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http://www.webmedcentral.com/images/Header_Logo.giftext/html2013-06-15T11:12:46+01:00http://www.webmedcentral.com/Dr. Gaurav BharadwajIatrogenic Complications of NG Tube - Accidental Fixation to the Pylorus of Stomach - A Case Study and Review of literature
http://www.webmedcentral.com/article_view/4098
Nasogastric tube is used in almost all the patients for feeding and gastric decompression specially treated for GIT problems or head and neck injury / surgeries for variable lengths of time . It may be used for a few hours in patients with no or minimal GI tract tampering while in others , it is used for a considerably longer time where it is used for temporary drainage . In such cases , the success or the failure of the surgery depends almost entirely on the functioning of the nasogastric tube . How so ever simple it may seem but this apparently harmless use of NG tube comes with a few not so known complications . A number of complications have been reported with the NG tube ranging from iatrogenic nasogastric perforation(1) , retained nasogastric tube / stapled NG tube (2,3,4,5), knotted NGT(6,7,8), misplacement into the airways(9,10) , even cranial cavity (11)in head injury patients , leading to pneumothorax(12) , respiratory distress and respiratory tract infections (13), nasogastric tube syndrome(14,15) , haemorrhage and mediastinitis(16)text/html2013-01-25T19:15:38+01:00http://www.webmedcentral.com/Dr. Murtaza A CalcuttawalaPerforated Duodenal Ulcer Emerging Pattern
http://www.webmedcentral.com/article_view/3966
Background: Twenty seven patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied Material and Methods: All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham's omental patch was carried out. This was followed by triple regimen for H .pylori eradication.Results: All patients were male, maximum incidence (61.54%) was noted in the age group of 21 to 30,O+ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between start of symptoms and surgery was 43 hrs. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series.Conclusion: We conclude that although a number of definitive surgeries have been described for acid peptic disease but requirement of such procedures has come down due to increasing use of H. pylori eradication therapy and proton pump inhibitors. However surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence has been greater in young males. Nowadays perforations are seen more in acute peptic ulcer disease. NSAID is one of the contributing etiological factors. Early diagnosis and timely management is advocated to reduce morbidity and mortality.text/html2015-03-02T13:31:33+01:00http://www.webmedcentral.com/Dr. Jedidiah S Prakash Modified Radical Mastectomy and Wound Drainage
http://www.webmedcentral.com/article_view/4822
Modified Radical Mastectomy [MRM] is a commonly practised surgical procedure for management of operable breast cancer. Necrosis of skin flaps , wound dehiscence , hematoma, seroma , venous thromboembolism and infection are early complications . Late complications include lymphedema , sensory loss, shoulder dysfunction etc. Suction drains are employed to minimize incidence of fluid collection , seroma , hematoma and lymphedema . Paucity of Indian studies comparing outcome of different vacuum suction drains is an indication to undertake topical prospective comparative studies .text/html2010-09-29T22:30:19+01:00http://www.webmedcentral.com/Mr. Usman KhanLong-term Clinical and Functional Evaluation of the Single Layer Interrupted Sutured W-ileoanal Pouch
http://www.webmedcentral.com/article_view/816
We present the long-term results of a unique consecutive series of 101 single layer W ileoanal pouch reconstructions (63 male, 38 female; age range 10-76 years, median 36 yrs) over a ten year period in a tertiary referral centre.All procedures were carried out by the same consultant colorectal surgeon using an interrupted single layer suture technique for the W ileal pouch construction and a stapled pouch-anal anastomosis, covered with a temporary loop ileostomy. 54 patients underwent primary restorative proctocolectomy and 47 patients with a previous colectomy and ileostomy underwent restorative proctectomy, 12 having been referred with a very short rectal stump (There was no operative mortality. One patient developed necrotizing fasciitis involving a drain site and 2 patients had significant pouch haemorrhage. One late death occurred after closure of the ileostomy related to pouch ischaemia in an older diabetic man. Two men developed fistula from the pouch-anal anastomosis. One was successfully treated with gracilis transposition, the other required pouch excision. There are presently 99 functioning pouches. 10 patients have clinical and histological evidence of pouchitis requiring treatment with steroids and/or antibiotics with good effect. 55 randomly selected patients (38 male, 17 female) underwent functional assessment.Median pouch stool frequency was 5 during the day and 1 during the night. 84% were fully continent and 13% had minor incontinence. 51% had little or no discrimination of fluid from flatus. The median number of anti-diarrhoeal drugs used was 1. 89% of patients made no changes to their diet, 5.4% made moderate adjustments and less than 2% made significant changes. 25% patients developed some degree of sexual dysfunction. This was more common in tertiary referrals with a very short rectal stump. 20% of patients developed transient urinary retention with 1 patient requiring long-term self catheterization. 80% of the patients reported no disadvantages in social or professional life, 13% had minor social life disturbances not affecting their professional lives and 3.6% had a significantly disturbed professional and social life. Interestingly, 3.6% admitted to an improvement in their lifestyle.Restorative proctocolectomy with a single layer interrupted suture W ileoanal pouch, which is not widely practised, offers excellent long-term clinical and functional results with an extremely low failure rate.text/html2010-10-05T20:12:43+01:00http://www.webmedcentral.com/Dr. Nikhil V GulavaniPrimary Soft Tissue Giant Cell Tumor Of Neck
http://www.webmedcentral.com/article_view/901
Soft tissue giant cell tumor (GCT-ST) of low malignant potential is an uncommon neoplasm, considered as the soft tissue counterpart of giant cell tumor of bone. We report a rare case of soft tissue Giant Cell Tumour of Neck in a 61 years old female with swelling in left side of neck, spontaneous in onset. Incisional biopsy was reported as Soft Tissue Gant Cell Tumour of low malignant potential. Wide local excision of the tumour was done.We consider that, this tumor shows characteristic histologic features and clinical behaviour that render it a specific entity, being different from fibrous histiocytoma giant cell type, and leiomyosarcoma with osteoclast-like giant cells of soft tissues. This is exceptionally rare and we know of only five previously published cases in the head and neck.text/html2010-12-22T16:04:48+01:00http://www.webmedcentral.com/Prof. Gabriel RodriguesClinico-microbiological Profile Of Necrotizing Fasciitis Secondary To Diabetes Mellitus In A Tertiary Care Hospital
http://www.webmedcentral.com/article_view/1399
Objectives: Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. The present study describes the clinical presentation and microbiological characteristics of this condition as well as risk factors, management and outcome of the patients.Materials and Methods: In this prospective study, tissue and/or wound swabs and blood for culture from 50 clinically suspected cases were cultured aerobically and anaerobically and the isolates tested for sensitivity. Clinical correlation and follow-up was done. Results: The age range was 17-87 years (mean=54 yrs) with a male predominance. The most common site of infection was the calf region (59.5%) and diabetes mellitus was the most common associated comorbidity (44.7%). Majority of the patients presented with symptoms of sepsis, systemic toxicity, or evidence of skin inflammation. Hyperacute cases presented with sepsis and quickly progressed to multiorgan failure (40%). 23 patients (57.5%) had microbiological isolates and in 16% of the cases, there was an anaerobic growth. Staphylococcus aureus and Klebsiella pneumonia were the most common isolates, whereas Pseudomonas aeruginosa was the most common environmental strains, suggestive to be colonizer. Antibiotics were instituted in all patients and all required debridement. Amputation had to be done in 2 patients. 21.3% of the patients were admitted in the ICU. Most of the patients recovered on treatment. Conclusions: Necrotizing fasciitis is a common condition that results in gross morbidity and mortality if not treated at early stages. A high index of suspicion is important in view of the paucity of the specific cutaneous findings early in the course of the disease.
text/html2011-02-02T17:34:22+01:00http://www.webmedcentral.com/Dr. Luke R OconeFactors Affecting The Biocompatability Of Plastics
http://www.webmedcentral.com/article_view/1519
Many otherwise chemically inert plastics or coatings are not biocompatible because triboelectrically and piezoelectrically generated positive charges destabilize colloids, disrupt cell membranes and promote oxidative reactions, which can result in promotion of tissue growth, fatty deposits, mineralization of implant surfaces, hemolysis and blood clot formation. Similar deleterious reactions can also occur in blood, tissue and organs stored or handled in plastics. It is likely that these destabilizing charges can be eliminated by electrically poling the plastics or coatings in order to make the plastic surfaces uniformly electron-rich. The locked-in dipoles created and re-oriented by poling should change both the triboelectric and piezoelectric properties of the plastic surfaces so that generation of positive charge is reduced or eliminated. It is also likely that the wettability of plastics will be affected by poling. Poling procedures are reviewed, and the application of these to implants is discussed.The ability to control triboelectric and piezoelectric properties should allow designers to improve the long-term biocompatibility of articles constructed from the plastics currently used in devices, and it should also facilitate greater use of other plastics, such as polytetrafluoroethylene (PTFE), which, unpoled, have generally unfavorable properties in many biomedical applications.text/html2011-02-22T20:50:03+01:00http://www.webmedcentral.com/Dr. Saleh M AbbasInguinal Lymph Nodes Management In Squamous Cell Carcinoma Of The Anal Canal
http://www.webmedcentral.com/article_view/1565
Current issues in the management of clinically negative inguinal lymph nodes in squamous cell carcinoma of the anal canal. Quality of the available evidence.BackgroundThe first line of management of squamous cell carcinoma (SCC) of the anal canal is chemo-radiation. The radiation field includes, in addition to the anal region and the perirectal nodes, the iliac and both inguinal triangles to target the inguinal nodes. More recently a selective approach has been investigated in patients with non-palpable inguinal nodes utilizing sentinel node biopsy and PET scan.MethodsMedline was searched using the keywords, squamous cell carcinoma, anal canal, inguinal lymph nodes, sentinel node and radiotherapy.Relevant articles were reviewed with regard to the management of inguinal nodes in SCC of the anal canal.Results:Currently the management of clinically normal inguinal nodes in SCC of the anal canal is prophylactic radiation of both inguinal areas. Clinically involved nodes are included in the radiation field plus a boost of radiation to the groin that harbor involved nodes. The radiation is refined recently by intensity modulation radiotherapy (IMR) to involve the diseased area and minimize radiation exposure of normal adjacent tissues. Alternatively, more recently, a selective approach with utilization of sentinel node biopsy and radiation to microscopically involved nodal areas has been described.Conclusion:The treatment of clinically normal inguinal nodes is currently by prophylactic radiation of both inguinal regions. It is possible that in the future radiation of clinically normal inguinal may become more selective with an increasing reliance on sentinel node biopsy. Further studies are needed in this field to assess the efficacy of this approach.
text/html2011-03-24T20:36:51+01:00http://www.webmedcentral.com/Mr. James M WilliamsonAdequacy of Non-Invasive Investigations for Coeliac Disease
http://www.webmedcentral.com/article_view/1794
IntroductionCoeliac disease can be an elusive diagnosis, partly due non-specific symptoms and the lack of unequivocal non-invasive investigations. Histology is the gold standard of diagnosis. The aim of this investigation was to assess if coeliac disease could be diagnosed using non-invasive investigations. MethodThe non-invasive investigations performed on all new, histologically proven, Coeliac’s over a 3-year period were assessed.Results74 patients were identified; positive non-invasive investigations were: 45 (of 62) for ferritin (73%), 43 (of 62) for tTG (69%) and 5 (of 22) for radiology (23%). When both serum ferritin and tTG levels were recorded the sensitivity increased to 46 out of 54 (85%), when all three investigations were utilised the sensitivity was 13 out of 16 (81%)ConclusionsAt best the sensitivity of non-invasive investigation is 85% and thus histological diagnosis remains the gold standard for diagnosis. We would advise an increased use of endoscopic assessment.text/html2011-10-31T17:27:34+01:00http://www.webmedcentral.com/Dr. Manu GuptaClinical and radiological Study of Urethral Injuries and Stricture Urethra
http://www.webmedcentral.com/article_view/2389
Objective:-To study clinical and radiological evaluation of urethral injuries and stricture urethra and evaluation of various methods used in the treatment of urethral injuries and stricture urethra .Methods :-After thorough history , Physical and local examination , RGU,MCU,Uroflowmetry, USG was done in all 55 patients after that suprapubic cystotomy and later on urethroplasty was done in urethral injury cases.Urethral dilatation was done as primary treatment in one patient of stricture urethra, in rest of the patients urethroplasty was done as a definitive treatment.Result:-Most common etiology of urethral injury and stricture urethra was trauma with membranous urethra being the most common site. Suprapubic cystotomy followed by urethroplasty in the patients of urethral injuries and urethroplasty as a primary definitive treatment in stricture urethra has better results.Conclusion:-RGU and MCU are good diagnostic modalities to localize the site of urethral injury and stricture urethra .Suprapubic cystotomy with delayed repair of urethral injury gives better results than primary catheter repair . In cases of stricture urethra , urethroplasty have better result than urethral dilatation.text/html2012-04-02T14:07:03+01:00http://www.webmedcentral.com/Prof. Samuel A DebrahClinical Spectrum of Acute Abdomen in Cape Coast
http://www.webmedcentral.com/article_view/3209
Background: Central Regional Hospital, Cape Coast, Ghana is the main referral center for the region.The hospital has been redesignated a Teaching Hospital to serve as the main teaching base for the School of Medical Sciences, University of Cape Coast.This study was done as part of assessment of the hospital’s emergency surgical needs for purpose of planning and resource allocation.Objectives: The study objectives were to quantify and to characterize cases of acute abdominal emergencies operated at the Central Regional Hospital, and to assess the clinicians diagnostic accuracy by comparing the preoperative diagnosis with the postoperative findings.Methodology: A retrospective and comparative study was performed based on the records of the Accident/emergency, wards, and theatre units, over a period from October 2009 to September 2010.A total of 122 cases were recorded.Results: Ruptured ectopic cyesis(23.8%) was the most frequent preoperative diagnosis, followed by non specific abdominal pain(18.9%), typhoid perforation(13.1%), acute appendicitis(12.3%) and intestinal obstruction(9.8%).Post operatively, ruptured ectopic cyesis(38.9%), acute appendicitis(16.7%) and typhoid perforation(12.5%) were recorded.The preoperative diagnosis was wrong in 2.7% (n=2) of cases.Conclusion: Ruptured ectopic cyesis was the most common abdominal condition operated on and incidence of typhoid perforation is high. Preoperative diagnoses was wrong in 2 cases.Key words: Acute abdomen, ectopic cyesis, abdominal paintext/html2012-05-03T12:47:20+01:00http://www.webmedcentral.com/Dr. Ajaz A WaniUncommon Cause of Duodenal Obstruction in a Young Adult
http://www.webmedcentral.com/article_view/3327
Annular Pancreas is a rare embryological abnormality characterised by the presence of a pancreatic tissue of variable width completely or partially obstructing the second part of duodenum. It is formed due to failure of normal migration of the ventral pancreatic bud, which results in a part of pancreatic tissue encircling the duodenum.It is one of the few medical conditions which can present itself in a wide range of clinical severities and can affect neonates and the elderly, thereby making the diagnosis difficult.We hereby report the case of a 27 year old male who presented with a 6 months history of pain upper abdomen and recurrent episodes of vomiting who at laparotomy was found to have Annular Pancreas. The case is reported hereby to have this rare diagnosis in mind while dealing with a recurrent symptomatology pertaining to upper gastrointestinal tract especially when all the common imaging modalities are non contributory.text/html2012-05-14T12:21:22+01:00http://www.webmedcentral.com/Dr. Mohanad M SultanAdvanced Breast Cancer with Cerb2 Over Expression - A case Report
http://www.webmedcentral.com/article_view/3362
A 53year old female presented with advanced carcinoma of the right breast with clinically positive right axillary lymph node. Triple assessment was done. FNAC confirmed ductal cancer, mammography showed soft tissue mass with micocalcification. Full systemic evaluation was done, and excluded any gross distant metastasis, at surgery, modified radical mastectomy with axillary clearance was done.
Histological the tumor was an invasive ducal carcinoma moderately differentiated ER/PR:-negative. Cer B2 shows > 90% strong membrane staining (3+ over expression) -Cer B2 (HER2) is transmembrane growth factor receptor, expressed in about 20% of invasive breast cancer & 80% of DCIS and associated with poor prognosis. It is one of a family of growth factor receptors and is product of erb-B2 gene. This receptor is present on the surface of breast cancer cell and is of 3 types HER1. Biological therapy is now targeting this receptor like humanized mouse antibody and herceptin (Transtuzumab).text/html2012-05-16T18:39:28+01:00http://www.webmedcentral.com/Dr. Mohanad M SultanRecurrent Fibrolipoma of the Left Thigh - A Case Report
http://www.webmedcentral.com/article_view/3378
A 43 year old male presented with giant fibrolipoma of the left thigh, recurrent for the 4th time. On contrast CT & MRI the tumor had massive adipose and non adipose components and enhanced heterogeneously with multiloculated mass engulfing the left femur and the femoral neurovascular bundle. The lesion was initially thought to be liposarcoma or spindle cell lipoma. At surgery the tumor was multiloculated with dense adhesions from the previous surgeries engulfing the left femur and the neurovascular bundle. Histologically, the tumor was diagnosed as fibrolipoma. Subcutaneous and intramuscular fibrolipoma are rare, and are defined as subtype of lipoma.text/html2014-04-28T05:41:49+01:00http://www.webmedcentral.com/Dr. Murtaza A CalcuttawalaRetroperitoneal Teratomas A Diagnostic Dilemma
http://www.webmedcentral.com/article_view/4614
Dermoid cysts (benign cystic mature teratomas) are congenital tumors consisting of derivatives from the ectoderm, endoderm and mesoderm germ cell layers. A teratoma is considered to be a non-seminomatous germ cell tumour and is typically located in either the sacrococcygeal region or in the gonads. Retroperitoneal teratomas are commonly identified in early childhood, but are rarely reported in adults (1, 2). They constitute less than 4% of all extra-gonadal teratomas with less than 120 cases having been reported, and only partly described in the retroperitoneum of adults (3). We report here a case of a histologically unusual retroperitoneal tumour detected on magnetic resonance imaging during the workup of low backache in a 55-year-old male. The evaluation and treatment of this condition and a review of the literature are included in this papertext/html2014-05-10T05:42:44+01:00http://www.webmedcentral.com/Dr. Shalaka M IndapIdiopathic Tumoral Calcinosis Cutis- A rare clinical entity
http://www.webmedcentral.com/article_view/4619
The deposition of calcium in the skin, subcutaneous tissue, muscles and visceral organs is known as calcinosis. This condition commonly occurs in the skin, where it is known as calcinosis cutis or cutaneous calcification. Calcinosis cutis is a disorder caused by an abnormal deposition of calcium phosphate in the skin in various parts of the body.
We report one such case of idiopathic tumoral calcinosis cutis over forearm in a 16-year-old boy. Histopathological examination of the lesion revealed fibrocollagenous tissue with foci of calcification surrounded by foreign body giant cells, with no evidence of any underlying pathology. Idiopathic calcinosis cutis is a rare phenomenon and occurs in the abscence of known tissue injury or systemic metabolic defect. Hence, it is important to delineate it from other causes of calcinosis cutis for further plan of managementtext/html2014-09-27T04:27:52+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanMissed Gallstone in the abdominal wall; case report
http://www.webmedcentral.com/article_view/4703
Laparoscopic cholecystectomy is the gold standard method for the treatment of gallstone disease. Spillage of gallstones during the procedure is a common incidence, ranging from 8% to 40%. These gallstones can contribute to associated abscess formation in remote locations to the site of the gallbladder fossa. This is a report of a 46 year old diabetic male complained of painful epigastric abdominal mass at the site of previous incision of laparoscopic cholecystectomy with local signs of inflammation. Diagnosed at first as strangulated incisional hernia and upon laparoscopic exploration it was found to be an anterior abdominal wall abscess of a missed gallstone.text/html2014-11-24T11:08:58+01:00http://www.webmedcentral.com/Dr. Anuradha S DnyanmoteClinico- pathological study of right Iliac Fossa Mass
http://www.webmedcentral.com/article_view/4766
A mass in the right iliac fossa is a common diagnostic problem encountered in clinical practice, requiring skill in diagnosis. A swelling in the right iliac fossa may arise from the structures normally present in that region or from structures, which are abnormally situated in the region.1
The common swellings which occur in the right iliac fossa are appendicular lump, carcinoma of the caecum, ileocecal tuberculosis and Crohn's disease. Rare swellings are actinomycosis, ameboma, psoas abscess and lymph node masses. A clinical diagnosis is often difficult due to other conditions such as obesity and guarding, with the mass being palpable only when patient is on the operating table.1
Patients with a mass in the right iliac fossa are often admitted in surgical departments. Most of the causes need surgical intervention and are curable. A mass in the right iliac fossa mainly arises from appendix, caecum, and terminal part of ileum, lymph nodes, ilieopsoas sheath, and retroperitoneal connective tissue. An important differential diagnosis is between an appendicular lump, carcinoma of the caecum and ileocecal tuberculosis. Non-operative management of an appendix mass followed by elective appendicectomy and is a safe and effective method of management.1
Appendicitis can occur rarely with carcinoma of the caecum, particularly in elderly patients. In India tuberculosis has been reported to be the cause in 3 to 20% of patients with intestinal obstructions. About 5 to 10 % of all gastrointestinal perforations (excluding appendix perforations) have been reported to be due to tuberculosis. Caecal carcinoma is more common in people of the high socio-economic group who use less fibrous diet. Local control continues to be a significant problem in the management of retroperitoneal sarcoma.1
As rightly said by Sir Hamilton Bailey "A correct diagnosis is the hand maiden of a successful operation. The diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and surgical science. In an age accustomed to early and accurate preoperative diagnosis, acute appendicitis remains an enigmatic challenge and a reminder of the art of surgical diagnosis. A lump in the abdomen has always held a fascination for clinicians. The patients presenting with mass per abdomen form bulk of the cases in surgery. Among the various quadrants of abdomen, the right iliac fossa enjoys the pride of place as far incidence of mass per abdomen is concerned. Although an extensive subject, this study was undertaken to unravel some of mystery of a mass in right iliac fossa, the very presence of mass proving a diagnostic problem. Mass per abdomen by reason of their wide spread complications has since long exercised the mind of many surgeons and is not an uncommon entity. 2
Patients with mass in right iliac fossa may well be confronted by a general practitioner, a surgeon or a gynaecologist and the correct diagnosis is regarded as a clinical puzzle by many. Thorough understandings of the anatomy and pathological process that may occur within the abdomen are essential for an accurate diagnosis and treatment of a mass in right iliac fossa.2
The most common differential diagnosis encountered by surgeons today are: 2
Appendicular Lump
Appendicular Abscess
Ileocaecal Tuberculosis
Right Ovarian Mass
Right Ectopic Kidney
Rectus Sheath Hematoma
Ca Caecum
Amoeboma
The aim of the present study is to recognize clinico-pathological entities presenting as mass in right iliac fossa with respect to their relative incidences, age, gender distribution management and complications and their management.