Ansari Mm

Mammary tuberculosis : Analysis of thirty-eight patients

Thirty‐eight patients with mammary gland tuberculosis were evaluated over a 5‐year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine‐needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy

BACKGROUND Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). MATERIALS AND METHODS A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. RESULTS One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). CONCLUSION Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.

Feasibility and outcome of proximal catheter ileostomy - A pilot study

Background/Aim: Loop ileostomy has high complication rates and causes much patient inconvenience. This study was carried out to evaluate the feasibility and outcome of a proximal catheter ileostomy in place of loop ileostomy in patients treated by intestinal repair and/or resection-anastomosis.Design: Prospective study.Setting: J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India. Patients and Methods: From November 2006 to November 2009, in all patients treated surgically by primary repair and/or resection-anastomosis of small and/or large bowel, we constructed a catheter ileostomy when a defunctioning proximal protective loop ileostomy was considered advisable. Catheter ileostomy was constructed in the fashion of catheter jejunostomy, with postoperative saline irrigation. Results: Catheter ileostomy was performed in 20 patients in the 3-year period. The mean age of the subjects was 28.6 years and the male: female ratio was 1.86:1. Four patients died of septicemia and multiple organ failure unrelated to catheter ileostomy in the immediate postoperative period. Catheter ileostomy started functioning within 48 hours of the operation, and twice-daily irrigation was found sufficient in 81.25% of the surviving patients. Only one patient developed peritubal leak with mild skin excoriation that cleared within 5 days. Another patient with Kochs abdomen underwent conversion to loop colostomy on re-exploration for postoperative adhesive obstruction. There was no instance of intestinal leak. Ileostomy wounds closed spontaneously within 7–14 days of catheter removal, and none required formal closure. Hospital stay ranged from 12–35 days (mean: 23 days). Conclusions: Catheter ileostomy is effective in protecting intestinal anastomosis/repair; there is minimal morbidity and no catheter-related leak/mortality, and we recommend the procedure.

Tension teratothorax : a case report

Respiratory distress caused by a giant mediastinal teratoma is hitherto unreported. This communication presents the case history of an 8-year-old boy who presented with this serious problem, along with perforation of the chest wall.

Corrosive pyloric obstruction without oesophageal involvement in children—a report of two cases

Two children with gastric outlet obstruction without oesophageal involvement secondary to acid ingestion are described. They presented with frequent vomiting along with pain in the epigastrium. The diagnosis was made by barium swallow and barium meal examination. Treatment consisted of gastrojejunostomy. The literature on this subject is briefly reviewed.

Bilateral traumatic rupture of the diaphragm.

A 3.5-year-old girl sustained compression injury leading to isolated bilateral diaphragmatic rupture with extensive herniation of abdominal viscera into the pleuropericardial cavities. Reduction of the hernia and repair of the defects were readily accomplished through a thoraco-abdominal approach with excellent outcome.

Clinical profile of thoracic trauma in children--a study from Aligarh, N. India.

A total of 60 cases of thoracic trauma in children, treated over a period of 4.5 years (January 1983 to June 1987), were analysed. Blunt-impact trauma was the major cause in 58.33% cases, stressing that bullock-cart accidents and bull-horn and buffalo-hoof injuries are still a continuing cause of chest injury in developing countries. Haemo- and/or pneumothorax were the main injuries (78.33%), but cardiac and oesophageal involvement were seen, in two cases each. Isolated first rib fracture was another surprising finding. Except for three, all the cases presented within 24 h of injury. Cyanosis and profound shock were found in five patients each. The majority of the patients (60%) were treated with intercostal tube drainage and major surgical operations were needed in 30%. In the remaining 10%, observation was sufficient. There were two deaths (3.33%), with a success rate of 96.67%.

Comment to: Paradigm shift regarding the transversalis fascia, preperitoneal space, and Retzius’ space (N. Asakage)

Modern high-definition laparoscopy has often revealed new visions of the structures known for centuries, and discovery of new structures like ‘rectusial fascia’, additional morphology of the ‘preperitoneal fascia’ and multiple Retzius spaces greatly facilitated accurate and judicious dissection for seamless laparoscopic inguinal hernioplasty. Dr. N. Asakage’s presentation of inguino-pelvic fascial anatomy and its embryology [Asakage N. Paradigm shift regarding the transversalis fascia, preperitoneal space, and Retzius’ space. Hernia 2018 Feb 27. https://doi.org/10.1007/s10029-018-1746-8 (Epub ahead of print)] is excellent and fascinating, albeit with certain reservations highlighted herein.

Complete posterior rectus sheath and total extra-peritoneal hernioplasty

Introduction: Variations in rectus sheath formation have been reported with little realization of its importance to the laparoscopic surgeons doing total extra-peritoneal preperitoneal (TEPP) hernioplasty. Observation of complete rectus sheath during laparoscopic mesh hernioplasty for inguinal hernia through TEP approach and its surgical implication are presented here. Materials and Methods: Setting - Elective. Location for the study - J. N. Medical College and Hospital, A. M. U., Aligarh. Study design - Prospective with effective from April 2010 to August 2013. Study population - Adults (≥18 years). Data collection - Instant documentation and video recording. Method of analysis - All data were computed through on-line calculators (www.graphpad.com/quickcalcs/and http://epitools.ausvet.com.au/). Results: Thirty-five TEPP hernioplasties were carried out in a period of 3 years. All patients were males, with an overall mean age of 48.7 ± 13.4 years. Posterior rectus sheath (PRS) was found complete in four patients with a mean age of 47.28 ± 09.74, and was associated with significantly increased surgical difficulties during the procedure. On Visual Analog Score, endoscopic vision was 4.3 ± 0.6 (4.0-5.5), and the ease of the procedure was 4.5 ± 0.8 (4.0-6.0) that is, both were less than satisfactory. Operating time was 3.1 ± 0.7 h (3.25-4.0). Out of four patients, peritoneal injury occurred in three patients, surgical emphysema in one patient, and postoperative seroma in one patient. Conclusions: PRS was complete in 11.43% of cases studied that was associated with an increased level of surgical difficulties and a higher rate of complications.

Low tension breast hydatid cyst—A case report

INTRODUCTION Features of low tension in breast hydatid cyst and symptoms secondary to cyst dying and disintegration are unique and not yet reported in the literature. MATERIAL AND METHOD An young woman of 30 years complained about pain and vague swelling in the right breast during follow-up with albendazole therapy following second laparotomy for post-surgical residual cavity of hydatid cyst in the left lobe of the liver. Breast ultrasound was diagnostic. RESULTS Segmental breast excision revealed a large dead hydatid cyst. Postoperative course was uneventful. CONCLUSIONS Breast hydatid cyst may become symptomatic and hypotensive after start of albendazole therapy.