Mir Yasir

Single-Incision Laparoscopic Cholecystectomy Using Conventional Laparoscopic Instruments and Comparison with Three-Port Cholecystectomy

Single-incision laparoscopic surgery also known as laparo-endoscopic single-site surgery for cholecystectomy is performed using a single umbilical skin incision through which a laparoscope and two instruments are introduced. It is virtually a “scarless” surgery. The present study was undertaken to evaluate the efficacy of single-incision laparoscopic cholecystectomy using conventional instruments and compare it with three-port laparoscopic cholecystectomy. Thirty patients who underwent single-incision cholecystectomy were compared to an equal number of patients who underwent three-port cholecystectomy. Both groups were assessed on the basis of operative time, intraoperative complications, postoperative pain, ambulation, hospital stay, and body image at first and third week. Single-incision cholecystectomy had the advantage of less postoperative pain, early ambulation, and better body image as compared to three-port cholecystectomy; the results being statistically significant. There was no statistically significant difference in operative time and hospital stay between the two groups. Single-incision laparoscopic cholecystectomy using conventional instruments is a safe and effective surgery. It gives better cosmetic results, almost scarless surgery, without increasing the cost of surgery.

Histopathological spectrum of lesions in nephrectomy specimens: A five-year experience in a tertiary care hospital

Context: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas. It is performed increasingly in the context of end-stage renal disease and to treat renovascular hypertension from non-correctable renal artery disease, or for severe unilateral parenchymal damage resulting from nephrosclerosis, pyelonephritis, vesicoureteric reflux, and congenital dysplasia. Objective: This study aimed to assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital, observe variations if any from the conventional pattern, and clinico-morphological correlation for proper postoperative management. Materials and Methods: A hospital-based five-year study included all nephrectomy specimens received in the department over a period of five years (November 1, 2005 to October 31, 2010). Results: A total of 140 cases over a period of five years were studied. A wide range of lesions were found on histopathological examination. The histopathological analysis correlated well with the clinical diagnosis; however, few benign lesions like xanthogranulomatous pyelonephritis may be misdiagnosed clinically as malignant. Similarly, cases of cystic diseases of kidney, renal sarcomas, renal squamous cell carcinomas, and angiomyolipomas were confirmed on histopathological analysis only. Conclusions: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens at our institution. In conclusion, a wide range of lesions are encountered on histopathology of nephrectomy specimens, many of which may be misdiagnosed clinically and radiologically; therefore, it is mandatory that every nephrectomy specimen be subjected to detailed histopathological examination for a clinico-morphological correlation to ensure proper management.

Double gall bladder: A rare anomaly diagnosed during the laparoscopic cholecystectomy

Gall bladder duplication is an unusual biliary anomaly with a reported incidence of 1:4000 in the autopsy studies of humans. Lack of awareness, non-specific symptoms and signs and inadequacy of imaging methods are possible reasons for the reported problem of overlooking of the additional gall bladders before and during the surgery. We present a 22-year-old male who presented to us with a history of acute cholecystitis 3 months back with ultrasonography documented cholelithiasis. Laparoscopic cholecystectomy, which was carried out as an elective procedure, revealed a double gall bladder. An accurate, preferably pre-operative diagnosis, identification and removal of all gall bladders during the laparoscopy are mandatory to prevent inadvertent damage to the biliary ductal system, possible overlooking of the second gall bladder and hence post-operative cholecystitis.

An Unusual Case Report - Longest Appendix in India (20.5 cm)

Introduction: The vermiform appendix is an organ that can have variable sizes, locations as well as functional potentials. Appendicitis is the most common surgical emergency, but its diagnosis can be a challenge to the treating surgeon. A 25 years-old male was admitted to the surgical ward with a right sided abdominal pain. The initial clinical presentation was vague. He underwent an appendicectomy which revealed a very long appendix. About half of the adult patients with appendicitis present with the known classical signs and symptoms, but the clinical scenario might be occasionally completely different usually due to varying appendicular tip position. We describe here the longest and largest appendix removed in India to date, measuring about 20.5 cm in length.

Cardiac sarcoidosis presenting as recurrent ventricular tachycardia: a case report

IntroductionSarcoidosis is a multi-systemic disorder involving various organ systems. Though cardiac involvement is uncommon it can present as life threatening arrhythmias and sudden death.Case presentationHere we present 27 years old married female with a series of arrhythmias with no initially obvious aetiology. On further evaluation she was diagnosed as having cardiac sarcoidosis.ConclusionCardiac sarcoidosis is an important cause of death in patients with systemic sarcoidosis. It is therefore necessary to have high index of suspicion when symptoms are present rather than ignoring them.

Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage

Background: While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery. Materials and Methods: The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years. Results and Conclusion: Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.

Footboards: Indigenous and novel method of screening for diabetes peripheral neuropathy – A pilot study

Background: To validate the effectiveness of indigenously designed “footboard (FB)” in early diagnosis of diabetic peripheral neuropathy (PNP) by comparing it with Semmes–Weinstein monofilament (SWM) and vibration perception (VP). Materials and Methods: Two hundred and forty-four patients with diabetes were examined for PNP using SWM and 128 Hz tuning fork. The findings were compared with indigenously designed FBs with 1, 2, and 3 mm elevations. Results: Out of 108 patients who did not have protective sensation as per SWM, only 10 (9.2%) felt 1 mm board bearings, and out of 72 patients who did not feel vibration, only 8 (11.1%) felt 1 mm board bearings. Out of 136 patients who had protective sensation, 128 (94.11%) felt 2 mm elevated board bearings, and out of 172 patients who had VP, only 152 patients (88.3%) felt 2 mm board bearings. With SWM as standard, the sensitivities and specificities, respectively, were 63% and 90% (1 mm board), and 94% and 60% (2 mm board). With VP, the sensitivities and specificities, respectively, were 59% and 90% (1 mm board), and 88% and 61% (2 mm board). Conclusions: FB, which simultaneously tests touch and pressure sensation, shows a high level of performance in detecting at-risk feet. FB may be simple, time-efficient, and inexpensive test for detection of neuropathy and needs further validation in a larger study.

Early experience with tangential excision and skin grafting of deep dermal burns of the hand among diabetics and nondiabetics

Introduction: Deep dermal injury of the hand should have a special management because it has a high potential to affect the functional capabilities of the hand. This study was established to measure the outcome of managing these special types of patients and comparing their outcome with nondiabetics. The goal was to intervene and cover the wound within a time limit of <14 days. Patients and Methods: Between the period of November 2011 and October 2013, we managed a total number of 12 patients with deep dermal burn to the hands in the Burn Unit at King Fahad General Hospital, Jeddah . Four patients were insulin-dependent diabetics, and eight were nondiabetics. An early tangential excision and skin grafting was done in these patients within 14 days of injury. Results: All 12 patients were male. The average age was 45 years. The average total body surface area (TBSA) burnt was 35%, with a range of 2-65%. Four patients were insulin-dependent diabetics, whereas eight patients had no medical comorbidity. Two of the diabetics had an isolated hand burn, and the other two had 30% and 50% of TBSA full-thickness burn, respectively. The graft take was satisfactory among the patients with no difference between the diabetics and the nondiabetics. The grafted hands underwent physiotherapy following the procedure. Satisfactory outcomes were seen among all the grafted hands, with near return to full function. Conclusions: Tangential excision is recommended during the first 5 days postburn to reduce the risk of infection and graft loss. Diabetic patients do not behave differently from nondiabetic patients in their response to graft take, wound healing, and return to work.

Papillary carcinoma thyroid, metastasis to cheek: First ever reported case in literature

Papillary thyroid carcinoma (PTC) metastasis to distant organs is rare and mainly includes lung and bone. Metastasis affecting oral and maxillofacial region is extremely rare. We describe a case of PTC metastasis to cheek. The patient presented with a painless swelling of the left cheek with a history of total thyroidectomy for papillary carcinoma thyroid 5 years back. Cheek metastasis from papillary carcinoma thyroid is extremely rare. To the best of our knowledge, this is the first recorded instance of cheek metastasis from PTC. Common malignancies can metastasize to unusual sites and although infrequent, may be the presenting feature. The successful management of such cases may be achieved by a multidisciplinary approach.

A Retrospective Study of Sigmoidoscopic Examination with Rigid Sigmoidoscope in a Medical School Sigmoidoscopy Center

DOI: http://dx.doi.org/10.5915/40-2-4449 Rigid sigmoidoscopy is a common outpatient procedure to diagnose many rectosigmoid pathologies. As better investigative tools replace it, we decided to consider its validity at our outpatient settings. A retrospective study of the data at our sigmoidoscopy center demonstrated its efficacy as an inexpensive and effective method to screen and diagnose numerous pathologies in a setup such as ours. Objectives : To determine the diagnostic yield of rigid sigmoidoscopy as an investigative tool with special emphasis on neoplastic lesions. To determine yearly trends in various pathologies. Design : Retrospective study of data from the records of a sigmoidoscopy center at SMHS Hospital, Kashmir, India, from April 2002 to April 2006. Main outcome measures : Number of sigmoidoscopy procedures performed, various pathologies picked up, sex distribution of pathologies, emphasis on rectosigmoid carcinoma cases and hemorrhoids. Results : During the study period, 6125 examinations were done on 5244 patients. A total of 3522 abnormalities were picked up, giving a diagnostic yield of 67.2%. The most common lesion found was hemorrhoids (2418 cases, 46.1%). Other pathologies included neoplasms (660 cases, 12.6%), anal fissures (227 cases, 4.3%), fistula in ano (91 cases, 1.7%), and others (126 cases, 2.4%). Certain temporal trends in various pathologies also were observed. Conclusions : Rigid sigmoidoscopy is a feasible diagnostic tool for diagnosing various rectosigmoid pathologies. The incidence of rectosigmoid carcinoma is increasing.