Anurag Rai - Academia.edu (original) (raw)

Papers by Anurag Rai

International Journal of Angiology, 2021

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aor... more Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.

International Journal of Angiology, 2021

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aor... more Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.

Heart, Lung and Circulation, 2018

The purpose of this research is to present a new mathematical modeling for a vehicle routing prob... more The purpose of this research is to present a new mathematical modeling for a vehicle routing problem considering concurrently the criteria such as distance, weight, traffic considerations, time window limitation, and heterogeneous vehicles in the reverse logistics network for collection of expired products. In addition, we aim to present an efficient solution approach according to differential evolution (DE) procedure to solve such a complicated problem. By using mathematical modeling tools for formulating the environmental sensitivities in vehicle routing problems, the reverse logistics must be managed according to criteria such as cargo weight carried by the vehicle, the vehicle speed and the covered distance by the vehicle. This leads to optimization and reduction of transportation fuel consumption and hence reduction of air pollution and environment concerns. This concept has led to creation and study of the green vehicle routing problems in this paper. Numerical analysis indicates that performance of the proposed DE algorithm can be validated in terms of CPU run time and optimality gap for solving the proposed model. Furthermore, sensitivity analysis show that extending maximum travelling distance by each vehicle, and increasing capacity of vehicles lead to reduction of total cost in the problem.

The Internet Journal of Surgery, 2009

Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is respon... more Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is responsible for up to 2% of the malignant neoplasms of this organ. While SCC commonly presents as abdominal lump and/or jaundice, some cases with unusual presentations have been reported in literature. Squamous cell carcinoma of the gall bladder may present rarely as empyema or acute cholecystitis. We report here a rather unusual presentation of a case of a squamous cell carcinoma of the gallbladder in a 60-year-old male presenting as pyoperitoneum.

Heart, Lung and Circulation, 2018

The purpose of this research is to present a new mathematical modeling for a vehicle routing prob... more The purpose of this research is to present a new mathematical modeling for a vehicle routing problem considering concurrently the criteria such as distance, weight, traffic considerations, time window limitation, and heterogeneous vehicles in the reverse logistics network for collection of expired products. In addition, we aim to present an efficient solution approach according to differential evolution (DE) procedure to solve such a complicated problem. By using mathematical modeling tools for formulating the environmental sensitivities in vehicle routing problems, the reverse logistics must be managed according to criteria such as cargo weight carried by the vehicle, the vehicle speed and the covered distance by the vehicle. This leads to optimization and reduction of transportation fuel consumption and hence reduction of air pollution and environment concerns. This concept has led to creation and study of the green vehicle routing problems in this paper. Numerical analysis indicates that performance of the proposed DE algorithm can be validated in terms of CPU run time and optimality gap for solving the proposed model. Furthermore, sensitivity analysis show that extending maximum travelling distance by each vehicle, and increasing capacity of vehicles lead to reduction of total cost in the problem.

The Internet Journal of Surgery, 2009

The spontaneous perforation of the intestine through the abdominal wall is an extremely rare cond... more The spontaneous perforation of the intestine through the abdominal wall is an extremely rare condition. We encountered a case of spontaneous enterocutaneous fistula through the anterior abdominal wall in the right inguinal region. In view of the rarity of this complication and the paucity of published articles, a case of spontaneous enterocutaneous fistula is being reported here. CASE REPORT This is a case report of a 60-year-old farmer who developed spontaneous enterocutaneous fistula in the right inguinal region. He presented in the surgical emergency ward of CSMMU with the complaints of pain in abdomen, fever, localized pain and swelling in the right inguinal region, absolute constipation, later he developed a wound in the right inguinal region with feculent discharge through its centre.

Heart, Lung and Circulation, 2018

S581 (p < .01). Freedom from red blood cell transfusion was 86% in the RAP group versus 76% in th... more S581 (p < .01). Freedom from red blood cell transfusion was 86% in the RAP group versus 76% in the conrol group (p = .03). Conclusion: Retrograde autologous priming is a safe method for minimising haemodilution due to crystalloid prime. We have seen a significant reduction in crystalloid usage. Blood transfusion rates were also significantly lower in the RAP group.

Journal of Medical Science And clinical Research, 2016

Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-savi... more Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-saving and definitive management. In traumatic lung injury patients, till date thorax trauma severity score (TTSS) was calculated by using conventational X raychest. MDCT 64 slice (Multirow Detector-CT) Scan has significantly shorter scanning time and higher injury detection rate than conventional X-ray chest and single slice CT Scan (SSCT). We observed role of early emergency CT scan Thorax (MDCT) in traumatic lung injury patients. Objective: The aim of this study is to validate thorax trauma severity score (TTSS) using early MDCT 64 slice (Multirow Detector-CT). Material & Methods: In this retrospective study, 80 patients of Isolated chest injuries (blunt and penetrating chest injuries) having AIS THORAX > 1 admitted at King George's Medical University Trauma Centre, Luck now ,between June 2012 to July 2013 who were scanned early in Emergency Department with MDCT 64-slice and helical single slice CT using the standardized multiple trauma protocol(ATLS guidelines), were eligible for the study.All records were noted from case sheet from the time of admission and subsequently followed regarding suitable management like surgical intervention or mechanical ventilation or thorax related complication or follow up complications. Results: Of the 80 patients included in the study, 52 (65%) developed thoraxrelated complications. The overall inhospital mortality rate was 10%. The receiver operating characteristic(ROC) curve for predicting mortality demonstrated an adequate discrimination by a statistically significant higher Area under curve (AUC) in patients who died of thorax-related complications than in patients who survived (P =0.002, confidence interval [CI] 95% for TTSS MDCT). In patients who developed ARDS the TTSS was significant higher (P = 0.0001, CI 95%).Area under curve (AUC) of TTSS ROC curve was highest for MDCT (0.81) then for Single slice CT (0.79) and least for x-ray(0.78), indicating highest sensitivity, specificity and predictive ability of MDCT, then SSCT and conventional x-ray for predicting mortality in emergency department. Area under curve (AUC) of TTSS ROC curve was highest for MDCT(0.92) then for Single slice CT (0.85)and least for x-ray (0.81), indicating highest sensitivity, specificity and predictive ability of MDCT, then Single slice CT and conventional x-ray for predicting ARDS. Conclusion: This study validate the Thoracic Trauma Severity Score(TTSS) with new emerging concept of early emergency Department Muti-row detector CT in secondary survey for predicting mortality in critically ill thoracic injury patients. TTSS MDCT (thorax trauma severity score on the basis of MDCT64 slice findings) appears capable of predicting ARDS more precisely then TTSSx-ray (thorax trauma severity score on the bases of chest x-ray findings).Thus shows the significance of early emergency MDCT in diagnostics and treatment decisions in traumatic lung injured patients.

International Journal of Medical Research and Review, 2016

Introduction: Ileal perforation is a common surgical emergency especially in Indian sub-continent... more Introduction: Ileal perforation is a common surgical emergency especially in Indian sub-continent due to increased incidence of enteric fever and tuberculosis-two most common causes of ileal perforation. Many different techniques had been applied for treatment of perforation like primary closure, exteriorization of perforation site or primary closure with proximal diversion stoma. Many cases are not suitable for primary closure; in such cases ileostomy is done. Ileostomy is associated with significant morbidity which adds to financial burden and decreases quality of life. Tube ileostomy has been explored as an alternative to conventional ileostomy sans its morbidity. Methods: Here we retrospectively analyzed ileal perforation cases treated with either loop ileostomy or tube ileostomy at our centre during last 3 years. Result: A total of 50 ileal perforation cases treated with ileostomy either tube ileostomy (n = 21) or conventional loop ileostomy (n = 29) were included for study and their immediate and late post operative complications were recorded and analysed. Conclusion: We found that tube ileostomy is a safe and effective mode of diversion and is associated with minimal stoma related morbidity like peristomal excoriation, hernia, retraction, prolapse, obstruction etc.

The Internet Journal of Thoracic and Cardiovascular Surgery, 2009

Introduction: of all causes of traumatic injuries, thoracic trauma is considered to be an attribu... more Introduction: of all causes of traumatic injuries, thoracic trauma is considered to be an attributed to thoracic injury. The favoured management for thoracic trauma till date is prolonged ICD insertion and to resuscitate patient to maintain hemodynamic parameter or to go for open thoracostomy in unstable patients as per indication. Video Assisted Thoracoscopic Surgery is being increasingly utilized as diagnostic as well as theraupeautic modality in management of stable patient with thoracic injury. This study was designed to evaluate the efficacy of VATS in the management of thoracic trauma in term of pain, dose of analgesic used, duration of hospital stay, restoration of pulmonary function and complication rate. Method: The study was conducted on 70 patients of thoracic injury (Blunt or Penetrating) who presented in Trauma Center of CSMMU (formerly K.G.M.U.), Lcuknow,India.. The patients were matched for Age and Sex and randomly, and are assigned in to two groups-I st group treated by VATS, II nd group treated by prolonged ICD insertion only, the outcome in various aspect was analyzed. Results: Various procedures were done using VATS (Video Assisted Thoracoscopic Surgery) Clot evacuation and irrigation, electrocoagulation of bleeder, stapling of avulsed lung parenchyma, diaphragmatic repair). Pain improvement (p<.001), improvement in dyspnoea (p<.05), early restoration of pulmonary function and radiological improvement were statistically significant in VATS treated group on 7 th post procedure day with less complication rate and less duration of hospital stay (p<.001). Conclusions: VATS (Video Assisted Thoracoscopic Surgery is a better option than conventional ICD insertion only for management of thoracic injury with better and early Clinico-radiological and functional improvement, with less early complication rate and shorter duration of hospital stay.

The Internet Journal of Surgery, 2009

A long loop of small bowel had herniated between the diaphragm and the right lobe of liver in a 7... more A long loop of small bowel had herniated between the diaphragm and the right lobe of liver in a 72-year-old lady presenting with acute abdomen and features of intestinal obstruction. The unresponsiveness to non-operative management warranted an exploration. A fibrous band between the small bowel mesentery and the lateral abdominal wall was found which had led to the rotation and internal herniation of small bowel. A review of literature over the past 30 years describes two cases of small bowel leading to the Chilaiditi syndrome. However, we present a unique case where a thick band between the small bowel mesentery and the lateral abdominal wall led to internal herniation and hepato-diaphragmatic interposition of small bowel.

The Internet Journal of Surgery, 2009

Epidermoid cysts are benign tumors arising from ectopic epiblastic inclusions. We report a case o... more Epidermoid cysts are benign tumors arising from ectopic epiblastic inclusions. We report a case of an epidermoid cyst in the pre-sacral region presenting as recurrent perianal sinus in a 16-year-old girl, misdiagnosed as fistula-in-ano.

The Internet Journal of Surgery, 2009

Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is respon... more Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is responsible for up to 2% of the malignant neoplasms of this organ. While SCC commonly presents as abdominal lump and/or jaundice, some cases with unusual presentations have been reported in literature. Squamous cell carcinoma of the gall bladder may present rarely as empyema or acute cholecystitis. We report here a rather unusual presentation of a case of a squamous cell carcinoma of the gallbladder in a 60-year-old male presenting as pyoperitoneum.

The Internet Journal of Surgery, 2009

The spontaneous perforation of the intestine through the abdominal wall is an extremely rare cond... more The spontaneous perforation of the intestine through the abdominal wall is an extremely rare condition. We encountered a case of spontaneous enterocutaneous fistula through the anterior abdominal wall in the right inguinal region. In view of the rarity of this complication and the paucity of published articles, a case of spontaneous enterocutaneous fistula is being reported here. CASE REPORT This is a case report of a 60-year-old farmer who developed spontaneous enterocutaneous fistula in the right inguinal region. He presented in the surgical emergency ward of CSMMU with the complaints of pain in abdomen, fever, localized pain and swelling in the right inguinal region, absolute constipation, later he developed a wound in the right inguinal region with feculent discharge through its centre.

BMJ case reports, 2012

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a danger... more To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Journal of Medical Science And clinical Research, 2016

Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-savi... more Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-saving and definitive management. In traumatic lung injury patients, till date thorax trauma severity score (TTSS) was calculated by using conventational X raychest. MDCT 64 slice (Multirow Detector-CT) Scan has significantly shorter scanning time and higher injury detection rate than conventional X-ray chest and single slice CT Scan (SSCT). We observed role of early emergency CT scan Thorax (MDCT) in traumatic lung injury patients. Objective: The aim of this study is to validate thorax trauma severity score (TTSS) using early MDCT 64 slice (Multirow Detector-CT). Material & Methods: In this retrospective study, 80 patients of Isolated chest injuries (blunt and penetrating chest injuries) having AIS THORAX > 1 admitted at King George's Medical University Trauma Centre, Luck now ,between June 2012 to July 2013 who were scanned early in Emergency Department with MDCT 64-slice and helical single slice CT using the standardized multiple trauma protocol(ATLS guidelines), were eligible for the study.All records were noted from case sheet from the time of admission and subsequently followed regarding suitable management like surgical intervention or mechanical ventilation or thorax related complication or follow up complications. Results: Of the 80 patients included in the study, 52 (65%) developed thoraxrelated complications. The overall inhospital mortality rate was 10%. The receiver operating characteristic(ROC) curve for predicting mortality demonstrated an adequate discrimination by a statistically significant higher Area under curve (AUC) in patients who died of thorax-related complications than in patients who survived (P =0.002, confidence interval [CI] 95% for TTSS MDCT). In patients who developed ARDS the TTSS was significant higher (P = 0.0001, CI 95%).Area under curve (AUC) of TTSS ROC curve was highest for MDCT (0.81) then for Single slice CT (0.79) and least for x-ray(0.78), indicating highest sensitivity, specificity and predictive ability of MDCT, then SSCT and conventional x-ray for predicting mortality in emergency department. Area under curve (AUC) of TTSS ROC curve was highest for MDCT(0.92) then for Single slice CT (0.85)and least for x-ray (0.81), indicating highest sensitivity, specificity and predictive ability of MDCT, then Single slice CT and conventional x-ray for predicting ARDS. Conclusion: This study validate the Thoracic Trauma Severity Score(TTSS) with new emerging concept of early emergency Department Muti-row detector CT in secondary survey for predicting mortality in critically ill thoracic injury patients. TTSS MDCT (thorax trauma severity score on the basis of MDCT64 slice findings) appears capable of predicting ARDS more precisely then TTSSx-ray (thorax trauma severity score on the bases of chest x-ray findings).Thus shows the significance of early emergency MDCT in diagnostics and treatment decisions in traumatic lung injured patients.

BMJ case reports, 2012

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a danger... more To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Journal of Emergencies, Trauma, and Shock, 2010

Diffuse guarding, rigidity, and a tympanic abdomen pointed towards peritonitis. The scrotal area ... more Diffuse guarding, rigidity, and a tympanic abdomen pointed towards peritonitis. The scrotal area was found to be stained with greenish material with fecal odor. A closer examination revealed fecal material flowing out of an opening at the root of the right scrotum, the surrounding skin being inflamed and macerated.[Figure 1] The inguinal hernia on the right side was tense, tender, irreducible and had a doughy consistency. The patient was immediately resuscitated with 2 liters of Ringer lactate with two large bore 16G catheters and reassessed in one hour when the patient's blood pressure improved to 106/74 mmHg. The patient was given 2g intravenous ceftriaxone, 500mg amikacin, and 500mg metronidazole. The patient's initial blood parameters showed hemoglobin of 8 g/dl, total leukocyte count 16500 cells/mm 3 , serum urea (48mg/dl), serum creatinine (0.8mg/dl), serum sodium, potassium 132 and 3.5 mEq/L, respectively. A plain abdominal radiograph of the abdomen revealed pneumoperitoneum. Further radiological investigations were limited to an ultrasound in the Emergency department showing free intraperitoneal air and fluid along with the confirmation of bowel loops in the inguinal hernia. Dye studies to identify the source of the fistula were withheld as the obstructed bowel contents in the strangulated inguinal hernia was the obvious source of the fecal fistula and the patient was planned for exploration. One unit of fresh whole blood was transfused prior to surgery. The patient underwent exploratory laparotomy through a vertical midline incision that revealed moderate amount of pus and dirty flakes contaminating the peritoneal cavity. The caecum with the appendix had traversed through right inguinal canal to lie in the scrotum. The caecum had

International Journal of Angiology, 2021

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aor... more Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.

International Journal of Angiology, 2021

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aor... more Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.

Heart, Lung and Circulation, 2018

The purpose of this research is to present a new mathematical modeling for a vehicle routing prob... more The purpose of this research is to present a new mathematical modeling for a vehicle routing problem considering concurrently the criteria such as distance, weight, traffic considerations, time window limitation, and heterogeneous vehicles in the reverse logistics network for collection of expired products. In addition, we aim to present an efficient solution approach according to differential evolution (DE) procedure to solve such a complicated problem. By using mathematical modeling tools for formulating the environmental sensitivities in vehicle routing problems, the reverse logistics must be managed according to criteria such as cargo weight carried by the vehicle, the vehicle speed and the covered distance by the vehicle. This leads to optimization and reduction of transportation fuel consumption and hence reduction of air pollution and environment concerns. This concept has led to creation and study of the green vehicle routing problems in this paper. Numerical analysis indicates that performance of the proposed DE algorithm can be validated in terms of CPU run time and optimality gap for solving the proposed model. Furthermore, sensitivity analysis show that extending maximum travelling distance by each vehicle, and increasing capacity of vehicles lead to reduction of total cost in the problem.

The Internet Journal of Surgery, 2009

Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is respon... more Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is responsible for up to 2% of the malignant neoplasms of this organ. While SCC commonly presents as abdominal lump and/or jaundice, some cases with unusual presentations have been reported in literature. Squamous cell carcinoma of the gall bladder may present rarely as empyema or acute cholecystitis. We report here a rather unusual presentation of a case of a squamous cell carcinoma of the gallbladder in a 60-year-old male presenting as pyoperitoneum.

Heart, Lung and Circulation, 2018

The purpose of this research is to present a new mathematical modeling for a vehicle routing prob... more The purpose of this research is to present a new mathematical modeling for a vehicle routing problem considering concurrently the criteria such as distance, weight, traffic considerations, time window limitation, and heterogeneous vehicles in the reverse logistics network for collection of expired products. In addition, we aim to present an efficient solution approach according to differential evolution (DE) procedure to solve such a complicated problem. By using mathematical modeling tools for formulating the environmental sensitivities in vehicle routing problems, the reverse logistics must be managed according to criteria such as cargo weight carried by the vehicle, the vehicle speed and the covered distance by the vehicle. This leads to optimization and reduction of transportation fuel consumption and hence reduction of air pollution and environment concerns. This concept has led to creation and study of the green vehicle routing problems in this paper. Numerical analysis indicates that performance of the proposed DE algorithm can be validated in terms of CPU run time and optimality gap for solving the proposed model. Furthermore, sensitivity analysis show that extending maximum travelling distance by each vehicle, and increasing capacity of vehicles lead to reduction of total cost in the problem.

The Internet Journal of Surgery, 2009

The spontaneous perforation of the intestine through the abdominal wall is an extremely rare cond... more The spontaneous perforation of the intestine through the abdominal wall is an extremely rare condition. We encountered a case of spontaneous enterocutaneous fistula through the anterior abdominal wall in the right inguinal region. In view of the rarity of this complication and the paucity of published articles, a case of spontaneous enterocutaneous fistula is being reported here. CASE REPORT This is a case report of a 60-year-old farmer who developed spontaneous enterocutaneous fistula in the right inguinal region. He presented in the surgical emergency ward of CSMMU with the complaints of pain in abdomen, fever, localized pain and swelling in the right inguinal region, absolute constipation, later he developed a wound in the right inguinal region with feculent discharge through its centre.

Heart, Lung and Circulation, 2018

S581 (p < .01). Freedom from red blood cell transfusion was 86% in the RAP group versus 76% in th... more S581 (p < .01). Freedom from red blood cell transfusion was 86% in the RAP group versus 76% in the conrol group (p = .03). Conclusion: Retrograde autologous priming is a safe method for minimising haemodilution due to crystalloid prime. We have seen a significant reduction in crystalloid usage. Blood transfusion rates were also significantly lower in the RAP group.

Journal of Medical Science And clinical Research, 2016

Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-savi... more Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-saving and definitive management. In traumatic lung injury patients, till date thorax trauma severity score (TTSS) was calculated by using conventational X raychest. MDCT 64 slice (Multirow Detector-CT) Scan has significantly shorter scanning time and higher injury detection rate than conventional X-ray chest and single slice CT Scan (SSCT). We observed role of early emergency CT scan Thorax (MDCT) in traumatic lung injury patients. Objective: The aim of this study is to validate thorax trauma severity score (TTSS) using early MDCT 64 slice (Multirow Detector-CT). Material & Methods: In this retrospective study, 80 patients of Isolated chest injuries (blunt and penetrating chest injuries) having AIS THORAX > 1 admitted at King George's Medical University Trauma Centre, Luck now ,between June 2012 to July 2013 who were scanned early in Emergency Department with MDCT 64-slice and helical single slice CT using the standardized multiple trauma protocol(ATLS guidelines), were eligible for the study.All records were noted from case sheet from the time of admission and subsequently followed regarding suitable management like surgical intervention or mechanical ventilation or thorax related complication or follow up complications. Results: Of the 80 patients included in the study, 52 (65%) developed thoraxrelated complications. The overall inhospital mortality rate was 10%. The receiver operating characteristic(ROC) curve for predicting mortality demonstrated an adequate discrimination by a statistically significant higher Area under curve (AUC) in patients who died of thorax-related complications than in patients who survived (P =0.002, confidence interval [CI] 95% for TTSS MDCT). In patients who developed ARDS the TTSS was significant higher (P = 0.0001, CI 95%).Area under curve (AUC) of TTSS ROC curve was highest for MDCT (0.81) then for Single slice CT (0.79) and least for x-ray(0.78), indicating highest sensitivity, specificity and predictive ability of MDCT, then SSCT and conventional x-ray for predicting mortality in emergency department. Area under curve (AUC) of TTSS ROC curve was highest for MDCT(0.92) then for Single slice CT (0.85)and least for x-ray (0.81), indicating highest sensitivity, specificity and predictive ability of MDCT, then Single slice CT and conventional x-ray for predicting ARDS. Conclusion: This study validate the Thoracic Trauma Severity Score(TTSS) with new emerging concept of early emergency Department Muti-row detector CT in secondary survey for predicting mortality in critically ill thoracic injury patients. TTSS MDCT (thorax trauma severity score on the basis of MDCT64 slice findings) appears capable of predicting ARDS more precisely then TTSSx-ray (thorax trauma severity score on the bases of chest x-ray findings).Thus shows the significance of early emergency MDCT in diagnostics and treatment decisions in traumatic lung injured patients.

International Journal of Medical Research and Review, 2016

Introduction: Ileal perforation is a common surgical emergency especially in Indian sub-continent... more Introduction: Ileal perforation is a common surgical emergency especially in Indian sub-continent due to increased incidence of enteric fever and tuberculosis-two most common causes of ileal perforation. Many different techniques had been applied for treatment of perforation like primary closure, exteriorization of perforation site or primary closure with proximal diversion stoma. Many cases are not suitable for primary closure; in such cases ileostomy is done. Ileostomy is associated with significant morbidity which adds to financial burden and decreases quality of life. Tube ileostomy has been explored as an alternative to conventional ileostomy sans its morbidity. Methods: Here we retrospectively analyzed ileal perforation cases treated with either loop ileostomy or tube ileostomy at our centre during last 3 years. Result: A total of 50 ileal perforation cases treated with ileostomy either tube ileostomy (n = 21) or conventional loop ileostomy (n = 29) were included for study and their immediate and late post operative complications were recorded and analysed. Conclusion: We found that tube ileostomy is a safe and effective mode of diversion and is associated with minimal stoma related morbidity like peristomal excoriation, hernia, retraction, prolapse, obstruction etc.

The Internet Journal of Thoracic and Cardiovascular Surgery, 2009

Introduction: of all causes of traumatic injuries, thoracic trauma is considered to be an attribu... more Introduction: of all causes of traumatic injuries, thoracic trauma is considered to be an attributed to thoracic injury. The favoured management for thoracic trauma till date is prolonged ICD insertion and to resuscitate patient to maintain hemodynamic parameter or to go for open thoracostomy in unstable patients as per indication. Video Assisted Thoracoscopic Surgery is being increasingly utilized as diagnostic as well as theraupeautic modality in management of stable patient with thoracic injury. This study was designed to evaluate the efficacy of VATS in the management of thoracic trauma in term of pain, dose of analgesic used, duration of hospital stay, restoration of pulmonary function and complication rate. Method: The study was conducted on 70 patients of thoracic injury (Blunt or Penetrating) who presented in Trauma Center of CSMMU (formerly K.G.M.U.), Lcuknow,India.. The patients were matched for Age and Sex and randomly, and are assigned in to two groups-I st group treated by VATS, II nd group treated by prolonged ICD insertion only, the outcome in various aspect was analyzed. Results: Various procedures were done using VATS (Video Assisted Thoracoscopic Surgery) Clot evacuation and irrigation, electrocoagulation of bleeder, stapling of avulsed lung parenchyma, diaphragmatic repair). Pain improvement (p<.001), improvement in dyspnoea (p<.05), early restoration of pulmonary function and radiological improvement were statistically significant in VATS treated group on 7 th post procedure day with less complication rate and less duration of hospital stay (p<.001). Conclusions: VATS (Video Assisted Thoracoscopic Surgery is a better option than conventional ICD insertion only for management of thoracic injury with better and early Clinico-radiological and functional improvement, with less early complication rate and shorter duration of hospital stay.

The Internet Journal of Surgery, 2009

A long loop of small bowel had herniated between the diaphragm and the right lobe of liver in a 7... more A long loop of small bowel had herniated between the diaphragm and the right lobe of liver in a 72-year-old lady presenting with acute abdomen and features of intestinal obstruction. The unresponsiveness to non-operative management warranted an exploration. A fibrous band between the small bowel mesentery and the lateral abdominal wall was found which had led to the rotation and internal herniation of small bowel. A review of literature over the past 30 years describes two cases of small bowel leading to the Chilaiditi syndrome. However, we present a unique case where a thick band between the small bowel mesentery and the lateral abdominal wall led to internal herniation and hepato-diaphragmatic interposition of small bowel.

The Internet Journal of Surgery, 2009

Epidermoid cysts are benign tumors arising from ectopic epiblastic inclusions. We report a case o... more Epidermoid cysts are benign tumors arising from ectopic epiblastic inclusions. We report a case of an epidermoid cyst in the pre-sacral region presenting as recurrent perianal sinus in a 16-year-old girl, misdiagnosed as fistula-in-ano.

The Internet Journal of Surgery, 2009

Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is respon... more Squamous cell carcinoma (SCC) of the gallbladder is a rare and aggressive affection and is responsible for up to 2% of the malignant neoplasms of this organ. While SCC commonly presents as abdominal lump and/or jaundice, some cases with unusual presentations have been reported in literature. Squamous cell carcinoma of the gall bladder may present rarely as empyema or acute cholecystitis. We report here a rather unusual presentation of a case of a squamous cell carcinoma of the gallbladder in a 60-year-old male presenting as pyoperitoneum.

The Internet Journal of Surgery, 2009

The spontaneous perforation of the intestine through the abdominal wall is an extremely rare cond... more The spontaneous perforation of the intestine through the abdominal wall is an extremely rare condition. We encountered a case of spontaneous enterocutaneous fistula through the anterior abdominal wall in the right inguinal region. In view of the rarity of this complication and the paucity of published articles, a case of spontaneous enterocutaneous fistula is being reported here. CASE REPORT This is a case report of a 60-year-old farmer who developed spontaneous enterocutaneous fistula in the right inguinal region. He presented in the surgical emergency ward of CSMMU with the complaints of pain in abdomen, fever, localized pain and swelling in the right inguinal region, absolute constipation, later he developed a wound in the right inguinal region with feculent discharge through its centre.

BMJ case reports, 2012

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a danger... more To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Journal of Medical Science And clinical Research, 2016

Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-savi... more Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-saving and definitive management. In traumatic lung injury patients, till date thorax trauma severity score (TTSS) was calculated by using conventational X raychest. MDCT 64 slice (Multirow Detector-CT) Scan has significantly shorter scanning time and higher injury detection rate than conventional X-ray chest and single slice CT Scan (SSCT). We observed role of early emergency CT scan Thorax (MDCT) in traumatic lung injury patients. Objective: The aim of this study is to validate thorax trauma severity score (TTSS) using early MDCT 64 slice (Multirow Detector-CT). Material & Methods: In this retrospective study, 80 patients of Isolated chest injuries (blunt and penetrating chest injuries) having AIS THORAX > 1 admitted at King George's Medical University Trauma Centre, Luck now ,between June 2012 to July 2013 who were scanned early in Emergency Department with MDCT 64-slice and helical single slice CT using the standardized multiple trauma protocol(ATLS guidelines), were eligible for the study.All records were noted from case sheet from the time of admission and subsequently followed regarding suitable management like surgical intervention or mechanical ventilation or thorax related complication or follow up complications. Results: Of the 80 patients included in the study, 52 (65%) developed thoraxrelated complications. The overall inhospital mortality rate was 10%. The receiver operating characteristic(ROC) curve for predicting mortality demonstrated an adequate discrimination by a statistically significant higher Area under curve (AUC) in patients who died of thorax-related complications than in patients who survived (P =0.002, confidence interval [CI] 95% for TTSS MDCT). In patients who developed ARDS the TTSS was significant higher (P = 0.0001, CI 95%).Area under curve (AUC) of TTSS ROC curve was highest for MDCT (0.81) then for Single slice CT (0.79) and least for x-ray(0.78), indicating highest sensitivity, specificity and predictive ability of MDCT, then SSCT and conventional x-ray for predicting mortality in emergency department. Area under curve (AUC) of TTSS ROC curve was highest for MDCT(0.92) then for Single slice CT (0.85)and least for x-ray (0.81), indicating highest sensitivity, specificity and predictive ability of MDCT, then Single slice CT and conventional x-ray for predicting ARDS. Conclusion: This study validate the Thoracic Trauma Severity Score(TTSS) with new emerging concept of early emergency Department Muti-row detector CT in secondary survey for predicting mortality in critically ill thoracic injury patients. TTSS MDCT (thorax trauma severity score on the basis of MDCT64 slice findings) appears capable of predicting ARDS more precisely then TTSSx-ray (thorax trauma severity score on the bases of chest x-ray findings).Thus shows the significance of early emergency MDCT in diagnostics and treatment decisions in traumatic lung injured patients.

BMJ case reports, 2012

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a danger... more To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Journal of Emergencies, Trauma, and Shock, 2010

Diffuse guarding, rigidity, and a tympanic abdomen pointed towards peritonitis. The scrotal area ... more Diffuse guarding, rigidity, and a tympanic abdomen pointed towards peritonitis. The scrotal area was found to be stained with greenish material with fecal odor. A closer examination revealed fecal material flowing out of an opening at the root of the right scrotum, the surrounding skin being inflamed and macerated.[Figure 1] The inguinal hernia on the right side was tense, tender, irreducible and had a doughy consistency. The patient was immediately resuscitated with 2 liters of Ringer lactate with two large bore 16G catheters and reassessed in one hour when the patient's blood pressure improved to 106/74 mmHg. The patient was given 2g intravenous ceftriaxone, 500mg amikacin, and 500mg metronidazole. The patient's initial blood parameters showed hemoglobin of 8 g/dl, total leukocyte count 16500 cells/mm 3 , serum urea (48mg/dl), serum creatinine (0.8mg/dl), serum sodium, potassium 132 and 3.5 mEq/L, respectively. A plain abdominal radiograph of the abdomen revealed pneumoperitoneum. Further radiological investigations were limited to an ultrasound in the Emergency department showing free intraperitoneal air and fluid along with the confirmation of bowel loops in the inguinal hernia. Dye studies to identify the source of the fistula were withheld as the obstructed bowel contents in the strangulated inguinal hernia was the obvious source of the fecal fistula and the patient was planned for exploration. One unit of fresh whole blood was transfused prior to surgery. The patient underwent exploratory laparotomy through a vertical midline incision that revealed moderate amount of pus and dirty flakes contaminating the peritoneal cavity. The caecum with the appendix had traversed through right inguinal canal to lie in the scrotum. The caecum had