International Journal of Contemporary Surgery
International Journal of Contemporary Surgery is a double blind peer reviewed international journal which has commenced its publication from January 2013. The journal is half yearly in frequency. The journal covers all aspects of surgical specialities like general surgery, orthopaedics, ENT, ophthalmology, Gynae and Obstetrics, Anaesthesia, CTVS surgery, Neurosurgery ,plastic surgery etc. The journal has been assigned ISSN 2320-9615 (Print Version) and ISSN 2321-1024 (Online Version). The journal is indexed in many international data bases like Google scholar , EBSCO , EMBASE. The journal is now open access. This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
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Blood Transfusion: Benefits, Risks, and Alternatives
Blood transfusion is a vital medical procedure used to restore lost blood and improve oxygen supply in patients. It plays a life-saving role in surgeries, trauma cases, and conditions like anemia and cancer. While transfusions can be highly beneficial, they are not without risks. Complications such as allergic reactions, infections, and iron overload may occur. Fortunately, with careful practices and growing alternatives like autologous donation and artificial blood, the safety of transfusion is steadily improving. This article provides an easy-to-understand but in-depth look at the uses, risks, preventive strategies, and substitutes for blood transfusion, based on the latest research and expert guidelines.
Blood transfusion, Anemia, Blood safety, Transfusion reactions, Blood alternatives, Patient blood management.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
Clinical Spectrum, Management Strategies, and Outcomes of Abdominal and Limb Vascular Ischemia in COVID-19: An Observational Study
COVID-19 exhibits wide spectrum of clinical manifestations, from mild symptoms to severe thrombotic events-death. Vascular coagulopathy plays critical role in severe complications. Patients with pre-existing peripheral vascular disease (PVD) are at heightened risk due to endothelial dysfunction, inflammation, and prothrombotic state. Present study aimed to evaluate vascular complications associated with COVID-19 & assess role of antithrombotic agents & corticosteroids during early (golden) stage of infection. Methods: This observational study was conducted in Department of General Surgery at D.Y. Patil School of Medicine, Nerul, Navi Mumbai, from Jan 2021–Dec 2022. 20 patients with confirmed COVID-19 & vascular ischemia involving abdomen and/or limbs were enrolled based on RT-PCR results, CT Severity Scores (CT-SS >5), CORADS >5, antibody positivity, and/or previous history of PVD. Detailed clinical assessment, laboratory investigations, imaging (Doppler studies, CECT, CT angiography), operative procedures, postoperative outcomes recorded. Patients followed for 1month post-discharge. Statistical analysis performed using SPSS v21, with Chi-square tests applied for categorical variables (p<0.05 considered significant). Mean age was 55.1 ± 11.9 years, with 75% males. Comorbidities included hypertension (25%), diabetes (10%), diabetes with hypertension (15%), other combinations including hypothyroidism, tuberculosis, and IHD (5% each). Laboratory abnormalities included elevated CRP, D-dimer, PT, leukocytosis (5% each). Imaging revealed SMA thrombosis as most frequent thrombus site (25%), followed by femoral artery involvement (15%). Surgical interventions included exploratory laparotomy with resection/anastomosis (15%), laparotomy with ileostomy (15%), right below-knee amputation (15%), femoropopliteal grafting (5%), and thromboembolectomy (5%), while 20% were managed conservatively. 17 patients (85%) were fully vaccinated, yet thrombotic events were still observed. Statistically significant association was found between thrombus location & surgical procedure performed (p=0.031). No significant association was observed between prior use of antiplatelet agents and diagnosis (p=0.154). Conclusion: COVID-19 associated with significant vascular complications, particularly SMA thrombosis and femoropopliteal involvement, even in fully vaccinated patients. Early imaging, prompt diagnosis, and timely surgical intervention are crucial to prevent limb loss and improve survival. While antiplatelet use did not significantly impact thrombus occurrence, further multicentric studies with larger sample sizes are needed to clarify preventive role of antithrombotic therapy and vaccination in mitigating vascular complications.
Copyright (c) 2025 Mohammad Dungarpurwala, Abhijit Budhkar, Anuradha Panchal, Niket Attarde, Meena Kumar, Isha Birdi, Shristi Visen https://creativecommons.org/licenses/by-nc/4.0
Vaginal Intraepithelial Neoplasia and Vaginal Cancer : A Clinical and Histopathological Review of Rare Yet Rising Entities
Vaginal intraepithelial neoplasia (VaIN) and primary vaginal malignancies represent a rare subset of lower genital tract neoplasms, accounting for approximately 1% of all gynecological cancers. VaIN, a precursor lesion with substantial oncogenic potential, remains a diagnostic and therapeutic challenge. Its incidence is increasing due to heightened awareness, expanded cytologic and HPV screening, and routine colposcopic evaluation. Risk factors include prior cervical intraepithelial neoplasia, hysterectomy for CIN, immunosuppression, prior pelvic irradiation, persistent high-risk HPV infection, smoking, HIV, and diethylstilbestrol (DES) exposure. The vaginal microbiome's composition is increasingly recognized as a determinant of host susceptibility to HPV and neoplastic transformation. The Lower Anogenital Squamous Terminology (LAST) classifies VaIN into low-grade (VaIN 1) and high-grade squamous intraepithelial lesions (VaIN 2 and 3), with the latter harboring a significant risk of progression to invasive disease. High-grade VaIN necessitates definitive treatment, whereas low-grade lesions may be monitored. Therapeutic modalities include wide local excision, laser ablation, LEEP, and in select cases, upper vaginectomy. Non-excisional therapies such as CO₂ laser vaporization, photodynamic therapy, and plasma energy ablation are feasible in the absence of invasion. The choice of treatment should be individualized based on lesion extent, visualization, and prior therapies. Recurrence is not uncommon, warranting vigilant long-term surveillance. Primary vaginal carcinomas, chiefly squamous cell in origin, are staged clinically using FIGO and TNM classifications. Definitive management involves external beam radiotherapy (EBRT) with concurrent chemotherapy, followed by image-guided adaptive brachytherapy. Prognosis is primarily stage-dependent. Uncommon histologic subtypes such as vaginal melanoma and sarcomas pose unique diagnostic and therapeutic considerations due to their aggressive nature and rarity. This review consolidates the evolving landscape of VaIN and vaginal cancer, emphasizing diagnostic standardization, risk stratification, and a tailored multimodal treatment paradigm aligned with contemporary oncologic principles.
Vaginal Intraepithelial Neoplasia, Cervical epithelial neoplasia, colsposcopy, Loop electrosurgical procedure
Copyright (c) 2025 Saloni Chadha, Bhawuk Dhir https://creativecommons.org/licenses/by-nc/4.0
Commentary Innovations in Tissue Regeneration and Wound Healing: A Comparative Study of Nigeria and South Africa
Tissue regeneration and wound healing represent critical areas in medical science, with significant advance-ments in recent years. These fields involve restoring damaged tissues and promoting recovery, which are essential for improv-ing patient outcomes and quality of life. Innovations such as biomaterials, stem cell therapy, advanced wound dressings, and regenerative medicine have significantly impacted these areas. This study provides a comparative analysis of innovations in tissue regeneration and wound healing in Nigeria and South Africa. The focus includes technological advancements, research contributions, and statistical data to highlight progress and challenges in both countries. Data from various healthcare institu-tions, research publications, and government reports form the basis of this analysis.Additionally, surgical innovations that minimize wound occurrence and improve wound healing, such as mini-mally invasive surgery, negative pressure wound therapy (NPWT), and the use of advanced suture materials, are transforming clinical outcomes in both Nigeria and South Africa. Minimally invasive techniques reduce tissue damage, leading to smaller wounds and faster recovery. NPWT has proven effective in managing chronic wounds and reducing infection rates, while an-timicrobial and absorbable sutures have lowered complications related to wound closure. Cold plasma therapy and stem cell applications are also emerging as promising approaches for chronic wound care and tissue regeneration. These innovations, coupled with the efforts in regenerative medicine and biomaterials, are providing both nations with effective tools to manage wound healing more efficiently. This comparative study aims to shed light on the current state of tissue regeneration and wound healing in these nations, offering insights into the advancements made, the effectiveness of various approaches, and the potential future devel-opments in this vital medical field.
Tissue regeneration, wound healing, innovations, Nigeria, South Africa, biomaterials, plastic material, stem cell therapy, advanced wound dressings, regenerative medicine, healthcare infrastructure, medical research, technological ad-vancements, comparative analysis.
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc/4.0
A Rare Case Report: The Unusual Combination of Dermoid Cyst and Cystadenoma in Ovarian Collision Tumors
Collision tumors, the coexistence of two distinct neoplasms in the same tissue without histological admixture, are rare, particularly in the ovary. This report documents an unusual case of a 50-year-old postmenopausal woman who presented with a 4-month history of lower abdominal pain and distention. Imaging and surgical findings revealed a large right ovarian mass, which histopathology identified as a mucinous cystadenoma coexisting with a benign cystic teratoma. This rare combination underscores the importance of considering collision tumors in differential diagnoses of ovarian masses. Molecular studies suggest a potential clonal relationship, with shared genetic changes supporting a teratomatous origin for mucinous tumors. This case contributes to the limited literature on ovarian collision tumors, emphasizing the need for awareness and accurate diagnosis of these rare entities to guide appropriate treatment strategies.
Copyright (c) 2025 Sumedha Gupta, Varsha Motwani, Dheer Singh Kalwaniya https://creativecommons.org/licenses/by-nc/4.0
Struma Ovarii with Follicular Thyroid Carcinoma
Struma ovarii (SO) is a rare ovarian tumor, constituting 1% of all ovarian tumors and 3% of ovarian teratomas, predominantly composed of thyroid tissue. While typically benign, SO can undergo malignant transformation. We report a case of a 41-year-old woman with a six-month history of abdominal distention. Imaging revealed a solid cystic mass in the right adnexa with ascites and elevated CA125 levels. The surgical intervention included a hysterectomy and bilateral salpingo-oophorectomy, with pathology confirming struma ovarii with follicular thyroid carcinoma. Postoperative recovery was uneventful, and all follow-up tests were normal. This case underscores the diagnostic challenge posed by SO due to its resemblance to ovarian cancer and highlights the importance of thorough exploration, pathological examination, and long-term follow-up. Serum thyroglobulin levels can be an effective marker for monitoring tumor recurrence. Our findings contribute to the understanding and management of SO with malignant transformation.
Copyright (c) 2025 Sumedha Gupta, Varsha Motwani, Archana Mishra, Dheer Singh Kalwaniya https://creativecommons.org/licenses/by-nc/4.0
Mature Ovarian Teratoma and Gliomatosis Peritonei: an Uncommon Case Report
Gliomatosis peritonei (GP) is a rare condition characterized by benign glial implants in the peritoneum, omentum, and lymph nodes, typically associated with immature ovarian teratomas and less frequently with mature teratomas. We present a case of a 21-year-old woman with severe abdominal pain and a large abdominal mass. Imaging revealed a large multilocular cystic mass suggestive of a dermoid cyst with torsion. During exploratory laparotomy, a large cystic mass with hair, teeth, and sebaceous material was found in the left ovary, alongside multiple nodules in the omentum. A left salpingo-oophorectomy, omentectomy, and peritoneal biopsies were performed. Histopathology confirmed a mature teratoma with GP. The patient's postoperative period was uneventful, and no adjuvant therapy was required. This case underscores the importance of recognizing GP in patients with ovarian teratomas, highlighting the typically benign nature and favorable prognosis of GP with proper surgical management.
Gliomatosis peritonei, Mature ovarian teratoma, Benign glial implants, Ovarian tumor
Copyright (c) 2024 Sumedha Gupta, Varsha Motwani, Shilpa, Dheer Singh Kalwaniya https://creativecommons.org/licenses/by-nc/4.0
Comparative Study of Collagen Density, Fibroblast, and Neovascularization in Tracheal Defect Reconstruction with Primary Repair and External Oblique Muscle Aponeurosis Patch (A Novel Study with New Zealand Rabbit)
Background: The lack of ideal materials and the high incidence of complications make tracheal defect reconstruction challenging. The use of aponeurosis as a surgical patch and flap in reconstruction is not uncommon, but no studies had been conducted to analyse its use in tracheal defect reconstruction, though its effectivity in wound healing was significant in reconstruction of other organs. Objective: This study aims to compare collagen density, fibroblast expression, and neovascularization in tracheal defect reconstruction using primary suture and using external oblique muscle aponeurosis patch. Methods: This randomized control trial is a laboratory experimental study using male New Zealand white rabbits. Randomization was carried out with permuted block randomization into a control group (primary suture) and a treatment group (reconstruction with external oblique muscle aponeurosis patch). Mascroscopic and histopathological assessments were carried out 14 days after surgery. Results: We got homogeneous samples in both groups (9 samples each) in terms of age (p = 0.763), weight before procedure (p = 0.347), and weight after procedure (p = 0.536). Macroscopically, no wound dehiscence, pus, or inflammation at the surgical site in either the control or treatment groups. Histopathological analysis showed that there were no differences in collagen density (p = 1.00), fibroblast expression (p = 0.414), and neovascularization (p = 0.558) between the two groups. Conclusion: It can be concluded that there are no differences in collagen density, fibroblast expression, and neovascularization in New Zealand rabbits with tracheal defect using primary suture and using external oblique muscle aponeurosis patch
Unexpected Findings: Cutaneous Metastasis in Squamous Cell Carcinoma of the Cervix – A Rare Case Report
Skin metastasis from squamous cell carcinoma of the uterine cervix is a rare occurrence with reported incidences ranging from 0.1% to 2%. This often indicates advanced-stage disease and poor prognosis. We present the case of a 50-year-old multiparous woman diagnosed with cervical squamous cell carcinoma FIGO stage 2A1 following a six-month history of abnormal uterine bleeding. Despite initial treatment with radical hysterectomy, the patient was noncompliant with postoperative radiotherapy and experienced disease recurrence manifesting as vaginal and cutaneous lesions. Subsequent chemotherapy failed to halt disease progression, leading to palliative care. The timing of skin metastasis onset following primary treatment is a crucial prognostic factor, with earlier appearances indicating poorer outcomes. Skin metastases are often preterminal, necessitating palliative care.
Copyright (c) 2024 Sumedha Gupta, Varsha Motwani, Dheer Singh Kalwaniya https://creativecommons.org/licenses/by-nc/4.0
A Case Report of Spontaneous Gastric Perforation in Newborns
Spontaneous gastric perforation is a serious, rare and life threatening condition. Perforation of the stomach is a full thickness injury to the wall of the organ. As the peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. Gastric perforation is caused by three different mechanisms. We report a case of gastric perforation in a Preterm, very low birth weight neonate in our NICU and based on the signs of abdominal distension and increased abdominal girth. Abdomen ultrasonography and Contrast dye study was done which showed perforation, following which exploratory laparotomy was performed and surgical repair was carried out. As it has high mortality rate so its prompt recognition and surgical intervention is utmost necessary
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc-nd/4.0
Behind the Pain: Recognizing The Warning Signs Of Acute Appendicitis
Acute appendicitis is a surgical emergency and one of the most common cause if acute abdominal pain. Appendicitis means inflammation of vermiform appendix. Common age group is 10 -20 years. Causes of appendicitis include obstruction of its lumen with fecolith, calculi, infection and lack of dietary fiber. Clinical presentation vary thus called chameleon of surgery .Typical feature include periumblical pain that migrates to right iliac fossa over the next 24 hours accompanied by nausea ,anorexia and vomiting. Typical features were first described by Murphy and are present in 50 percent of the cases.Atypical symptoms include diarrhea,constipation,urinary tract infection. Pregnant women feel pain in the upper abdomen due to displacement of appendix by uterus. It can be classified as un complicated which means inflammation with abscess formation and complicated that means appendix is inflammed along with abcess formation and peri appendiceal phelgmon. Clinical signs include elevated temprature and rebound tenderness. Physical examination includes a postive rovsing sign, obturator sign, obturator sign or psoas sign. Alvardo scoring system is one the few scoring systems used to diagnose a case of suspected appendicitis. Total score is 10.A score of 7-10 indicated surgical intervention. Among the imaging modalities usg abdomen is the first choice but CT abdomen is superior to it because of its increased sensitivity and specificity. Laproscopic appendectomy is most effective surgical intervention. Uncomplicated cases can be treated with piperacillin tazobactam. Complicated cases can be treated with combination antibiotics cephalosporin combined with flouroquinolones or metronidazole.
Colon cancer is most common type of malignancies all over the world. Various risk factors including genetic mutations,old age,family history, smoking, drinking excessively, poor diet and several others are associated with increasing cases of colorectal carcinoma(CRC). Diagonosis is usually made by colonoscopy and and confirmed by tissue biopsy. After diagonosis delay to treatment can worsen the disease progression and long-term outcome. Treatment options for CRC include surgical resection either open or laparoscopic both with their merits and demerits. Laparoscopic resection have been well accepted for treatment and is known to result in less hospitalisation and blood loss while open surgery still has same overall survival rate, morbidity and mortality. Surgical treatment is associated with postoperative complications including port site metastases, surgical site infections (SSIs),Adhesions, intestinal obstruction, venous thromboembolic events, colonic ischemia, these complications can be decreased by preoperative assessment, intraoperative care and postoperative interventions. Controlling nutritional status (COUNT) score is prognostic factor of postoperative complications and mortality of patients with CRC. 5-years survival rate has increased upto 70% due to improved treatment modalities.
Colon cancer, colorectal cancer, surgical treatment, complications.
Comparison of Hemodynamic Stability in Patients with Intrathecal 0.75% Hyperbaric Bupivacaine Alone and with Pethidine
Objective: To find out better hemodynamic stability in patients with intrathecal 0.75% hyperbaric bupivacaine alone and with pethidine. Study Design: Quasi experimental Place and Duration: This study was conducted in department of Anesthesiology. Combined Military Hospital Multan from 2-3-23 to 2-12-23 total duration of the study was 6 months. Methodology: Pregnant women numbering 80 with gravidity 2 undergoing elective lower segment cesarean section surgery meeting the inclusion criteria were selected. They were divided in two equal groups A and B, n-40 each. Group A received 10mg of 0.75% bupivacaine whereas group B were injected with 7.5mg of 0.75% bupivacaine plus 25mg of pethidine. Comparative decrease in blood pressure in terms of ‘mean arterial pressure’, incidence of hypotension, bradycardia, nausea and post spinal shivering were noted. Results: Mean Arterial Pressure (MAP) decreased in both groups at 2.5-minute post intrathecal injection but this decline was more prominent in group A 70±2 versus 80±3 for group B respectively (p 0.001). At I0 minute the decline in MAP was lesser but the difference between the two groups remained significant statistically. Similarly, frequency of bradycardia and post-op shivering remained on the lower side in group B. The major difference was seen in the frequency of hypotension in both the groups. Conclusion: Addition of pethidine to bupivacaine for intrathecal use keeps the hemodynamic profile of the patients relatively more stable and thus avoids the feto-maternal adverse events.
Hemodynamic stability,intrathecal bupivacaine , pethidine
Laparoscopic Management of Complicated Appendictis
AIMS The aims of this study are to evaluate the effectiveness, feasibility and safety of Laparoscopy for managing complicated appendicitis and to look for postoperative complications as well as morbidity, in a tertiary care hospital. OBJECTIVES To study the Laparoscopic Appendicectomy in cases of Complicated Appendicitis with respect to: 1. Mean duration of the surgical procedure. 2. Number of days of antibiotics given, post operatively. 3. Post -operative day-start of oral feeds. 4. The incidence of Postoperative morbidity. 5. Analgesics required. MATERIALS AND METHODS This prospective study was conducted in a tertiary care hospital at Ahmedabad on 50 patients who underwent Laparoscopic appendicectomy between June 2022 to March 2023 CONCLUSION Our study has shown results encouraging the use of laparoscopic appendicectomy in cases of complicated appendicitis, having found less post- operative morbidity along with early start of post-operative oral feeds and decrease requirement of post-op antibiotics. Although the laparoscopic method can be technically challenging, but the results have demonstrated its feasibility and safety. Although the number of patients enrolled in this study is far too small, preliminary results show that our experiences with Laparoscopic appendicectomy in Complicated Appendicitis has been encouraging, although technically demanding, but with proper surgical technique, it can be done without much of post-op complication. As laparoscopic approach is having less morbidity in our study, we recommend the use of laparoscopy even with complicated appendicitis.
T-Skin Staplers are Faster on Long Skin Slice Closure Surgery: a case study
Introduction: A T-Skin stapler is a type of skin staple commonly used in the closure of surgical wounds on skin slices. Quick and accurate treatment of patients is required. However, there is still limited research comparing the handling speed of the tool with other skin staples. Method: We used a T-Skin stapler that is built of sterile grade 317 L medical metal with code SS1 and the surgical thread type T-Silk no. 330 with code S21. We created numerous portions in goat experimental animals that were aged over 2-3 years and weighed more than 20.5-26 kg after randomly inflicting gout on animals with surgical incision wounds (10 cm). Result: The T-Skin stapler and surgical threads had comparable results with respect to wound closure, but the TSkin stapler was faster in all steps observed. A comparison of the speed of surgical wounds with a stapler was found to be 6.3 times faster than using sutures with surgical threads. The time used to remove the staples was an average of 92.4 seconds, while the time taken for thread removal was 110.6 seconds. Conclusion: The T-Skin stapler and surgical threads had comparable results with respect to wound closure; however, the T-Skin stapler was faster in all steps observed.
T Skin staplers, surgical wound, animals research
Torsion of undescended testis within inguinal canal is a rare surgical emergency. The delay in detection as well as treatment may result in poor salvage of affected testes. There are limited number of such cases are reported in medical literature. Clinical examination and early surgical intervention remain the main stay of management. We present a case of a14-year-oldmale child presented to surgical OPD with abdominal pain, vomiting and right groin swelling. He was diagnosed as the torsion of cryptorchid testis in right inguinal canal. Emergency exploration done through the inguinal approach and orchidopexy was carried out on the right side.
Testicular torsion, inguinal testis, undescended, orchidopexy
Comparison between Single Anastomosis Sleeve Ileal Bypass and Roux-en-Y Gastric Bypass in obesity management
Background: Obesity is associated with a higher incidence of several diseases, including diabetes, cardiovascular disease, and cancer. Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. This study aimed to compare the outcome of SASI bypass with that of RYGB regarding weight loss, improvement in comorbidities, malnutrition, and postoperative complications. Methods: Patients with morbid obesity who underwent RYGB or SASI bypass and were followed for 12 months from May 2020 through May 2021 were included in the current prospective study. Weight loss, improvement in comorbidities, complications, and nutritional status were compared between a group of consecutive patients who underwent SASI bypass and a group of patients who underwent RYGB during the same study period. Conclusion:The average percentage of postoperative weight loss was not significantly different between the two groups. There were no significant differences in the remission of comorbidities between the two groups. Few postoperative complications were reported in both groups. The outcome of SASI bypass and Roux en Yregarding weight loss and improving of comorbidities were satisfactory
Bariatric; bypass; laparoscopic; obesity; Rouxen Y; SASI
Comparative Study between Piezosurgery and Conventional Surgical Method in the Treatment of Otosclerosis
Aim: This work aimed to compare Piezosurgery stapedotomy with the conventional approach in the management of otosclerosis in terms of intraoperative time, postoperative complications, and air-bone gap improvement. Methods: This randomized controlled clinical trial was conducted in Beni-Suef University hospital from August 2021 to June 2022 according to the ethical considerations of the local institutional review board. It included 40 patients suffering from hearing loss due to otosclerosis, diagnosed based on clinical features, audiometry and impedancemetry. Patients were randomly divided into two groups: group P underwent stapedotomy by the Piezosurgery medical device, and group C underwent stapedotomy by the conventional method. Results: Both groups were matched regarding their baseline characteristics. The air bone gap (ABG) postoperatively reached a mean of 7.7±6.7 dB (median=6) in group P and 7.6±6.8 (median=7) dB in group C, with no significant difference. The percentage of reduction of A-B gap was 76.21%±17.6% in group P (Piezosurgery), while group C (conventional) was 75.8% ±18.7%, with no significant difference. The operative time in group P was (35.5± 4.5) minutes vs (29.7 ±3.2) minutes in group C, with a significant difference. Regarding the complication, there was no significant difference between Piezosurgery and conventional surgery regarding intraoperative and postoperative complications (P-value > 0.05). Conclusion: This work concluded no difference between conventional techniques and Piezosurgery in (ABG) reduction postoperatively, intraoperative, and postoperative complications, only surgical time was longer in Piezosurgery group and was statistically significant.
Piezosurgery, Otosclerosis, Air bone gap.
Comparative Study of Outcome of Platelet-Rich Plasma (PRP) and Temporalis Fascia in Myringoplasty
Aim: this study aims to evaluate the efficacy of a PRP hourglass graft compared with the conventional method employing a temporalis fascia underlay graft in treating tympanic membrane perforation. Materials and methods: this randomized controlled trial randomized was conducted in the period from October 2018 to December 2020 on forty patients with chronic otitis media safe dry mucosal disease presented to department of otorhinolaryngology, Beni Suef University. They were randomly assigned into two groups (the first group underwent myringoplasty using autologous PRP graft and the 2nd group underwent myringoplasty using autologous temporalis fascia graft only (20 in each)). Results: Though all post-operative A-B gaps at 500, 1000 and 2000 Hz seemed to be to be lower with temporalis fascia graft, yet not significant. However, the average A-B gap was statistically higher in PRP group than temporalis fascia, P-value = 0.035. Myringoplasty with temporalis fascia graft showed significant reduction in A-B gaps at 500, 1000 and 2000 Hz. While PRP showed no significant improvement was shown at low frequencies (500 Hz), with significant improvement at higher frequencies (1000 & 2000 Hz). Both methods showed an improvement in average A-B gaps, P-value =0.001 in temporalis fascia group and 0.034 in PRP group. Post-operative full healing after 3 months, complications, graft lateralization, and displacement into the middle didn’t differ significantly in both groups. Conclusion: After a successful myringoplasty treatment, patients with PRP grafts had comparable hearing results to those with fascial grafts, as shown by significant reductions in the mean air-bone gap from pre-operative to post-operative.
Comparative Study between DE Vega and Pericardial Band Annuloplasty in Management of Functional Tricuspid Valve Regurge
Dilated annulus tricuspid regurgitation is a frequent pathology mostly with functional right ventricular impairment. Our study was to compare result of De Vaga (DV) repair Versus Band Annuloplasty (BA) in patients with severe functional Tricuspid valve regurge. A total of 80 patients underwent TV repair at Beni-Suef university Hospital with 40 DV and 40 had BA; accompanying interventions done for mitral valve or double valve replacement. Clinical and echocardiographic follow-up data were obtained. Follow-up after 6months was done completely. A higher proportion of grade 0 and I of tricuspid regurge post-operatively in BA group and a higher proportion of TR grade II among DV group. After 6-12 months follow-up, The NYHA higher grades (I, II, III) were significantly more prevalent in the DV. There was no statistical difference between the BA group and the DV group regarding the proportion of morbidity and mortality. The 2 interventions are considerable in tricuspid valve repair although good evidence in support of BA compared with DV suture repair for treatment of moderate to severe TV regurgitation; longer follow up durations is recommended for better post-operative evaluation to morbidities and mortalities.
Tricuspid regurgitation; band annuloplasty; De Vega; interventions; follow-up.
Copyright (c) 2022 Zakaria Moustafa AL mashtoly, Medhat Ahmed Refaie Mohamed, Ismail Nasr El sokkary, Ahmed H. Mohamed
Newer Insights into HPV Infection and Pregnancy
HPV is highly prevalent in reproductive age group and pregnancy and is of public health interest because of its unequivocal linkage to lower genital tract infections. Treatment of HPV infection and lesions caused by these infections has to be taken care after delivery also as these are involved in disease progression and carcinomas. The safety of available therapies and the risk of vertical and horizontal transmission and the risk of JORRP in neonate must also betaken into account. Also, the concerns and correct timing for vaccination must be looked into.
HPV infection, Vaccination immunotherapy, JORRP
Copyright (c) 2022 Sujata Das, Pragya Mishra, Rupali Dewan
Surgical Anatomy of Anterior Abdominal Wall: Know before you Incise
Incision and closure of the abdominal wall is among the most frequently performed surgical procedures. Anterior abdominal wall is the first structure which a surgeon encounters in any abdominal surgery. Both in open surgery and laparoscopic surgery, correct knowledge of layered structure of the anterior abdominal wall is a must to enter the abdominal wall with maximum efficacy and safety. Hence knowledge of all structures which one encounters on entering abdominal wall layer by layer is essential for surgeon. Here we discuss in detail about anatomy of abdominal wall and different types of incisions.
Copyright (c) 2022 Archana Mishra, Nupur Anand
Approach to Premalignant Lesions of Vulva
Vulvar itching is a condition which frequently affects the women’s quality of life and can be quite disturbing, even hindering their sleep. It has multifactorial origin, thus its management can sometimes be challenging. A good history is essential for making a diagnosis. Equally important is any similar history in spouse, family history, any other GI symptoms, incontinence or any other skin problems. Commonest cause of vulvar pruritus is vulvovaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. In this article we discuss in detail about lesions of vulva, their diagnosis and management.
vulva, itching, lesions, premalignant, vaginal discharge.
Prevalence, Risk Factors, and Management of Pressure Sores in the Teaching Hospital – Medical and Surgical Treatment
Pressure ulcer have a profound impact upon the subjects lives, including physical, social and financial status, change of body image and loss of independence and control. The incidence of pressure sore formation is highly variable, depending on the population of patients evaluated.Pressure sores continues to affect the practice of every medical and surgical professional are common cases of morbidity in hospitalized persons. They lead to inconvenience to the patient and the treating doctor and it’s still challenging for surgeon to treat and is a cause of mortality. Thus it requires multidisciplinary approach for its management. The preventive measures need to be constantly evaluated & updated; hence this study was carried out to analyze current status of pressure sores, their prevalence, risk factors and management (Medical v/s Surgical) & outcome
Pressure ulcers, Bed sores, Decubitus ulcers, Pressure sores, Pressure injury
Copyright (c) 2019 Mohit Kumar Mathur, Jagdish Mutreja, Nishant Singh Gill, KC Vyas, Ashutosh Niranjan, Ravi Kale
Histopathological Study and Pattern of Lymph Node Involvement in Carcinoma Esophagus: A Tertiary Care Centre Experience from Northern India
Background: Esophageal cancer remains one of the deadliest cancers with an overall 5-year survival rate estimated to be less than 18%. Squamous cell carcinoma of the esophagus is the predominant histology in the cervical esophagus and upper and middle thirds of the thoracic esophagus, whereas adenocarcinoma predominates in the distal esophagus. Lymph node involvement and the number of lymph node metastases are important prognostic factors Materials and Methods: 30 patients of mid and lower thoracic esophageal carcinoma treated between 2008 to 2014 were studied retrospectively. Histopathological profiles were analysed mainly in terms of pattern of lymph node involvement. Results: 26 cases were squamous cell carcinoma and 3 were adenocarcinoma while 1 case was pathological complete response after neoadjuvant treatment. 22/30 were moderately differentiated. 24/30 had lymph node involvement where T3N1 was the commonest stage as 50% had achieved this stage. Mediastinal group of lymph nodes were involved in 23 cases upper abdominal lymph nodes were involved only in 1 case while cervical lymph nodes were not involved in any case. Among mediastinal group paraesophageal, paratracheal lymph node involvement was the commonest followed by subcarinal and recurrent laryngeal group of lymph nodes. Conclusion: Squamous cell carcinoma is still the commonest variety prevailing in this region. Majority of the cases present in advanced stage with lymph node involvement. Mediastinal group of lymph nodes are involved in majority of the cases hence precise clearance of this group is of utmost importance to prevent local recurrence and prolonged survival.
Carcinoma esophagus, squamous cell carcinoma, Mediastinal lymph nodes
Copyright (c) 2022 Sanjeev Parshad, Sushil Kumar, Ravinder Kumar, Kapil Kadian
Muscles Cramp and Sleep Disturbances among Hemodialysis Patients
Muscle cramps are often experienced by the patients on hemodialysis that result in discomfort, shortened treatment times, and inadequate dialysis dose. Up to 50% people with chronic renal failure undergoing dialysis suffer from muscle cramps, especially involving the lower limbs. The cramps can happen during dialysis or at home. The cramps in this type of patient are linked to depression, a decline in quality of life, and sleep disorders. The etiology of cramps in hemodialysis patients is not clear. Muscle Cramping of the hands, feet, and legs is fairly common among patients onhemodialysis. Muscle Cramps are also associated with low bloodpressure. However, some Muscle cramping continues even after a normal bloodpressure. When patients are below dry weight, they also experience muscle cramps. Thesevere muscle cramps are experienced near the end of the dialysis and persisting for atime after dialysis is often due to dehydration.(1) The most frequent sleep disorders seen in patients on dialysis are conditioned insomnia, excessive daytime sleepiness, obstructive or central sleep apnea, as well as restless legs syndrome (RLS) and periodic limb movement disorder. Many uremic and non-uremic factors are thought to participate in the pathogenesis of sleep disorders in these patients. The treatment of sleeping disorders includes nonpharmacological and pharmacological measures that can improve the functionality and quality of life in patients on dialysis. (2)
Muscle Cramps, Nocturnal Muscle Cramps,Restless Leg Syndrome, Quality of Life, Intradialysis stretching exercise.
Copyright (c) 2022 Gulshan Roy Chowdhury
Comparative Study of Muscle and Fascio-cutaneous Flaps for Coverage of Exposed Tibia
Background- Trauma is a leading cause of tibial fractures. In salvageable lower limb trauma, morbidity can be greatly reduced with early soft tissue coverage of exposed tibia. Muscle flaps have traditionally been preferred over fascio-cutaneous flaps for coverage. With better description of the vascular supply of the lower limb, however, there is now a shift towards fascio-cutaneous flaps: pedicled or free soft tissue transfer. Methods- 216 patients who underwent flap coverage for exposed tibia in our institute between January 2015 and December 2020 were evaluated in this retrospective, comparative study. Parameters studied were surgical complications, such as partial or complete flap necrosis, minor wound complications, venous congestion, donor-site complications; development of wound infection and osteomyelitis; duration of hospital stay; functional outcome and final aesthetic outcome Conclusion- Fascio-cutaneous flaps were found superior to muscle flaps for coverage of exposed tibia in many respects especially for middle and lower third defects. For upper third of tibia, gastrocnemius muscle and musculocutaneous flaps provide adequate coverage. But in case of middle and lower thirds, adequate coverage can be provided by perforator-based, propeller or distal sural flaps. If adequate donor vessels are available, micro-vascular free soft tissue transfer, should be the preferred choice for large defects.
muscle flaps, perforator flaps, propeller flaps, exposed tibia, free flaps
Copyright (c) 2022 Bhawna Prabhakar, Sanjay Sadhu, Apoorva Pratap Singh
Arterio-venous Fistula for Dialysis- Procedure, Complications and Outcome
Background- In India, a 2018 estimate put the number of patients on chronic dialysis at about 175,000, giving a prevalence of 129 per million population. About two thirds of all patients with kidney failure die without receiving dialysis every year. For the other third, the majority (64.2%) undergo renal replacement therapy via hemodialysis. AV fistulas are the preferred method for vascular access for hemodialysis. This study describes the outcome of 634 AV fistulas created in our institute between January 2015 and December 2020. Methods- 634 patients who underwent AV fistula creation in 5 years were retrospectively studied. Evaluation criteria were patency of AV Fistula at 1 week, 1 month, 6 months, 1 year and 2 years after creation; suturing technique- continuous versus interrupted, 6-0 versus 8-0 suture; end-to-side versus side-to-side anastomosis, mean operating time; duration of hospital stay; and complications- minor bleeding episodes, major bleeding requiring intervention, serous discharge, hyperaemia, upper limb swelling, aneurysm of anastomosis and recipient vein, delayed rupture. Conclusions- Patency rate of AV Fistula at 1 week was 91.2%, at 1 month was 84.6%, at 6 months was 83.8% and at 1 year was 82.9%, after creation. After 2 years 74.8% AVF’s were still useful for dialysis. Factors affecting patency were location of anastomosis, low-dose Aspirin and regular dialysis
AV Fistula, Vascular access for dialysis, Radio-cephalic AV Fistula, Brachio-cephalic AV Fistula
Copyright (c) 2022 Bhawna Prabhakar, Sanjay Sadhu, Tanuj Bhatia
To Study the Repair of Incisional Hernia by Preperitoneal Meshplasty
The preperitoneal mesh repair an excellent method called as Rive’s stoppa technique where mesh was placed between peritoneum and abdominal wall or rectus muscle and posterior rectus sheath(9). The main advantage of pre peritoneal mesh repair are - Less chance of mesh infection and erosion through skin because the graft lies in preperitoneal plane between posterior rectus sheath and peritoneum, avoids adhesions, bowel obstruction, enterocutaneous fistula and erosion of mesh, minimal morbidity and duration of hospital stay is less compared to other techniques. The main disadvantage is it is more time consuming, extensive preparation of preperitoneal plane and surgical experience. In our study 30 patients of incisional hernia were subjected to preperitoneal mesh repair by Rive’s stoppa technique. It was found that there were : 1. Less number of postoperative complications. 2. No recurrence was noticed in this study. 3. Preperitoneal mesh repair had excellent long-term results with minimal morbidity.As Compared with other types of mesh repair techniques (in literature), the preperitoneal mesh repair is the gold standard treatment for incisional hernia repair.
Incisional Hernia, Hernioplasty,preperitoneal repair
Copyright (c) 2021 Sandeep Yadav, Tripta S Bhagat, Reena Singh
Probiotic is little known for its benefits on upper gastrointestinal health. The objective of this systematic review was to examine the efficacy of probiotics in alleviating the frequency and severity of symptoms in gastroesophageal reflux disease (GERD) in the general adult population.. In total, 13 prospective studies that were published in 12 articles were included in the analysis and scored per the Jadad scale as high- (five studies), medium- (two), and low- (six) quality. One article reported on two probiotic groups; thus, 14 comparisons were included in the selected studies, of which 11 (79%) reported positive benefits of probiotics on symptoms of GERD. Five out of 11 positive outcomes (45%) noted benefits on reflux symptoms: three noted reduced regurgitation; improvements in reflux or heartburn were seen in one study; five (45%) saw improvements in dyspepsia symptoms; and nine (81%) saw improvements in other upper gastrointestinal symptoms, such as nausea (three studies), abdominal pain (five), and gas-related symptoms (four), such as belching, gurgling, and burping. In conclusion, probiotic use can be beneficial for GERD symptoms, such as regurgitation and heartburn.
gastroesophageal reflux disease, regurgitation, heartburn, probiotics
Copyright (c) 2021 Krishan Gopal, Shashi Shekhar