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  • ISSN: 2379-0911
    Early Online
    Volume 6, Issue 1
    Clinical Image
    Luigi Conti*, Davide Pertile, Filippo Banchini, Antonio Banchini, Franco Voltolini, and Patrizio Capelli
    Retained surgical items (RSI) are still an open issue with relevant medico-legal implications; the mere occurrence of these events is expression either of an objective omission by medical staff and carelessness of safety protocols, adducing to the involved health professionals a civil, administrative and penal accountability.
    Research Article
    Vikal Chandra Shakya*, Anir Ram Moh Shrestha, Anang Pangeni, Bikram Byanjankar, Rabin Pandit, Anuj Jung Rayamajhi, Prajwal Bhattarai, Rupesh Yadav, Subhash Paudel, Lokesh Raj Sharma, and Rabin Koirala
    Spectrum of perforation peritonitis in the Nepalese setting hasnít been well documented. This study helps us to understand the different spectrum of this entity as we encounter them in our set-up. This study is a prospective descriptive study in patients presenting with a diagnosis of perforation peritonitis who underwent operative intervention from January 2010 to December 2016 at tertiary centers in central Nepal. A total of 500 patients were included in the study. The mean age of presentation was 37.02 + 19.87 years (range 2-94 years). The most common cause was, duodenal perforation, 201 cases (40.2%); followed by appendicular, 185 patients (37%). The morbidity rate was 37.2%. The mortality rate was 8.2%. 1.8% patients left against our medical advice. The scenario of perforation peritonitis is different in our setting, the most common cause being due to acid-peptic disease, then appendicular perforation and small bowel perforations. The morbidity rate and mortality rate is comparable to other series.
    Ramanuj Mukherjee, Shreya Sengupta*, and Sayantan Bose
    Port site infections have emerged to become an important post laparoscopic morbidity. Several studies have been conducted till now related to port site infections and revealed that the most common bacteria isolated from those port-site infection were Non-tuberculous mycobacterium. However the treatment protocol, including the drug regimen and duration of therapy varied from clinician to clinician and from hospital to hospital. Hence this meta-analysis, to review the results of contemporary literature. Source of the organism was water used for washing instruments and an important factor of ineffectiveness of 2% glutaraldehyde with a short contact period against non-tuberculous mycobacteria.
    Review Article
    Santoni R, Banchini F, Grassi C, Conti L*, Capelli P
    Gastrointestinal stromal tumor (GIST) is the term for a specific, immunohistochemically KIT-positive (90% of KIT mutations involve exon 11) mesenchymal neoplasm of the gastrointestinal tract and abdomen.
    Neoadjuvant therapy can be effectively used for the treatment of metastatic and recurrent GIST or when the surgery canít be radical at the first time.
    Symptoms of GIST are gastrointestinal bleeding, gastric pain, intestinal obstruction, hemoperitoneum because of tumor rupture. Most of GISTs are detected incidentally (CT scan, endoscopy for other reasons) and they are less than 5 cm in size.
    As is known, surgical resection is always the first therapeutic option if R 0 can be achieved. Post-therapy surgery with Gleevecģ (Novartis) is the choice in metastatic, recurrent GIST and in situations where due to the site or size, surgery may not prove radical or may jeopardise the patientís quality of life. Borderline cases should be discussed collectively in key centres with a radiologist, oncologist and surgeon.
    Case Report
    Kunal Chowdhary, Muzzafar Zaman*, Gurinder Kaur, Aliya Shah, Rahul Yadav, and Ashish Chowdhary
    Appendicitis has rarely been reported following solid organ transplantation. Only a few cases of appendicitis have been reported in literature after renal transplantation. The clinical condition is particularly difficult to diagnose because of the atypical presentation in such patients. Early contrast enhanced computer tomography of the abdomen helps in preventing delays in diagnosis and treatment. Nowadays, Laparoscopic appendicectomy is the treatment of choice in these patients.
    Case Report
    Kunal Choudhary, Muzzafar Zaman*, Gurinder Kaur, Aliya Shah, Rahul Yadav, and Ashish Choudhary
    Acquired abdominal intercostal hernia (AAIH) is protrusion of abdominal viscera through an intercostal space under an intact diaphragm and is a very rare condition. In most cases the disease is acquired post trauma or surgery. The main presentation being swelling over the chest with or without pain. Complications like incarceration or strangulation may occur if left untreated. Computer tomography remains the gold standard investigation and AAIH should be always suspected when chest swelling occurs after a trauma or surgery. Surgery remains the only modality of treatment with tension free mesh repair being the preferred method either done via open or laparoscopic technique. We present one such rare case report of acquired abdominal intercostal hernia through the defect between 10th and 11th rib over the left upper abdomen over a previous surgical scar.
    Research Article
    Kunal Chowdhary, Muzzafar Zaman*, Gurinder Kaur, Aliya Shah, Rahul Yadav and Ashih Chowdhary
    Introduction: Biliary calculus disease is commonest disorder affecting the gastrointestinal tract. There is good evidence in the literature to support wound infection post cholecystectomy due to presence of bacteria in bile with reported incidence ranging from 4-10 % in various studies. Some surgeons use the outcome of bile cultures to guide their choice of empirical therapeutic antibiotics for subsequent wound infections. The present study evaluates the microbial spectra of bile in patients of cholelithiasis and association with postoperative wound infection in a rural setup.
    Aim: To study the incidence of microbial spectra in gallstone disease and effect of bacteriobilia on wound infection.
    Material and methods: The study included fifty patients of symptomatic gallstone disease including all age group and both the gender. All the patients underwent cholecystectomy laparoscopic or open with or without common bile duct exploration after giving single prophylactic antibiotic dose (Inj. Ceftriaxone 1gm). 2 to 3ml bile was taken for culture either from common bile duct or from the gall bladder for microbiological analysis in a sterile labeled container. Colony morphology was read and confirmed with biochemical reaction. Patient were divided into two groups with group A included patients with positive bile culture, group B having patients with sterile bile culture report. In the postoperative period those patients with positive bile culture were given antibiotics according to culture report. Patient with wound infections were recorded and wound cultures sent and compared with bile culture report for similarities of reports. Statical analysis of the collected data done using Chi-square test.
    Results: Bile exhibited positive culture in 14 (28%) case with Escherichia coli 7(14%) as the most common organism encountered followed by Klebsella 2(4%), Citrobacter 2(4%), Dipheroids 1(2%), Enterococcus Facaelis 1(2%), Candida 1(2%). Anaerobic organism growth was not seen in any of the bile culture.
    Conclusion: Bile spillage during intraoperative period of bile containing bacteria predisposes to post operative wound infection. Prophylactic antibiotic should be administered to all the cases undergoing cholecystectomy.
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