Single Incision Laparoscopic Assisted Appendectomy: Experience of 82 Cases

INTRODUCTION

Single Incision Laparoscopic Surgery (SILS) is one of the most recent developments which have been made in the field of minimal assesses surgery. It has potential advantages of less postoperative pain and better cosmesis, but at the same time, this procedure is time consuming and it increases the cost of surgery.

AIM

In this study, we evaluated the feasibility, safety and potential advantages of single incision laparoscopic assisted appendectomy.

MATERIALS AND METHODS

Single incision laparoscopic assisted appendectomy was done in 82 patients who were diagnosed with acute or chronic appendicitis. A single 10mm incision made over right lower quadrant was used for placing two 5mm trocars and appendisectomy was done as in open surgery, after delivering out the appendix from the incision.

RESULTS

Mean operative time was 32.56 ± 15.5 minutes. Mean post-operative pain scores as per visual analogue scalewere 6.5, 4.2 and 1.2 on 12 hours day 1 and day 2 after surgery respectively. Mean length of hospital stay was 1.4 ± 1.2 days.

CONCLUSION

Single incision laparoscopic appendectomy is safe and feasible.

Elucidation of Analgesic Effects of Butorphanol Compared with Morphine: A Prospective Cohort Study

Pain is a complex subjective experience comprising of both physical and emotional components. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage.”Opioids are essentially important constituent of balanced anaesthesia. They provide adequate analgesia, reduces requirement of inhaled anaesthetic agents, maintain cardiovascular stability and provide adequate post-operative analgesia. Morphine remains the most widely used analgesic and the gold standard against which all new opioids are compared. Butorphanol has been employed successfully for the relief of postoperative pain, labor pain, preanaesthetic medication and in balanced anaesthesia. We studied the analgesic property and the side effects of butorphanol and compared them with equipotent dose of morphine. This study revealed that butorphanol had more or less similar effects on haemodynamic parameters as compared to morphine. But butorphanol showed fewer side effects than morphine. This study suggested that patient compliance was on butorphanol.

Assessment of the effects of pranayama/alternate nostril breathing on the parasympathetic nervous system in young adults

BACKGROUND AND AIM

Pranayama, the art of breath control, is considered to be the heart of yogic exercises. The present study was performed with the aim of evaluating the effect of Pranayama/Alternate Nostril Breathing (A.N.B.) on the parasympathetic nervous system in healthy young adult males.

METHODS

A comparative account of the expiratioin: inspiration ratio (E:I ratio) and the orthostatic tolerance test (30:15 ratio) at the basal level, at the start of the study and after the practice of A.N.B for 5 minutes and following a training period of 6 weeks.

RESULT AND CONCLUSION

This study showed that the parasympathetic tone was enhanced appreciably in the participants. The observations of this study suggest that the yogic exercise of A.N.B. influences the parasympathetic nervous system significantly.

Adenosquamous carcinoma of colon

Primary adenosquamous carcinoma of the colon is an aggressive entity. We report a 41-year-old man with a combination of adenocarcinoma and squamous cell carcinoma of the cecum, treated by right hemicolectomy and ileo-transverse anastomosis. Postoperatively he received adjuvant chemotherapy. However, the tumor recurred at the original site within two months and thereafter the patient was lost to follow up.

A randomized clinical trial of low dosage combination of pentamidine and allopurinol in the treatment of antimony unresponsive cases of visceral leishmaniasis

OBJECTIVES

A randomized clinical trial of low dosage combination of pentamidine and allopurinol was carried out with objectives to assess the efficacy and toxicity as compared to full dosage of pentamidine in antimony unresponsive visceral leishmaniasis (VL) patients.

METHODS

Using a randomized control clinical trial, a total of 158 antimony unresponsive patients of VL were randomly allocated into two treatment groups. Patients in one group (n=80) received half the dosage of pentamidine i.e. 2 mg/kg body weight by IM route on alternate day and allopurinol in dose of 15 mg/kg body weight in three divided dosages for 30 days; patients in the second group (n=78) received pentamidine in dose of 4 mg/kg body weight by IM route on alternate day for 15 injections in 30 days. The efficacy and safety of the two regimens were compared.

RESULTS

Apparent cure i.e. clinical and pathological cure at the end of therapy, in 78 (97.5%) and 67 (86%), and ultimate cure i.e. clinical and parasitological cure at the end of follow-up of six months, in 73 (91.25%) and 58 (74.35%) patients was observed in the combination regimen and single regimen group respectively. The difference of the ultimate cure between two groups of the patients was statistically significant (p < 0.01). In single regimen group, 11 (14%) patients showed primary unresponsiveness (with no response during treatment) and nine (13%) relapse (after six months of follow-up) respectively, where as in combination regimen group, two (2.5%) patients showed primary unresponsiveness and five (6.4%) relapse respectively. By the end of the treatment, the incidence of injection-related toxicity, such as rigor and fever, was same in both groups. No hyperglycemia was observed in combination therapy probably due to reduced dose of pentamidine and three patients in single regimen developed hyperglycemia and one of them developed irreversible hyperglycemia.

CONCLUSIONS

The study showed that the combination of pentamidine (half dose) and allopurinol is more effective in achieving ultimate cure with an added advantage of reduced toxicity in unresponsive cases as compared to full pentamidine dose.

Fibromatosis of thyroid gland-a case report

Fibromatosis covers a broad group of benign fibrous tissue proliferations of varied microscopic appearances that are intermediate in their biological behaviour between bengin fibrous tumour and fibrosarcoma, Extra abdominal fibromatosis in the neck occassionally cause serious sequellae when aggressive invasion of vital structure occurs. However, the principle of wide excision is difficult to apply in some patients because of the important organs surrounding the tumour. We describe a primary spindle cell tumour of thyroid that raised initial diagnostic problems and was eventually diagnosed as fibromatosis of thyroid gland.

Subphrenic abscess following laparoscopic cholecystectomy and spilled gallstones

The natural biology of spilled intraperitoneal gallstones is not known. We report a patient with subphrenic abscess following spilled gallstones at laparoscopic cholecystectomy.

Hydatid cyst in head of pancreas presenting with obstructive jaundice

We report a patient with hydatid cyst in the head of the pancreas who presented with obstructive jaundice. At operation, the cyst was compressing the common bile duct and pancreatic duct. Excision of the cyst with choledochoduodenostomy was performed.

Role of HLA-DR antigen on T-cell activation in visceral leishmaniasis

Ability of peripheral blood monocytes in association with HLA-DR molecules to support T-cell activation in response to soluble Leishmania donovani antigen was investigated. Adherent cells were stained with monoclonal antibodies. The increased number of cells with DR expression was more efficient in presenting L. donovani antigen to sensitized T-cells. The results suggest that quantitative variation in monocytes with expression of DR molecules, correlates with their ability to support T-cell response to L. donovani antigen, in vitro, as assessed by migration inhibition factor (MIF). However, it is not clear whether this is due to only HLA-DR antigen on the surface or whether other factors are involved.