Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals.

North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64 % among all admissions. Of these individuals, 13.65 % (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.

Rational Hyperoxia in the Perioperative Period: a Safe and Effective Tool in the Reduction of SSI.

Oxygen supplemented at a concentration higher than 40-50 % for at least 2 h perioperatively is expected to reduce surgical site infections (SSI). Although supplementation of 80 % of oxygen perioperatively has shown to reduce SSI in various studies, this concentration is known to be associated with airway complications. This study was taken up to assess the efficacy of 60 %, i.e. <80 and >50 %, inspired oxygen supplemented perioperatively in reducing SSI. One hundred and eighty-eight patients who underwent elective class I and II surgeries were studied. Patients were divided equally into two groups and subgroups and matched for age, sex, type of surgeries, etc. The control group received 30 % and the study group received 60 % oxygen supplementation perioperatively for 2 h. Wounds were observed for the development of SSI. 8/94 patients in the study group and 13/94 patients in the control group developed SSI (p < 0.01). The results indicate a relative risk of 1.62, risk difference of 0.0531 and attributable risk of 38.42 %. Hence, it may be concluded that perioperative oxygen supplementation at 60 % concentration reduces SSI.

Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. AIM: To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. MATERIALS AND METHODS: This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. RESULTS: Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. CONCLUSION: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection.

Extended Open Transgastric Necrosectomy (EOTN) as a Safer Procedure for Necrotizing Pancreatitis.

The treatment of infected necrotizing pancreatitis has evolved from time to time and the success of surgical intervention depends on the timing of necrosectomy. Bacterial infection occurs in 40-70% of patients with necrotizing pancreatitis. Infection is the main risk factor for mortality among patients with pancreatic necrosis. Timely intervention is generally required for pancreatic necrosis but is now deferred until four weeks after disease onset in order to permit encapsulation and demarcation of the necrotic material. Demarcation facilitates necrosectomy and reduces complications related to the drainage and debridement procedures. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Direct endoscopic necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of walled-off necrosis. The pancreas is approached through the posterior wall of stomach and debridement is done.

Desmoid infilterating ileum, a rare complication.

The desmoid tumor is an uncommon neoplasm that occurs sporadically or as a part of inherited syndrome. Desmoid tumors are benign, but may infiltrate adjacent structures. Rarely severe and fatal, clinical problems are seen if mesenteric vessels or abdominal organs are involved. Ileum is one of the rare sites and literature search regarding this yielded scant results. Hence, we decided to report this case of aggressive desmoid tumors of the abdominal wall infiltrating ileum.