Biomedical subjects

Rajinder Singh

Publications and source records attributed to Rajinder Singh.

39 records · Page 3Linked to original sources

PubMedDate not supplied

External duodenal fistula following closure of duodenal perforation.

AIM: Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN). METHOD: Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery. RESULTS: Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality. CONCLUSIONS: EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.

Adult↗

PubMedDate not supplied

Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial.

At present the use of prophylactic antibiotics in elective laparoscopic cholecystectomy is controversial. This prospective study was carried out to define the role of prophylactic antibiotics in elective laparoscopic cholecystectomy to prevent postoperative infection. Ninety three patients were randomly placed in two groups. Group A comprised of 40 while group B consisted of 53 patients. Patients in Group A received 1.5 grams of second generation cephalosporin (cefuroxime sodium) diluted in 100ml of normal saline, at the time of induction of anesthesia. Group B patients received an equal volume of normal saline only. A sample of gall bladder bile was collected by direct gall bladder puncture intra-operatively for aerobic and anaerobic culture. Age, sex, weight of the patient, American Society of Anesthesiologists classification grade, presence of diabetes mellitus, episodes of colic 30 days preceding surgery, intra-operative gall bladder rupture, stone and / or bile spillage, results of bile culture, gall bladder histology, length of hospital stay, and number of septic complications were recorded and analyzed. In group A, one patient (2.5%) had post operative wound infection and in group B, two patients (3.8%) had post operative infection which was statistically similar (p>0.1). There was no difference between the two groups in terms of demographic, intra operative and post operative denominators. Therefore the study concluded that prophylactic antibiotics did not have a significant role to play in prevention of postoperative wound infection in elective laparoscopic cholecystectomy.

Adult↗

PubMedDate not supplied

Pleurocutaneous flap: how useful it is in management of chronic empyema.

BACKGROUND: Definitive surgical treatment of chronic empyema is associated with considerable morbidity and mortality. Methods. Retrospective study of 50 patients with chronic empyema who underwent pleurocutaneous flap procedure during the period 1994 to 2003. RESULTS: Their age ranged from 14 to 70 years; there were 32 males. Thirty-seven (74%) patients were on intercostal tube drainage; nine (18%) presented with bronchopleural fistula; and four (8%) had past-pneumonectomy empyema. Following pleurocutaneous flap procedure, 28 (56%) responded with re-expansion of the lung; 15 (30%) had persistence of pus discharge and air-leak suggestive of bronchopleural fistula. Definitive surgery could be undertaken in nine of the 15 patients. CONCLUSIONS: Pleurocutaneous flap procedure renders the patient ambulatory, facilitates re-expansion of the lung and helps as a tide-over procedure before definitive surgery in patients with chronic empyema.

Adolescent↗