Dr. Dayananda

Description:Non-Hodgkin lymphoma (NHL) involving base of the tongue is a rare presentation with an incidence of only 7% of total cases. Because of its rarity it is often diagnosed late as lymphoma and mismanaged widely. We present one such case of 70-year-old female with complaints of difficulty in swallowing being diagnosed as NHL lesion of diffuse large B-cell variety arising in base of the tongue.

Description:BACKGROUND : Inguinal hernia repairs are commonly performed operations. GPRVS is one of the methods . Also known as Stoppa s repair uses large prosthetic mesh placed in preperitoneal plane covering both the hernial orifices i . e ., it covers the whole Myopectineal Orifice Bilaterally. Stoppas repair is use full in cases of bilateral hernias, recurrent and multi recurrent hernias, unilateral hernias where risk of recurrence is more i . e. , When associated with COPD, BPH, Poor abdominal tone and previous surgery. Purpose of present study is to know the role of Stoppa s repair in management of inguinal hernias especialy Bilateral , recurrent and unilateral hernias which are at the risk of recu rrence. METHODS: Study done in victoria hospital attached toBangalore medical college and research centre . 250 cases were included for stoppa s repair. Bilateral hernias , recurrent hernias, unilateral hernias with one or more risk factors for recurrence and femoral hernias . Demographic data such as age, gender, occupation, smoking, symptoms as well as comorbid conditions such as chronic obstructive pulmonary disease, prostatism, and recurrence were collected. Duration of surgery was also noted. Complications such as seroma, hematoma, orchitis, and wound infection were recorded. Duration of hospital stay was recorded. Chronic groin pain and recurrences in each group were also recorded. RESULTS: Out of 250 patients 225 had bilateral inguinal hernia and 25 unila teral inguinal hernia , 48 were recurrent and 7 were re recurrent hernia. All the patients were males with age group between 21 to 80 years. All the patients had swelling in the groin region 43.3 % of patients had associated pain. Direct hernia was common v ariety in this study as mean age in the study was more than 40 yrs. Most of the patients had one or the other risk factor for recurrence smoking was most common 76.6% . O ther risk factors are COPD , BPH , Poor abdominal tone, previous surgery and strenuous wo rk. All the patients were subjected to GPRVS under spinal anaesthesia / epidural anaesthesia with proper size of mesh and duration of surgery was 52 min. Intra operative course was uneventful except 4 cases of peritoneal tear which were sutured without any additional morbidity. P atients were allowed early ambulation . Post - operative course was uneventful without major complications and mortality. 4 cases of Recurrences were seen. Minor complications like seroma were managed conservatively with no sequelae. Th ese results were comparable to other studies . CONCLUSION: Our study s hows, Stoppa s repair is effective and safe procedure can be done in cases of bilateral, recurrent and hernias which are at high risk of recurrence. Procedure is simple, easy learning curve , complications are low with lower recurrence rate

Description:Acute acalculous cholecystitis is relatively rare as compared to the calculous cholecystitis. But complications like gangrenous changes and Gall bladder (GB) perforation is more common with acalculous variety than calculous cholecystitis.GB perforation following acalculous cholecystitis has a mortality of 10-50 % as compared to that of 1% following calculous cholecystitis. The literarature pertaining to this is very few and does not conclude a standard mangement in such cases. Hence we try to review the literature pertaining to gall bladder perforation in acalculous cholecystitis and try to predict when a surgical intervention is crucial in reducing the morbidity and mortality associated with it