Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbi...Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.展开更多
Background:Kashmir has a population that largely consumes polished rice which is deficient in thiamine.Furthermore,lactating women in this region are prone to severe thiamine deficiency because of their traditional fo...Background:Kashmir has a population that largely consumes polished rice which is deficient in thiamine.Furthermore,lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices.Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.Methods:This was a one year prospective hospitalbased study.We included 50 exclusively breastfed infants in our study.AH patients were evaluated as per unit protocol including complete septic workup and metabolic workup.Most of our patients belonged to low and middle income group families,and mothers were on customary dietary restriction.Demographic and anthropometric data were collected from all the study participants.In addition,data regarding the treatments received by the study population and overall mortality were collected.Results:The mean age,male:female ratio,and mean weight of the study population were 3.15±0.97 months,1.5∶1,and 5.1±1.1 kg,respectively.Traditional food avoidance practices were followed by 80% of the mothers.Irritability was observed in 40 (80%) patients.Blepharoptosis was observed in 30 (60%).Septic workup including cerebro spinal fluid analysis was normal in all patients.Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity.Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L).Ten percent of the study infants died.Conclusion:In exclusively breasffed infants,we observed acute infantile encephalopathy with epidemiological,clinical,biochemical,and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.展开更多
文摘Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.
文摘Background:Kashmir has a population that largely consumes polished rice which is deficient in thiamine.Furthermore,lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices.Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.Methods:This was a one year prospective hospitalbased study.We included 50 exclusively breastfed infants in our study.AH patients were evaluated as per unit protocol including complete septic workup and metabolic workup.Most of our patients belonged to low and middle income group families,and mothers were on customary dietary restriction.Demographic and anthropometric data were collected from all the study participants.In addition,data regarding the treatments received by the study population and overall mortality were collected.Results:The mean age,male:female ratio,and mean weight of the study population were 3.15±0.97 months,1.5∶1,and 5.1±1.1 kg,respectively.Traditional food avoidance practices were followed by 80% of the mothers.Irritability was observed in 40 (80%) patients.Blepharoptosis was observed in 30 (60%).Septic workup including cerebro spinal fluid analysis was normal in all patients.Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity.Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L).Ten percent of the study infants died.Conclusion:In exclusively breasffed infants,we observed acute infantile encephalopathy with epidemiological,clinical,biochemical,and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.
