Patients In Department Of Surgery Research Articles

Risk Factors in Post Operative Wound Infections Following Elective Abdominal Operations

Introduction: Surgical site infections are common post operative complication and cause significant post operative morbidity and mortality, and have serious consequences for outcomes and costs. Different risk factors are involved, including age, sex, smoking, nutrition, diabetes, pre existing illness, pre operative hospital stay time, pre operative shaving, level of surgeon, length of incision, duration of operation, per operative blood transfusion, wound drainage and nature of wound. The objective of this study was to determine the risk factors affecting abdominal surgical site infections and their rate at Dhaka Medical College & Hospital, a major referral teaching hospital in Bangladesh. Objectives: were to identify risk factors in post operative wound infections following elective abdominal surgery. Materials and Methods: A Cross sectional type of observation study was carried out among 153 patients in Department of Surgery, Dhaka Medical College Hospital, Dhaka from January 2008 to December 2009. Results: Patients (n = 153) who had undergone elective surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. To test the independence of the risk factors, the significant variables (p _.05) in the univariate analyses were entered into a stepwise logistic regression equation. Data were collected through pre and postoperative examinations. The subjects were followed till discharge. Of the 153 patients, 13 suffered from SSI (8.5%). Among the infections superficial SSI was in 8 cases (61.54%), deep SSI in 3 cases (23.08%), and organ/space SSI in 2 (15.38%) cases. There were 14 different variables in study to determine the risk factors. In univariate analysis ten risk factors were identified: age, underweight, diabetes, ASA score, pre operative hospital stay, per operative blood transfusion, length of incision, duration of operation, wound drain and contaminated wound. And in multivariate analysis duration of operation, diabetes mellitus and ASA score appeared to be independent risk factors for wound infection. Conclusion: The total elimination of wound infection is not possible, a reduction in the infection rate to a minimal level could have significant benefits in terms of both patient comfort and medical resources used. The SSI may be reduced to a more acceptable level by reducing the average operation time to less than 2 hours, pre operative hospital stay, and by reducing contamination during operation and wound drainage. Furthermore post operative study in large scale is recommended. Medicine Today 2023 Vol.35(1): 56-62

Study of indications, techniques and results of operations on the sympathetic nervous system

Pain is an unpleasant sensation related to a noxious stimulus and accompanied by emotional and physiological reactions. Many factors affect these responses and the level of pain perceived from a given stimulus varies, both between subjects and within the same subject on different occasions. It is often assumed that all pain is similar but an individual's sensitivity to different types of experimentally induced pain is variable. This work was carried out on selected group of patients in Department of Surgery, underwent lumbar sympathectomy, cervical sympathectomy and celiac ganglion block were admitted during three years includes 55 cases i.e. 34 cases of lumbar sympathectomy 2 cases of splanchnicectomy, 3 cases of cervical sympathectomy and 16 cases of coeliac ganglion block. All the patients studied were smoker except the patients who were women and underwent sympathectomy.The most common presenting symptoms was pain in the lower limbs. Most often it was associated with ulcer or frank gangrene. Wasting of the foot and leg muscles was seen in quite a considerable number of the patients about 37%.Pain was relieved in approximately 88% patients underwent sympathectomy.

Sociodemographic Profile of Encephalocele Patients in Department of Surgery, Neurosurgery Division, Dr. Mohammad Hoesin General Hospital From 2015-2019: A Retrospective Study

Background: Encephalocele is a collection of congenital diseases characterized by protrusion of brain tissue with or without protrusion of the meninges through a defect in the skull.1 Incidence of encephalocele is found in 1 in 35.000 live births in North America and Europe. Five Types of encephalocele based on anatomical location have different patterns, where in western countries it is reported that it is more often located in the occipital area, whereas in Southeast Asia the frontoetmoidal type is more frequently reported. geographic.3 On this basis, this study was carried out.
 Method:This research is a retrospective study with a descriptive design. Data taken from January 1st, 2015 to December 31st, 2019.
 Result: There were 27 encephalocele patients with complete medical record data with the most distribution being women, age range 1 month to 1 year, work of self-employed parents, ethnic Sumatran parents, region of occipitocervical lesions, onset of action 1 month to 1 year, and the most complications. is a cele rupture
 Conclusion: The level of parental awareness and appropriate management of all medical personnel determine the prognosis of encephalocele sufferers.

Laparoscopic Cholecystectomy with Low Tension Pneumoperitoneum under Spinal Anesthesia with Sedation

Introduction: Cholecystectomy is the commonest operation of the biliary tract. It is known that open upper surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia. Objective: In the present study study we performed laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum with sedation to evaluate, analyze and document whether laparoscopic cholecystectomy could be performed under spinal anesthesia and to assess the benefits and harms of low-tension pneumoperitoneum. The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent was obtained from all patients. Materials and Methods: A prospective observational study with symptoms of cholelithiasis who underwent laparoscopic cholecystectomy under spinal anesthesia with low tension pneumoperitoneum (7-9 mmHg) was conducted on 40 patients in Surgery Department of Al-Azhar University Hospital in Assiut from December 2018 to June 2019. Results: We successfully performed the operations in 27 patients without major complications. Only 13 patients (32.5%) who converted to general anesthesia due to anxiety despite using sedation. The operation was converted to open cholecystectomy in one case only (2.5%) due to disturbed anatomy and adhesions. Mean age was 45 years (range 21-57years). BMI was ≤ 32. All patients were satisfied on follow up. Conclusion: Laparoscopic cholecystectomy under spinal anesthesia with low-tension pneumoperitoneum with sedation by experienced surgeons is safe, cost-effective, feasible, associated with minimal postoperative pain and smooth recovery

Role of diagnostic laparoscopy in chronic abdominal conditions with uncertain diagnosis

Background:The aim of the study is to evaluate the benefits of diagnostic laparoscopy in cases of chronic abdominal conditions with uncertain diagnosis; this study was conducted that it might obviate the need for imaging techniques in establishing the final diagnosis of these conditions.Methods: This study was conducted in 150 patients in Department of Surgery with uncertain diagnosis after five weeks of onset of symptoms was patients who had history of abdominal pain for 3 months or more, if physical examination and diagnostic tests are unrevealing, previous history of abdominal operation. Laparoscopy was performed after completion of all the necessary hematological, biochemical, radiological, and ascetic fluid analysis, gastrointestinal endoscopic and imaging techniques, and Mantoux test.Results:This study was done in 150 patients who had chronic abdominal pain showed peak incidence in 3rd decade and the age group of 18-25 had the highest percentage of 30%. Males were 52 and females were 98. Duration of pain in laparoscopy was the highest in 15-25 weeks. Lower abdomen had more number of cases i.e 100. Findings during laparoscopy were highest in appendicitis.Conclusions:Laparoscopy is considered an effective therapeutic and used in diagnosis of management of patients with abdominal pain.

A Study of Role of Antibiotics in Cases of Acute Pancreatitis in Western Uttar Pradesh

Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Infectious complications with incidence of 40–70% in severe acute pancreatitis are predominant cause of morbidity and mortality. The role of prophylactic antibiotic therapy in Acute Pancreatitis is still not clear. To assess the frequency of infection & role of antibiotic therapy in Acute Pancreatitis a study was conducted on 24 patients in Department of Surgery, Santosh Medical College & Hospital, Ghaziabad. All the patients underwent all specific investigations and managed with only supportive treatment unless infection was proven. In our study it was observed that frequency of infection in acute pancreatitis is 4.16% and appropriate supportive therapy is the mainstay of management of acute pancreatitis. Antibiotics are required in acute pancreatitis only when there is a definite evidence of infection in terms of positive culture sensitivity or any intervention is done. Appropriate surgical intervention is the treatment of choice in those with infected pancreatitis.

Study of prescribing pattern of antimicrobial agents in indoor patients of a tertiary care hospital

Background: To evaluate prescribing pattern of antimicrobial agents in indoor patients of medicine and surgery department of SBH Government Medical College, Dhule. Methods: This was a retrospective cross sectional study carried over a period of 3 months. The patients who were admitted and received antimicrobial therapy in department of Medicine and Surgery were randomly selected and included in the study. The case record sheet and drug chart were obtained from Medical Record Section of the Hospital. The data was collected using case record form specially prepared for the study. The cases were categorised according to slightly Modified Kunin’s Criteria. Results: Total numbers of patients receiving antimicrobial therapy were 130 in medicine department and 93 in surgery department. Most commonly prescribed antimicrobial agent was cefotaxime (21.7%) in medicine and metronidazole in surgery (30.6%) department. The average number of antimicrobials per patient was found to be 1.7 and 3.02 in medicine and surgery department respectively. The switch on therapy from parenteral to oral route was employed in 16.15% patients in medicine department and 11.82% patients in surgery department. As per Kunin’s modified criteria, 66.2% and 58.06% patients received antimicrobial therapy appropriately in Medicine and surgery department respectively. Conclusion: This study highlights the problem of over-prescription of antibiotics and a trend towards polypharmacy. The interventions to rectify the problem of inappropriate use of antimicrobial agents are needed to make therapy more rational and cost effective.

Experiences of vasectomy for voluntary sterilisation of males.

Voluntary sterilisation of men has increased considerably in Finland since June 1st, 1970, because of the new sterilisation law. Vasectomy was performed ambulatorily in 94 patients in Department of Surgery II of the University Central Hospital of Helsinki during the first 1 1/2 years. The patients were mainly in the age group of 31 to 40 years. Eight patients had immediate postoperative complications, scrotal hematoma being the most common. During the short observation period, no significant psychological complications have been detected. Recanalisation of the cut vasa was seen in 5 patients (5%), in all of whom a new vasectomy was performed.The present authors stress the importance of histological verification of the divided vas deferenses. It is still more important to verify the sterility with postoperative sperm analyses. Before sterility can be ascertained, two negative sperm analyses with an interval of at least 1 month must be recorded.