Biomedical subjects
Publications and source records attributed to M C Misra.
A 45-year-old man was admitted with pyrexia and intermittently palpable lump in the left lumbar region. Laparotomy revealed a primary omental tumor which on histological examination showed alveolar rhabdomyosarcoma of the omentum. Following surgery the fever subsided. Presentation of omental rhabdomyosarcoma with fever has not been reported earlier.
A case of aneurysm of the inferior thyroid artery is presented. It is usually not possible to diagnose the exact site of origin clinically. Digital subtraction angiography can determine the precise site and type of aneurysm. In view of the high incidence of complications, early surgical treatment is recommended.
Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually). A case of primary pelvic hydatid cyst presenting with obstructive uropathy leading to chronic renal failure is presented. A combination of preoperative albendazole therapy of 1.2 g/day for 8-12 weeks and surgical excision were effective in alleviating the symptoms and improving the renal function.
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Spontaneous choledochoduodenal fistula is a rare complication of peptic ulcer disease, the surgical therapy of which is generally directed towards the ulcer disease itself, in the form of vagotomy with antrectomy or gastrojejunostomy. The case reported herein is of a 40 year old man who presented with a spontaneous choledochoduodenal fistula which was successfully treated by a truncal vagotomy and posterior retrocolic gastrojejunostomy. Such procedures as cholecystectomy, common bile duct exploration and bilio-enteric reconstruction, should only be performed in the case of a biliary stricture, which occurs rarely.
Prospective analysis of 100 consecutive patients who underwent elective cholecystectomy with drainage over a one year period is presented. Drainage after cholecystectomy detected bleeding and bile leak in four patients. Conservative management of bile leak was adequate in two patients while one patient with bleeding required re-exploration. Drainage did not increase morbidity in the form of wound infection, hospital stay or rate of other complications. After cholecystectomy routine drainage through the right flank is recommended.
The results of a new out-patient approach to fistula in ano are presented. The technique involved passing a multi-strand stainless steel wire through the fistulous tract and has been used in 56 patients with low fistulae as well as high horseshoe anal fistulae. Recurrence was seen in only 2 patients and none of the patients experienced temporary or permanent incontinence of flatus or faeces.
The present study was carried out at the Department of Surgery, All India Institute of Medical Sciences Hospital, New Delhi, between January 1982 and October 1984. Clinical diagnosis of acute cholecystitis was confirmed by ultrasound scanning or Tc99m labelled HIDA Scan. Group I (n=24) comprised patients who underwent emergency cholecystectomy while Group II (n=23) comprised patients who were managed conservatively, and had an elective cholecystectomy performed 6-12 weeks later. There was no mortality or wound infection in either group. The incidence of other complications was 8.3 per cent and 8.6 per cent in Groups I and II, respectively. Emergency cholecystectomy (Group I) reduced the total hospital stay of a patient by approximately 70 per cent and post cholecystectomy syndrome was seen in Group II patients only. We thus recommend emergency or early cholecystectomy during the acute stage of cholecystitis, as it is safe, effective and economical, provided it is done by an experienced surgeon.
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Explore the source record for details and available documents.
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A prospective study was conducted to determine the safety and efficacy of cholecystectomy through a 5 cm transverse abdominal incision. 181 consecutive patients who underwent elective cholecystectomy for symptomatic gall stone disease in a single surgical unit at the All India Institute of Medical Sciences, New Delhi between December 1990 to February 1992, were prospectively randomized into 5 cm transverse and midline incision groups. Operative time, blood loss, post-operative stay and complications were compared in the two groups. Ninety seven patients were included in the transverse incision group and 84 patients in the midline group. Cholecystectomy could be safely performed through a 5 cm transverse incision in 84 patients (86.8%) without increase in operative complications, morbidity or mortality. In another 84 patients cholecystectomy was performed through a midline incision. The average operating time and blood loss were comparable in both groups. The average post-operative stay in 5 cm transverse incision group was 2.6 days (range 1-4 days) and in the midline group was 4.0 days (range 3-5 days). There were 7 post-operative complications (all wound infections) in the 5 cm transverse group and 12 post-operative complications (10 wound infections and 2 pneumonitis) in the midline group. However, the difference in wound infection rate was not statistically significant (p > 0.1). In Conclusion, Cholecystectomy can be safely performed through a 5 cm transverse incision.