Vilvapathy Senguttuvan Karthikeyan

Clear Liquid Diet vs Soft Diet as the Initial Meal in Patients With Mild Acute Pancreatitis A Randomized Interventional Trial

BACKGROUND Patients recovering from mild acute pancreatitis are usually started on a liquid diet and advanced to a solid diet. Evidence suggests a soft diet as the initial meal is tolerated well by such patients. However, the results are controversial. OBJECTIVES To assess the safety of starting an early soft diet compared with a liquid diet in patients with mild acute pancreatitis as the initial meal. METHODS We randomized 60 patients with mild acute pancreatitis into 2 groups to receive either a clear liquid diet (CLD) or a soft diet (SD) as the initial meal, and parameters such as tolerance to diet, recurrence of pain, length of hospitalization (LOH), need to stop feeding, post-refeeding length of hospitalization (PRLOH), and postdischarge readmission rate within 30 days were analyzed. RESULTS The demographic and baseline parameters (amylase, total leucocyte count, Balthazar score) in the 2 groups were comparable. Patients in both groups tolerated the diet well except 1 patient in the SD group, who developed vomiting and diarrhea, not severe enough to stop feeding. LOH and PRLOH were significantly lower in the SD group (4.23 ± 2.08 and 1.96 ± 1.63 days, P < .0001) compared with the CLD group (6.91 ± 2.43 and 4.10 ± 1.64 days, P < .0001). PRLOH in the SD group was 2.14 days less when compared with the CLD group. CONCLUSION In patients with mild acute pancreatitis, a soft diet as the initial meal is well tolerated and leads to a shorter total length of hospitalization.

Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study.

Background and Objective: With the safety of laparoscopic cholecystectomy (LC) having been established, the current stress is on reducing the postoperative morbidity associated with this procedure. Hence, this study was undertaken to compare the effect of low-pressure (8 mm Hg) (LPLC) versus standard-pressure (12 mm Hg) (SPLC) pneumoperitoneum on postoperative pain, respiratory and liver functions, the stress response, and the intraoperative surgeon comfort in patients undergoing LC. Materials and Methods: Patients undergoing LC (n=43) were randomized into the LPLC (8 mm Hg) group (n=22) and the SPLC (12 mm Hg) group (n=21). Postoperative pain, changes in liver function, peak expiration flow rate, C-reactive protein level, and intraoperative surgeon comfort were assessed. Results: The postoperative pain scores (P=0.003, 0.000, 0.001, and 0.002 at 0, 4, 8, and 24 h), total analgesic requirement (P=0.001), and the number (total and good) of demands for analgesic in the first 24 hours (P=0.002 and 0.001) were lower in the LPLC group. The surgeon comfort in the LPLC group was significantly lesser (P=0.000). The liver function and peak expiration flow rate did not show any significant changes. C-reactive protein levels varied significantly only at 24 hours postoperatively (P=0.001). Conclusions: The use of low-pressure pneumoperitoneum (8 mm Hg) for LC is associated with a significantly lower postoperative pain. However, the use of this low-pressure pneumoperitoneum can jeopardize the surgeon’s comfort.

Effect of intravenous lignocaine on perioperative stress response and post-surgical ileus in elective open abdominal surgeries: a double-blind randomized controlled trial

Perioperative stress response can be detrimental if excessive and prolonged. Intravenous (i.v.) lignocaine, while being an effective analgesic, has the added benefit of anti‐inflammatory activity. This study was done to assess the effect of i.v. lignocaine on operative stress response and post‐surgical ileus after elective open abdominal surgeries.

Randomized Controlled Trial on the Efficacy of Bilateral Superficial Cervical Plexus Block in Thyroidectomy

As thyroid surgery is being performed as an ambulatory procedure, recent studies concerning post thyroidectomy analgesia have focused on regional techniques such as bilateral superficial cervical plexus block (BSCPB) and bilateral combined superficial and deep cervical plexus block. But, data regarding the efficacy of BSCPB are controversial. Hence we compared the efficacy of BSCPB with 0.25% bupivacaine with and without clonidine in thyroidectomy, as preventative analgesia.

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Massive inguinoscrotal hernias extending below the midpoint of the inner thigh, in the standing position constitute giant inguinoscrotal hernias. We report a patient who presented with giant right inguinal hernia with bilateral hydrocele for 25 years. He had no cardiorespiratory illnesses. He was taken up for surgery under general anesthesia after preoperative respiratory exercises. Sliding hernia with entire greater omentum, small bowel, and appendix as contents was identified. Meshplasty after omentectomy with bilateral subtotal excision of sac, right orchidectomy, and scrotoplasty were done. Giant inguinoscrotal hernias pose significant problems while replacing bowel contents because of the increase in intraabdominal and intrathoracic pressures. Recurrence is another complication seen after successful surgical management. Various techniques such as preoperative pneumoperitoneum, debulking abdominal contents with extensive bowel resections, or omentectomy and phrenectomy have been tried. Postoperative elective ventilation is also needed in many cases. We describe simple reduction with omentectomy as a viable technique in this patient. He did not need elective ventilation due to preoperative respiratory exercises and preparation and review of the literature.

Melioidosis Presenting as Pseudomyxoma Peritonei: Yet Another Pretense of the Great Mimicker: An Unreported Entity

BACKGROUND Melioidosis, a lethal infectious disease caused by Burkholderia pseudomallei, an important human pathogen in tropical regions, is notorious for its diverse clinical presentations. METHODS We report a case of a 55-year-old woman with a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy for ovarian mucinous cystadenocarcinoma five years back, who presented with complaints of chest pain, abdominal distention, and breathlessness for one week. Ultrasound-guided aspiration of the peritoneal free fluid revealed a thick gelatinous material consistent with pseudomyxoma peritonei. Cytologic analysis of the aspirate was negative for malignant cells, but bacterial culture proved positive for Burkholderia pseudomallei. RESULTS She was started on ceftazidime, and she improved symptomatically and was discharged on oral doxycycline and chloramphenicol after three weeks of intravenous antibiotic therapy. CONCLUSION This case is being reported to emphasize an unusual presentation of melioidosis and the significance of timely appropriate antibiotic therapy.

Decolonisation of MRSA and its effect on surgical site infections – a study in a tertiary care institute

Two‐thirds of surgical site infections (SSI) because of Staphylococcus aureus are caused by Methicillin resistant Staphylococcus aureus (MRSA). This study was done to assess the efficacy of topical 2% mupirocin with 2% chlorhexidine gluconate body wash in decolonizing MRSA and its impact in preventing SSI because of MRSA. The various risk factors associated with MRSA carriers and SSI were also studied because of paucity of data in the developing world.

Metachronous multiple primary malignant neoplasms of the stomach and the breast: report of two cases with review of literature.

Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly.

Spotty skin pigmentation and multiple blue naevi as cutaneous markers for spinal melanotic schwannoma

Spinal melanotic schwannomas are rare spinal tumours with a very poor prognosis in terms of mortality due to difficulty in complete resection and local recurrences. A 67-year-old man presented with acute onset progressive paraparesis for 2 weeks. The patient also had spotty skin pigmentations (blue naevi) in his right lateral thigh. MRI revealed an intradural extramedullary enhancing lesion in the lower thoracic cord level. With a preoperative diagnosis of simple nerve sheath tumour excision was planned. At laminotomy, an infiltrating “en plaque” like lesion reaching up to mid and upper thoracic cord level was identified and excision was carried out. Postoperative histopathology was unique with the identification of melanin and presence of epitheloid cells, with the additional detection of psammoma bodies and adipose-like cells. Melanotic schwannomas though rare and carry poor prognosis must be borne in mind in patients with spotty skin pigmentation and acute onset limb weakness.

Melioidosis of chest wall masquerading as a tubercular cold abscess.

Melioidosis caused by Burkholderia pseudomallei, an important human pathogen in the tropical regions causes protean and multisystem clinical manifestations. A 50-year-old man on treatment for pulmonary tuberculosis developed a chest wall abscess. With a suspicion of tuberculous cold abscess, pus culture was done and it revealed Burkholderia pseudomallei. He was treated with 10 days of ceftazidime and incision and drainage was done. Wound healed well and he has now completed three months of oral cotrimoxazole eradication therapy and is on follow-up without recurrence. We report this case for the unusual presentation of melioidosis and the diagnostic challenge posed due to clinical similarity with tuberculosis.