ABSTRACT
Traditional examination has inherent deficiencies. Objective Structured Clinical Examination (OSCE) is considered as a method of assessment that may overcome many such deficits. OSCE is being increasingly used worldwide in various medical specialities for formative and summative assessment. Although it is being used in various disciplines in our country as well, its use in the stream of general surgery is scarce. We report our experience of assessment of undergraduate students appearing in their pre-professional examination in the subject of general surgery by conducting OSCE. In our experience, OSCE was considered a better assessment tool as compared to the traditional method of examination by both faculty and students and is acceptable to students and faculty alike. Conducting OSCE is feasible for assessment of students of general surgery.
ABSTRACT
BACKGROUND: The aim of this study was to assess the cosmetic outcome of patients undergoing oncoplastic breast conserving surgery in Indian population. MATERIALS AND METHODS: A prospective cohort of 35 patients who were eligible for breast conservation surgery was included in the study from year 2007 to 2009. Patients with central quadrant tumors were excluded from the study. A double - blind cosmetic assessment was done by a plastic surgeon and a senior nurse not involved in the management of patients. Moreover, self-assessment was carried out by the patient regarding the satisfaction of surgery, comfort with brasserie, social and sexual life after oncoplastic surgery. RESULTS: In this study, 35 patients underwent oncoplastic breast conservation surgery by various techniques. The cosmetic outcome scores of the surgeon and nurse were analyzed for inter rater agreement using inter-class Correlation Coefficients. There was a good association between them. The risk factors for poor cosmetic outcome was studied by univariate analysis and significant correlation was obtained with age, volume of breast tissue excised and estimated percentage of breast volume excised (P < 0.05). Moreover, 96% of patients were moderately to extremely satisfied with the surgery. Patients were offered an option for cosmetic correction of contralateral breast by mastopexy or reduction mammoplasty however, none of them agreed for another procedure. CONCLUSIONS: Oncoplastic breast surgery helps to resect larger volume of tissue with wider margins around the tumor. It helps to achieve better cosmesis and extends the indications for breast conservation. Most of the patients were satisfied with mere preservation of the breast mound rather than a symmetrical contralateral breast.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Mammaplasty , Mastectomy, Segmental , Adult , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Staging , Prospective Studies , Treatment OutcomeABSTRACT
Arteriovenous malformations are uncommon congenital lesions of the hand. Although present at birth, they usually manifest later in life. Ultrasonography, MRI and digital subtraction angiography play an important role in the diagnosis of these lesions. We report the imaging appearances of an unusual case of combined soft-tissue and intraosseous arteriovenous malformation (AVM) of the hand with marked periosteal elevation in a 12-year-old child. Although associated skeletal changes are common, diffuse periosteal elevation owing to direct communication of the AVM with the subperiosteal space has not, to the best of our knowledge, been reported previously.
Subject(s)
Arteriovenous Malformations/diagnosis , Hand Deformities, Congenital/diagnosis , Hand/blood supply , Periosteum/blood supply , Arteriovenous Malformations/therapy , Child , Hand Deformities, Congenital/etiology , Hemangioma/diagnosis , Humans , Magnetic Resonance Angiography , Male , Tomography, X-Ray Computed , Ultrasonography, Doppler, ColorABSTRACT
BACKGROUND: Modern concepts of treating inflammatory periodontal disease aim at changes in the subgingival ecosystems within the periodontal pockets to alter the complex microbial community into a microbiota compatible with good periodontal health. Systemic antimicrobial therapy, although effective, involves a relatively high dose with repeated intakes over a prolonged period of time to achieve the required inhibitory concentrations in the sulcular fluid. The adjunctive use of local drug delivery may provide a beneficial response, especially in specific areas where conventional forms of therapy might fail. The aim of this study was to compare the efficacy of two local drug delivery systems, one containing metronidazole and the other containing tetracycline hydrochloride as adjuncts to mechanotherapy in the treatment of chronic periodontitis. MATERIALS AND METHODS: There were three groups that were labeled as group A (Scaling + Tetracycline), group B (Scaling + Metronidazole), and group C (Scaling alone). A microbiological analysis was carried out to determine the efficacy of these systems in changing the pathogenic flora in deep pockets. In addition, a multiplex polymerase chain reaction was carried out to confirm the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis (Pg), and Tannerella forsythensis in the flora associated with chronic periodontitis. RESULTS: There was clinical improvement in groups A and B, which correlated with an improvement in the microbiological parameters; these results were sustained for 90 days following therapy. In Group C, the flora showed a shift towards baseline at the end of 90 days. CONCLUSIONS: According to this study, both the local antibiotic therapies resulted in greater improvement in microbiological parameters when used as an adjunct to mechanotherapy as compared to mechanotherapy alone.
ABSTRACT
AIM: To assess 25-hydroxyvitamin D (25OHD) concentrations in patients with primary hyperparathyroidism and to study the relationship, if any, between vitamin D concentration and bone disease. METHODS: Consecutive patients with diagnosed primary hyperparathyroidism were enrolled in the study. Clinical and biochemical details, including serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH) and 25OHD levels, were recorded. An abbreviated skeletal survey and preoperative localisation with ultrasound/CT scan of the neck and tetrofosmin/technetium-99m hexakis(2-methoxyisobutylisonitrile) parathyroid scan was performed. RESULTS: 39 patients with primary hyperparathyroidism were identified (mean (SD) age 38.4 (15.0) years (range 12-72)). The most common presenting features were bone pain (80%), fatigue (80%) and proximal muscle weakness (78%). Brown tumours were present in 58% of cases, renal calculi in 42% and nephrocalcinosis in 12%. The mean (SD) corrected serum calcium concentration was 12.47 (1.58) mg/dl (3.2 (0.4) mmol/l). Serum 25OHD concentration was <5 ng/ml in 11 patients (28%), 5-10 ng/ml in nine (23%), 10-20 ng/ml in 14 (36%), and >20 ng/ml in five (13%). Serum alkaline phosphatase, PTH and gland weight were higher, whereas serum 25OHD was lower, in patients with skeletal disease. Patients with 25OHD concentrations Subject(s)
Bone Diseases/complications
, Calcium/blood
, Hyperparathyroidism, Primary/complications
, Vitamin D Deficiency/complications
, Vitamin D/analogs & derivatives
, Adolescent
, Adult
, Aged
, Alkaline Phosphatase/blood
, Child
, Female
, Humans
, Hyperparathyroidism, Primary/blood
, India
, Male
, Middle Aged
, Organ Size
, Parathyroid Glands/anatomy & histology
, Vitamin D/blood
ABSTRACT
We present the imaging findings of severe bilateral mammary duct ectasia in a postmenopausal woman. Mammographic, ultrasonographic, and magnetic resonance findings are described. Needle biopsy was used to confirm the diagnosis. Etiology, clinical significance, and management strategies for this lesion are discussed.
Subject(s)
Breast Diseases/diagnosis , Mammary Glands, Human/pathology , Biopsy, Needle , Dilatation, Pathologic/diagnosis , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Mammography , Middle Aged , Pain/diagnosis , Postmenopause , Ultrasonography, MammaryABSTRACT
INTRODUCTION: To compare the accuracy of graded compression ultrasonography (US) and unenhanced spiral computed tomography (CT) in the diagnosis of acute appendicitis. METHODS: This prospective study comprised 58 consecutive patients with high clinical suspicion of acute appendicitis. After careful clinical assessment and laboratory investigations, all the patients were independently evaluated by graded compression US followed by unenhanced spiral CT, in order to establish the diagnosis. CT was performed from the level of the third lumbar vertebral body to the pubic symphysis, and no patient was given oral, rectal or intravenous contrast agents. The results were compared with operative findings and clinical follow-up. RESULTS: Out of the 58 patients evaluated, surgical confirmation was obtained in 52 patients and the remaining six patients were managed conservatively. Statistical analysis was based on the 52 patients who were surgically confirmed. 48 of the operated patients had evidence of appendicitis and four patients had negative findings. In our study, 90 percent of patients were adults and the following results were more applicable to the adult age group. Analysis of the data for US and CT, respectively, revealed a sensitivity of 67.3 percent versus 95.8 percent, specificity of 100 percent versus 75 percent, accuracy of 71.2 percent versus 90.3 percent, positive predictive value of 100 percent versus 97.8 percent, and negative predictive value of 15.8 percent versus 60 percent. Out of the operated patients, four patients did not have acute appendicitis and alternative diagnosis was suggested by US and CT in one patient. Of the six patients managed conservatively, an alternative diagnosis was reached both by US and CT in two patients. CONCLUSION: We conclude that unenhanced spiral CT is more sensitive than US in detecting appendicitis, especially in adult patients.
Subject(s)
Appendicitis/diagnostic imaging , Image Enhancement , Tomography, Spiral Computed/methods , Acute Disease , Adolescent , Adult , Aged , Child , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of Results , UltrasonographyABSTRACT
BACKGROUND: Use of protective footwear before entering the intensive care units is enforced with the assumption that it lowers the incidence of bacterial floor colonization. The present study was carried out to find the efficacy of protective footwear on bacterial floor colonization. METHODS: The study was carried out in the intensive care unit of a tertiary care hospital. The study was divided into two phases of two weeks each, phase I with and phase II without use of protective footwear. Samples were taken at six different sites namely footwear exchange area; visitors /staff route; partitioned patient cubicle; central monitoring area; open patient cubicle and scrub up areas. Floor samples were taken at 0600, 1100, 1700 and 2200 hours and air samples at 0600 and 1700 hours. Bacteria were identified and colony forming units (cfu) measured from floor and colony forming units/metre(3) (cfu/m3) from air sample cultures. RESULT: A total of 9521 bacterial colony forming units were isolated from 192 samples in phase I from the floor samples and 9971cfu from 192 samples in phase II. From 96 air samples in each phase, a mean of 262 cfu/m(3) in phase I and 220cfu/m(3) in phase II were isolated. The difference between the two phases was statistically not significant (p value > 0.05 for both). CONCLUSION: Floor and air colony counts showed no significant difference in the two phases with and without protective footwear. Protective footwear had no significant impact on bacterial contamination of floors.
ABSTRACT
BACKGROUND: In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS: SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS: We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION: Station II nodes may predict metastatic involvement of additional nodes in the axilla.
Subject(s)
Axilla , Breast Neoplasms/pathology , Lymphatic Metastasis/diagnosis , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Coloring Agents , Cross-Sectional Studies , False Negative Reactions , Female , Humans , Lymph Node Excision , Middle Aged , Pilot Projects , Predictive Value of Tests , PrognosisABSTRACT
Retroperitoneal fibrosis (RPF) is an uncommon entity that usually presents as a fibrous plaque-like lesion that encases the aorta and inferior vena cava below the level of the renal arteries. We present an unusual mass-like appearance of this disease simulating a tumour, with foci of calcification, seen in a young girl.
Subject(s)
Retroperitoneal Fibrosis/diagnosis , Retroperitoneal Neoplasms/diagnosis , Adolescent , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Retroperitoneal Fibrosis/diagnostic imaging , Retroperitoneal Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Rhabdoid tumor is a distinct entity reported in renal and extrarenal sites. Malignant tumors of various types may have rhabdoid phenotype. There are eight case reports of carcinomas of thyroid with rhabdoid phenotype. All of these cases, except two, have been reported in middle-aged women (42-72 yr) and have had an aggressive clinical course with death occurring within few months to 4 yr after diagnosis. We report a case of poorly differentiated carcinoma of the thyroid with rhabdoid phenotype in a 22-yr-old male. The rhabdoid cells were immunopositive for thyroid transcription factor-1, vimentin, epithelial membrane antigen, and focally for cytokeratin. Synaptophysin, chromogranin, thyroglobulin, carcinoembryonic antigen, smooth muscle actin, myogenin, and desmin were all negative. To the best of our knowledge this is the ninth case report of carcinoma of the thyroid with rhabdoid phenotype. This case, unlike the previous reported cases, has certain unusual features including presentation in a young male, the absence of either follicular/papillary differentiation, and immunohistochemical profile of the rhabdoid cells.
Subject(s)
Adenocarcinoma/pathology , Rhabdoid Tumor/pathology , Thyroid Neoplasms/pathology , Adenocarcinoma/metabolism , Adenocarcinoma/surgery , Adult , Biomarkers, Tumor/metabolism , Fatal Outcome , Humans , Keratins/metabolism , Male , Mucin-1/metabolism , Nuclear Proteins/metabolism , Rhabdoid Tumor/metabolism , Rhabdoid Tumor/surgery , Thyroid Neoplasms/metabolism , Thyroid Neoplasms/surgery , Thyroid Nuclear Factor 1 , Transcription Factors/metabolism , Vimentin/metabolismABSTRACT
Our laboratory has designed a specific nested-PCR (N-PCR) assay, based on the hupB gene of Mycobacterium tuberculosis (Rv2986c) and Mycobacterium bovis (Mb3010c) as a method to differentiate these closely related species. The present paper deciphers the utility of this assay for identification of pathogenic Mycobacteria in clinical samples. Extra-pulmonary clinical samples obtained from cattle and humans were investigated. Pre-dominance of M. tuberculosis (15.7%) and M. bovis (26.8%) was seen in humans and cattle, respectively. However, more importantly, both mycobacterial pathogens (mixed infection) were identified in a number of samples. In humans 8.7% of the samples and 35.7% in cattle were classified as mixed infection. The detection of mixed infection with the mycobacterial pathogenic duo in humans and bovines denotes the prospect of potential transmission of these pathogens from humans to cattle (zoonosis) and vice versa (reverse zoonosis).
Subject(s)
Tuberculosis, Bovine/transmission , Tuberculosis/microbiology , Zoonoses , Animals , Bacterial Proteins , Bacterial Typing Techniques , Cattle , DNA, Bacterial/analysis , Histones/genetics , Humans , India , Mycobacterium bovis/genetics , Mycobacterium tuberculosis/genetics , Polymerase Chain Reaction/methods , Sensitivity and Specificity , Tuberculosis/diagnosis , Tuberculosis, Bovine/diagnosisABSTRACT
BACKGROUND: The presence of skeletal metastases significantly influences the therapeutic strategy adopted for soft tissue sarcoma. However, literature on the prevalence of skeletal metastases in soft tissue sarcoma is limited and none of the available data is based on the Indian patient population. AIM: To determine the prevalence of skeletal metastases at presentation in patients of soft tissue sarcoma and to rationalise the use of preoperative skeletal scintigraphy in such patients. METHODS AND MATERIAL: Preoperative bone scans were evaluated in 122 patients with soft tissue sarcoma (median age, 34 years; range, 4-83). The scans were classified into 3 grades: Grade 1: metastases very likely; Grade 2: equivocal; Grade 3: normal or benign lesion. In all the patients studied, the ability of the patient to localize the site or sites of pain was recorded and that was correlated with the site of metastases in scintigraphy. RESULT: Seventeen (13.9%) patients had Grade 1 scan; 16 of them had bony pain that was not readily explainable by trauma or other local factors. Ten ( 8.1%) patients had Grade 2 scan, five of them had bony pain which was not readily explainable by trauma or other local factors. Ninety-five patients (77.8%) had Grade 3 scan. Of these, 9 had localised bone pain which could be definitely associated with trauma or joint degeneration. CONCLUSION: The prevalence of skeletal metastases at presentation in patients with soft tissue sarcoma is low (13.9%). The low rates of skeletal metastases in bone pain-free patients (0.9%) versus the high rate in symptomatic patients (76.1%) supports the use of bone scanning in symptomatic patients only.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Sarcoma/diagnostic imaging , Sarcoma/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m MedronateABSTRACT
BACKGROUND: The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy. METHODS: Between January 2001 and November 2002, 40 patients with a diagnosis of acute cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 24 h of admission (early group, n = 20) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy, 6 to 12 weeks later (delayed group, n = 20). RESULTS: There was no significant difference in the conversion rates (early, 25% vs delayed, 25%), operating times (early, 104 min vs delayed, 93 min), postoperative analgesia requirements (early, 5.3 days vs delayed, 4.8 days), or postoperative complications (early, 15% vs delayed, 20%). However, the early group had significantly more blood loss (228 vs 114 ml) and shorter hospital stay (4.1 vs 10.1 days). CONCLUSIONS: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 to 96 h of the onset of symptoms.
Subject(s)
Cholecystectomy, Laparoscopic , Cholecystitis/surgery , Acute Disease , Adult , Cholecystectomy, Laparoscopic/adverse effects , Feasibility Studies , Female , Humans , Male , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Time FactorsABSTRACT
Acute bowel infarction is a major complication in patients with superior mesenteric vein and portal vein thrombosis. However, in some patients, sufficient collaterals can prevent acute bowel infraction. We present a case of mesenteric vein and portal vein thrombosis with intestinal obstruction due to acute bowel oedema and ischaemic adhesion without infarction or stenosis.
Subject(s)
Intestinal Obstruction/etiology , Mesenteric Veins , Portal Vein , Venous Thrombosis/complications , Humans , Intestinal Obstruction/pathology , Intestinal Obstruction/therapy , Intestines/blood supply , Male , Middle Aged , Neovascularization, PathologicABSTRACT
Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.
Subject(s)
Cecal Diseases/surgery , Colectomy/methods , Ileal Diseases/surgery , Laparoscopy/methods , Tuberculosis, Gastrointestinal/surgery , Adult , Barium Sulfate , Cecal Diseases/diagnostic imaging , Enema , Female , Follow-Up Studies , Humans , Ileal Diseases/diagnostic imaging , Male , Radiography , Treatment Outcome , Tuberculosis, Gastrointestinal/diagnostic imagingABSTRACT
A 13-year-old haemophilia A patient presented with pain in the abdomen, 4 days after a blunt abdominal trauma. The computed tomography scan of the abdomen showed a large splenic haematoma. The patient was initially managed with factor VIII replacement therapy, but 4 weeks later he had a delayed rupture of the splenic haematoma with haemoperitoneum and shock. An elective splenectomy under factor VIII therapy was successfully performed.