in the 2^nd and 3^rd decades (57.7%) with age ranging from 18 to 68 years. There were 28 (63.63%) males and 17 (37.7%) females. Fever with abdominal pain were the symptoms in all subjects followed by vomiting, distension of abdomen and constipation respectively. Most of the patients presented during 2^nd and 3^rd week of illness. 5 patients presented early i.e. within 24 hours and 40 patients presented late i.e., after 24 hours. Widal test was positive in 35 (79.45%) cases. Majority of patients (66.6%) group showed leucocytosis, while 7% showed leucopenia and 17% had normal WBC counts. Single perforation was found in 27 patients (60%), 2 perforations in 14 patients (31.1%) and more than 2 perforations were found in 4 patients (8.8%). Gas under diaphragm was present in all the patients. The most commonly done procedure in 33 cases (73.33% ) was simple closure of the perforation and resection and end to end ileo ileal anastomosis was done in 10 patients whereas ileo transverse anastomosis with ileostomy was done in 2 patients with multiple perforations. The most common post-operative complication was surgical site infection followed by respiratory infections, wound dehiscence. Enterocutaneous fistula was present in one case Mortality rate of 6.6 % was seen.

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Usha Prakash Vaswani ¹, Sudhir Bhamre ¹

Affiliations
1 Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, IN

Abstract

Background: Perforation is one of the most important complications of a peptic ulcer. In spite of modern management, it is still a life threatening emergency. Operative method is still the treatment of choice and simple closure of perforation with Graham’s patch is an established procedure of choice in our institution. Material and Methods: A prospective study was conducted on 30 diagnosed patients of perforated peptic ulcer at Dr. Vasantrao Pawar Medical College, Nashik to study the clinical profile and clinical outcome of peptic ulcer perforation patients post operatively from August 2014 to December 2016. Results: A total of 30 patients were included, majority of patients presented in the 4^th decade of life and 88.67% were males, 76.67% of the total patients had positive history suggestive of peptic ulcer disease and 36.66% patients had associated co morbidities, (36.67%) had severe dehydration, 10% patients presented with hypotension, with a systolic blood pressure of less than 90mmHg. In 23.33% of patients surgery was performed within 5 days of onset of acute abdominal pain and 16.67% presented with severe contamination of the peritoneal cavity, 33.33% presented with gastric perforation and 66.67% presented with duodenal perforation. 30% patients suffered from post operative wound infection and 30% patients suffered from post-operative respiratory infections. 16.67% patients presented with post operative sepsis. The mortality rate in this study was 10%. Conclusion: Perforated peptic ulcer is one of the most commonest acute abdominal emergencies. The outcome of the patient depends on the age of the patient, associated co morbidities, time interval between acute abdominal pain and surgery, timely resuscitation, contamination of the abdomen and post operative sepsis.

Keywords

Outcome, Peptic Ulcer, Perforation, Time Interval between Onset of Acute Abdominal Pain and Surgery.

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Udaykumar Ramrao Badhe ¹, Sudhir Bhamre ¹

Affiliations
1 Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, IN

Abstract

Aims and Objective: The purpose of this study was to evaluate the clinical presentation of patient with extradural hematoma secondary to head injury and to decide upon the mode of management and also to study the results of the management and the outcome and the factors affecting morbidity and mortality. Materials and Methods: Data was collected through a prescribed proforma from the patients admitted in Surgery Department, Dr. Vasantrao Pawar Medical College and Hospital, Adgaon with extradural hematoma during the period of November 2014 to October 2016. The sample size of the study was 30 patients who completed the inclusion and exclusion criteria. All the patients with head injury on CT scan diagnosed to have EDH were included in the study. The management includes conservative measures and/or surgical intervention. The patients were followed for the results during the period of stay in hospital. Results: Temporo-Parietal (20%) and temporal region (20%) was the most common location of EDH. The most significant factors which influences surgical mode of management were higher age group, lower GCS and CT scan variables. Lower GCS was very significantly associated with unfavorable outcome along with CT scan variables irrespective of mode of management. Conclusion: From this study we concluded that neurological status of patient on presentation and the volumetric details of EDH are the most important factors in management and outcome of EDH. EDH patients were managed surgically and carried high number of unfavorable outcome previously. With early detection and treatment due to better connectivity of patients to hospitals, with the help of CT scan and good hospital care, we can expect a decrease in the number of unfavorable outcomes.

Keywords

Conservative Management, CT Scan, Extradural Hematoma, GOS, GCS, Surgical Management.

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Sudhir Bhamre ¹, Sanket Chaudhari ¹

Affiliations
1 Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon - 422203, Nashik, Maharashtra, IN

Abstract

Introduction: Solitary nodule of thyroid has increased in incidence in the present day as compared to two decades before. Because of possibility of malignancy, some clinicians especially those in surgical subspecialties recommended that all nodules have to be removed. Material and Methods: Data collection by meticulous history taking and clinical examination, appropriate laboratory and radiological investigations, operative findings, histopathological report and follow-up of cases. Results: Study was conducted with 35 patients. The peak incidence of solitary thyroid nodule was observed in 3^rd to 4^th decade with four times more common in females as compared to male. The common causes of solitary thyroid nodule were colloid goitre (31.4%), Multinodular goitre (20%) and adenomatous goiter (17.1%), 94% of cases presented with euthyroid state. Incidence of malignancy in solitary thyroid nodule was 23%. The most common cause of malignancy was papillary carcinoma (14.3%). Conclusion: Solitary thyroid nodule is more common in 3^rd to 4^th decades. Solitary thyroid nodule is more common in females. Most of the patients presenting with solitary thyroid nodule are euthyroid and only a small percentage of patient with toxicity or hypothyroidism. USG can be accurately used to detect patients with multinodular goiter who clinically present as solitary thyroid nodule. Common causes of solitary thyroid nodule are colloid goitre, MNG, and adenomatous goiter. The most common cause of malignancy in solitary thyroid nodule is papillary carcinoma followed by follicular carcinoma.

Keywords

Euthyroid, Malignancy, Solitary Nodule.

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Sudhir Bhamre ¹, Ravikumar Phad ¹

Affiliations
1 Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon - 422203, Nashik, Maharashtra, IN

Abstract

Introduction: Urethral stricture disease remains a common cause of morbidity among men. Many questions about the etiology of urethral stricture disease remain unanswered till now. This study was done in a tertiary care center along with a review of the literature to evaluate the etiology of urethral strictures and to determine the factors that may influence possible preventive or curative strategies. Materials and Methods: Data collected from Patients visiting the OPD &/or admitted in the IPD for urethral stricture during the August 2015 to December 2017 this period at tertiary care centre with the help of relevant history, clinical examination, appropriate investigation including and treatment which includes medical and surgical intervention. Results: In study iatrogenic (40%) was main etiological factor for which H/O catheterization was main contributory factor for about 41% among iatrogenic cause. Direct visual internal urethrotomy was common surgical procedure performed with success rate (58%). Anastomotic urethroplasty was associated with success rate of 87.5%. Conclusion: Avoiding unnecessary urethral catheterization and repeated urethral instrumentation can reduce these iatrogenic strictures. Contrast urethrogram was the most common imaging modalities followed by Urethroscopy. Anastomotic urethroplasty had higher success rate as compared to DVIU and Urethral dilatation.

Keywords

Direct Visual Internal Urethrotomy (DVIU), Urethral Stricture, Urethroplasty.

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Sudhir Bhamre ¹, Deepa Verma ²

Affiliations
1 Professor and Head, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Former PG Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Acute urinary retention (AUR) is defined as the sudden inability to pass urine even with a distended bladder. A population-based study reported the incidence AUR of 2.2 to 6.8 per 1000 men per year. One in 10 men over the age of 70 may experience AUR within 5 years. In contrast, AUR is rare in women. Definitive management of AUR depends on the precipitating cause which can be medical or surgical. Immediate treatment of AUR is to drain the urinary bladder either by urethral catheterization or by a suprapubic cystostomy. Prospective studies on AUR are few in India, and very less is known regarding its prevalence. In view of this, there is a need to formulate a baseline data in the area of acute urinary retention. Aims and Objectives: 1. To study etiology of Acute Urinary Retention in patients presenting at Tertiary Care Hospital. 2. To study the clinical profile of patients presenting with Acute Urinary Retention to a Tertiary Care Hospital. Material and Methods: It is a Prospective Observational Study conducted on patients visiting the Emergency department, OPD and/or cases admitted in the IPD for Acute Urinary Retention in the department of General Surgery at Tertiary Care Hospital. Relevant history was taken and detailed clinical examination along with appropriate investigation including ultrasonography, etc. were carried out in all cases. Appropriate medical (including medication, urethral catherization or suprapubic catherization) or surgical treatment (like surgeries for urethral stricture, phimosis, urethral calculus etc.) was given to the patient as per standard hospital protocols. Results: Mean Age of the study group was 61.54 years with majority of the patients 68% were more than 60 years of age. Male preponderance was observed in the study group with prevalence ratio of 48 (96%) males to only 2 (4%) females. Most common etiology of acute urinary retention was benign prostate hyperplasia (44%) followed by urethral stricture (26%), carcinoma prostate (6%), phimosis (6%) and bladder neck calculi (4%). Foley’s catheterization was done in 41 cases (82%) while supra-pubic catheterization was done in 9 cases (18%) cases. Out of the 36 cases in which trial without catheterization was attempted, 32 were successful. Out of the 45 cases with surgical management, TURP was done in 22 cases while Urethrotomy and Cystolithotrypsy was done in 12 and 4 cases. TURP + bilateral orchidectomy and circumcision was done in 3 and 2 cases respectively. Conclusion: The most common age for presentation with Acute Urinary Retention is 51-70 years and with male predominance. In our study we can conclude that the most common etiology for AUR is Benign Prostatic Hyperplasia followed by Urethral Stricture, Carcinoma of Prostate and Phimosis. The primary management to relieve the retention in an emergency situation is mainly by urethral catheterization failing which Suprapubic catheterization is done but definitive management for AUR is surgical.

Keywords

Acute Urinary Retention, Benign Prostatic Hyperplasia, Suprapubic Catheterization, Transurethral Resection of Prostate, Trial Without Catheter, Urethral Stricture

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Sudhir Bhamre ¹, Anuj Tiwari ²

Affiliations
1 Professor and Head, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre Nashik – 422003, IN
2 Former PG Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Introduction: Incompetent valves of deep, superficial or perforating veins lead to varicose veins. Dilated, elongated or tortuous subcutaneous veins of lower legs are a manifestation of increase in venous pressure. This increase in venous pressure results from the reflux of blood due to incompetence. The diseased Great Saphenous Vein (GSV) is removed by High Saphenous Ligation and Stripping (HLS) surgery. Aims and Objectives: To study the clinical and socio-demographic profile, precipitating factors/ risk factors, complications and clinical outcomes of management of varicose veins. Material and Methods: Data collected from 150 patients with varicose veins by appropriate history taking and clinical examination, relevant radiological and laboratory investigations and follow-up of cases to study the clinical outcome. Results: Study was conducted with 150 patients. Most common age group affected with primary varicose veins was between 41-60 yrs of age with male predominance (64.7%). Most of the cases in present study were engaged in work involving long standing hours i.e. farming (34%) and housewives (28%). Most common presenting complaints were oedema (88%), dilated veins (74%) and pain (71.3%). Conservative management was tried in all cases while Trendelenburg operation and SPJ ligation was done in 26.7% and 9.3% cases. Stripping and PERF ligation was done in 28.7% and 25.3% cases respectively. A total of 24.7% were lost to follow up. By the end of 6 month, quality of life improved in 70% cases. By the end of 6 month, symptoms improved in 72.5% cases while it disappeared in 26.5% cases. Conclusion: Males have been found to have larger incidence than females. They are mostly affected in their fourth and fifth decade of life. Ulceration and pain are the frequent findings in this condition. Compression stocking has beneficial effects if prolonged standing cannot be avoided during work hours. Trendelenburg operation with flush ligation with subfascial or extra fascial stripping is the definitive management and shows significant clinical improvement.

Keywords

Long Standing, Trendelenberg Operation, Varicose Stripping, Varicose Veins

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Sudhir Bhamre ¹, Yash R. Godbole ²

Affiliations
1 Professor and Head, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN
2 Senior Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, India., IN

Abstract

Introduction: Foot complications are a major cause of hospitalization in patients with Diabetes Mellitus (DM), which consumes a high number of hospital days because of multiple surgical procedures and prolonged length of stay. Patients with DM have up to a 25% lifetime risk of developing a foot ulcer, which precedes amputation in up to 85% of cases. A mainstay of Diabetic Foot Ulcer (DFU) therapy is debridement of all necrotic, callus, and fibrous tissue, with a primary goal to obtain wound closure. Materials and Methods: Cases with diabetic foot ulcer presenting to our OPD/IPD and signing the informed consent form before study as well as fulfilling the inclusion criteria mentioned along with detailed clinical examination of the patient as well as laboratory workup the study was an open labelled randomised control trial. Results: The study was carried out with 64 patients selected randomly and sorted into two groups, i.e. the control and test subjects. No difference was observed in two groups with respect to wound depth after debridement (p-0.85). However, the depth of wound was significantly less in insulin group at week 1, 2 and 3 as compared to control group. The percentage decrease in wound depth was more in insulin group than control group by the end of 3rd week. Primary closure was observed in 62.5% and 84.4% patients while STSG was required in 37.5% and 15.6% cases of control and insulin group respectively.

Keywords

Amputation, Diabetes, Foot Ulcer, Insulin, Skin Graft

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