Role of tramadol as an adjuvant in ultrasound-guided serratus anterior muscle block for modified radical mastectomy - A randomized control trial.

Background And Aims: Modified radical mastectomy (MRM) is associated with significant acute post-operative pain that may progress to chronic pain syndromes in 25-60% of patients. Serratus anterior muscle (SAM) block has proved to be an excellent analgesic option in patients undergoing MRM. Although many adjuvants have been utilized for the prolongation of analgesia, the role of tramadol in SAM has not been studied as yet.

Ultrasound-guided erector spinae plane block compared to serratus anterior muscle block for postoperative analgesia in modified radical mastectomy surgeries: A randomized control trial.

Background And Objectives: The present study was undertaken to compare the analgesic efficacy of erector spinae plane (ESP) block with serratus anterior muscle (SAM) block in patients undergoing modified radical mastectomy (MRM). We hypothesized that ESP block would provide better postoperative pain relief than SAM block following MRM.

Methods: Eighty American Society of Anaesthesiologists (ASA) I-II adult females, scheduled for MRM, were randomly allocated to receive either ultrasound-guided ipsilateral single-shot ESP or SAM block after induction in the respective planes, using 20 ml of 0.

Primary Cutaneous Mucormycosis: A Necrotising Soft Tissue Infection with Poor Prognosis.

Background: Cutaneous mucormycosis is an unusual fungal infection that continues to occur. It needs aggressive surgical debridement and timely administration of antifungals due to its high fatality rate. High clinical suspicion on the part of a surgeon is required to prevent the same.

Hypocalcaemia - A rare complication of ileostomy.

Hypocalcaemia is an uncommon complication of ileostomy. We present one such case where significant symptoms only resolved on reversal of the ileostomy.

Peritonitis-associated hyperlactatemia for evaluating mortality in secondary peritonitis.

Background: In sepsis, lactate measurements correlate with mortality; however, the role of lactate in predicting mortality in patients of secondary peritonitis is not yet fully established.

Methods: Data were maintained prospectively on 224 patients of secondary peritonitis over a period of 10 years. Arterial lactate measurements were performed twice in each patient - once, initially on admission (AL ) and the other, 24 h after surgery (AL ); from these values, percentage lactate clearance was calculated.

Mucor as a cause of surgical site infection.

Mucor is an uncommon cause of surgical site infection. We present such a case after intramedullary nailing of the femur and discuss its presentation and management.

Determinants of Mortality in Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTI) are frequently encountered, with a high mortality despite advances in health care.

Material And Methods: Patients presenting with NSTI were prospectively followed up in an attempt to identify factors that were significantly associated with mortality.

Results: There were a total of 86 patients [65 males (75.

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.

Isolated giant ileal neurofibroma sans neurofibromatosis.

Neurofibromas are benign neoplasms that are usually seen in hereditary disorders such as von Recklinghausen's disease [neurofibromatosis type 1 (NF1)]. The occurrence of isolated ileal neurofibroma in patients without the classic manifestations of NF1 or multiple endocrine neoplasia (MEN) syndromes is an extremely rare entity . We report one such case of isolated ileal neurofibroma in a 60 year old woman without any other stigmata of NF.

Prospective Observational Study on acute Appendicitis Worldwide (POSAW).

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis.

Post-cholecystectomy syndrome: A new look at an old problem.

Background: Despite being the most commonly performed operations, sometimes cholecystectomy fails to relieve symptoms; this is now a well-recognised clinical entity termed 'post-cholecystectomy syndrome' (PCS). Very few studies from India deal with PCS, and the present study was carried out to find the incidence and risk factors for PCS in patients undergoing elective laparoscopic cholecystectomy (LC).

Materials And Methods: The records of 207 patients undergoing elective LC were prospectively maintained for 6 months after surgery.

Relative value of immunohistochemistry in detection of mycobacterial antigen in suspected cases of tuberculosis in tissue sections.

Background: The diagnosis of tuberculosis (TB) depends on identification of the infecting organism. The diagnosis presents as a challenge due to its diverse clinical presentation and low yield of acid-fast bacilli (AFB) in tissue sections.

Aim: The aim of the present study is immunohistochemical localization of tubercle bacilli or their components that persist in the granulomas, but have lost the property of staining with acid-fast stain, assess the advantage of immunostaining over conventional Ziehl-Neelsen (ZN) staining and further to study the staining pattern on immunohistochemistry (IHC).

Abdominal cocoon in a young man.

Background: Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered.

Methods: A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy.

Presentation and management of gallbladder remnant after partial cholecystectomy.

Background: Partial cholecystectomy is usually performed with the aim of preventing bile duct injury and/or vascular injuries in situations where there is difficulty in performing cholecystectomy. Occasionally, such patients can become symptomatic due to recurrence or persistence of disease in the gallbladder remnant and may require further treatment.

Patients And Methods: A case series of various presentations and follow up of seven patients who had undergone open partial cholecystectomy for symptomatic gallstone disease in the past.

Primary cutaneous zygomycosis in India.

Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts.

Free tubercular perforation of the ileum.

Background: Peritonitis secondary to small bowel perforation is a common surgical emergency seen across the globe.

Methods: A young male patient presented with ileal perforation that was repaired primarily. He recovered uneventfully after the operation.

Neuroendocrine tumors of the ampulla of vater: presentation, pathology and prognosis.

Context: Neuroendocrine tumors of the pancreatic ampulla are uncommon. The final diagnosis is based on histology, and at times, it may be difficult to diagnose them pre-operatively since they present with a similar clinical picture to adenocarcinomas of this region.

Objective: To identify neuroendocrine tumors of the ampulla, as well as their presentation and management.

Fatal primary cutaneous zygomycosis caused by Saksenaea vasiformis: case report and review of literature.

Background: Primary cutaneous zygomycosis caused by Saksenaea vasiformis is rare. Such infections usually are not suspected, and delay in their diagnosis and treatment results in a poor outcome.

Methods: Case report and review of the relevant English-language literature.

Traumatic lumbar hernia.

Background: Trauma has various presentations ranging from common injuries that are easily managed to uncommon presentations such as traumatic hernia that may be missed.

Methods: Despite being operated for fracture of the femur after a road traffic accident, a 50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months after the accident. In this period, the patient underwent incision and drainage thrice for swelling in the right flank which was diagnosed as an infected hematoma by a doctor.