Kshitij Raghuvanshi

Abstract

Background: Acute cholecystitis is the commonest complication of cholelithiasis. Although Laparoscopic Cholecystectomy has now been accepted as the gold standard for managing cholecystitis with or without cholelithiasis, a similar acceptance for the management of acute cholecystitis (AC) remains controversial because of technical difficulties. The aim of the study is to evaluate the applicability of LC in the cases presented with acute cholecystitis. Material and Methods: A Prospective comparative study was done of all the patients admitted in a tertiary care hospital with acute and chronic cholecystitis who will be undergoing surgery above the age of 20 years. Data analysis is done by using SPSS (Statistical package for social sciences) Version 19.0. We have used Chi-square test significance between acute and chronic cholecystitis with respect to qualitative data variables of Mann-Whitney U test. Results: The current study included 58 cases, of which 25 presented with acute cholecystitis and 33 with chronic cholecystitis. All 25 cases with acute cholecystitis reported abdominal pain. Of the 25 cases in the acute cholecystitis group, 21 cases (88 %) did not report any postoperative complication. There was no significant difference in the operative time between acute and chronic cholecystitis. Conclusion: Laparoscopic Cholecystectomy is safe in both acute and chronic cholecystitis. Our study suggests that it is advisable to operate in the acute cholecystitis that to in the 24-72 hours after the presentation of symptoms. It is important that this type of surgery is performed only by experienced surgeons or under close supervision of experts. Keywords: Laparoscopic, Cholecystectomy, Gall bladder, Acute, Chronic.

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Abstract

Background: Urolithiasis (urinary stones) is an ailment affecting 12% of the world population. 70% of urolithiasis is located in the lower third of the ureter. Nowadays to increase the expulsion rate and reduce analgesic consumption, there is great deal of enthusiasm for adjuvant pharmacologic intervention when a conservative therapy. The aim of the study is to evaluate the efficacy of a 1-blocker (tamsulosin) therapy in the management of distal ureteral stones when administered as the only drug or in conjugation with Corticosteroid (deflazecort), when the watchful waiting therapy is considered. Material and Methods: A prospective study performed on 200 patients with distal ureteral stones. The patients enrolled in this study were assigned into three groups: Group A (patients received Tamsulosin and NSAID) Group B (patients received both Tamsulosin and Deflazacort and NSAID) Group C (control). Results: In our study, Majority of patients were in the age group of 21-30 (109 cases). The study showed that 100% (200 patients) complained of pain in abdomen. Mean size of stone in Group A was 6.12mm, mean size of stone in group B was 6.55mm and mean size of stone in group C was 5.88mm. In Group A 42 (64%) patients passed stone, Group B, 56 (88%) Patients passed stone, and in Group C, 25 (37%) patients passed stone. Conclusion: Use of Tamsulosin (alpha1-blocker) with Deflazecort (corticosteroid) proves to be more efficacious than Tamsulosin used alone. In addition, Tamsulosin used on its own as a medical expulsive therapy. Keywords: Tamsulosin, Corticosteroid, Ureter stone.

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