International journal of dental and medical specialty

2-5

Authors: Ayanat Husain, Huma Firdaus, Saurabh Pathak

Background: Laparoscopic surgery widely, known as single incision laparoscopic cholecystectomy (LC), has been proved as the gold standard surgical technique and is now considered the treatment of choice as well as preferred surgical technique in cholecystectomy. The use of laparoscopic technique in cholecystectomy is widely used for cholelithiasis patients. An abdominal ultrasonography (USG) often precedes this surgery and can verify the diagnosis, as well as help in showing possible complications during the perioperative period. Aim: A prospective study was conducted to evaluate the pre operative with and without (based on clinical findings) USG findings and predictive difficulties in cholelithiasis patients comparing with surgical findings in LC. The post-operative evaluating criteria were as follows: (1) Duration of surgery, (2) Bleeding, (3) Dissection of Calot’s triangle, (4) Dissection of gallbladder wall, (5) Spillage of bile and stone, (6) Difficulty of gall bladder stone. Methods: We studied and evaluated surgical difficulties in 150 patients of cholelithiasis who underwent abdominal USG test for surgical LC. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative USG and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. All patients had routine blood tests (including liver function tests), electrocardiography, chest X-ray, and abdominal ultrasound scan performed preoperatively. All patients received general anesthesia, and the standard Reddick and Olsen technique was performed. The harmonic scalpel was used in all cases. Results: On evaluation of surgical difficulties in cholelithiasis patients, we found 135 females and 15 males for surgical LC. Out of which 36 (24.0%) cases to be predicted as difficult, 26 (17.33%) were laparoscopic converted for open surgery, 36 (24.0%) were technically difficult. 54 (36.0%) cases were predicted easy to perform on USG. On evaluation, our findings were found to be significant, and hence, we concluded that pre-operative ultrasound examination if of importance for predicting difficulties in LC, but still required further studies.

12-15

Authors: Shivaji Patil, Anannya Mukherji, Akshaya Shetty

Background: Hyponatremia is defined as common electrolyte disturbance or decline blood sodium concentration in critically ill patients. Hyponatremia often results in intensive care unit (ICU) admissions and are also associated with significant mortality and morbidity. The study was undertaken to assess the follows points: (1) To assess the incidence of hyponatremia in patients in ICU. (2) To describe the etiological factors responsible for hyponatremia. (3) To describe clinical manifestations of hyponatremia. (4) To describe treatment modalities for hyponatremia in ICU patients. Materials and Methods: (1) Study design - Cross-sectional. (2) Study period - 01/09/2014 to 01/05/2015 data on patients admitted to the hospital in the ICU with hyponatremia were collected. (3) Inclusion criteria - Patients admitted to the ICU with serum sodium levels ≤130 mEq/L, age of patients >18 years. (4) Exclusion criteria - Patients, who did not give consent, age of the patients <18 years, patients admitted to the ICU with serum sodium levels >130 mEq/L, and post-operative patients. (5) Sample size: 100 cases. (6) Sampling type: Purposive. Results: A total of 100 hyponatremic and 50 non-hyponatremia critically ill admitted patients in ICU were observed and evaluated out of which 41 (hyponatremic) [Table 2] were males and 59 were females in the study. We have included the non-hyponatremia patients to evaluate with hyponatremia patients. In our study, we observed that in hyponatremic patients, 66% patients had neurological manifestations. These include seizures, reduced consciousness level, confusion, unsteadiness, and falls. Conclusion: Hyponatremic patients should be diagnosed early in ICU, and the treatment should be start accordingly. It is frequent finding in critically ill patients admitted to ICU. Most etiological factors involved in it are severe sepsis, renal failure, liver cirrhosis, trauma, hypothyroidism, and hypocortisolism. A patient with hyponatremia needs longer duration stay in ICU with higher mortality rate and longer ventilation days.

20-24

Authors: K P Mohammed Sadique, Benny Varghese, Elsy P Simon, Sandeep Lal Cherukara, Nithu Marina Terence

Periapical inflammatory lesions occur in response to the ingress of microbes from the root canal. The treatment rendered in endodontic procedures includes root canal cleaning and shaping followed by obturation. In an event when the pathology cannot be cleaned due to obturation, surgical intervention has to be delivered. The rationale of surgical endodontics is to eliminate the pathological tissue in an infected necrotic tooth present at the apex of a root canal and throughout the apex and retrofill the space inside the root canal with biologically inert material so as to achieve a tight seal. Herein we are documenting a case report of 26-year-old male patient with a chief complaint of swelling and pain in the upper front teeth region and a large bony defect radiologically in which a periapical endodontic surgery was performed. The surgical defect was filled with platelet-rich fibrin (PRF). Clinical examination revealed uneventful wound healing. Radiologically, the defect has been almost entirely replaced by new bone at the end of 8 months. On the evidence of the outcomes obtained in our case report, we hypothesize that healing process was enhanced by an autologous PRF and can be used as a regenerative material of choice in such type of endodontic procedures.