Surgery Outpatient Department Research Articles

Epidermal Inclusion Cyst Presenting as Prepatellar Bursitis

An epidermal inclusion cyst is one of the rare benign lesions that can occur around the knee and can mimic prepatellar bursitis. They can occur anywhere in the body, but more prevalent sites are the face, neck, trunk, behind the ears, and palmoplantar region. In the present case, a 52-year-old man with epidermal inclusion cyst presented to the surgery outpatient department (OPD) with symptoms clinically mimicking as prepatellar bursitis, occurring at a rather unusual site, ie; the anterior aspect of the left knee. The possibility of an epidermal inclusion cyst should always be considered in an atypical soft tissue mass when presenting around the knee. Histopathological examination confirms the diagnosis.

Sinonasal Ringertz Tumor

Abstract Inverted papilloma is a benign epithelial tumor characterized by ingrowth into the ectodermal Schneiderian membrane in the nasal cavity and the paranasal sinuses. A 35-year-old male patient presented to our Otorhinolaryngology and Head and Neck Surgery Outpatient Department with complaints of left-sided nasal obstruction for 4 years. Histopathological examination was reported as inverted papilloma. The patient recovered well without any evidence of residual lesion.

Deficient functional wound closure as measured by elevated trans-epidermal water loss predicts chronic wound recurrence: An exploratory observational study

A single-center, prospective, observational pilot study was performed to evaluate wound healing endpoint and recurrence by measuring transepidermal water loss (TEWL) post-closure at the site of wound repair. Patients with clinically-defined chronic wounds (such as pressure ulcers, diabetic ulcers, and trauma wounds) who visited the Plastic Surgery outpatient department or were in-patients at the All India Institute of Medical Sciences, Rishikesh, India, and were referred for chronic wound management, were enrolled. Non-invasive point-of-care TEWL measurements were obtained, from closed wound-site and contralateral healthy skin site, starting from confirmation of closure (post-closure, V0) continuing every 2 weeks for a maximum of five visits or until the wound recurred. Statistical analyses of the data involved logistic regression and likelihood ratio chi-square tests to assess differences in TEWL at visit 0 (V0) between the closed wound site and reference skin, with the TEWL score as the sole predictor of recurrence. Of the 72 subjects that completed the study, 44 (61%) showed no recurrence and 28 (39%) had wounds that recurred over a period of 12 weeks. A significant association was found between the V0 (post-closure) TEWL score and the odds of wound recurrence, both in univariate analysis (OR [95%CI] = 1.26[1.14,1.42] (p < 0.001) and after adjusting for covariates in multivariable analysis (OR [95%CI] = 1.34[1.19,1.61] (p < 0.001). The likelihood ratio chi-square analysis demonstrated that the V0 TEWL score is a significant universal predictor of recurrence across all wound types studied. Cases of closed wounds with subsequent recurrence showed an overall higher post-closure V0 TEWL score, compared to those who did not have a wound recurrence, across visits. The TEWL score cut-off value predictive of recurrence was 24.1 g.m–2.h–1 (AUC = 0.967). The outcome of this pilot study on a wide range of chronic wounds leads to the hypothesis that post-closure TEWL at the site of wound healing is a reliable biomarker of wound recurrence. It also raises the question whether the clinical endpoint of wound closure should include re-establishment of skin barrier function as additional criterion. The current standard of care wound closure endpoint calls for re-epithelialization of the wound with no discharge for two consecutive weeks disregarding the functional parameter of restoration of skin barrier function at the wound-site.

Impact Assessment of the "4+1 Nursing Operation Mode" on Enhancing the Efficacy of Alveolar Surgery Diagnosis and Treatment.

The aim of this study is to evaluate the impact of the "4+1 Nursing Operation Mode" on improving the efficacy of alveolar surgery and the effectiveness of nursing. A total of 200 patients were recruited from the oral and maxillofacial surgery outpatient department at the School and Hospital of Stomatology, Wuhan University, between November and December 2023. These patients were allocated into 2 groups: a control group and an experimental group. The treatment for these groups involved different combinations of physicians and nurses, including doctors A and B, and nurses A, B, and C. In November 2023, doctor A treated 50 patients with the assistance of nurses A and C under the "4+1 Nursing Operation Mode," while another 50 patients were treated by doctor A with the assistance of nurse A following the "Four-Handed Operation Mode." In December 2023, doctor B treated 50 patients with the assistance of nurse B under the "Four-Handed Operation Mode," and another 50 patients were treated by doctor B with the assistance of nurses B and C using the "4+1 Nursing Operation Mode." Patient visit durations were documented, and patient satisfaction with diagnostic and treatment services was evaluated via a questionnaire survey. In comparison to the "Four-Handed Operation Mode," the "4+1 Nursing Operation Mode" resulted in a 27% reduction in patient visit times and an improvement in patient satisfaction with nursing services. The "4+1 Nursing Operation Mode" surpasses the "Four-Handed Operation Mode" in terms of efficiency. It not only reduces patient visit times and enhances doctor work efficiency but also improves patient satisfaction with nursing services.

A comparative study of the outcome of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy. Bilateral internal sphincterotomy (BIS) as a treatment option for chronic anal fissure has not been evaluated. Aims and Objectives: The aims and objectives of the study are to compare the efficacy of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure. Materials and Methods: Study design: A prospective randomized comparative study. Study area: Patients coming to General Surgery outpatient department at College of Medicine and Sagore Dutta Hospital with chronic anal fissure. Study period: July 2022 to December 2023 (18 months). Sample Size: 100 patients. Study Group: Group A=Patients who had undergone unilateral internal sphincterotomy (UIS)=50 patients and Group B=Patients who had undergone BIS=50 patients. Results: 2 (4%) patients in Group A and 3 (6%) patients in Group B developed incontinence for flatus postoperatively. No patients in either group developed incontinence for stools. The Mean Fissure Healing Time (Mean±SD) (Weeks) post-sphincterotomy was 4.32±0.91339 in Group A and 2.66±0.65807 in Group B. There were 6 cases of recurrence in the unilateral sphincterotomy group. Second surgery was needed in 4 patients who underwent unilateral sphincterotomy. Conclusion: As compared to UIS, BIS results in a faster healing of chronic anal fissure, with no increase in incontinence, decreased pain score, and less recurrence rates.

Navigating Patient Flow: Assessing the Bottlenecks in Out-Patient Services in a Tertiary Care Hospital in India

Abstract Introduction: Patient flow in hospital outpatient departments (OPDs) is affected by bottlenecks arising from patient load and service capacity mismatch. We evaluated OPD service bottlenecks at a medical college in India by measuring patient flow and service delivery rates and examined possible associations between the service rate and sociodemographic variables. Methods: Two hundred and fifty-two eligible patients in the queue were selected by systematic random sampling from general medicine, respiratory medicine, general surgery, and orthopedic OPDs. Structured interview schedules and checklists were used to gather required information. Waiting times and service delivery rates were compared statistically. Results: Most patients were newly registered (63.89%) and visited the institute directly (87.30%). Surgery had the highest number of doctors. In all OPDs, patient flow exceeded the doctor service rate; the orthopedic OPD had the longest waiting time to see a doctor (85.71% of total time). Patients attending the surgery OPD had the least waiting time and maximum consultation time (25.62% and 65.88% of the total time, respectively). Waiting and consultation times varied significantly between the OPDs. In respiratory medicine, patients took a significantly longer time to consult (P = 0.032). Conclusions: The study recommends facilitating properly scheduled consultation times, rearrangement of infrastructure, and a larger healthcare workforce in OPDs.

Cystoscopic extraction of a wired earphone from male urinary bladder

Abstract A foreign body in the urinary bladder is an uncommon urological emergency, resulting from scenarios such as iatrogenic injuries, self-insertion for pleasure, sexual abuse, assault, and migration from the adjacent sites. Self-inserted urinary bladder foreign bodies for sexual enjoyment pose a substantial issue for clinicians due to their difficulty in the diagnosis and therapy. Most patients were admitted late owing to embarrassment, resulting in severe short-and long-term consequences. This case study describes the intriguing presentation of a 57-year-old male who came to the surgery outpatient department 17 days after experiencing burning when urinating along with blood and dysuria. Wire-like radiodensities in the soft tissues of the pelvis were seen on an X-ray; their morphology was described as that of an earphone wire. The wired earphone foreign body was removed using a cystoscopy procedure. The patient’s hospital stay was minimal, and he was discharged with antibiotics and analgesics.

Evaluation and Comparison of the Root Surface Microtopography Following the Use of Gracey Curettes, Piezo-ceramic Scalers, and Piezo-surgery Scalers: An In vitro Study

Abstract Background: Nonsurgical periodontal therapy plays a pivotal role in comprehensive periodontal treatment by effectively removing plaque and calculus through both supragingival and subgingival scaling and root surface debridement. This therapeutic approach encompasses methods aimed at curbing infection, restoring lost tissue integrity, and preserving a healthy periodontium. The ultimate objective of scaling and root planing (SRP) is realized through manual or power-driven scalers. Objectives: This study aims to assess and contrast the microtopography of root surfaces following in vitro SRP using the Gracey curette, Piezo-ceramic ultrasonic scaler, and Piezo-surgery ultrasonic scaler. Materials and Methods: A randomized in vitro investigation was conducted at Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai. Thirty freshly extracted adult human single-rooted teeth, encompassing incisors, canines, and premolars were procured from the Oral and Maxillofacial Surgery outpatient department. The teeth were categorized into three groups: Group A – Gracey curette 7/8 (n = 10), Group B – Piezo-ceramic ultrasonic scaler (Universal insert) (n = 10), and Group C – Piezo-surgery scaler PS1 (n = 10). The evaluation was conducted using electron scanning microscopy (ESEM) and confocal analysis post-SRP. Each tooth was sectioned longitudinally into mesial and distal halves, resulting in 20 samples per group. A demarcation line was established on the middle third of the root surface, distinguishing the test area (T) (coronal) from the control area (C) (apical). In the electron scanning microscopy (ESEM) analysis subset, a notch was created on the upper right corner below the cementoenamel junction in 10 samples from each group. The remaining samples (n = 10 from each group) were not notched for confocal microscopic analysis. Scanning Electron Microscopy analysis was conducted at the Indian Institute of Technology facility in Powai, Mumbai. Results: The overall findings indicated nonsignificant differences among the three groups in the t-test area when examined at × 500 using confocal microscopy and ESEM. However, at × 1000 using ESEM, Group C (Piezo-surgery scaler) exhibited a significantly greater mean surface roughness compared to Group A (Gracey curette) and Group B (Piezo-ceramic ultrasonic scaler) in the t-test area. Conclusion: The Piezo-surgery PS1 root planning tip yields the smoothest root surface following SRP, as indicated by the study’s outcomes.

Post-Cancer Treatment-Related Symptom Distress and Fear of Cancer Recurrence in Colorectal Cancer Survivors

Colorectal cancer (CRC) is a primary cause of cancer-related mortality, and, after treatment, cancer survivors often worry that disease recurrence may worsen their health. Nevertheless, limited research on fear of cancer recurrence (FCR) and treatment-related symptoms has been conducted on survivors of CRC. This study was designed to explore (1) symptom distress severity and post-treatment FCR in CRC survivors and (2) the predictors of FCR. A cross-sectional correlational research design and convenience sampling approach were used to recruit patients at the colorectal surgery outpatient department of a medical center in central Taiwan. Basic demographic data, the Symptom Distress Scale - Chinese Modified Form, and Fear of Progression Questionnaire - Short Form were used as monitoring tools. Pearson's product-moment correlation analysis, independent t-tests, one-way ANOVA, and stepwise linear regression analysis were used for statistical analysis. One hundred fourteen survivors of CRC with an average age of 63.44 were enrolled as participants. The top five symptoms of distress were numbness, bowel patterns, fatigue, insomnia, and dry mouth, and the average FCR score was 18.09. Gender, educational level, monthly disposable income, and symptom distress were identified as significant predictors of FCR, with an overall explanatory power of 41.4%. Level of post-treatment FCR in survivors of CRC is influenced by symptom distress severity. Early intervention by healthcare providers to control or alleviate physical symptoms can help prevent the emergence of negative emotions and improve quality of life in this patient group.

Pattern of Ultrasonographic Prescriptions and Findings in Rural Northern India: A Mixed Methods Study

Abstract Background: Ultrasonography (USG) is used extensively across countries to diagnose and manage diseases. However, the existing USG services must be utilised rationally and effectively. Aim: Understanding the pattern of USG prescriptions and findings is important for improving the quality of healthcare services delivered by any healthcare system. Patients and Methods: A mixed methods study was conducted at a rural sub-district hospital in northern India to assess the pattern and completeness of prescriptions and USG findings and explore the patient and doctor-related factors influencing the USG prescription practices. Results: Of the 505 patients studied, 324 (64.2%) were females. The median age was 32 years (interquartile range: 24–45 years). The availability of complete medical history and clinical examination recording was 471 (85.7%) and 145 (28.7%), respectively. The indication for USG was mentioned in 436 (86.3%) prescriptions. Of the total, 251 (49.7%) had abnormal ultrasound findings. The abnormal finding was significantly high amongst patients (a) aged 45–59 years (P = 0.015) and (b) referred from surgery, paediatrics and other outpatient departments (P = 0.001) after adjustment to other factors. Patient-related factors such as non-harmfulness, free availability, reassurance of normality and health system/provider-level factors such as absence or low awareness of guidelines and changed clinical practice were the reasons for the current pattern of USG prescriptions. Conclusion: Although the medical history is better recorded, the incomplete recording of clinical examination needs improvement. Placing a guideline for prescribing USG, imposing nominal user fees and patient education and counselling can be tested for effectively utilising the USG services. Further, tracking the change in clinical management following the USG in Indian setting is the need of the hour.

Prevalence and predictors of postcholecystectomy syndrome in Nepalese patients after 1 week of laparoscopic cholecystectomy: a cross-sectional study

Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34–12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients’ tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients.

FibroScan as a surveillance marker post-cavopulmonary anastomosis for single-ventricle physiology.

Single-ventricle physiology encompasses a group of congenital cardiac malformations with only one functional ventricle. The Fontan procedure is the final palliation of this pathway and has its complications. One of these is Fontan-associated liver disease (FALD). It is known that all patients with Fontan will have FALD, due to the physiology of the Fontan circuit, and only the severity will vary. The pathophysiology of hepatic damage in FALD is unique and not easily detectable by routine non-invasive investigations. Therefore, this study is aimed to identify if FibroScan can be used as a surveillance marker to detect and assess the progression of FALD. Patients who attended the Cardiothoracic and Vascular Surgery Outpatient Department (OPD) for follow-up post-cavopulmonary anastomosis (bidirectional Glenn and Fontan) were enrolled in this study. They underwent routine examinations and tests, and in addition a FibroScan was performed. FibroScan showed that the liver stiffness measurement (LSM) was increased in all patients who had undergone Fontan and a couple of patients who had undergone bidirectional (BD) Glenn. The LSM was 12.29 (± 3.59) kPa in patients post-Fontan and 6.64 (± 4.24) kPa in patients post-BD Glenn. This raised LSM was not associated with a parallel rise in liver enzymes or other laboratory markers associated with liver function. This emphasizes the suitability of FibroScan as an early and non-invasive surveillance tool for monitoring the progression of hepatic venous congestion and FALD. We have found that LSM via FibroScan can effectively be a surveillance or screening test for FALD. Serial FibroScans can be used to monitor the progress of liver disease. Raised LSM may also have a role in predicting the morbidity for completion of Fontan post-BD Glenn operation. Large-scale studies are needed to validate our findings.

Efficacy of Individualized Homeopathic Medicines in the Treatment of Hemorrhoids: Double-Blind, Randomized, Placebo-Controlled Trial.

Objectives: To investigate the efficacy and safety of individualized homeopathic medicines (IHMs) in treating hemorrhoids compared with placebo. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The trial was conducted at the surgery outpatient department of the State National Homoeopathic Medical College and Hospital, Lucknow, Uttar Pradesh, India. Subjects: Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months. Excluded were the patients with grade IV hemorrhoids, anal fissure, and fistula, hypertrophic anal papillae, inflammatory bowel disease, coagulation disorders, rectal malignancies, obstructed portal circulation, patients requiring immediate surgical intervention, and vulnerable samples. Interventions: Patients were randomized to Group 1 (n = 70; IHMs plus concomitant care; verum) and Group 2 (n = 70; placebos plus concomitant care; control). Outcome measures: Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire, and secondary-the EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS); all of them were measured at baseline, and every month, up to 3 months. Results: Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed. The level of significance was set at p < 0.05 two tailed. Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos. Sulfur was the most frequently prescribed medicine. No harm or serious adverse events were reported from either of the groups. Conclusions: IHMs demonstrated superior results over placebo in the short-term treatment of hemorrhoids of grades I-III. The findings are promising, but need to be substantiated by further phase 3 trials. Clinical Trial Registration Number: CTRI/2020/03/024342.

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.&#x0D; Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.&#x0D; Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.&#x0D; Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.&#x0D; JOPSOM 2021; 41(2):20-27

Correlative Study of Ultrasound Scan, Fine-needle Aspiration Cytology and Histopathology of Thyroid Swellings

Abstract Introduction: Thyroid swellings are common clinical entities with a reported prevalence of about 10% of the adult population. As ultrasound technology is advancing, so is the detection of thyroid lesions, even if they are as small as a few millimetres in size. While fine-needle aspiration cytology (FNAC) is the standard procedure for thyroid nodule diagnosis; it involves risks and unnecessary costs. However, histopathological examination (HPE) is the gold standard for the classification of thyroid swellings. While individual characteristics of USS which increase the suspiciousness of malignancy, have been studied repeatedly but are inconclusive, we therefore need a comprehensive system of stratifying thyroid nodules and characterising them with confidence so that we can reduce the number of needless painful aspiration and biopsy procedures. Aim: This study aims to determine the diagnostic accuracy of ultrasound scans and FNAC in thyroid swellings by comparing them with HPE results. Materials and Methods: It was a prospective observational study conducted in a tertiary care centre over a period of 2 years. During this period, a total of 200 patients presented with palpable thyroid nodules in the surgery outpatient department out of which 160 patients were included in our study. All the patients underwent a triple assessment (clinical examination, sonogram and FNAC) and were later posted for surgery, the specimen obtained was sent for HPE. Data were collected and the results were analysed and compared. Results: One hundred and sixty cases with thyroid swellings were studied. Out of the 160 cases, 136 were female and 24 were male with female-to-male ratio of 5.6:1. Based on various ultrasound characteristics of thyroid nodules, each thyroid nodule was classified into ACR-TIRADS categories and then FNAC was done. On HPE diagnosis of 160 cases, 98 (61.3%) patients were benign and 62 (38.8%) patients were malignant. The results of histopathology were correlated with ultrasound features and statistical analysis was done calculating sensitivity, specificity, positive predictive value and negative predictive value for each feature. The sensitivity and specificity for irregular margin were 38.7% and 93.9%, for taller-than-wide were 21% and 100%, for punctate echogenic foci/microcalcification were 8.1% and 100%, for hypoechogenicity were 91.9% and 64.3% and for solid consistency were 69.4% and 76.5%. The risk of malignancy for TIRADS categories 2, 3, 4 and 5 in our study was 2.5%, 21%, 64% and 94%, respectively. In comparison with FNAC diagnosis and HPE, FNAC is 98.0% sensitive and 54.8% specificity in detecting benign lesions while 4.84% sensitivity and 97.96% specificity in detecting malignant lesions. Conclusion: ACR-TIRADS is a good predictor of malignancy. Individual characteristics such as solid composition, hypoechogenicity, irregular borders, taller-than-wide shape and microcalcifications were highly predictive of malignancy. FNAC is of greater help in the pre-operative diagnosis and should be treated as a first-line diagnostic test for thyroid swellings to guide the management though it is not a substitute for HPE.

Orofacial Space Infections in Systemically Compromised Individuals: A Case Series and Review of Literature

1.1. Aim and Objectives: To review the management of head and neck infections due to odontogenic origin in medically compromised and non-compromised patients. Specifically, to observe their severity, response to common first-line broad-spectrum antibiotics, responsible bacterial microflora, and complications thereof. 1.2. Material and Methods: 45 cases of odontogenic oro-facial and cervico-facial cellulitis reporting or referred to the maxillofacial surgery outpatient department (OPD) were included in the study. Out of these, 38 were those diagnosed with some form of systemic debilitating condition and 7 were systemically healthy individuals. All the cases were managed by the same team of surgeons. Presenting cellulitis was surgically decompressed by incision and drainage. Pus specimens were subjected to culture sensitivity testing and antibiotic sensitivity testing (ABST). All patients were postoperatively monitored for wound healing, Lenth of Stay (LOS), complications, and incidence of morbidity and mortality. A prospective cohort study design was employed for the compilation and review of data

A Rare Case of Pleomorphic Adenoma in the Left Submandibular Salivary Gland

Pleomorphic adenomas, which are benign tumours of the salivary glands, are most commonly found in the parotid gland and comparatively infrequently seen in the submandibular gland. These benign mixed tumours, known as pleomorphic tumours, are composed of different types of myoepithelium, epithelium, and mesenchyme. Regardless of the histologic type, parotid gland neoplasms result in distinct swellings in front of and below the ear. With the exception of neglected malignant tumours, both benign and malignant lesions are normally palpable when they are first discovered. Malignancies are often discovered more quickly due to their rapid growth, even though benign tumours are known to exist for many months to years before gaining clinical attention. Ultimately, there are no reliable clinical criteria to distinguish between benign and malignant lesions. A 58-year-old female patient presented to the general surgery outpatient department with a six-month history of a firm, palpable, slow-growing, painless, freely mobile mass in the submandibular region that was not attached to the surrounding tissue, bone, or skin. There was no significant past history, and the patient was not on any medication. Axial and coronal views of the Computed Tomography (CT) scan showed a well-defined radiolucent mass in the medial aspect of the left submandibular gland. The patient underwent surgical exploration and excision of the mass under general anaesthesia, and the excised specimen was sent for histopathological examination. The entire gland was dissected freely and removed, with utmost care taken not to affect the nearby neurovascular structures. No enlarged lymph nodes were noted. The histopathological examination of the biopsy specimen revealed features of pleomorphic adenoma. Surgery is the treatment of choice for pleomorphic adenoma, and the tumour tissue must be completely removed because any residual tumour tissue has a high risk of recurrence or transformation into a malignant tumour. The patient was followed up for more than two years with no signs of recurrence.

Chronic Cholecystitis with Cholelithiasis with Gall Bladder Adenomyomatous Hyperplasia in a Young Female - A Case Report

A thirty-year-old female presented to the Surgery outpatient department of Shri Ram Care Hospital, Bilaspur, Chhattisgarh, with complains of pain in whole abdomen with abdominal distention, nausea, anorexia, dyspepsia and constipation off and on for the last twenty days. There was no history of jaundice in the past. There were no bowel / bladder complaints. On examination, pallor was present. Per abdomen palpation revealed splenomegaly. She was evaluated completely; clinically, radiologically and by routine investigations. She was found to be anaemic (her haemoglobin level was 5.8 gm/dl) and her ultrasound abdomen revealed multiple gall bladder calculi with splenomegaly. She was admitted and a laparoscopic or if needed, an open cholecystectomy was planned after three units of blood transfusion.&#x0D; She underwent the procedure well at Shri Ram Care Hospital and her cholecystectomy specimen was sent to Anushka Diagnostics, Bilaspur, for histopathological evaluation.

Outcomes of non-surgical treatment of chronic anal fissure: A comparative study

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P &lt;0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P &lt;0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P &lt;0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN. Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Epidermal cyst protruding from the occipital region of the scalp: a case report

Introduction and importance: Epidermal cysts are the most common subcutaneous tumor typically observed on the scalp, face, neck, back, or trunk. Epidermal cysts conventionally range in size from 1 to 5 cm, with sizes greater than 5 cm rarely reported. Case presentation: Here, we present a case of a 58-year-old female housewife who presented to our surgery outpatient department (OPD) with a history of a mass in the left occipital region. The mass was first noticed 3 years back and was small and associated with mild itching. The mass progressively increased in size over the course of 3 years. Her present complaint was a painful mass associated with itching, headache, and pus discharge when compressed. The pain was relieved by taking medication. Clinical discussion: The epidermal cyst was confirmed on biopsy, and subsequent excision of the cyst was done under general anesthesia; the occipital bone was eroded by the inferior part of the cyst – reconstruction of scalp defect done by rotational scalp flap. Conclusion: Epidermal cysts, being a slow-growing benign tumor, can pose diagnostic difficulties, especially when located in the scalp area. In addition to that, when cranial bones and intracranial structures are affected by the cyst, they can even lead to complications and interventional difficulties.