Bailey and Love's Short Practice of Surgery

https://pmj.bmj.com/content/postgradmedj/58/680/396.2.full.pdf

Background The Alvarado score is utilized to determine the likelihood of appendicitis based on clinical signs, symptoms, and laboratory results. The goal of this study was to determine whether Alvarado scores can be used to aid in the accurate diagnosis of appendicitis. Methods Alvarado score evaluations were performed on 300 patients that were referred to or presented to the emergency room with acute abdominal pain. Results Out of the 300 patients, 85.66% had Alvarado scores of 7 or less and 14.33% had Alvarado scores greater than 7. For patients that had confirmed appendicitis, 25.7% had Alvarado scores of 7 or less, whereas 93% had Alvarado scores greater than 7. The Alvarado scoring system had poor sensitivity at 37%, and the specificity of this scoring system was high at 95%. Conclusion Our findings suggest that patients presenting with abdominal pain and Alvarado scores greater than 7 are more likely to have appendicitis. As such, the Alvarado scoring system may be utilized to better predict whether a patient has appendicitis. An Alvarado score that is positive for appendicitis would consist of a score greater than 7, which suggests that the patient has a 93% chance of having appendicitis. A negative Alvarado score is 7 or lower, suggesting a 26% probability of having appendicitis. In all, the Alvarado scoring system is a good rule-in test, but it does not adequately rule-out appendicitis.

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Evaluation of the Alvarado score in acute abdominal pain.

Using a practical scoring system for diagnosing acute appendicitis can help reduce the rate of unnecessary surgery. This prospective study was carried out to evaluate Alvarado scoring system for diagnosing of acute appendicitis in our set up. Out of total 100 patients, appendicitis was confirmed in 80 patients, thus giving negative appendectomy rate of 20% (male 6%, female 14%). Perforation rate was 4%. Positive predictive value was 89%. The sensitivity was 54% and specificity 75%. Alvarado score is not a sensitive tool for aiding diagnosis of acute appendicitis.

Evaluation of Alvarado score in diagnosing acute appendicitis.

Intra-abdominal Infections: Pathophysiology and Treatment

Background: Acute appendicitis, the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances and is essentially clinical. However a decision to operate based on clinical suspicion alone can lead to removal of normal appendix in 15-30% cases. Several diagnostic scoring systems have been devised as an aid to early diagnosis of acute appendicitis and to reduce the incidence of negative appendicectomy. One such scoring system was described by Alvarado and later modified by Kalan et al. The present study is attempted to evaluate the efficiency of modified Alvarado score in pre-operative diagnosis of acute appendicitis. Methods: One hundred twenty consecutive patients suspected of acute appendicitis that were admitted, investigated and treated were taken for the study. After detailed examination and investigations a modified Alvarado score was applied to these patients. They were assigned in three groups and were treated accordingly. Results: The result of the study showed that high scores in men and children (7-9) had a sensitivity of 92.3% and 83.3% respectively, whereas in females it had a sensitivity of 72.7%. The score (5-6) in males and females had a sensitivity of 57% and 50% respectively. Conclusions: The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it’s not true as far as women are considered. Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in females.

Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

Background: Traumatic brain injury is one of the leading causes for morbidity and mortality in trauma cases. GCS is the standard scoring system used globally to assess the neurological status of patients with traumatic brain injury. The GOS is used to objectively assess and categorize patients recovering from head injury. In this study we assessed the GOS of patients recovering from traumatic brain injury and analysed its correlation with the initial GCS thereby evaluating the use of GCS in predicting recovery of patients with head injury. Methods: 82 patients with isolated traumatic brain injury were included in the study. GCS was recorded at admission, 6 hours and 12 hours. GOS was recorded at 7 days and 28 days. Statistical analysis was done using Pearson’s Correlation co-efficient. Results:  There was statistically significant positive correlation between GCS recorded on admission with GOS recorded on day 7 and GOS recorded on day 28. Positive Correlation was also seen between GCS recorded at 6 hours with GOS recorded on day 7 and GOS recorded on day 28. Similar positive correlation was also seen between GCS recorded at 12 hours with GOS recorded on day 7 and GOS recorded on day 28. Conclusions:  GCS can be used as a tool to stratify risk, prognosis and neurological recovery in patients with traumatic brain injury. It has to be used with caution in patients with polytrauma as other serious injuries may increase the risk, morbidity and mortality.

/pdf/correlation-of-glasgow-outcome-score-to-glasgow-coma-score-1sy55z90pw.pdf

Correlation of Glasgow outcome score to Glasgow coma score assessed at admission

Background: An incisional hernia develops in 7% to 11% of laparotomy incisions. Laparoscopic repair was applied to the ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to compare the outcomes after open and laparoscopic ventral hernia repair. Methods: It is prospective study involved 100 patients with ventral hernia, were subjected either to repair by laparoscopy or to open repair. The open surgical operations were performed by the retro-rectus mesh repair, whereas the laparoscopic repairs were performed using the intra-peritoneal on lay dual mesh (IPOM) repair technique. Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (p=0.000). The mean duration of post-operative analgesics used in laparoscopic group is 2.84±0.60 days as compared to open ventral hernia repair 5.47±2.16 days (p=0.000) which is significant. The mean postoperative stay in hospital was shorter for the laparoscopic group than for the open hernia group (2.66 versus 6.88 days; p=0.000). Antibiotics used in laparoscopy group is for 1.33±0.70 days as compared to open repair 2.52±0.98 days (p=0.000). Return to the activity or normal daily work is significantly low in laparoscopic group as compared to open repair of hernia            (4.13 versus 13.98 days; p=0.000). There were fewer post-operative complications in laparoscopy. Conclusions: The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications; shorter hospital stays, and earlier returns to daily activity. Hence, it should be considered as the procedure of choice for ventral hernia repair.

/pdf/comparative-analysis-of-open-versus-laparoscopic-ventral-2i2zz5t444.pdf

Comparative analysis of open versus laparoscopic ventral hernia repair

Background: Despite advances in critical care medicine, prognosis in peritonitis due to hollow viscous perforation remains poor especially when associated with multi-organ dysfunction. Various grading systems are available to analyse and stratify patients by different parameters and predict outcome. In a prospective non randomised observational study, the efficacy of Mannheim peritonitis Index (MPI) was analysed in predicting the outcome in patients treated for peritonitis due to hollow viscous perforation. Methods: A total of 100 consecutive patients with peritonitis undergoing surgical treatment at SDM College of Medical Sciences Hospital Dharwad, were included in study. Demographic, clinical data, evaluation with surgical treatment, outcome details were documented and analyzed using SPSS software. Results: The mean MPI score in this study was 23.81 with 11 lowest and 39 as the highest. The overall mortality was 14% and morbidity 35%.  MPI scores of ˂21, 21-29 and ˃29 had an overall mortality of 0%, 3%, and 11% respectively. MPI score of 29 had sensitivity of 87.21%, specificity of 78.57% and predictive power of 0.945 in predicting mortality. Higher mortality rates were associated with presence of multi- organ failure, duration of symptoms of more than 24 hours, faecal peritonitis and presence of malignancy. The sensitivity and specificity for morbidity at MPI score of 29 were 86.14% and 83.58% respectively. Conclusions: The study clearly suggests increasing risk of mortality, morbidity and overall hospital stay with increasing MPI score. The MPI scoring system is simple and effective in predicting outcome of patients with peritonitis.

/pdf/analysis-of-mannheim-peritonitis-index-scoring-in-predicting-5bt0dca21o.pdf

Analysis of Mannheim peritonitis index scoring in predicting outcome in patients with peritonitis secondary to hollow viscous perforation

Background: Wounds and their management are fundamental to the practice of surgery. In the past 15 years there have been significant advances in complex acute and chronic wound management. One of the one of the most significant discoveries was the improvement in wounds with negative pressure–assisted wound closure. In this study, the efficacy of topical negative pressure dressing with that of a control group using conventional moist wound dressings, in healing of wounds, was assessed with quality of wound healing. Methods: This is a prospective randomized observational study, 50 patients visiting medical college hospital with acute and traumatic wounds, sub-acute wounds, chronic open wounds, of which 25 patients underwent topical negative pressure dressing. The remaining 25 patients underwent conventional moist wound dressings. Wounds were assessed depending on wound size and percentage of reduction of wound size, wound bed score, percentage of granulation tissue cover, graft take up as the percentage of ulcer surface area. Statistical analysis was done using unpaired students T test and paired T test. A p-value <0.05 was taken as significant. Results: Our study shows statistically significant reduction in wound size, in the study group 19.52 square centimetres (cm 2 ) as compare to control group i.e. 6.64 cm 2 (p<0.001). There is significant increase in wound bed score in the study group (mean difference was 9.60±2.16) where as in the control group there was not much increase in wound bed score (mean difference was 5.12±1.99) (p valve 0.00001). The percentage of granulation tissue formation in the study group was 81.0±8.29 and in the control group was 53.60±19.23 (p value=0.00001). The percentage of graft take up in the study group was 83.42±4.43 and in the control group was 63.18±11.24 (p value=0.00001). The mean hospital stay and cost of hospital stay is also reduced in topical negative pressure dressing group when compared to conventional wound dressings group. Conclusions: It is concluded that topical negative pressure dressing is better the conventional wound dressings in wound healing.

/pdf/comparative-analysis-of-the-efficacy-of-topical-negative-2hcpqs6fkb.pdf

Sanjay N. Koppad

Papers

Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

Correlation of Glasgow outcome score to Glasgow coma score assessed at admission

Comparative analysis of open versus laparoscopic ventral hernia repair

Analysis of Mannheim peritonitis index scoring in predicting outcome in patients with peritonitis secondary to hollow viscous perforation

Comparative analysis of the efficacy of topical negative pressure dressing with conventional wound dressing in wound healing