iosr-JDMS   Volume-17 ~ Issue-1 ~ January-2018

Abstract: Background: Thoracic spinal anaesthesia has proven its efficacy over general anaesthesia as a routine anaesthetic technique for laparoscopic surgeries. This study aimed to compare the block characteristics of isobaric and hyperbaric bupivacaine in thoracic spinal epidural anaesthesia for laparoscopic cholecystectomies. Materials and methods: The study included 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy, divided randomly into two equal groups. Both the groups were given thoracic combined spinal epidural anaesthesia (CSE) at the T9-T10 / T10-T11 interspace using 1.5 ml of isobaric bupivacaine 0.5% (5 mg/ml) + 25μg (0.5 ml) of fentanyl in group I and 1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25μg (0.5 ml) of fentanyl in group H...........

Keywords: Baricity, hyperbaric bupivacaine, isobaric bupivacaine,laparoscopic cholecystectomy, thoracic combined spinal epidural anaesthesia

[1]. Zundert AAJ van, Stultiens G, Jakimowics JJ, Peek D, van der Ham W. G. J. M, Korsten H. H. M, Wildsmith J. A. W. Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease, Br Jr Anaesth 2006; 96:464–66.
[2]. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G,Hatzitheofilou C. Spinal vs general anesthesia for laparoscopic cholecystectomy: Interim analysis of a controlled randomized trial, Arch Surg 2008;143:497-501. [3]. Møller IW, Fernandes A, Edstrom HH. Subarachnoid anaesthesia with 0.5% bupivacaine: Effects of density, Br J Anaesth. 1984;56:1191–5.
[4]. Helmi M, Uyun Y, Suwondo BS, Widodo U. Comparison of intrathecal use of isobaric and hyperbaric bupivacaine during lower abdominal surgery. J Anesthesiol 2014 ; 2014:4.
[5]. Hogan QH, Prost R, Kulier A,Taylor ML, Liu S, Mark L. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure,Anesthesiology. 1996;84:1341–9.

Abstract: Introduction: Over the last few years, rituximab (RTX) has emerged as a second- line therapy and has shown a 40-48% response rate in steroid resistant and up to 80% remission rate in steroid dependent nephrotic syndrome. The better outcome of RTX therapy in dependent nephrotic syndrome compared to resistant nephrotic syndrome is possibly due to excessive loss of RTX in the urine during active state of proteinuria. Objective: To assess the therapeutic response of RTX during non-proteinuric state in children with steroid and CNIs/MMF resistance nephrotic syndrome following induction of remission by a combined therapy of Prednisolone, CNIs and MMF. Materials and Methodology: In this study we analysed the data of steroid and CNIs/MMF –resistance idiopathic nephrotic children, aged 1-14 years from January 2014 to January.........

Keywords: Rituximab, Steroid resistant Nephrotic Syndrome, second line therapy.

1. Avner E., Harmon W., Niaudet P., Yoshikawa N. Pediatric Nephrology. 6th. Vol. 1. Springer; 2009.
[2]. Vivarelli M, Moscaritolo E, Tsalkidis A, Massella L, Emma F. Time for initial response to steroids is a major prognostic factor in idiopathic nephrotic syndrome. J Pediatr. 2010;156:965–971. doi: 10.1016/j.jpeds.2009.12.020.
[3]. Safdar OY, Aboualhameael A, Kari JA. Rituximab for troublesome cases of childhood nephrotic syndrome. World Journal of Clinical Pediatrics. 2014;3(4):69-75. doi:10.5409/wjcp.v3.i4.69.
[4]. Counsilman CE, Jol–van der Zijde CM, Stevens J, Cransberg K, Bredius RGM, Sukhai RN. Pharmacokinetics of rituximab in a pediatric patient with therapy-resistant nephrotic syndrome. Pediatric Nephrology (Berlin, Germany). 2015; 30(8):1367-1370. Doi: 10.1007/s00467-015-3120-8.
[5]. Bagga A, Sinha A, Moudgil A. Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med, 2007; 356:2751-2752..

Abstract: Introduction: Peptic ulcer disease (PUD) is a worldwide health problem because of its high morbidity, mortality and monetary loss. The incidence of uncomplicated peptic ulcer disease has lowered dramatically due to usage of proton pump inhibitors and H2 receptor antagonists. Complicated peptic ulcer disease is still a concern all over the world and perforation is the most common complication followed by bleeding. Material and Methods: This is a retrospective/prospective study of 60 cases of peptic ulcer perforation carried out in MediCiti institute of Medical science, from July 2012 to September 2017. Out of 60 peptic ulcer perforations, 51(85%) were males and 9 (15%) were female showing strong male predominance with male: female ratio 5.66:1. More number of cases observed in 5th...........

Keywords: Gas under diaphragm (GUD), Non steroidal anti inflammatory drugs (NSAIDs) Peptic ulcer disease (PUD), Peptic ulcer perforation (PUP).

[1]. Testini M, Portincasa P, Piccini G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol. 2003;6: 2338- 2340. [PCM free article] [PubMed].
[2]. Soll AH. In: Seleisenger & Fordtran's Gastrointesstinal and Liver Disease; Pathophysiology, Diagnosis, Management. 6' Feldman M, Scharschmidt BF, Sleisenger MH,editor. Philadelphia , PA: W.B. Saunders; 1998. Peptic ulcer and its complications; pp. 620-678.
[3]. Turkdogan MK, Hekim H, Tuncer I, Aksoy H, the epidemiological and endoscopic aspects of peptic ulcer disease in Van region. Eastern Journal of Medicine 1999; 6(1): 6-9
[4]. Elngib E, Mahadi SE, Mohamed E, Ahmed ME. Perforated peptic ulcer in Khartoum. Khartoum Medical College Journal. 2008; 6(2):62-64.
[5]. Makela JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict Morbidity and Mortality in patients with Perforated Peptic Ulcers. EUR J Surg. 2002; 6:446- 45. [PubMed] [Cross Ref]..

Abstract: At times Laparoscopic Cholecystectomy becomes difficult. Laparoscopic Cholecystectomy may be rendered difficult by various problems encountered during surgery. Aims And Objective: To calculate the male to female ratio in case of gall stones, age distribution along with the operative difficulties and techniques in two incisions two ports and four incisions four ports laparoscopic cholecystectomy and compare the outcome of two ports and four ports laparoscopic cholecystectomy in terms of operation time, hospital stay, complication rate, cosmesis, conversion rate to open Cholecystectomy. Material And Methods: The present study will be conducted in three...........

Keywords: Gallstone Pancreatitis, Acute cholecystitis, Difficult Laparoscopic Cholecystectomy,Cosmesis

[1]. Johnson DE, Kaplan MM. Pathogenesis and treatment of gallstones. New Engl J Med 1993; 328:412-21.
[2]. Diehl AK. Epidemiology and natural history of gallstone disease. Gastroenterol Clin North Am 1991; 20:1-19.
[3]. Heaton KW, Braddon FEM, Mountford RA, Hughes AO, Emmett PM. Symptomatic and silent gallstones in the community. Gut 1991; 32:316-20.
[4]. Prakash A. Chronic cholecystitis and cholelithiasis in India. Int Surg 1968; 49:79-85.
[5]. Khurro MS, Mahajan R, Zargar SA, Javid G. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989; 30:201-05..