Inguinal abscess after gallstone spillage during lap cholecystectomy: An unusual presentation

62 year old lady was presented with small painful swelling in inguinal regional. On examination, there was 2x2 cm swelling in the right inguinal region with overlying skin red in color. Swelling was tender to touch with raised local temperature, firm in consistency, non-reducible and non-compressible with no transmitted pulsations. FNAC report was showing only inflammatory cells. Ultrasound was normal for abdomen but it showed presence of foreign body deep inside the sinus tract. Sinus tract was excised along with foreign body. Gallstone abscess are although rare to develop but they are seen occasionally. As are seen in our case lap cholecystectomy was performed 9 months ago and a single 7 mm stone was extracted from abscess in inguinal region.

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.

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

The Prospective Study Comparing The Post-Operative Shoulder Tip Pain (VAS) Score In Standard Pressure V/S Low Pressure Cholecystectomy

Background: Cholelithiasis is one of the most common surgical diseases. About 1-15% adult population have gallstones. The present study is done to compare the frequency and intensity of post-operative shoulder tip pain (VAS) score in standard pressure v/s low pressure cholecystectomy.Methods: The Comparative, Randomized and Prospective study is conducted on 100patients’ under-going Laparoscopic Cholecystectomy for Cholelithiasis with 50 patients in each group: Group A- Low pressure pneumoperitoneum at 7 to 10mm Hg, Group B- Standard pressure pneumoperitoneum at 12 to14mm Hg in the Department of General Surgery, Muzaffarnagar Medical College and hospital. Postoperative pain was measured at 6, 12, 24, 48 hours using a Visual Analogue Scale (VAS). Statistical analysis was carried out using the chi square and independent student t tests with the help of SPSS (statistical package for social sciences, version 17.0). A p value < 0.05 was taken as statistically significant. Results: Low insufflation pressure reduced pain frequency as well as pain intensity after laparoscopic cholecystectomy. Analgesic requirement is also less in low pressure.Conclusion: Low pressurepneumoperitoneum is ideal for laparoscopic cholecystectomy for decrease frequency and intensity of postoperative shoulder tip pain.

A Descriptive Study to Assess the Neuro-psychological Deficits among Epileptic Children.

Background: Neuropsychological deficits are common among epileptic children and these deficits of epileptic children may be influenced by factors like age, gender, frequency of seizures, duration of seizures, age at onset of seizures, type of seizures and family history. Material and Method: A non experimental research design was utilized to assess the Neuropsychological Deficits among Sample of 60 children with epilepsy, with age group of 8-16 years, attending outpatient neurology unit of Christian Medical College & Hospital, Ludhiana, Punjab. Symptom checklist -90 was used to assess the psychological deficits and Performance of intelligence to assess neurological deficits was assessed with the help of Bhatia’s Battery. Analysis and interpretation of data was done by using descriptive and inferential statistics. Results: Out of 60 patients, 60% of epileptic children were free of psychological deficits, 36.7% had mild and 3.3% had moderate level of psychological deficits. Children had maximum psychological deficits score (50.08%) in anger hostility related symptoms and least (12.75%) in phobic anxiety symptoms. 43% of epileptic children had borderline and dull normal IQ level which indirectly represented neurological deficits, maximum in cognition i.e. 43.33% and lowest in loss of coordination or loss of fine motor control. Epileptic children had more mean percentage neurological deficits score but with little difference in both Koh’s block design test (68.6%) and in ‘Pattern Drawing Test’ (68.1%) i.e. they had more problems related to the analytical- synthetics ability and the lowest mean percentage neurological deficits score (19.2%) were in “Immediate Memory Test”. Conclusion: Epileptic patients suffers from various degrees of neuropsychological problems, which if could be recognized early and intervened in time can further reduce the disability among these children’s and will lower the psychosocial impact of epilepsy at large.

Two case reports of Ultrasonography features in male genital tuberculosis.

Genitourinary tuberculosis is the common manifestation of extra-pulmonary tuberculosis. In the male genital tract, the epididymis followed by seminal vesicle, prostate, vas deferens and testis are commonly affected sites. Ultrasonography (USG) is the best imaging modality for the diagnosis of the diseases of male genital tract. We are presenting USG findings in two cases of male genital tuberculosis with involvement of the prostate, seminal vesicle, epididymis and vas deferens.