Problems in the diagnosis of lymphogranuloma venereum - A review of 6 cases

Six cases of lymphogranuloma venereum are described in White South Africans. All initially presented diagnostic problems. This sexually transmitted disease is uncommon in South Africa, and 5 of. the 6 patients presented with inguinallymphadenopathy without a primary lesion. The value of serological tests in the diagnosis of this disease is emphasized

INTERNAL INTESTINAL FISTULAE CAUSED BY AMOEBIASIS

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Outlook Magazine, Spring 1972

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A Prospective study on Splenic Injury

INTRODUCTION: An injured spleen is a well-known entity to those involved in trauma care. The majority of individual with a splenic injury now receive nonoperative intervention and therapy. This shift from operative to nonoperative treatment over the past several decades is a tremendous success story in which clinical judgment and reason triumphed over standard surgical dogma. Furthermore, this success has prompted surgeons to adopt similar management strategies for other solid organ injuries. Recent work with clinical outcomes data in splenic trauma has given rise to model clinical practice guidelines. These guidelines serve to standardize and justify management decisions based on the best possible data and accepted clinical parameters. AIM OF THE STUDY: The aim of the study is to evaluate the following aspects: 1. To evaluate the impact of blunt or penetrating abdominal trauma on spleen. 2. To evaluate various modes of injury. 3. To evaluate various modes of clinical presentation of cases. 4. To evaluate the value of various available investigations employed. 5. To evaluate the various methods of treatment. 6. To evaluate various associated injuries occurring. 7. To evaluate the morbidity and mortality. MATERIALS AND METHODS: This study was a prospective study of 20 cases of splenic injury abdomen admitted in the triage ward of Mahatma Gandhi Memorial Government Medical College Hospital -Trichy, from October 2010 to October 2012. Once the patient is admitted the name, age, sex and mode of injury are noted. The time interval between splenic injury and admission and time interval between admission to hospital and surgery are recorded. After resuscitating the patient, all patients were subjected to careful clinical examination. Depending on the clinical findings, decision was taken for further investigations such as four-quadrant aspiration, X-ray abdomen, ultrasound and CT abdomen . The decision for operative & non-operative management depended upon the outcome of clinical examination & diagnostic tests. Patients selected for conservative management were placed on strict bed rest, serial clinical examination which included hourly pulse rate, blood pressure, respiratory rate and repeated abdominal examination. In those who are operated, the operative findings and methods of management are recorded. Cases are followed up till their discharge from the hospital. If patient expired postmortem findings are noted. Post operative morbidity and duration of hospital stay were recorded. The above facts are recorded in a proforma prepared for this study. OBSERVATIONS AND RESULTS: The total number of patients who had sustained splenic injuries were 20. In this study of the 20 patients 15 cases were male and 5 cases were females. The increase in the incidence of association of males is due to acts of violence and vehicular accidents. CONCLUSION: • Road traffic accident is the commonest cause for splenic injury Abdomen. • Predominance of male over female in splenic injury abdomen with the ratio of 3:1. • People in the age group of 3rd & 4th decade were commonly involved in splenic injury abdomen constituting about 55 %. • Based upon the grading of injuries and hemodynamic stability of the patient and other associated injuries, decision of laparatomy versus conservative management decision was taken. • 12 patients were managed surgically,8 underwent splenectomy and 4 underwent splenorrhaphy by topical hemostatic agents and sutural repair. • Overall mortality due to splenic injury abdomen was 15%. • Sepsis and associated injury were the major causes of death

Hospital of Saint Raphael Annual Report, 1918

Eleventh Yearhttps://elischolar.library.yale.edu/hospital_st_raphael_annual_reports/1007/thumbnail.jp

The Natural History and Management of Patients With Pancreatic Pseudocysts as a Complication of Acute Pancreatitis

In this thesis I have studied the natural course, outcome and management of patients who developed a pancreatic pseudocyst following an episode of acute pancreatitis. The clinical information for this work originated in 2 studies involving a total of 129 patients with a pseudocyst. This represents one of the largest reports of such patients in medical literature. One study was of 100 patients with a pseudocyst presenting to Glasgow Royal Infirmary, over a period of 23 years (1962 - 1984 ) (Chapter 3 ) (Imrie et al 1988 . Appendix 1). The second study was of 29 similar patients (Chapter 4) documented during a prospective trial of therapeutic peritoneal lavage in patients with severe acute pancreatitis recorded in Leeds, Bristol and Glasgow (1982 - 1984) (Corfield et al 1985, Mayer et al 1985. Appendix 1). Using the information derived from these studies, I have formulated an assessment system for predicting the likelihood of spontaneous resolution of a pseudocyst (Chapter 8). With the addition of results obtained from an analysis of percutaneous needle aspiration (Chapter 6) and analysis of acute phase reactant proteins within pseudocyst fluid (Chapter 7) I propose a new plan of management for patients with acute pancreatic pseudocysts. The important findings of this thesis are summarised as follows:- 1. The "waiting time" for conservative management of a pancreatic pseudocyst could safely be extended to 12 weeks. Bradley et al (1979) have suggested that a period of 6 weeks from the time of pseudocyst formation should be regarded as both the maximum time to wait for spontaneous resolution of a pseudocyst and the optimum time to consider some form of drainage procedure. A pseudocyst was drained surgically in 78 (%) of the 100 patients from Glasgow Royal Infirmary and resolved spontaneously in the other 22 (%). The median time from diagnosis to drainage by cystogastrostomy was 12 weeks (range 2 - 69 weeks). The median time to complete spontaneous resolution was also 12 weeks (range 2 - 104 weeks). Of the 29 patients from Leeds, Bristol and Glasgow surgical drainage was performed in 11 (38%) at a median time of 7 weeks (range 3-38 weeks) and spontaneous resolution occurred in 15 (52%) at a median time of 7 weeks (range 2-20 weeks). Bradley et al (1979) also found an increasing proportion of patients developed complications the greater the time a pseudocyst was left untreated. Only 6 (5%) of all 129 patients studied suffered complications as a result of an undrained pseudocyst. Based on the above results I suggest that 6 weeks is too short a period and 12 weeks is a more appropriate time to wait for spontaneous resolution to occur provided the is repeatedly assessed by clinical examination and ultrasound scanning to confirm that the diameter of the pseudocyst is not increasing and that the clinical state of the clinical state of the patient is not deteriorating. 2. No single factor causing acute pancreatitis predisposes to pseudocyst formation. Of the 100 patients from Glasgow Royal Infirmary alcohol was the cause of acute pancreatitis in 59%, gallstones in 27% and the aetiology was idiopathic in 9%. In contrast, of the 29 patients from Leeds, Bristol and Glasgow alcohol was the aetiological factor in 23%, gallstones in 48% and it was idiopathic in 23 %. This distribution was very similar to that of a total of 418 patients with acute pancreatitis studied in the three cities (Chapter 4)(gallstones 54%: alcohol 20%: idiopathic 21%). This suggests that no single aetiological factor of acute pancreatitis is more likely to cause pseudocyst formation. 3. The aetiology of the preceding acute pancreatitis is an important factor in determining the outcome of patients with a pseudocyst. The mortality amongst patients from Glasgow Royal Infirmary with gallstone induced pancreatitis and pseudocyst formation was 22% significantly greater than that of patiens with alcohol induced disease (5% mortality. The majority of patients who died as a result of gallstone induced disease did so because of sepsis and/or haemorrhage. The implication from this is that, if possible, in order to decrease the possibility of infection, the biliary tract should be cleared of stones at the time of definitive pseudocyst surgery. 4. Spontaneous resolution of a pseudocyst can be predicted using a multi-factor assessment system. A pseudocyst resolved spontaneously in 22 (%) of the 100 Glasgow Royal Infirmary patients and 15 (52%) of those from Leeds, Bristol and Glasgow. Differences in clinical, laboratory and radiological findings in these patients were compared with those of patients whose pseudocyst needed drainage. The proportion of patients with a palpable abdominal mass was significantly greater in those who required surgery in both groups of patients. The results for the patients from Leeds, Bristol and Glasgow also showed a significantly higher proportion with abdominal distension and a leukocytosis (>10 x 10e9 cells/1) amongst those who underwent surgery. (Abstract shortened by ProQuest.)

Twenty Five Years Of Surgical Odyssey - 1985 - 2010

25 Years: Just the First Step of a Long Journey Editor\u27s Foreword Deans Message A Rewarding Journey The Journey Ahead First Chairperson\u27s Message A Futuristic Tomosynthesis Snippets, On Reviewing 28 Years in an Organization Departmental 0rganogram Brief Profiles of Past and Present Department Professors Sectional Photographs Our Volumes Over the Years SURGERY ALUMNI - RESIDENCY & FELLOWSHIP PROGRAMS List Of Residents\u27 Submitted CPSP Dissertations (FCPS-II) Publish Or Perish: A Compilation Of 25 Years of Department\u27s Published Research Analysis Of 2 5 Years of Published Research Research Grants Received by The Department Surgical Grand Rounds: What Happens After the Cake and Tea?https://ecommons.aku.edu/surgery_newsletter/1018/thumbnail.jp