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Q U a R T E R L Y M E D I C a L B U L L E T I N Q u a r t e r l y M e d i c a l B u l l e t i n Vol. 6 Issue 1 e-mail : [email protected] July - December 2019 Chief Patron LAPROSCOPIC SACRO-COLPOPEXY: Shri J.P. Agarwal Chairman AN ADVANCED ENDOSCOPIC PROCEDURE Dr. ANJANA VERMA1, Dr. PANKAJ SAXENA2 Patrons 1 Professor, Department of Obstetrics and Gynecology, GMCH, Udaipur. Dr. R.K. Nahar 2Professor & HOD, Department of General Surgery, GMCH, Udaipur. Vice-Chancellor Shri Kapil Agarwal Vice-Chairman Vaginal vault prolapse is a mash around 15Х3 cm introduced. Split part of Shri Ankit Agarwal Executive Director c o m m o n c o m p l i c a t i o n mash was xed anteriorly and posteriorly to vault Dr. F. S. Mehta following vaginal hysterectomy with prolene sutures as below as possible. Mash Dean GMCH with negative impact on pulled up and vertical limb was xed to sacral Mr. Bhupendra Mandliya women's quality of life due to promontory by a tacker. Mash was then Resgistrar - G.U. associated urinary, anorectal retroperitonized using 1-0 vicryl. Ports closed. Advisors and sexual dysfunction. Pre- Post-operative period was uneventful with existing pelvic oor defect excellent outcome. Dr. A.K. Gupta Dr. Anjana Verma prior to hysterectomy is the Dr. A.A. Saifee Conclusion: Laproscopic repair may be challenging single most important risk factor for vault prolapse. Dr. S.K. Luhadia due to the need for extensive dissection and Treatment options are: Dr. G.L. Dad suturing skills, but it offers benets in terms of Dr. D.M. Mathur 1. Pessary with limited success minimal blood loss, lower recurrence rate and less 2. Utero-sacral ligament suspension or sacro- dyspareunia. Editorial Board spinous xation Editor-in-chief Dr. Pankaj Saxena by vaginal route Co-editor 3. Abdominal or laproscopic sacro-colpopexy – Dr. Manu Sharma preferred procedure with least recurrence Associate Editors rate supported by many studies. Laproscopy Dr. Jayalakshmi L.S. needs advanced surgical and suturing skills. Dr. Pallav Bhatnagar The choice of procedure should be based on Dr. Ashutosh Soni age, co-morbidity, previous surgery, level of physical and sexual activity of the patient, and HIGHLIGHTS experience of surgeon. CASE REPORT A 45 years old lady presented with vault prolapse w Laproscopic Sacro- post vaginal hysterectomy (20 years back). No colpopexy: An Advanced signicant past or present illness was identied and Endoscopic Procedure investigations were within normal limits. w N e w E r a o f R e n a l Laproscopic sacro-colpopexy was planned after Transplant in Southern counseling. Rajasthan Four ports were used; one 10 mm supra-umbilical w Oral Manifestations of M u c o c u t a n e o u s for scope, two 5 mm ports on left and one 5 mm Disorders port on right side. Vault was pushed up from below w Laparoscopic Trans- with sponge on forceps and after delineating a b d o m i n a l P r e - bladder margins, peritoneum overlying vault peritoneal approach for incised, bladder dissected anteriorly till urethra and Inguinal Hernia Repair: rectum posteriorly till levator ani. Peritoneum O u r I n s t i t u t i o n a l overlying sacral promontory medial to right Experience common iliac vessels and crossing ureter was w News that will make Your picked up and incised by sonoscissor. Heart Skip a Beat Retroperitoneal fat dissected to allow exposure of w Free Cochlear Implant anterior vertebral ligament. Peritoneal incision then Programme at GMCH in extended along rectosigmoid to continue till Collaboration with Govt. deepest part of cul-de-sac. A Y shaped prolene of India 2 Desk of the Dean Dear reader, community outreach programs. The University has been The current issue of Spandan features clinical case reports organizing workshops and conferences. I extend my best from a variety of specialties, academic experiences, wishes to the Editorial Board, who have been striving to progress in medical education technologies and create a wider circulation and increase readership of Spandan. Dr. F. S. Mehta, Dean Editor's Desk Greetings and good wishes! The current issue of Spandan gives us an extra and skill of the clinicians in our institute, bringing in laurels with the delight and a sense of pride as we present some first renal transplant, the first exploits in cutting edge technology in outstanding clinical material that is distinctively cath lab etc. I am deliberately withholding the description of other the ‘first of its kind’, not only in the institute but extraordinary material to keep your curiosity alive. also in the southern region of Rajasthan. Our Wishing you a happy and enjoyable reading. readers will surely be appreciative of the talent Dr. Pankaj Saxena, Editor-in-Chief NEW ERA OF RENAL TRANSPLANT IN SOUTHERN RAJASTHAN 1Dr Pankaj Trivedi, 2Dr Vishwas Baheti, 3Dr Gulshan Mukhiya, 4Dr Suraj Gupta, 5Dr Kishan Patel 1,2Consultant Urologist,3,4Consultant Nephrologist,5Post-graduate Resident in General Surgery, GMCH, Udaipur. In southern Rajasthan, Geetanjali Medical created with external iliac artery and vein of recipient. Leich- College and Hospital (GMCH) has Gregor type- extravesical ureteric re- implantation is created history by starting renal performed. Donor is discharged in about 3-4 days and transplant programme. The living kidney recipient with normal serum creatinine approximately within transplantation program in India has 10 days. So far, we have performed three successful renal evolved in the past 45 years and is transplant, most recently on September 22nd, 2019. currently the second largest program in The burden of kidney disease in India requires two strategies; numbers after the USA. The prevalence on the one hand, there is a need to look at prevention and Dr Pankaj Trivedi of end-stage renal disease requiring early identication of kidney disease and on the other, there is transplantation in India is estimated to be between 151-232 a requirement to increase the deceased donation rate. per million. It is estimated that almost 220,000 people require Concerted efforts from government, public and private sector kidney transplantation in India per year. Against this, currently, hospitals along with non-government organizations are approximately 7500 kidney transplantations are performed at required to give momentum to improve the donation rate and 250 kidney transplant centers in India. Of these, 90% come take care of organ shortage. from living donors and 10% from deceased donors. The Indian Society of Organ Transplant reported only 783 cadaveric donors in period 1971-2015. A kidney donor can be c l a s s i e d a s : l i v i n g r e l a t e d , l i v i n g u n r e l a t e d (altruistic/emotionally related), deceased / cadaveric (brain- dead), beating or a non-beating heart donor. Prospective transplant candidates must have documented chronic renal disease dened by GFR less than 20 ml/min or serum creatinine more than 8 mg/dl. Figure 1 shows the common indications of transplant. Our team consists of 2 Urologists, 2 nephrologists and dedicated kidney transplant unit (KTU) and staff. First renal transplant in GMCH was done on February 24th, 2019. The recipient had chronic glomerulonephritis and was on dialysis for about one year. The donor was the patient's mother. At our institute, we perform laparoscopic donor nephrectomy (LDN), which is standard of care surgery for donors with all modern equipments and armamentarium. After kidney harvesting, renal perfusion is done on bench surgery. Graft is placed in the Figure 1. Major causes of ESRD right iliac fossa. Renal graft artery and vein anastomosis is and indications of transplant 3 ORAL MANIFESTATIONS OF MUCOCUTANEOUS DISORDERS Dr. Anu Babu1, Dr. Archana M S 2, Dr. Preeti Gupta3 Senior Lecturer1, Associate Professor2, Tutor3, Dept. of Oral Medicine and Radiology, Geetanjali Dental & Research Institute “Mucocutaneous diseases are the diseases affecting the skin and the mucosa having structural and morphological alteration in the components of skin and mucosa”. The oral cavity often mirrors systemic health and may be the initial site of presentation of an underlying disease process. Clinicians should understand that oral cavity is an integral part of human body and does not exist in isolation. Mucocutaneous disorders can be classied based on the site of involvement as: Dr. Anu Babu LESIONS AFFECTING BOTH LESIONS AFFECTING LESION AFFECTING SKIN AND ORAL MUCOSA PREDOMINANTLY SKIN WITH MINIMAL TYPICALLY ORAL MUCOSA WITH ORAL MUCOSAL INVOLVEMENT MINIMAL SKIN INVOLVEMENT VESICULOBULLOUS LESIONS VESICULOBULLOUS LESIONS VESICULOBULLOUS LESIONS Pemphigus Bullous pemphigoid Cicatricial pemphigoid Epidermolysis bullosa Recurrent herpes simplex infection Bechet's syndrome Hand foot mouth disease Herpes zoster RED AND WHITE LESIONS Lichen planus Lupus erythematosus FIGURE I FIGURE 3 FIGURE 2 FIGURE 4 FIGURE 5 4 FIGURE 9 FIGURE 6 FIGURE 10 FIGURE 7 FIGURE 8 FIGURE 11 LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL APPROACH FOR INGUINAL HERNIA REPAIR: OUR INSTITUTIONAL EXPERIENCE Dr. P. K. Saxena1 and Dr. Kalpesh Patel2 1Professor & Head, 2Post-graduate Resident, Department of General Surgery, GMCH, Udaipur Laparoscopic hernia repair has emerged Almost all patients began oral as an effective alternative method for intake and passed urine after 6 treating inguinal hernia. It has several hours of surgery. The average signicant advantages over traditional duration of operation was 55.3 open tension free repair. minutes. We observed that At our institute we began laparoscopic with experience the learning hernia repair in 2017. The rst patient curve for the laparoscopic was a 48 year old male operated in i n g u i n a l h e r n i a r e p a i r Figure 1.
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