Lalit Sharma

Meta-analysis of Randomized Controlled Trials on Hydrocolloid Occlusive Dressing Versus Conventional Gauze Dressing in the Healing of Chronic Wounds

Chronic wound management is a difficult area in surgical practice. A wide range of dressings have been recommended for the management of chronic wounds. The present meta-analysis was undertaken to determine the effectiveness of hydrocolloid dressing (HCD) in the healing of chronic wounds compared with conventional gauze dressing. All available controlled clinical trials published before December 2001 that compared HCD to conventional gauze dressing in the healing of chronic wounds were systematically reviewed. We identified and analysed 12 randomized trials (11 published; 1 unpublished) comprising 693 patients with 819 ulcers. The overall odds ratio under the fixed effect model was 1.72, that is, 72% more ulcers healed completely with HCD than with conventional gauze dressing. This result was both clinically and statistically significant.

Generalized peritonitis in India—The tropical spectrum

Generalized peritonitis is a common surgical emergency in India, the ‘Tropical Spectrum’ of generalized peritonitis being different from the western spectrum. A total 155 cases of generalized peritonitis were surgically treated at the All India Institute of Medical Sciences between 1981 and 1987, all patients undergoing peritoneal toilet with drainage after the cause of their peritonitis had been treated. The most common cause of peritonitis was peptic ulcer perforation, with simple closure being associated with a 2 per cent mortality, while typhoid perforation was the second most common cause. The diagnosis was clinical supported by the operative findings of a terminal ileal perforation while bacteriological, serological and histopathological confirmation was retrospective. Appendicular perforations were less common than in the west but the clinical picture was the same. Tubercular perforations were not uncommon with a previous history of subacute intestinal obstruction and evidence of tuberculosis on chest X-ray suggesting the diagnosis. Ruptured amebic liver abscess was the most common hepatobiliary cause of generalized peritonitis with drainage of the abscess producing good results. The average hospital stay was 15 days with an overall mortality of 8 per cent.

Bilateral anterior dislocation of the shoulders with proximal humeral fractures: a case report

Bilateral simultaneous anterior dislocation of the shoulders with bilateral 3-part fracture of the proximal humeri is unusual. A 42-year-old man presented with pain and restriction of movement on both shoulders. He was injured by a heavy object falling over his back while he was leaning forward holding an overhead bar. His arms were abducted and externally rotated. The injury was not correctly diagnosed, and the patient was treated with repeated manipulations and splintage for 2 weeks. Radiological examination revealed bilateral anterior dislocation of the shoulders with displaced 3-part fractures of the proximal humeri involving the shaft, greater tuberosity, and head. The patient was treated with open reduction and internal fixation through a deltopectoral approach using multiple Kirschner wires. The shoulders were kept immobilised for 3 weeks until the removal of the wires. The patient was able to resume work 3 months after surgery. He had an excellent and comfortable range of motion in both shoulders at one-year follow-up.

Pilonidal disease of the umbilicus : a report of two cases

Two cases of umbilical pilonidal sinus are reported herein. Both patients were young adult males aged 21 and 27 years, respectively. The predisposing factors are briefly discussed, however, the exact etiology of this disease remains unknown. Umbilectomy is the most commonly offered treatment and although it is rare, this entity probably goes undiagnosed in the majority of cases.

Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma

Background: The epidemiological data of a given population on spinal trauma in India is lacking. The present study was undertaken to evaluate the profile of patients with thoracolumbar fractures in a tertiary care hospital in an urban setup. Materials and Methods: Four hundred forty patients with thoracolumbar spinal injuries admitted from January 1990 to May 2000 to the All India Institute of Medical Sciences were included in the analysis. Both retrospective data retrieval and prospective data evaluation of patients were done from January 1998 to May 2000. Epidemiological factors like age, sex and type of injury, mode of transport, time of reporting and number of transfers before admission were recorded. Frankels grading was used to assess neurological status. Functional assessment of all patients was done using the FIM™ instrument (Functional Independence Measure). Average followup was 33 months (24-41 months). Results: Of the 440 patients, females comprised 17.95% (n=79), while 82.04% (n=361) were males. As many as 40.9% (n=180) of them were in the third decade. Fall from height remained the most common cause (n=230, 52.3%). Two hundred sixty (59.1%) patients reported within 48 hours. Thirty-two (7.27%) patients had single transfer, and all 32 showed complete independence for mobility at final followup. 100 of 260 (38.5%) patients reporting within 48 hours developed pressure sores, while 114 of 142 (80.28%) patients reporting after 5 days developed pressure sores. Conclusion: The present study highlights the magnitude of the problems of our trauma-care and transport system and the difference an effective system can make in the care of spinal injury patients. There is an urgent need for epidemiological data on a larger scale to emphasize the need for a better trauma-care system and pave way for adaptation of well-established trauma-care systems from developed countries.

Macronodular adrenal hyperplasia causing Cushing's syndrome: Report of two cases and an overview

Of the various entities producing adrenal hyperfunction, nodular adrenal hyperplasia is rarely described, however, recent reports have established it as a distinct cause of Cushings syndrome. Although the etiology of this disease remains uncertain, two distinct forms are recognised, namely: macronodular hyperplasia and micronodular dysplasia. Establishing the diagnosis preoperatively is difficult but essential to ensure the correct treatment is performed. Two cases of macronodular hyperplasia are reported herein followed by a review of the available literature on this subject.

Typhoid enteric perforations

Forty-five cases of typhoid enteric perforation are presented. The disease was most common in young males. Half of the perforations occurred during the second week of fever. Diagnosis was mainly clinical, supplemented by radiological evidence of pneumoperitoneum and confirmed at laparotomy by the presence of perforations in the terminal ileum. Laboratory investigations including Widal test and blood culture were of little value. All the 45 were managed operatively by simple closure of the perforation(s) and drainage of the peritoneal cavity. Burst abdomen occurred in 9 per cent and fecal fistula in 20 per cent. Overall mortality was 11 per cent—much lower than that reported in the literature in case of management of typhoid enteric perforations.

Large post-traumatic subarticular cystic lesion following avulsion injury of PCL mimicking tumour

We describe a patient with a large subarticular cystic lesion in the proximal tibia developed following traumatic avulsion of PCL. There was a demonstrable communication between the cyst and the joint cavity and ingrowth of the synovial tissue was the most probable pathogenetic mechanism for the development of the cyst. We recommend that the post-traumatic cyst must be kept as a differential diagnosis in a patient presenting with cystic lesion around a joint, especially if there is a history of significant trauma in recent past.

Giant malignant cystosarcoma phylloides with hepatic metastases

A 36 year old female noticed an asymptomatic lump in her breast 8 months back. For the last 3 months it had grown rapidly and had assumed huge proportions. Marked pallor was present. There was massive enlargement (about 40cm × 30cm x 30cm) of the left breast. Skin was stretched and shiny with large distended veins (Fig. 1). Consistency was variegated firm nodules and areas of softening. Axillary nodes were not enlarged. Liver was palpable 2 cm below the costal margin. Hemoglobin was 5.7 gm%. Liver function tests revealed elevated serum alkaline phosphatase. Chest X-ray was normal. Radioisotope liver scan revealed multiple space-occupying lesions in the right lobe. Multiple blood transfusions were given. Six litres of hemorrhagic fluid was aspirated from the left and a simple mastectomy performed. The tumour weighed 7.6 Kg. Histopathological examination revealed malignant cystosarcoma phylloides. Local recurrence developed 4 weeks later and the patient was lost to follow-up. Cystosarcoma phylloides is a rare breast neoplasm. It can grow to large proportions tumours weighing 4.9Kg and 5.1Kg have been reported (1). It is generally a benign tumour, malignant lesions accounting for only 25% of cases (2). Distant

Soft tissue chondrosarcoma of the back--a case report.

A case of extraosseous chondrosarcoma arising from the soft tissues of the back is presented. The tumour was completely excised with a wide margin of normal tissues. Extraosseous chondrosarcoma arising from the soft tissnes of the back has apparently never been reported.