RESUMO
CONTEXT: Nonsurgical uses of tranexamic acid include the management of bleeding associated with leukemia, ocular bleeding, recurrent hemoptysis, menorrhagia, hereditary angioneurotic edema, and numerous other medical problems. However, there is hardly any documentation of the use of tranexamic acid in laparoscopic cholecystectomy. AIMS: This study was conducted to evaluate the role of tranexamic acid in limiting blood loss in laparoscopic cholecystectomy and to evaluate the effect of blood loss on morbidity in terms of hospital stay and mortality of the patient. SUBJECTS AND METHODS: The study was conducted on sixty patients admitted with gallstones, candidates for laparoscopic cholecystectomy. Thirty patients received an intravenous 20 mg/kg bolus dose of tranexamic acid at induction of anesthesia (Group A), and another thirty did not receive the aforementioned drug at induction (Group B). STATISTICAL ANALYSIS: The two groups were compared, and the data collected were entered and tabulated using Microsoft Office Excel and analyzed using appropriate statistical tests. RESULTS: The mean postoperative hospital stay (2.4 vs. 2.63, P = 0.4147), drain fluid hemoglobin (Hb) (0.83 vs. 0.90, P = 0.2087), drain fluid hematocrit (0.2434 vs. 0.2627, P = 0.3787), mean drain output (85 vs. 87.23, P = 0.9271), mean pulse rate at the start of surgery (74.2 vs. 75, P > 0.999), mean pulse rate 24 h after surgery (75.9 vs. 76.4, P = 0.5775), and mean change in Hb (0.240 vs. 0.266, P = 0.2502) in both the groups were not significant. CONCLUSIONS: There is no active role of tranexamic acid in elective laparoscopic cholecystectomy.
RESUMO
CONTEXT: Oncosurgery is an emerging branch with the set goals of prolonging the life and ensuring the best possible quality of life to the surviving patient. The use of harmonic scalpel has proved to be beneficial in a variety of surgeries but its role in breast surgery is still controversial. AIMS: We conducted this study to compare the intraoperative and postoperative outcomes in modified radical mastectomy using harmonic scalpel versus electrocautery. SUBJECTS AND METHODS: Fifty female patients with confirmed diagnosis of breast carcinoma and planned for modified radical mastectomy were taken up for surgery. Twenty-five patients were operated using harmonic scalpel (Group A) and another 25 were operated using unipolar cautery (Group B). RESULTS: The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.40 ± 29.96 vs. 99.80 ± 24.00 min, P < 0.001). The smaller amount of drainage content (431.60 ± 145.94 vs. 594.20 ± 278.63, P = 0.013) and intraoperative blood loss (426.00 ± 76.54 vs. 502.00 ± 104.56, P = 0.005) in the group operated with the ultrasound harmonic scalpel was statistically significant. There was no significant difference between the groups with regard to drain duration (5.24 ± 0.97, P = 0.127), seroma (12% vs. 16%, P = 0.684), hematoma (4% vs. 4%, P = 1.000), wound infection (24% vs. 32%, P = 0.529), flap necrosis (8% vs. 28%, P = 0.066), pain intensity (measured on visual analog scale) (5.08 ± 1.29 vs. 5.20 ± 1.68, P = 0.778), and lymphedema (4% vs. 8%, P = 0.552). The length of hospital stay could not be compared effectively because all the patients were discharged on the 10th or 11th postoperative day. The cost of the equipment used in the electrocautery group was almost negligible as compared to the harmonic group. CONCLUSIONS: The use of harmonic scalpel versus electrocautery is somewhat advantageous but not cost-effective.
RESUMO
Renal Cell Carcinoma (RCC) is notorious for its unpredictable dissemination patterns involving both lymphatic and haematogenous route without a clear-cut preponderance for any. Unlike other intra-abdominal malignancies like colorectal carcinoma, renal cell carcinoma is often known to metastasize to distant sites even after a confident and unsuspecting curative resection or often as the primary presentation constantly adding and agitating our presentation patterns for this sneaky tumour. Presented below is a case of such an unsuspecting female patient. She was referred from the orthopaedic OPD to surgery OPD with a right clavicular swelling which was histopathologically examined and diagnosed as a metastatic renal cell carcinoma following which she was diagnosed with right renal cell carcinoma.
