Indian J Surg
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Severe child trauma poses a heavy burden upon the public's health and the nations' economies, in terms of mortality, morbidity, and disability. The burden varies by the maturity level of the adopted trauma system. This work aimed to identify the impact of trauma system maturity on the outcomes of care of severely injured children. ⋯ Analysis revealed that Indiana children significantly stay longer in hospital, and that no differences in the rates of patient mortality, discharge-home, and selected procedures were found. Trauma system maturity impacts the volume and complexity of interventions, as well as the mortality, morbidity, and disability associated with severe children and adolescent trauma. The cost of such burden could be directed to improving the quality of the state's injury management services.
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Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after the cholecystectomy done for unsuspected benign gallbladder disease. Laparoscopic cholecystectomy (LC) is the most common procedure performed for benign gallbladder disease worldwide. Majority of GBC patients have associated gallstones. ⋯ At cholecystectomy for benign gallbladder disease all gallbladder specimens should be opened before closing abdomen and if available all suspicious specimens should be sent for immediate frozen section. All gallbladder specimens should be subjected to histopathology examination to avoid missing GBC. The surgeon should have a high index of suspicion for GBC if encountering difficult cholecystectomy for a benign disease, and in patients with atypical clinical and ultrasound findings in high incidence areas.
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Acute appendicitis is a clinical diagnosis, so it's impossible to have a definitive diagnosis by gold standard (histopathology) pre operatively. The treatment being surgical, negative appendicectomy rates are high. Present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appendicitis and its co relation by histopathology. ⋯ Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value. The normal appendicectomy frequency was 13% and positive predictive value was 86%. Alvarado scoring system is easy, simple, cheap, useful tool in pre operative diagnosis of acute appendicitis and can work effectively in routine practice.
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Congenital transmesenteric internal hernia is a rare condition presenting as recurrent pain abdomen or acute intestinal obstruction. Preoperative diagnosis of internal hernia is very rare. Early intervention and surgical correction goes a long way in preventing high morbidity and mortality associated with cases of internal hernia. We report a case of congenital transmesenteric intra-abdominal hernia presented as acute abdomen with timely surgical intervention in the form of emergency laparotomy with untwisting and reduction of small bowel herniated through large congenital terminal ileal mesenteric defect and repair of mesenteric defect.
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Trained doctors and para-medical personnel in accident and emergency services are scant in India. Teaching and training in trauma and emergency medical system (EMS) as a specialty accredited by the Medical Council of India is yet to be started as a postgraduate medical education program. The MI and CMO (casualty medical officer) rooms at military and civilian hospitals in India that practice triage, first-aid, medico-legal formalities, reference and organize transport to respective departments leads to undue delays and lack multidisciplinary approach. Comprehensive trauma and emergency infrastructure were created only at a few cities and none in the rural areas of India in last few years. ⋯ Though a late start, evolution of trauma services was observed and huge infrastructure for trauma have come up at Delhi and Lucknow. Postgraduate accreditation in Trauma and EMS and creation of National Injury Control Program must be mandated to improve trauma care in India. Integration of medical, non traumatic surgical and pediatric emergency along with pre-hospital care is recommended.