Indian J Surg
· 2020 Jun · PMID 32837058
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Hungarian obstetrician Ignac Semmelweis (1818-1865) was one of the earliest clinical investigators of modern medical science. In nineteenth century Europe, puerperal fever (childbed fever) was a major clinical and public...Hungarian obstetrician Ignac Semmelweis (1818-1865) was one of the earliest clinical investigators of modern medical science. In nineteenth century Europe, puerperal fever (childbed fever) was a major clinical and public health problem with very high maternal mortality. It was thought to be caused by miasma, epidemicity, or the Will of Providence. Apart from bloodletting, there was no cure for it. Semmelweis cared for the childbed fever women during their illness, and when they died, he did autopsies on them. Astute clinical observations and logical reasoning goaded Semmelweis to suspect the role of "unholy" hands of "holy" physicians in the transmission of puerperal fever. He enforced a hand-washing policy for physicians. Those with unwashed hands were disallowed into labor room. The hand-washing practice for 1 year led to unprecedented decrease in maternal mortality. It enabled Semmelweis to establish a strong, specific, temporal causal association between unclean hands and puerperal fever. Although not accepted during his lifetime, this causal hypothesis contributed significantly to the understanding of etiopathophysiology of not only puerperal fever but also many other communicable diseases. Clinical hand washing, since then, has prevented millions of deaths of humankind. In the present times too, his idea of hand hygiene plays a central role in COVID-19 pandemic management. Authors present a brief account of life and work of this maverick genius, who was born "too early in the darkness." He is also called the "Father of infection control" and "Savior of mothers."
Indian J Surg
· 2020 Dec · PMID 32837057
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A tribute is being paid to the Dr. Takuo Aoyagi who invented pulse oximetry to measure the oxygen saturation in the blood in 1974. The importance of pulse oximetry is felt more in this coronavirus pandemic. Takuo Aoyagi...A tribute is being paid to the Dr. Takuo Aoyagi who invented pulse oximetry to measure the oxygen saturation in the blood in 1974. The importance of pulse oximetry is felt more in this coronavirus pandemic. Takuo Aoyagi expired at Tokyo on 18 April 2020.
Indian J Surg
· 2020 Aug · PMID 32419746
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We performed the technique of uniportal thoracoscopic McKeown esophagectomy. The incision was located in the fourth intercostal space on the right axillary midline. The right recurrent laryngeal nerve lymph nodes were di...We performed the technique of uniportal thoracoscopic McKeown esophagectomy. The incision was located in the fourth intercostal space on the right axillary midline. The right recurrent laryngeal nerve lymph nodes were dissected. Four hemlocks were applied to clamp the proximal and distal ends of the aortic arch. The esophagus was suspended with purse-string at the level of the azygos vein arch to assist the dissection of the left recurrent laryngeal nerve lymph nodes. A silk thread was drawn out from the incision in order to remove the subcarinal lymph nodes. A thoracic drainage tube was placed at the back of the incision at the end.
Indian J Surg
· 2021 Aug · PMID 32419745
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is a helminth, widely distributed in tropical and subtropical countries. Its infestation in humans usually does not produce symptoms. However, in some patients, severe and life-threatening forms of this infection can occ...is a helminth, widely distributed in tropical and subtropical countries. Its infestation in humans usually does not produce symptoms. However, in some patients, severe and life-threatening forms of this infection can occur, especially in immunocompromised individuals. Severe parasitic infection is triggered by any imbalance in the host's immunity favouring the auto-infective cycle. This results in an increase in the intraluminal parasitic burden. In addition, tissue infestation is also very common. Clinical presentation is variable, and it is very difficult to diagnose clinically. Diagnosis requires a high index of suspicion. In some cases, the diagnosis is established only on histopathological examination of the excised tissue by the pathologist. Here, the authors report a case of an elderly male diabetic patient, who presented to the emergency department with the features of acute abdomen. On exploratory laparotomy, he was found to have the features suggestive of gangrene of small bowel. Resection of the gangrenous bowel was done, and end-to-end anastomosis was done as the rest of the bowel appeared to be normal. However, the patient died of multi-organ failure and septicaemia on the second postoperative day. The resected intestine showed tissue infestation of on histopathological examination. In this review article, the authors summarize a case of hyper infection syndrome of strongyloidiasis and discuss the various aspects of infection with emphasis on life cycle of the parasite and different clinical features of the disease.
Dilek ON, Güngör F, Acar T
… +4 more, Atay A, Karasu Ş, Bağ H, Dilek FH
Indian J Surg
· 2021 Feb · PMID 32410790
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Hepaticojejunostomy is a challenging and complex procedure to be done with confidence in conditions that contain a large number of segmental bile ducts. Portoenterostomy can be defined as the joining of multiple bile duc...Hepaticojejunostomy is a challenging and complex procedure to be done with confidence in conditions that contain a large number of segmental bile ducts. Portoenterostomy can be defined as the joining of multiple bile ducts into a single cavity using segmenter bile duct ends, stents, and surrounding connective tissues. During surgery, in cases with advanced stage biliary tract tumors that cannot be performed hepatectomy, after aggressive dissections to provide a negative surgical margin, a large number of segmental bile ducts can be revealed and needs to ensure the continuity of bile flow. Here, our clinical series of portoenterostomy (PE) in which we applied in patients who had aggressive hilar dissection and resection for hilar cholangiocarcinomas and biliary tract tumors were discussed. The study included 15 patients who underwent PE for biliary tract tumors and hilar cholangiocarcinomas between 2015 and 2019. Six of the patients had a tumor-negative surgical margin, with a mean follow-up of 14.4 months (range 2 to 28 months). Nine of the patients had a tumor-positive surgical margin, with a mean follow-up of 7.7 months (range 2 to 17 months). Portoenterostomy instead of hepaticojejunostomy in small and multiple biliary radicles and bile duct cancers has been successfully performed in 15 patients of bile duct cancer and Klatskin tumor. In the presence of active inflammation, fibrosis, major bile duct trauma, and thin bile duct radicles, this method, which is described in detail, provides an excellent salvage surgical procedure with less morbidity.
Indian J Surg
· 2020 Jun · PMID 32390694
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Informed consent has become a challenging issue when surgery at the time of novel corona virus disease 2019 (COVID-19) is to be performed, in view of increased risk of the need of intensive care unit (ICU) in the post-op...Informed consent has become a challenging issue when surgery at the time of novel corona virus disease 2019 (COVID-19) is to be performed, in view of increased risk of the need of intensive care unit (ICU) in the post-operative period and the associated high mortality if a patient exhibits COVID-19 symptoms in the post-operative period. We have devised a new informed consent format for all patients undergoing surgery incorporating a few points specific for the disease.
Liu Z, Zhang Y, Wang X
… +4 more, Zhang D, Diao D, Chandramohan K, Booth CM
Indian J Surg
· 2020 Apr · PMID 32292252
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The whole world is going through an unprecedented period during the pandemic of COVID-19. This pandemic has affected all aspects of daily life with far-reaching implications, especially in most aspects of healthcare. Pra...The whole world is going through an unprecedented period during the pandemic of COVID-19. This pandemic has affected all aspects of daily life with far-reaching implications, especially in most aspects of healthcare. Practice of surgery across the globe is in a standstill as of now. When we restart surgical practices across world, we have to bring new protocols and practices in place to combat the transmission. This article discusses the major changes in surgical practice, which need to be brought in. This article is based on scientific information about transmission of virus and experiences of some of the authors from China, a country which successfully dealt with and contained the virus outbreak.
Yu Z, Zhu J, Jiang H
… +4 more, He C, Xiao Z, Wang J, Xu J
Indian J Surg
· 2018 Aug · PMID 32288384
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Surgical resection for hilar cholangiocarcinoma is the only curative option, but low resectability rate and poor survival outcomes remain a challenge. This study was to assess the surgical resection for hilar cholangioca...Surgical resection for hilar cholangiocarcinoma is the only curative option, but low resectability rate and poor survival outcomes remain a challenge. This study was to assess the surgical resection for hilar cholangiocarcinoma and analyze the prognostic factors influencing postoperative survival. One hundred forty-two patients with hilar cholangiocarcinoma who underwent surgical resection between January 2006 and December 2014 were analyzed retrospectively based on clinicopathological and demographic data. Univariate and multivariate analysis against outcome were employed to identify potential factors affecting prognosis. Ninety-five patients were performed with R0 resection with median survival time of 22 months; whereas, 47 patients underwent non-R0 resection (R1 = 20, R2 = 27) with that of 10 months. Of these 95 patients, 19 underwent concomitant with vascular resection and reconstruction and 2 patients underwent pancreaticoduodenectomy. 64.8% patients ( = 92) underwent combined with hepatectomy. The one-year, three-year, and five-year survival rates after R0 resection were 76.3, 27.8, 11.3%, respectively, which was significantly better than that after non-curative resection ( = 0.000). Multivariate analysis revealed that non-curative resection (RR: 2.414, 95% CI 1.586-3.676, = 0.000), pathological differentiation ( = 0.015) and preoperative serum total bilirubin above 10 mg/dL (RR: 1.844, 95% CI 1.235-2.752, = 0.003) were independent prognostic factors. Aggressive curative resection remains to be the optimal option for hilar cholangiocarcinoma. Non-curative resection, pathological differentiation, and preoperative serum total bilirubin above 10 mg/ dL were associated with dismal prognosis.
Zargaran A, Ash J, Kerry G
… +4 more, Rasasingam D, Gokani S, Mittal A, Zargaran D
Indian J Surg
· 2018 Jun · PMID 29973771
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Technology advances in medicine have led to increased usage of smartphones and applications in facilitating provision of care. As the increased power of technology paves the way for advances, it is fundamental that ethic...Technology advances in medicine have led to increased usage of smartphones and applications in facilitating provision of care. As the increased power of technology paves the way for advances, it is fundamental that ethical considerations are comprehensively explored. This paper explores the importance of consent, confidentiality, and data security in use of smartphone applications for transferring medical information.
Indian J Surg
· 2018 Jun · PMID 29973769
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We are all stressed out to read and understand our medical practice which is so vast and seems monotonous. Amidst so much tension, we can still enjoy our profession if we can narrate the sequence in a different style. Po...We are all stressed out to read and understand our medical practice which is so vast and seems monotonous. Amidst so much tension, we can still enjoy our profession if we can narrate the sequence in a different style. Poetry is one way of such expression. Poetry is a combination of knowledge and feeling. Just as we have all read Zachary Cope's Surgery in Verse which correlates the disease with its signs in a different way that is poetry, I have tried to use poetry in my medical practice, too. We can understand as well as express better. The whole topic seems so easy once it comes in the form of poetry. Writing in a poetic form requires a thorough knowledge of the subject. Added to this are empathy and sympathy. It needs a deep sense of understanding to feel what the sufferer would feel. Imagination can take us to any part of the world and beyond however minute the structure imagined may be. This is an attempt to present poetry in medical, both while learning and during practice.
Indian J Surg
· 2018 Jun · PMID 29973767
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We report a large, asymptomatic, intraperitoneal loose body in a 72-year-old male, presented with bilateral inguinal hernia.We report a large, asymptomatic, intraperitoneal loose body in a 72-year-old male, presented with bilateral inguinal hernia.
Indian J Surg
· 2018 Jun · PMID 29973766
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An elderly male presented to our emergency room with acute abdomen. Clinical and imaging evaluations suggested small bowel obstruction due to primary jejunal enterolith with associated stricture. We performed surgical ex...An elderly male presented to our emergency room with acute abdomen. Clinical and imaging evaluations suggested small bowel obstruction due to primary jejunal enterolith with associated stricture. We performed surgical exploration when initial nonoperative therapeutic management failed to resolve the symptoms. Primary jejunal enterolith obstruction is a rare disease presentation reported in literature.
Indian J Surg
· 2018 Jun · PMID 29973765
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A case of road traffic accident with incidental finding of multiple opacities in the pelvis radiography was evaluated and diagnosed as chalk eating was the cause and managed conservatively. We report here the details of...A case of road traffic accident with incidental finding of multiple opacities in the pelvis radiography was evaluated and diagnosed as chalk eating was the cause and managed conservatively. We report here the details of the case.
Indian J Surg
· 2018 Jun · PMID 29973764
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Thymomas are exceedingly rare tumours of the anterior mediastinum in children. An early awareness helps timely surgical intervention. Thymomas can occasionally be extremely aggressive. The loss of contour on chest X-Ray,...Thymomas are exceedingly rare tumours of the anterior mediastinum in children. An early awareness helps timely surgical intervention. Thymomas can occasionally be extremely aggressive. The loss of contour on chest X-Ray, to be confirmed as a large anterior mediastinal mass at computerised tomography, serves identification of a typical bilobed thymic tumour.