The low incidence of injury to the recurrent laryngeal nerve (RLN) and external branch of the sup... more The low incidence of injury to the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) quoted in the literature is derived from expert series. The exact incidence of nerve injury of a thyroid surgeon will be revealed only if pre-operative and post-operative laryngoscopy is becoming routine practice. It is found that the injury rates are increased with routine post-operative laryngoscopy. Subjective voice change occurred in one third of patients all whom had normal vocal cord motion. Therefore, it is important to take written informed consent for voice change in addition to identification of both nerves and documenting it.
Background: Despite being one of the oldest reported medical conditions, the management and treat... more Background: Despite being one of the oldest reported medical conditions, the management and treatment of fistula in ano are still in the evolving phase. The management of fistula-in-ano requires confirmation of the diagnosis, identifying the fistulous tract and inner opening. In majority of patients a single primary fistula tract exists and the anatomy can be determined by examination under anaesthesia adhering to the principles described by Goodsall. A thorough clinical examination of the patient is essential in the assessment of fistula-in-ano, sometimes helped by imaging such as magnetic resonance imaging and endoanal ultrasonography. Although Goodsall’s rule was accepted in the past, as a method to determine the course of the fistula, recent studies showed poor conflicting results. Thus, this study attempts to scrutinize the predictive accuracy of Goodsall’s rule.  Methods: After approval from ethical committee and obtaining informed consent from each patient, prospective analys...
Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. Ther... more Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPA...
Background: Acute pancreatitis is a condition associated with a lot of morbidity. There are sever... more Background: Acute pancreatitis is a condition associated with a lot of morbidity. There are several scoring systems that predict the severity of acute pancreatitis, but none are perfect. The aim of this study is to study the various predictors of severity know the association of the parameters with severity of disease.Methods: Our study is a prospective observational study conducted on 80 consecutive patients who presented with features of acute pancreatitis between 20-80 years age group, attending the department of General Surgery, Sree Gokulam Medical College and research foundation, Venjaramoodu, Trivandrum during the period of November 2012 to May 2014. The obtained data was uploaded in Microsoft excel sheet and analysed. Finally, all these variables were correlated with the severity of the disease to find out the association and significance using appropriate statistical methods like Pearson Chi-square test, ANOVA and Kruskal Wallis test.Results: In our study 59 (74%) were male...
Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency ... more Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency room. There are several options for the management of ureteric stones. Ureterorenoscopy and lithotripsy is the commonly used modality because it is less morbid and invasive, but the drawback is proximal stone migration which leads to persisting symptoms and increased costs. The aim of this study is to use an anti-retropulsion device to reduce the rate of proximal stone migration.Methods: This description study was conducted in Sree Gokulam Medical college from December 2014 to December 2015, on 75 consecutive patients who had ureteric stones, of ages 20-60 who were willing to give consent. All patients underwent ureteroscopy and lithotripsy and in those patients from who anti-retropulsion device could not be manipulated proximal to the stone lithotripsy alone was done. Both groups were compared for procedure time, post-operative symptoms and stone free rates.Results: The average time tak...
Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. ... more Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. The early detection of patients who could go in for complication is critical so that appropriate treatment can be initiated to reduce mortality. There is no pre-operative investigation which accurately point out the patients who are going to develop severe disease. Hence this prospective study was done to identify whether preoperative bilirubin level can predict the severity of the disease.Methods: The study was conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant...
Road traffic accidents are one of the most common causes of death in India. Those involved in RTA... more Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA.Â
Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important r... more Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important risk factor. Increasing use of tobacco has made oral cancer a major public health issue. This study aims to get a profile of oral cancer in a tertiary hospital. Methods: This is a prospective study done from January 2014 to June 2015. 106 patients who were above the age of 18 who were previously untreated and biopsy proven were included. Epidemiological factors like age, sex, premalignant conditions, duration of symptoms, site of primary, clinical stage, level of metastases were studied. Results: Oral cancer was seen most in males 63(59.4%). It was most commonly seen in sixth decade of life. Betel nut was the most important risk factor. Oral sub mucous fibrosis was the most common premalignant condition. Tongue was the most common primary site. Clinically most patients presented in stage IV. Level I was the most involved lymph node station. Conclusions: Oral cancer to a great extent can be prevented. Public awareness and education from the grassroots about the ill effects of tobacco would go a long way in dealing with the health menace that oral cancer has become.
Background: Diabetic foot a complication of diabetes can lead to significant morbidity and have f... more Background: Diabetic foot a complication of diabetes can lead to significant morbidity and have financial burden. The standard of dressing diabetic foot ulcers has been saline dressings. Negative pressure vacuum devices have come and had a significant impact on treatment of diabetic ulcers. But in developing countries the cost associated with it makes it inaccessible to a large population. Our study aims to compare the use of modified vacuum dressing against saline dressing and compare healing rates, costs involved and hospital stay of patients.Methods: Our study was prospective study of 80 patients randomised into two groups, of 40 each. Group A consisted of patients with modified vacuum dressing and group B with wet saline dressing. Simple randomisation technique was used. They were compared for healing rates, hospital stay and cost involved.Results: There was a 43.75% decrease in area of the ulcer in group A compared to 25.15% in group B after 4 weeks. Decrease in wound depth was...
Background: Involvement of cervical lymph nodes is the single most important prognostic factor in... more Background: Involvement of cervical lymph nodes is the single most important prognostic factor in oral carcinoma. This study was aimed to evaluate the correlation between tumour stage and lymph node metastasis.Methods: A descriptive study was planned in oral cancer patients who fall within the inclusion criteria. This was compared with the postoperative histopathologic status of cervical nodes. Correlation analysis was done between tumor stage and lymph node metastasis.Results: Total 106 patients were included in the study. The male female ratio was 1.4:1. Majority of the patients 37(34.9%) were in the sixth decade of life. Carcinoma of the tongue was present in 17 cases while only 4 had carcinoma of lower alveolus. Most of the patients with oral cancer presented at an early stage (T1-T2). Stage IV was the commonest with 51 (48.1%) patients. Level I was the most commonly involved lymph node station (78.1%) in squamous cell carcinoma of oral cavity. A weak significant positive correl...
Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important r... more Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important risk factor. Increasing use of tobacco has made oral cancer a major public health issue. This study aims to get a profile of oral cancer in a tertiary hospital. Methods: This is a prospective study done from January 2014 to June 2015. 106 patients who were above the age of 18 who were previously untreated and biopsy proven were included. Epidemiological factors like age, sex, premalignant conditions, duration of symptoms, site of primary, clinical stage, level of metastases were studied.
The low incidence of injury to the recurrent laryngeal nerve (RLN) and external branch of the sup... more The low incidence of injury to the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) quoted in the literature is derived from expert series. The exact incidence of nerve injury of a thyroid surgeon will be revealed only if pre-operative and post-operative laryngoscopy is becoming routine practice. It is found that the injury rates are increased with routine post-operative laryngoscopy. Subjective voice change occurred in one third of patients all whom had normal vocal cord motion. Therefore, it is important to take written informed consent for voice change in addition to identification of both nerves and documenting it.
Background: Despite being one of the oldest reported medical conditions, the management and treat... more Background: Despite being one of the oldest reported medical conditions, the management and treatment of fistula in ano are still in the evolving phase. The management of fistula-in-ano requires confirmation of the diagnosis, identifying the fistulous tract and inner opening. In majority of patients a single primary fistula tract exists and the anatomy can be determined by examination under anaesthesia adhering to the principles described by Goodsall. A thorough clinical examination of the patient is essential in the assessment of fistula-in-ano, sometimes helped by imaging such as magnetic resonance imaging and endoanal ultrasonography. Although Goodsall’s rule was accepted in the past, as a method to determine the course of the fistula, recent studies showed poor conflicting results. Thus, this study attempts to scrutinize the predictive accuracy of Goodsall’s rule.  Methods: After approval from ethical committee and obtaining informed consent from each patient, prospective analys...
Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. Ther... more Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPA...
Background: Acute pancreatitis is a condition associated with a lot of morbidity. There are sever... more Background: Acute pancreatitis is a condition associated with a lot of morbidity. There are several scoring systems that predict the severity of acute pancreatitis, but none are perfect. The aim of this study is to study the various predictors of severity know the association of the parameters with severity of disease.Methods: Our study is a prospective observational study conducted on 80 consecutive patients who presented with features of acute pancreatitis between 20-80 years age group, attending the department of General Surgery, Sree Gokulam Medical College and research foundation, Venjaramoodu, Trivandrum during the period of November 2012 to May 2014. The obtained data was uploaded in Microsoft excel sheet and analysed. Finally, all these variables were correlated with the severity of the disease to find out the association and significance using appropriate statistical methods like Pearson Chi-square test, ANOVA and Kruskal Wallis test.Results: In our study 59 (74%) were male...
Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency ... more Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency room. There are several options for the management of ureteric stones. Ureterorenoscopy and lithotripsy is the commonly used modality because it is less morbid and invasive, but the drawback is proximal stone migration which leads to persisting symptoms and increased costs. The aim of this study is to use an anti-retropulsion device to reduce the rate of proximal stone migration.Methods: This description study was conducted in Sree Gokulam Medical college from December 2014 to December 2015, on 75 consecutive patients who had ureteric stones, of ages 20-60 who were willing to give consent. All patients underwent ureteroscopy and lithotripsy and in those patients from who anti-retropulsion device could not be manipulated proximal to the stone lithotripsy alone was done. Both groups were compared for procedure time, post-operative symptoms and stone free rates.Results: The average time tak...
Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. ... more Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. The early detection of patients who could go in for complication is critical so that appropriate treatment can be initiated to reduce mortality. There is no pre-operative investigation which accurately point out the patients who are going to develop severe disease. Hence this prospective study was done to identify whether preoperative bilirubin level can predict the severity of the disease.Methods: The study was conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant...
Road traffic accidents are one of the most common causes of death in India. Those involved in RTA... more Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA.Â
Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important r... more Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important risk factor. Increasing use of tobacco has made oral cancer a major public health issue. This study aims to get a profile of oral cancer in a tertiary hospital. Methods: This is a prospective study done from January 2014 to June 2015. 106 patients who were above the age of 18 who were previously untreated and biopsy proven were included. Epidemiological factors like age, sex, premalignant conditions, duration of symptoms, site of primary, clinical stage, level of metastases were studied. Results: Oral cancer was seen most in males 63(59.4%). It was most commonly seen in sixth decade of life. Betel nut was the most important risk factor. Oral sub mucous fibrosis was the most common premalignant condition. Tongue was the most common primary site. Clinically most patients presented in stage IV. Level I was the most involved lymph node station. Conclusions: Oral cancer to a great extent can be prevented. Public awareness and education from the grassroots about the ill effects of tobacco would go a long way in dealing with the health menace that oral cancer has become.
Background: Diabetic foot a complication of diabetes can lead to significant morbidity and have f... more Background: Diabetic foot a complication of diabetes can lead to significant morbidity and have financial burden. The standard of dressing diabetic foot ulcers has been saline dressings. Negative pressure vacuum devices have come and had a significant impact on treatment of diabetic ulcers. But in developing countries the cost associated with it makes it inaccessible to a large population. Our study aims to compare the use of modified vacuum dressing against saline dressing and compare healing rates, costs involved and hospital stay of patients.Methods: Our study was prospective study of 80 patients randomised into two groups, of 40 each. Group A consisted of patients with modified vacuum dressing and group B with wet saline dressing. Simple randomisation technique was used. They were compared for healing rates, hospital stay and cost involved.Results: There was a 43.75% decrease in area of the ulcer in group A compared to 25.15% in group B after 4 weeks. Decrease in wound depth was...
Background: Involvement of cervical lymph nodes is the single most important prognostic factor in... more Background: Involvement of cervical lymph nodes is the single most important prognostic factor in oral carcinoma. This study was aimed to evaluate the correlation between tumour stage and lymph node metastasis.Methods: A descriptive study was planned in oral cancer patients who fall within the inclusion criteria. This was compared with the postoperative histopathologic status of cervical nodes. Correlation analysis was done between tumor stage and lymph node metastasis.Results: Total 106 patients were included in the study. The male female ratio was 1.4:1. Majority of the patients 37(34.9%) were in the sixth decade of life. Carcinoma of the tongue was present in 17 cases while only 4 had carcinoma of lower alveolus. Most of the patients with oral cancer presented at an early stage (T1-T2). Stage IV was the commonest with 51 (48.1%) patients. Level I was the most commonly involved lymph node station (78.1%) in squamous cell carcinoma of oral cavity. A weak significant positive correl...
Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important r... more Background: Oral cancer is the 3 rd most common cancers in India. Tobacco is the most important risk factor. Increasing use of tobacco has made oral cancer a major public health issue. This study aims to get a profile of oral cancer in a tertiary hospital. Methods: This is a prospective study done from January 2014 to June 2015. 106 patients who were above the age of 18 who were previously untreated and biopsy proven were included. Epidemiological factors like age, sex, premalignant conditions, duration of symptoms, site of primary, clinical stage, level of metastases were studied.
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