Foot ulcers are serious complications of Diabetes Mellitus (DM) and are known to be resistant to conventional treatment. They may herald severe complications if not treated wisely. Electromagnetic radiations in the form of photons are delivered to the ulcers in laser form to stimulate healing. This study was conducted to evaluate the efficacy of Low Level Laser Therapy (LLLT) in diabetic ulcer healing dynamics. To determine mean percentage reduction of wound area in study and control groups. Settings: KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Study Design: Randomized-Control Study. Methods: A total of 68 patients with Type 2 DM having Meggitt-Wagner Grade I foot ulcers of atleast more than 4 weeks duration, less than 6 × 6 cm2 with negative culture were studied. Patients were randomized into two groups of 34 each. Patients in study group received LLLT with conventional therapy and those in control group were treated with conventional therapy alone. Healing or percentage reduction in ulcer area over a period of 15 days after commencement of treatment was recorded. Statistical Analysis: Unpaired Student T Test and Mann Whitney U test. Mean age of the patients was 50.94 years in control group and 54.35 years in study group (p = 0.065). There was no significant difference between control and study group with respect to mean FBS and HbA1c levels (p > 0.05), suggesting no biochemical differences between two groups. Initial ulcer area was 2608.03 mm2 in study group and 2747.17 mm2 in control group (p = 0.361). Final ulcer area was 1564.79 mm2 in study group and 2424.75 mm2 in control group (p = 0.361). Percentage ulcer area reduction was 40.24 ± 6.30 mm2 in study group and 11.87 ± 4.28 mm2 in control group (p < 0.001, Z = 7.08). Low Level Laser Therapy is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers (DFU).
Adjuvant therapies; Diabetic foot ulcers; Low Level Laser Therapy (LLLT); Wound healing
Liposarcomas are common soft tissue of the retroperitoneum and the limbs. They are rarely found in the greater omentum. Once in the peritoneum, these can become enormous and can be mistaken for ovarian mass. The authors report a case of giant omental liposarcoma revealed by an abdominal mass and genital prolapse due to the compression syndrome. A complete macroscopic resection of the omental tumour was performed. A post operative chemotherapy was also prescribed. A description of this clinical presentation in the preoperative assessment, the characteristics of this tumour, together with the use of adjuvant chemotherapy are discussed in this report.
Liposarcoma; Great omentum; Surgery; Chemotherapy
Sarcomas of the breast are relatively rare and account for 1% of all primary malignant tumors of the breast. Pure and primary chondrosarcoma of the male breast is an extremely rare tumor. It may arise either from the breast stroma itself or from underlying bone or cartilage. Differential diagnoses include cystosarcoma phyllodes and breast metaplastic carcinoma with chondroid differentiation.
Chondrosarcoma; Male breast
We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21–30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan.
Pilonidal sinus; V-Y advancement flap
The aim of the study was to evaluate Chivate’s new procedure of transanal suture rectopexy for haemorroids for pain, bleeding, hospital stay, recurrence and complications. During the period between January 2006 and December 2008, the procedure was used for 166 cases symptomatic of grade II, III and IV haemorrhoids, at six different institutes by five different colorectal surgeons. In the series, 92 cases were males and 74 cases were females; average age was 49.5 years; youngest patient was 23 years of age and eldest was of 82 years of age. According to the gradation, II—52 cases, III—86 cases and IV—28 cases were enrolled for the procedure. The piles mass was reduced by head low and manually. The mucosa and submucosa were transfixed to muscle of the rectum by 0.5–1.0 cm long stitches. Similar stitching was continued all along the complete circumference of the rectum, 2 and 4 cm distal to the dentate line. In all cases, antibiotics and anti-inflammatory medicines were prescribed for 5 days. No pain was noticed in 162 cases; in 4 cases a pain dull in nature was described by the patients. All the 166 cases were discharged after 24 h. Intraoperative bleeding from the suture line was observed in 15 cases, which required temporary compression. On proctoscopy, in 3 cases intra-anal grade I, protrusion of piles cushion without bleeding was noticed. No incontinence, no recurrent bleeding, no frequency of stool, or no tenusmus was observed. In 2 cases, 6 months after operation, residual external piles were observed, which required excision. The procedure requires no special costly instruments or any disposables. Patients require short stay for 24 h. The procedure is a painless cure for haemorrhoids.
Haemorrhoids of grade II; III and IV; Fixing of rectal mucosa and submucosa to the muscles of the rectum by 0.5–1 cm double-locking stitches along the complete circumference at 2 and 4 cm above dentate line
Morgagni hernia represents a rare type of diaphragmatic hernia which usually occurs on the right side, in the anterior mediastinum. Predisposing factors of Morgagni hernia include pregnancy, obesity or other causes of increased intraabdominal pressure, and a history of trauma. Most of adults diagnosed with a foramen of Morgagni are asymptomatic. We report a case of an overweight 23-year-old asymptomatic patient with a Morgagni hernia incidentally diagnosed on chest x-ray. There was a satisfactory result after the repair by a transthoracic approach.
Foramen of Morgagni; Diaphragm; Hernia; Thoracotomy
We report a case of retroperitoneal mass, in a postmenopausal lady,about a size 10-8 cm in left side of abdomen. This turned out pathologically lymphangio-myoma. Retrospectively when we searched in literature we found that, commonly lymphangiomyoma seen in premenopausal women and is associated with ascites or renal angiomyolipoma or plural effusion. But in our case CxR -PA was normal and abdominal USG was not showing renal or ovarian involvement. It was a rare case and presentation was rare than the literature.
Lymphangioleiomyomatosis; LAM; Angiomyolipoma; Lymphangiomyoma
Clinical and anorectal manometric results of Delorme’s procedure for full-thickness rectal prolapse were assessed retrospectively. Thirty-seven patients with full-thickness rectal prolapse who were operated on with Delorme’s procedure were included in the study. They were 11 males and 26 females with mean age of 54 ± 4.4 years (range 15–70 years) and mean follow-up period of 27 ± 4.6 months (15–48 months). The mean operative time was 65 ± 4.5 min (60–90 min); there was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2–6 days). Outcomes of the procedure were satisfactory in 29 patients (78.4%). Dissatisfaction came from recurrence and persistence of fecal incontinence. Prolapse recurrence had been observed in six patients; three of them were treated by the same technique and showed no recurrence, and the others were treated by either mucosal resection (1) or abdominal resection rectopexy (2). Constipated patients showed improved symptoms in 7 of 10 cases. Of 11 patients who were incontinent preoperatively, seven patients became fully continent. Postoperatively, anorectal manometric studies (MRP, MSP, MTV, and UDV) showed significant improvement in all patients with intact RAIR. Delorme’s operation, coupled with avoidance of abdominal procedures, is the treatment of choice of rectal prolapse in elderly frail patients and in patients with defecatory disorders.
Rectal prolapse; Delorme’s operation; Anorectal dysfunction
Morgagni-Larrey hernia is an uncommon entity. The majority of the literature describes hernia occurring mostly on the right side, a few on the left side and rarely bilateral. Retrospective chart review was done for the patients with the diagnosis of adult diaphragmatic hernia from January 1997 to December 2010. Post-operative course was evaluated for outcome, morbidity and mortality. Out of 20 patients, 13 (65 %) were males and 7 (35 %) were females. Their age ranged from 17 to 50 years (mean = 29.6). Abdominal discomfort was the most common presentation. Eight patients (40 %) were asymptomatic at presentation. Plain X-Ray chest was done for all. Ten patients (50 %) underwent suture repair, 6 (30 %) had mesh placement and the other 4 (25 %) underwent both: suture repair buttressed with mesh. Volvulus of stomach was noted in 5 (25 %) cases. All patients had left sided hernia. There was insignificant morbidity and no mortality. There was no recurrence in 16 patients followed up for a mean duration of 20 months (range = 8 to 32 months). In Morgagni-Larrey hernia, abdominal approach gives good accessibility to reduce the hernia and to undertake repair. When complicated with incarceration, perforation, gangrene or volvulus of the herniated bowel; this can be dealt with ease. Plain X Ray of the chest is fairly accurate in suggesting the diagnosis of Morgagni-Larrey hernia.
Morgagni-Larrey hernia; Adult diaphragmatic hernia
To analyze the incidence of nerve sheath tumors in a tertiary care hospital over a period of 5 years and review the literature. Medical case records from last 5 years were retrieved and histopathology and operative details were studied in a retrospective analysis. There is a slight male preponderance when it comes to nerve sheath tumors and acoustic schwannomas accounted for the largest fraction among schwannomas. Nerve sheath tumors include a wide spectrum of schwannomas, neurofibromas and malignant peripheral nerve sheath tumors. Hence combination of clinical, pathological and surgical expertise is needed to diagnose accurately.
Neurofibroma; Schwannoma; Malignant Peripheral Nerve Sheath Tumors
Choledochal cysts are rare disease and of unknown etiology. These are typically a surgical problem of infancy and childhood, but in nearly 20 % of the patients the diagnosis is delayed until adulthood. The presentation and therapeutic strategies for choledochal cysts in adult may differ from that of childhood. The surgical management of choledochal cysts in adults is complicated by associated hepatobiliary pathology. Despite the absence of clinical trials, a consensus for the management of choledochal cysts is excision. This review examines the spectrum of hepatobiliary pathology encountered with choledochal cysts and the surgical alternatives for managing choledochal cysts based on review of relevant literature in English language indexed on MEDLINE.
Choledochal cyst; Hepaticojejunostomy; Cholangiocarcinoma; Pancreatitis; Magnetic Resonance Cholangiopancreatography (MRCP)
Hemangioma is the commonest benign hepatic neoplasm. Most cases are asymptomatic. Spontaneous rupture is rare (1–4%). Only 34 cases have been reported in adults. None had history of trauma. We report a case, the first from India of spontaneous rupture of a giant hepatic hemangioma, in a 25 year old male presenting with acute abdomen. He underwent right hepatectomy. Histopathology suggested cavernous hemangioma.
Spontaneous rupture; Hepatic hemangioma
Our study aims to review the literature on the management of pyogenic liver abscess, focusing on the choice of drainage. A case series of our experience with clinicopathological correlation is presented to highlight the indication and outcome of each modality of drainage. Intravenous antibiotic is the first line, and mainstay, of treatment. Drainage is necessary for large abscesses, equal to or larger than 5 cm in size, to facilitate resolution. While percutaneous drainage is appropriate as first-line surgical treatment in most cases, open surgical drainage is prudent in cases of rupture, multiloculation, associated biliary, or intra-abdominal pathology. Percutaneous drainage may help to optimize clinical condition prior to surgery. Nevertheless, in current good clinical practices, the choice of therapy needs to be individualized according to patient’s clinical status and abscess factors. They are complementary in the management of liver abscesses.
Pyogenic liver abscess; Ultrasound-guided percutaneous drainage
We represent a simplified surgical method for posterior pelvic exenteration in a woman by using the transvaginal way in addition to classic abdominal approach. A modified posterior pelvic exenteration technique was performed in a patient with bulky pelvic tumor. The transvaginal way was used for the deep perineal dissection when the abdominal dissection was arrested. An ultralow coloanal anastomosis was completed by using the transvaginal way. After the recovery period, the patient was discharged from hospital without any complication. The transvaginal access should be reminded in the circumstances of the abdominal dissection arrested in posterior pelvic exenteration operations in women.
Posterior pelvic exenteration; Transvaginal route; Deep pelvic dissection
In this study, three primary central nervous system tumors of different histological cell types occurring together without neurofibromatosis are reported. These included a sellar pituitary adenoma with apoplexy, a large torculo-tentorial meningioma in the posterior fossa, and a cervical spinal intramedullary schwannoma. Displacement of primitive multipotent cells in different central nervous system compartments or the oncogenic effects of activated signaling of growth factor receptors are the proposed pathophysiological mechanisms for the simultaneous genesis of different types of tumors. There was associated tonsillar herniation, cervicodorsal syringomyelia, and hydrocephalus. The radiological features and treatment strategy of these rare synchronous tumors are highlighted.
Synchronous tumors; Central nervous system tumors; Tentorial meningioma; Simultaneously occurring tumors; Intramedullary schwannoma; Suboccipital craniectomy
It is the practice of many surgeons to use the routine nasogastric tube after biliary operations, but its usefulness has been questioned. This study was designed to determine the effect of postoperative nasogastric intubation on gastrointestinal function in patients with obstructive jaundice. In this randomized clinical trial, 40 patients who underwent choledochoduodenostomy or hepaticojejunostomy were randomly divided into two groups. Patients in the experimental group did not have the nasogastric tube, and in the control group the nasogastric tube was routinely applied after surgery. Gastrointestinal function was compared in these two groups. Patients with no nasogastric intubation did not show any postoperative complications or prolonged hospital stay. On the contrary, nasogastric tube insertion postponed return of bowel function and increased the incidence of nausea and vomiting, while it did not affect the incidence of postoperative ileus. Routine use of the nasogastric tube after choledochoduodenostomy or hepaticojejunostomy can delay normal gastrointestinal function and increase postoperative discomfort.
Nasogastric intubation; Gastrointestinal function; Postoperative ileus
Ischemic diseases of the gastrointestinal tract are some of the commonly encountered gastrointestinal diseases which are difficult to diagnose and still more difficult to treat. Presentation of colon ischemia is even more subtle, and this review article details about the various presentation patterns of ischemic colitis and their management.
Ischemic colitis; Colon ischemia; Universal fulminant colitis
Primary Hyperparathyroidism (PHPT) has been reported to occur in members of same family either alone or in syndromic association. We report a family of patients with multi glandular disease wherein we have successfully used intra operative PTH (IOPTH) to assess the completeness of resection. Three members of one family were affected (One male and two females). Two of them had symptomatic disease whereas one was asymptomatic. Since the genetic studies are not available we used a combination of radiological, clinical and laboratory findings to rule out the other components of MEN syndromes. Extent of surgery in familial isolated hyperparathyroidism (FIHP) is controversial. Hence for confirmation of adequate parathyroid tissue resection we used IOPTH. Role of IOPTH has been well established in sporadic PHPT but controversial in multi glandular syndromes. IOPTH was successfully used to confirm the excision and establish cure.
Hyperparathyroidism; Intra operative PTH; Familial isolated hyperparathyroidism
No Scalpel Vasectomy (NSV) is a modern method of delivery, ligation and excision of vas deference without use of a knife. It provides a permanent sterilization option for male. It is a safe, effective method of vasectomy with low complication and greater patient compliance. To evaluate effectiveness and its acceptance of the procedure data were collected on men who accepted NSV between Jan’2008 to Mar’09. Demographic information, motivating factors, educational status and surgical complications were recorded. The cases were done in rural hospitals & Primary health centers as camp procedure. A total of 649 vasectomies performed using NSV method from Jan’08 to Mar’09. The mean age of the acceptors was 35 years with 4 numbers of children on average. Complications included bleeding during surgery in 4 cases (0.6%), haematoma in one case (0.2%), and superficial wound infection occurred in two cases (0.3%) and scrotal pain in 4 cases (0.6%). NSV is an effective, minimal access method of vas delivery, ligation and excision. It provides safe and effective contraceptive option to male population with minimal complications. Doctors, health workers along with the simplicity of procedure and early return to work are great motivating factors. It is easily performed as camp procedure in a simple medical setup. Doctors can be effectively trained hands on during the camp procedure.
Male sterilization; NSV
Internal hernia is a rare cause of small bowel obstruction. It may account for 0.2 to 0.9 % of cases of intestinal obstruction. Intestinal obstruction due to internal hernia is very dangerous and lethal because it may be silent or may present as severe acute abdominal pain. We describe a case of acute intestinal obstruction which presented in our emergency department.