This is to certify that the dissertation entitled “A STUDY OF INCIDENCE AND PATHOLOGICALPATTERN OF CARCINOMAOESOPHAGUS AT GOVERNMENTRAJAJIHOSPITAL, MADURAI” submitted by Dr.K.SELVAKUMAR to the Faculty of General Surgery, The Tamil Nadu Dr.M.G.R. Medical university, Chennai in partial fulfillment of the requirement for the award of M.S. Degree in General Surgery is a bonafide work carried out by him during the period of Nov 2007 – Nov 2009 under my direct supervision and guidance.
A strong association exists with human leukocyte antigen (HLA)-B35 in most ethnic groups. A proposed mechanism is that the disease results from a viral infection that provides an antigen, either viral or resulting from virus- induced host tissue damage, that uniquely binds to HLA-B35 molecules on macrophages. The antigen-HLA-B35 complex activates cytotoxic T lymphocytes that damage thyroid follicular cells because they have some structural similarity with the infection-related antigen. The transient presence of autoantibodies (eg, inhibitory immunoglobulins that bind to thyrotropin [TSH], antibodies that block thyroid stimulation, thyroid antimicrosomal antibodies, thyroglobulin [TGB] antibodies) has been noted in the acute phase of the disease, but their presence is attributed to a virally induced autoimmune response and is not implicated in the pathological process. In contrast with autoimmune thyroid disease, the immune response is not self-perpetuating; therefore, the process is limited.
It gives me immense pleasure to express my deep sense of gratitude to my Unit chief Prof.Dr.M.Sekaran M.S Department of General Surgery, GovernmentRajajiHospital and Madurai Medical College for this excellence guidance and valuable suggestion during the course of study and in preparation of this dissertation.
As the study was conducted in a GovernmentHospital majority of the cases belonged to the low socioeconomic status accounting for 75% of the cases. The scenario is similar across India where majority of the population belong to the low socioeconomic group further contributing evidence of dietary role of carcinogens. Studies at Chennai and other parts of the country have shown consistent correlation between the lower socioeconomic group and higher prevalence of gastric cancer.
e) De-worming of dogs should be carried every 3-4 months. Arecoline hydrobromide in a dose rate of 0.4mg per kg body weight was effective in removing the parasite in 95% of dogs. Treatment of dogs each month with bunamidine hydrochloride may reduce the prevalence rate of hydatidosis in domestic livestock more quickly. It is important to limit the home slaughtering of sheep for human consumption in order to lessen the chances of hydatid disease in dogs. It is necessary to have dog proof sheep killing facilities and offal disposal facilities to reduce the incidence of infestation in dogs.
It is composed of cultural and behavioral patterns and lifelong personal habits that have developed through process of socialization or social interaction with parents, peer groups, friends and siblings and through school and mass media. Current day health problems especially skin disorders, CHD, obesity, cancer are associated with lifestyle changes lack of sanitation, poor nutrition, personal hygiene, elementary human habits, customs and cultural patterns. The personal environment which includes the individual’s way of living and life styles such as eating habits, or personal habits. In this present study behavioral and individual determinants of Paediatric population living with dermatological disorders is low family income/ poor diet/Malnutrition, poor housing facilities, overcrowded conditions, defect of gene/Error in metabolism among parents, Decrease on knowledge personal hygiene, and exposure of sunlight during summer holidays.
The most common site involved in our study was the buccal mucosa (36.42%), followed by the tongue (35.18%), though the difference was only 1.24%. According to western literature (Watkinson et al., 2000; Rivera et al.) oral tongue is considered to be the most commonly involved sub site in the oral cavity. Two cancer centers in the United States reported an increase in the proportion of oral tongue cancers diagnosed in men younger 40 years. 93-94 It was later confirmed after analyzing Scottish data that this increase was not restricted to the under 40 population but could be detected in all age groups till 65 years.
However, in a study conducted by Mclean et al., it was shown that organisms can be cultured from most of the wounds in both of their study groups at the end of the operation. The incidence of wound infection depends on the type of surgery. Kearns et al concluded that the use of diathermy for skin incision is associated with lesser early postoperative pain and less analgesia requirement. Ahmad et al. also noted similar findings that postoperative pain was significantly less with diathermy incisions in first 24 hours. Similar findings were noted by Siraj et al., in 2011, and reported that incision time in the diathermy group is significantly less than in the steel scalpel group.
Corticosteroids are usefulin the management of systemic symptoms& local pressure effects.  Their use in the management of abdominal tuberculosis remains uncertain. Corticosteroids are frequently givenfor treatment abdominal tuberculosis.  Treatment can induce fibrosis that results in intestinal obstruction, but they reduces the risk if given duringthe first 2 months of treatment.  They are useful in case of established intestinal strictures, but this is questionablebecauseall strictures respondonlyto conventional anti – TB therapy.  some evidence are there which states that corticosteroids reduce the incidence of adhesions,  but a conflictingstudy found an increase. 
cent and 78 per cent, respectively. The diagnostic usefulness of the white-cell count is reduced in the presence of coexisting conditions such as cirrhosis and HIV infection, both of which are associated with an increased incidence of abdominal tuberculosis. In patients with cirrhosis and AIDS the response of white cells is poor and the total white blood-cell count is often within the normal range. Another characteristic of tuberculous ascites is high total protein, usually 2.5 g/dl or more, and the serum ascitic fluid albumin gradient (SAAG) is less than 1.1. However, high total protein is seen in several conditions, and the sensitivity, specificity, and diagnostic accuracy of this test for tuberculosis are only 65, 78, and 74 per cent, respectively. As with the white blood-cell count, the protein content of ascitic fluid in cirrhotic patients with peritoneal tuberculosis is significantly lower; the concentration is less than 2.5 g/dl in 30 to 50 per cent of patients, and the SAAG is highly variable. Other biochemical tests, such as lactate dehydrogenase (elevated to over 90 units/I), low pH, and an ascitic fluid:blood glucose ratio of less than 0.96, are usually positive in tuberculous ascites, but these tests are non-specific and of little diagnostic value 12 .
In another study by Rithin Suvarna et al, 2%topicaldiltiazem was compared with that of 0.2% topical glyceryltrinitrate(GTN) in the management of chronic fissure in ano. Healing rate with topical Diltiazem (71.87%) was better than GTN (68.23%) with p valueof 0.0001, making it statistically significant. Also the major adverse effect was headache in both groups but with much lesser incidence in Diltiazem group (5.2% vs. 67%). Recurrence rate was also low in Diltiazem group (9.67% vs. 19.56%) suggesting that the topical Diltiazem was a better chemical agent with higher efficacy and lesser morbidity.
The fascial-muscular layers and parietal peritoneum are approximated by a single row of 2-0 (B&S 28) stainless-steel monofilament wire sutures or 0 or No. 1 polypropylene. A large atraurnatic needle is passed through one side of the incision, passing through the anterior rectus sheath, the rectus muscle, the posterior rectus sheath, and the parietal peritoneum, about 2.5 to 3 cm from the edge of the incision, entering the peritoneal cavity. The needle and suture arc then passed through the same layers on the opposite side of the wound in the reverse order. The needle is then reinserted and a suture is passed in the same plane and direction, but it is passed through close to the incised edge of the anterior rectus sheath. When closing a midline incision, one passes the suture through the cut edge along the linea alba. With method Goligher reported a dehiscence/incisional hernia incidence of 0.9%.
Hundreds of Millions of People around the world undergo surgery each year. Infection of the surgical site (formerly referred to as ‘wound infection’, terminology that is no longer used owing to confusion between infections of surgical incisions and those of traumatic wounds) is a consequence of surgery, but it is not inevitable. Surgical site infection (SSI) entirely the fault of the operating surgeon, despite the contrary belief of many members of the quality improvement bureaucracy. This review will examine the factors that increase the risk of s urgical site infection , and interventions that can decrease the incidence of infection.
Familial incidence in India and abroad vary between 7.5% and 41%. 38 Inheritance was thought to be autosomal dominant with variable expression and incomplete penetrance 39-41 . Few human leukocyte antigen (HLA) associations like HLA-DR4 in blacks, HLA-B13 in Moroccan Jews, and HLA- BW35 in Yemenite Jews with vitiligo have been reported. An association with catalase have been reported 42 . VIT1 gene found on chromosome 2p16 has been associated with vitiligo. Recently, variants of a gene NALP1 found on chromosome 17p13 were associated with vitiligo, and other autoimmune diseases like thyroiditis. NALP1 is a member of NLR super family of proteins which is involved in the pathogenesis of vitiligo 43 .
Simple febrile seizure has an age range classically described as 6 to 60 months. The peak incidence is usually in the second year of life. Febrile seizures are prevalent in up to 5% of children, with the overall incidence estimated to be 460/100,000 in the age group of 0–4 years. Most febrile seizures are simple; however, up to 30% might have some complex features. The risk of recurrence of febrile seizure is related to various factors, including younger age group, prolonged seizures duration, degree of fever, and positive personal and family history of Febrile Seizure. In fact, a positive family history of febrile seizures in first-degree relatives is observed in up to 40% of patients. Gender distribution has been studied in the literature. One previous study found a mild male predominance, but this has not been supported by other literature reviews. Seasonal variation with regard to seizure incidence has not yet been fully understood. Studies have shown that febrile seizures tend to occur more in the winter months and are more common in the evening. The underlying pathophysiological explanations for these observations remain obscure.
According to Shukla 1988 the incidence of abdominal tuberculosis is high in India. But recent literature indicates that the disease is also prevalent all over the world (Chen ws Taiwan 1992). Shafer RW New York reports those 47 cases in 1983 and 113 cases in 1988. In GovernmentRajajiHospital, Madurai, Tamilnadu over 24 months of study, 60 cases are reported in various surgical units and treated as inpatients. In United Kingdom the frequency has recently increased due to arrival of Asian immigrants (VK Kapoor and L.K. Sharma 1988).
In my study of 82 patients increased incidence of age for gall stone disease was between 41-50 years and females was found to have gall stone disease than males and almost most of the patient have right hypochondrial pain and tenderness and only 6 patients have been incidently diagnosed to have gall stones and they were preceeded with cholecystectomy with incisional hernia.
4. Histo-pathological findings - Most of the tumours are low grade and slowly growing. Staubitz et al found 10 per cent of the lesions to be anaplastic. Many investigatiors reported reduced survival rates in patient with anaplastic lesions. However, a number of workers noted no correlation between the histological grading and survival. Frew et al advanced evidence for a more favorable prognosis when the pattern of growth was in clumps rather than in solid cords. El Dimiry et al reported similar observation.
Shakya Dhana R et al. (2009) conducted a cross sectional study on 60 consecutive inpatients to measure the Psychiatric co morbidity in cases admitted for alcohol dependence in the department of Psychiatry of a tertiary care hospital in dharan in eastern Nepal. The study reveals the mean age of the cases was 39.19 years, 75% were male and 90% were married. Three fourths used other substances besides alcohol; main being nicotine, opioid and cannabis. Eighty percent cases had one or other or more than one diagnosable psychiatric illness, including ICD-10 mental and behavioral disorders in 63% and personality problems severe enough to affect the course of substance use disorder in 48% of the total cases. The most common psychiatric disorder in ADS cases was anxiety disorders, followed by mood affective disorders, and psychotic illness. Furthermore the study reveals Psychiatric co-morbidity is common in people with alcohol dependence.
standardization, and the types of instruments used to assess self-efficacy varied. This paper highlights the need for more controlled trials that investigate potential between- subjects effects of different types of COPDSME programs on self-efficacy outcomes. Incorporating practice models for patient-centered primary care in COPD requires the use of tailored efficacy building strategies for specific self-management behaviours. Facchiano L, Hoffman Snyder C, Nunez DE. (2011) was conducted a study in missourito investigate the breathing retraining as a self-management strategy for individuals with chronic obstructive pulmonary disease (COPD) guided by Rosswurm and Larrabee's evidence-based practice model. Scientific literature review, grey literature review, and hand searching.An exhaustive review of the literature revealed evidence that regularly practiced pursed lip breathing is an effective self-management strategy for individuals with COPD to improve their dyspnea.They concluded that implementation of this non-pharmacological self-management intervention will improve perception of dyspnoea, functional performance, and self-efficacy in individuals with COPD.