Efficacy of Intravenous Lignocaine 2% Versus Oropharyngeal Topical 10% Xylocaine Spray Before Induction of Anaesthesia in Attenuating the Pressor Response to Direct Lryngoscopy and Endotracheal Intubation

The current Study was done to compare the efficacy of intravenous lignocaine 2% versus oropharyngeal topical 10% xylocaine spray before induction of anaesthesia in attenuating the pressor response to direct laryngoscopy and endotracheal intubation. A total of 60 patients were divided randomly into two groups of 30 patients each. Group I received intravenous lignocaine 2% @ 1.5 mg/kg. Group II received topical 10% xylocaine spray @ 1.5 mg/kg body weight just before induction of anaesthesia. All hemodynamic parameters were measured immediately after laryngoscopy and intubation and at 1, 3, 5 minutes after laryngoscopy and intubation in both the groups. Mean values of haemodynamic parameters in Group I increased after intubation and then started declining but did not reach the baseline even at 5 minutes. In Group II all mean values of haemodynamic parameters increased after intubation and then started declining to almost baseline at 5 minutes. The differences in mean values of haemodynamic between the two groups immediately after intubation and at 1, 3 and 5 minutes thereafter were statistically highly significant (p<0.001). Oropharyngeal topical xylocaine 10% when applied before induction of general anaesthesia is more effective method for attenuating the pressor response to direct laryngoscopy and endotracheal intubation when compared to intravenous lignocaine 2%

Clinical Study of Acid-Peptic Disease in a Semi-Urban Setup in Western Uttar-Pradesh

Background: Acid peptic disease is a common morbidity is India. We aim to find the present dynamics of age, sex and causative factors in our semiurban setup in western Uttar-Pradesh. Methods: a prospective study was done to include patients with acid peptic like symptoms presenting between January 2016 to December 2017. Upper GI endoscopy was done in patients with severe and recurrent symptoms. Results: In our study, out of 488 patients, 24 presented with perforated ulcers while 255 patients underwent upper GI endoscopy. 42 patients had normal mucosa on endoscopy. Highest incidence was seen in the age group of 31-40 years.68.86% of the patients had some sort of tobacco or alcohol intake. Conclusion: Peptic ulcer disease is still associated with considerable morbidity even in this era of proton pump inhibitors and H2 receptor blockers available as OTC products. The highest incidence was in the age group of 31-40 years. Lifestyle factors like smoking, alcohol intake, spicy, oily and salty food intake and tobacco chewing are present in majority of patients. Incidence of the disease in females is seen to be increasing.

Comparison of the Diagnostic Accuracy of FNAC and Biopsy in the Diagnosis of a Palpable Breast Lump

Background: Mammary gland carcinoma is the most common malignant tumor. Annually worldwide more than1,000,000 cases of breast carcinoma occur, which is the leading cause of carcinoma death in women. The most relevant and important method to diagnose breast cancer is Fine Needle Aspiration Cytology (FNAC). The use of core needle biopsy (CNB) has been increasing because of various limitations. Advantages of core needle biopsy over FNAC is, that core needle biopsy provide sufficient tissue for definitive histological diagnosis, differentiate between invasive cancer and carcinoma. The purpose of this study was to determine if there is a difference in diagnostic accuracy in using CNB and FNAC in patients with palpable breast lumps undergoing breast surgery. Methods: This was cross sectional type of study conducted in the Department of General Surgery at Muzaffarnagar Medical College, Muzaffarnagar. The study was carried out from July 2016 to March 2018. The study population was recruited from the patients presenting with suspicious palpable breast lump clinically and/or radiologically, attending at General Surgery Outpatient Department (OPD), Muzaffarnagar Medical College, Muzaffarnagar. Hundred (100) patients suffering from breast lumps were included in this study. Results: Total 58 patients (58% of total patients with breast lump) were found with malignancy having C5 category of FNAC. All of them confirmed malignancy after the surgery. FNAC showed malignancy in 58% cases of breast lump. There was no false positive case in FNAC findings. Rest of 42 patients showed non-malignant breast lumps which showed C2, C3 and C4 category of FNAC. Findings after excision biopsy showed that there were 26 patients (26%) were false negative. Conclusion: Findings of the present study suggest that FNAC is almost equally effective technique for the diagnosis of malignancy in patients suffering carcinoma of mammies. FNAC is considered as an economical, less complicated, rapid and reliable method for the pathological diagnosis of breast carcinoma in a developing country like India. Malignant tumour can be exactly diagnosed by FNAC as it is highly sensitive for malignancy. CNB should be put after FNAC If initial FNAC fails to determine the type of tumour, CNB can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer. Excision biopsy should be considered as last option for pathological diagnosis.

The Prospective Study to Evaluate the Efficacy of ALVARADO Score and RIPASA Score in Diagnosis of Acute Appendicitis and Correlation with Histo- Pathological Findings

Background: Acute abdomen is one of the most common surgical emergencies with the life time risk of 7%. The diagnosis of appendicitis is challenging due to overlapping of symptoms with other diseases and variable accuracy of clinical examination. The present study was carried out to diagnose acute appendicitis and its complications, to compare ALVARADO and RIPASA scoring systems and correlating these with intra-operative and histopathological findings. Methods: This prospective study of 100 patients was conducted in Department of Surgery admitted in Muzaffarnagar Medical College and Hospital, Muzaffarnagar. Any patients irrespective of sex admitted with age more than 13 yrs presented with right iliac fossa pain suspected to be acute appendicitis and underwent appendectomy. Diagnosis of acute appendicitis was confirmed by operative findings and histological assessment of the appendectomy specimen. In every clinically diagnosed case, ALVARADO and RIPASA scoring systems were applied. Patients were monitored following admission, surgery and till discharge from the hospital. Intra-operative findings such as length of appendix, site of appendix, presence of gangrene or nor, free fluid present or not, presence of fecolith or not, base of caecum evaluated. Histopathologic findings of operated case were collected and correlated with either scores. Results: Out of 100 patients 64% were males and 36% were females. When Alvarado score applied in the study group; 55 patients were in > 7 group and 45 patients in < 7 group. When correlate with histopathology, 90% patients fall into acute appendicitis group and 10% in nonappendicitis group. RIPASA score revealed that there were 89% patients in high probability of acute appendicitis, while 11% were in low probability. When correlate with histopathology 90% fall into appendicitis group and 10% in non-appendicitis group. Conclusion: In the study we conclude that for the diagnosis of appendicitis both ALVARADO and RIPASA scoring systems were equally good. However, RIPASA score is a useful rapid diagnostic tool for establishing a quick decision in patients with RIF pain. Moreover, it also reduces the cost of expensive radiological investigations and thus making a more cost effective approach for patients belonging to lower socioeconomic group