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Research & Reviews : Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print)
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Research & Reviews : Journal of Surgery
Contents
1. Role of Imaging and Clinico-Endoscopic Assessment in the Upstaging and Management of Laryngeal Malignancies Rashad Rafiq Mattoo, Sajad Majid Qazi, Basharat Rashid, Zubair Lone
1
2. A Precious Stone to Surgery: Al Zahrawi—A Literary Review M.U.Z.N. Farzana, I. Al Tharique
17
3. Giant Primary Hydatid Cyst of Spleen—A Rare Clinical Entity Dharmendra Kumar Pipal, Harmendra Kumar Pipal, Saurabh Kothari, Poojan Purohit, Anupam Bhargava, Vibha Pipal
21
4. Comparison between Intravenous Injection of Iron Sucrose and Oral Administration of Iron for the Treatment of Iron Deficiency Anemia in Pregnancy Vineeta Yadav, R Nagarathanama, Nagendra Prasad
25
5. Sociodemographic Determinants of Tobacco Use among Patients Admitted in a Tertiary Care Hospital Balamurugan G., Vijayarani M.
29
Research & Reviews: Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print) Volume 5, Issue 3 www.stmjournals.com
Role of Imaging and Clinico-Endoscopic Assessment in the Upstaging and Management of Laryngeal Malignancies Rashad Rafiq Mattoo1,*, Sajad Majid Qazi1, Basharat Rashid2, Zubair Lone1 1
Department of Otorhinolaryngology Head and Neck Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India 2 Department of Preventive and Social Medicine, National Institute of Unani Medicine, Kottigepalya, Bengaluru, Karnataka, India
Abstract Carcinomas of larynx are the very common primary head and neck malignancies. Cancer of larynx accounts for 30 percent of all head and neck cancers. The American Cancer Society’s most recent estimates for laryngeal cancer in the United States for 2013 are, about 12,260 new cases are laryngeal cancer, being 9680 in men and 2580 in women. Laryngeal cancer has also a strong socioeconomic association, being twice as common in more deprived groups compared to the more affluent groups. Anatomically larynx is divided three sub divisions and certain potential spaces through which cancer tends to spread outside the site of its origin. The causal relationship between alcohol and tobacco intake, genetic predisposition, diet, and socioeconomic conditions in the development of squamous cell cancers of the head and neck applies as well to laryngeal cancer. Site predilection for the origin of cancers of laryngeal cancers being, glottic carcinoma 60 to 65%, supraglottic carcinoma 30 to 35% and subglottic carcinoma less than 5%. Clinico-endoscopic evaluation can be undertaken with indirect laryngoscopy, fibre optic laryngoscopy/telescopic laryngoscopy (700hopkins) and direct laryngoscopy. Imaging (USG, CECT±CEMRI) plays a significant complementary role to clinical endoscopy in pretherapeutic staging of laryngeal malignancies. In present study, patients of laryngeal malignancy were treated by radiotherapy or concurrent chemoradiation, some by total laryngectomy with neck dissection and few by total laryngectomy with partial pharyngectomy along with neck dissection and further some patients were treated by total laryngectomy alone depending upon the best treatment options. Keywords: Laryngeal carcinoma, clinico-endoscopic assessment, radiological imaging, pretherapeutic staging
INTRODUCTION Carcinomas of larynx are the very common primary head and neck malignancies. Cancer of larynx accounts for 30 percent of all head and neck cancers [1]. The American Cancer Society’s most recent estimates for laryngeal cancer in the United States for 2013 are, about 12,260 new cases are laryngeal cancers being 9680 in men and 2580 in women. Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the larynx. Regarding site predilection for the origin of cancers of laryngeal cancers being; glottic carcinoma being 60 to 65%, supraglottic carcinoma 30 to 35% and subglottic carcinoma less than 5% [2]. One of the most important influences on prognosis is the presence of metastases to the cervical lymph nodes. The causal relationship
between alcohol and tobacco intake, genetic predisposition, diet, and socioeconomic conditions in the development of squamous cell cancers of the head and neck applies as well to laryngeal cancer. Chemical carcinogens in the workplace that relate to laryngeal cancer include asbestos, nickel compounds, and certain mineral oils. Glasswool has been associated with an increased mortality for laryngeal cancer in an Italian study [3]. Clinico-Endoscopic Evaluation This can be undertaken with indirect laryngoscopy (I/L), fibreoptic laryngoscopy (FOL)/telescopic laryngoscopy (700 Hopkins) and direct laryngoscopy. Office endoscopic assessment of the larynx is more useful than
RRJoS (2016) 1-16 © STM Journals 2016. All Rights Reserved
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Research & Reviews: Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print) Volume 5, Issue 3 www.stmjournals.com
A Precious Stone to Surgery: Al Zahrawi—A Literary Review M.U.Z.N. Farzana1,*, I. Al Tharique2 1
Department of Amraz-e-Niswan wa Qabalat (Gynaecology and Obstetrics), Institute of Indigenous Medicine, University of Colombo, Rajagiriya 2 Pharmacy Department (Unani), National Ayurvedic Teaching Hospital, Colombo, Sri Lanka
Abstract Islamic medicine, also known as Arabic Medicine and Greeco-Arab medicine, refers to medicine developed during the Golden Age of the Arab practiced within the Mediterranean as well as most Islamic countries greatly. Then it is broadened from Spain to central Asia, India and Sri Lanka. There was massive enlightenment in the Arab-Islamic world, during that time Europe was very much embrace of the Dark Ages. The Renaissance of European science was very much thankful to the affluent of the sciences by Islamic Golden Age. But, in the East, the development of Muslim scholars developed botany, pharmacy, chemistry and science that the Muslim world is given credit for science and medicine. There are many scholars of Baghdad who translated and assimilated the Greek effort, while incorporating their own experiences. The most eminent scholars such as Muhammad Ibn Zakariya Al Razi, Ali Ibn Al Abbas Al Majoosi, Al Zahrawi, Al Tabbari, Abu Ali Ibn Sina, Ibn Al Haitham, and Ibn Zuhar Ibn Rushdetc mostly contributed to the medicine in that era. Various medical scientists were materialized in medieval period, but Al Zahrawi (934– 1013AD) was one of the greatest physicians at that time; especially he was the pioneers in the surgery and his contribution in surgery not to concurrent with now. Keywords: Al Zahrawi, surgery, Islamic medicine
INTRODUCTION The dark period (8th–15th century) of European scholars who were interested in science and philosophy came to realize how much they needed to learn from the Arab, because the knowledge of science was nothing during that era in Europe (dark period). Then they set about studying Arab manuscripts in these disciplines and translating the most importance ones into Latin. There were a lot of outstanding physicians such as Muhammed Ibn Zakariya Al Razi or Razes (865–994), Abu Ali Al Hussain Ibn Sina or Avicenna (981– 1037) who remarkably contributed to the scientific treasure of this era, in the Arab world [1]. Meanwhile, in the Western world, the Muslim physicians and philosophers strongly promoted the scientific movement [2]. Abdul Qasim Al Zahrawi or Abucasis (936–1013), Ibn Zuhr or Avenazoaz (1092– 1162) and Ibn Rushd or Averroes (1126–1198) were the most eminent physicians in the Western region [3].
Cordoba was the capital of Spain in the 9th century which has several teaching institutions and had the largest collection of books. When someone complimented Sir Isaac Newton on his outstanding scientific achievements, he is reported to have said that he could see the father, it was became he stood on the shoulders of giants. Every field of human endeavor, including science and medicine has produced such giant figures. One such giant, in the field of surgery in particular and in medicine in general was Abul Qasim Khalaf Ibn Al Abbas Al Zahrawi known as Albucasis, whose monumental work played a vital role in preserving and transmitting the scientific legacy of the Greeks to Europe and in enriching it by his own seminal contributions [4].
BIOGRAPHY Abul Qasim Khalaf Ibn Al Abbas Al Zahrawi (936–1013AD) also known in the west as Albucasis was born in the town of Al Zahra
RRJoS (2016) 17-20 © STM Journals 2016. All Rights Reserved
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Research & Reviews: Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print) Volume 5, Issue 3 www.stmjournals.com
Giant Primary Hydatid Cyst of Spleen—A Rare Clinical Entity Dharmendra Kumar Pipal1,*, Saurabh Kothari1, Poojan Purohit1, Anupam Bhargava1, Vibha Pipal2 1
Department of General Surgery, Dr. Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India 2 Department of Gynaecology, Jodhpur, Rajasthan, India
Abstract Hydatid cyst (echinococcosis) is a zoonotic disease, caused by infestation of larval form of parasite of tapeworm, Echinococcus granulosus (eg). Humans are infected through faeco-oral route by the ingestion of food and milk, contaminated by dog faeces containing the ova of parasite or by direct contact with dog. Liver is the commonly involved organ (57.8%) followed by the lungs (26.4%). The kidneys, spleen, brain, soft tissues of neck, appendix and mesentery are less frequent sites. This case report describes the management of a huge primary hydatid cyst of spleen in a 58-year-old female by en bloc splenectomy. A 58-year-old female patient presented with complaining of pain abdomen and lump in left hypochondrium FPR 6–7 months of duration. Per abdominal examination was in favour of splenomegaly. Patient was further investigated by ultrasound (USG) abdomen and computed tomography (CECT) abdomen and finally diagnosed as a case of large primary hydatid cyst. She was treated surgically by en bloc splenectomy with preoperative and postoperative antihelminthic drugs. Complete en bloc resection of spleen is reserved for gold standard treatment for primary hydatid cyst of spleen as it results in complete removal of all parasite and parasitic tissue from the body. Hydatid cyst of spleen is a rare disease but it should be considered as a differential diagnosis in each case of splenic cyst especially in those geographical regions where the disease is endemic. Once diagnosed a splenic hydatid, surgical management by splenectomy is a gold standard treatment. Keywords: Hydatid cyst, splenectomy, Echinococcus granulosus
INTRODUCTION Hydatid disease is a major worldwide health problem which is mainly encountered in sheep and cattle raising area of the world and is endemic in South America, Africa, Middle East, Turkey, Southern Europe, India, New Zealand and Australia. It is a zoonosis caused by ingesting eggs of the parasite Echinoccocus granulosus. Hydatid cyst is most frequently found in the liver (60–70%), which act as a first filter followed by lungs (30%) which acts as a second filter. However it can, though rare, occur in any organ primarily or in association with hepatic or pulmonary or as multiorgan hydatidosis such as muscles, bones, kidneys, spleen, thyroid, pancreas, breasts etc. Dog is the definitive host of example while sheep, cattle and human beings are the intermediate host. Splenic hydatid cyst is a rare entity, it can occur primarily or in association with hepatic, pulmonary or multiorgan hydatidosis. Most of the cases of hydatid cysts are acquired in childhood. It has a long latent period
ranging from 5–20 years. Splenic hydatid cyst is a very uncommon event as the ova of parasite get trapped in filters such as liver and lungs before reaching to the systemic circulation. The eggs of parasite escaped from liver–lung barrier can result in splenic hydatid cyst formation. Secondary hydatid cyst usually follows systemic dissemination or by intraperitoneal spread of ruptured liver hydatid cyst or after surgery. Hydatid cyst has three layers: 1. Adventitia (pseudocyst): It is an inseparable fibrous tissue due to reaction of liver/spleen to the parasite. 2. Laminated membrane (ectocyst): It is formed by the parasite itself; is white,
RRJoS (2016) 21-24 © STM Journals 2016. All Rights Reserved
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Research & Reviews: Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print) Volume 5, Issue 3 www.stmjournals.com
Comparison between Intravenous Injection of Iron Sucrose and Oral Administration of Iron for the Treatment of Iron Deficiency Anemia in Pregnancy Vineeta Yadav*, R Nagarathanama, Nagendra Prasad Department of Obstetrics and Gynecology, Rajarajeshwari Medical College, Bengaluru, Karnataka, India Abstract The aim of this study was to compare the therapeutic benefits of intravenous iron and oral iron administration for the treatment of iron deficiency anemia (IDA) in pregnancy. A total of 50 patients with gestational age between 25 and 35 weeks with established IDA with Hemoglobin (Hb) 7–9 g/dl were randomized to receive either oral ferrous sulphate 200 mg twice daily or required dose of intravenous iron sucrose 200 mg in 100 ml NS on alternate days. The Hb level, hematocrit, mean corpuscular volume and packed cell volume were measured at recruitment and on 1st week, 3rd week and at 37 weeks. Adverse drug reactions were also noted in both the groups. Hb values varied drastically with time between the two groups at 1st week, 3rd week and at term. Intravenous iron sucrose helped in treating IDA in pregnancy more effectively than oral iron therapy, without any side effects or reactions. Keyword: Iron deficiency anemia (IDA), iron sucrose, oral iron therapy
INTRODUCTION Iron deficiency anemia (IDA) is the most common nutritional deficiency in pregnant women. As per the World Health Organization (WHO), IDA is about 18% in developed countries and 35–75% (average 56%) in developing countries. Anemia is estimated to affect 20–50% of the world’s population and pregnancy is one of the most important risk factors. The Centre for Disease Control and Prevention defines anemia when hemoglobin (Hb) and hematocrit values are less than 11 g/dl and 33% in the first and third trimester and 10.5 g/dl and 32% in the second trimester [1]. Globally, the prevalence of anemia is 55.9% with variations between developed and developing countries. In India, prevalence ranges between 33% and 89%. Estimates of the worldwide prevalence of iron deficiency anemia in pregnancy are much higher than estimates in the developed world, due to malnutrition and lack of prenatal iron supplement programmes in underdeveloped countries [2]. IDA has varied consequences on both maternal and fetal wellbeing. Maternal consequences include cardiovascular symptoms, reduced physical and mental performance, increased risk of infection, preeclampsia, postpartum hemorrhage, blood transfusions etc. Anemia is responsible for 40–
60% of maternal deaths in non-industrialized countries. Fetal consequences are increased risk of growth retardation, prematurity, intrauterine death, pre-labour rupture of membranes and infection [3]. The common treatments of IDA include oral/parenteral iron and blood transfusion. Oral iron administration is associated with side effects and takes long period of time for treatment. Parenteral administration of iron dextran, iron sorbitol is associated with anaphylactic reactions and blood transfusions are associated with cross reactions and viral infections [4]. Iron sucrose has been shown to have several advantages such as low incidence of side effects, high availability for erythropoiesis, little renal excretion and low tissue accumulation and toxicity [5–7].
AIMS AND OBJECTIVES To compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anemia in pregnancy.
RRJoS (2016) 25-28 © STM Journals 2016.All Rights Reserved
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Research & Reviews: Journal of Surgery ISSN: 2319-3425(online), ISSN: 2349-3712(print) Volume 5, Issue 3 www.stmjournals.com
Sociodemographic Determinants of Tobacco Use among Patients Admitted in a Tertiary Care Hospital Balamurugan G.1,*, Vijayarani M.2 1
Department of Mental Health Nursing, M.S. Ramaiah Institute of Nursing Education and Research, MSRIT Post, Bangalore, Karnataka, India 2 College of Nursing, Indiranagar, Bangalore, Karnataka, India
Abstract Tobacco use is the most important contributor to morbidity and premature death among modifiable lifestyle factors. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of nonsmokers being exposed to secondhand smoke and the annual death toll could rise to more than eight million by 2030. A crosssectional survey was conducted where males and females of 18–65 years of age who were admitted and gave informed consent, were included in the study. Sample size (398) was based on an estimated prevalence of tobacco use of 23–47%, confidence interval 95%, and precision 15% in Master sample size estimation software 2.0. Males and females between 18–65 years of age, who were admitted as inpatient atleast for 24 h, able to speak and willing to participate in the study, were included. Self-reported daily tobacco use questionnaire was administered through face to face interview. Bivariate analysis was done for each variable under study in relation to daily tobacco use. Unadjusted Odds ratios and 95% confidence intervals were obtained. Variables of interest such as age, gender, religion, and socioeconomic status were put in the regression model. Overall 28.6% of the study population (20.8% men and 7.7% women) was using tobacco on a daily basis. Among the tobacco users, the various modes by which tobacco was consumed included cigarette smoking (45.6%), beedies (22.8%), Kutka (18.4%) and tobacco leaves (26.3%). The present study suggests that preventive message needs to be modified to make the tobacco control more effective. Keywords: Tobacco, prevention, smokeless, abuse, lifestyle
BACKGROUND One of the major problems the society is facing is the increasing substance use and abuse [1]. Despite many studies of this problem, there is still little understanding of the causes, appropriate treatment and, most importantly, successful approaches to prevention [2]. Tobacco serves as the gateway to drug addiction—addicts progress from one drug to the next, which is usually more potent and hazardous than the previous one [3]. In India, tobacco chewing is also prevalent, whereas in other parts of the world, smoking is more common [1]. Tobacco use is the most important contributor to morbidity and premature death among modifiable lifestyle factors [4]. Tobacco use and exposure comes in both smokeless and smoking forms. Smokeless tobacco is consumed in unburnt forms through chewing
or sniffing and contains several carcinogenic, or cancer-causing, compounds. Smoking tobacco, by far the most commonly used form globally, contains over 4000 chemicals, of which 50 are known to be carcinogenic [5]. Tobacco kills up to half of its users, i.e., nearly 6 million people each year. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of nonsmokers being exposed to secondhand smoke and the annual death toll could rise to more than eight million by 2030 [6]. India, with a population of 1.2 billion, currently has around 275 million tobacco users, and it may increase up to 1.5 billion by 2020 [7]. Factors which push the population to the risk of tobacco use need to be found out and preventive strategies devised accordingly [8].
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