A Study of Presentation and Management of Complicated Groin Hernias in Adults

INTRODUCTION: A hernia is defined as the abnormal protrusion of a viscus or tissue through a normal or abnormal aperture. Abdominal wall hernias of the groin include inguinal, femoral and obturator Hernias. Groin Hernias are the most common type of Hernias. Several risk factors have been implicated in the development of groin hernias, including obesity, chronic cough, prostatic enlargement, pregnancy and perhaps most importantly aging, which studies suggest contributes significantly to the breakdown of tissues resulting in the development of some groin hernias. Coughing (or) severe straining as occurs with constipation (or) prostatism frequently precipitates the clinical appearance of the hernia. Most groin hernias are clinically important and should be repaired electively, before they begin to enlarge. Any sudden increase in the size of the mass suggests incarceration or the development of a sliding component. The risks of delaying surgery can be considerable, with the most important concern being the chance of developing complications like incarceration / irreducibility, obstruction and fatal strangulation of hernia contents. If this occurs emergency surgency is inevitable, regardless of the patient’s medical status, comorbid medical conditions or concomitant medications including the use of anticoagulants. The mortality rate in a strangulated Hernia is related directly to the length of time of strangulation and the age of the patient. Our study is intended to have a close look at the clinical presentation of the groin hernias which have proceeded on to complications and the best possible way of successfully managing the case with a background aim of preventing the recurrence of the disease. AIMS AND OBJECTIVES Aims of this study are to know the following: 1. The incidence of Groin hernias presenting with complications, 2. The contribution of obstructed groin hernias to the incidence of intestinal obstruction, 3. The modes of clinical presentation of complicated Groin Hernias, 4. The ideal way of managing a complicated Groin Hernia, 5. Peroperative complications, if any, 6. Ideal method of Hernia Repair, 7. Incidence of Postoperative complications, if any, 8. Follow up of the cases. MATERIALS AND METHODS: The clinical material for this study consists of 50 cases who were admitted and operated for complicated groin Hernia in various surgical units in Thanjavur Medical College during the period February 2005 to February 2006. The patients under study were admitted from casualty with complaint of a groin swelling and associated features of its complication. Those patients who were admitted to have a irreducible hernia initially but become reducible on performing the maneuver of ‘Taxis’ were excluded from the study. In the admission ward, useful history regarding the duration of swelling, duration of irreducibility, history suggestive of obstructive and systemic disturbances were carefully ilicited from the patients (or) their attenders. If the swelling was recurrent, history about the previous operative procedure was ascertained. Enquiries were made about the co-morbid medical illness and about personal habits. The patients vitals were recorded with emphasis on mental status and degree of dehydration. Examination of the groin swelling carried out in detail and subsequent abdominal examination to rule out obstruction and peritonitis. The patients were thoroughly screened for any predisposing factors viz. per rectal examination for stricture, prostatic enlargement (or) growth; abdomen examn. for ascites; Respiratory system examination for chronic Respiratory Tract infection. CONCLUSION: 1. The major complications of groin hernia in our study included irreducibility, obstruction and strangulation. 2. Obstructed groin hernia remains the most common cause of small intestinal obstruction, admitted in emergency department. 3. Most of the complicated groin hernias occur in old aged people. Males out number female in overall incidence. Femoral Hernia is commoner in females. 4. Primary indirect Inguinal Hernia were the most common type of hernia in the study. 5. Right sided Hernias are more common than left regardless of the type of Hernia. 6. Obstruction of the bowel in the hernial sac is the most commonly presented complication. 7. Neck of the hernial sac was the most common constricting agent causing complication. 8. Ileal loops were the most common content of the hernial sac. 9. Initial resuscitation was instituted in all cases of strangulation which helped in smooth preoperative course and smoother postoperative recovery

Study on factors influencing the course and outcome of inflammatory lesions of kidney in adults

INTRODUCTION: Inflammation of renal parenchyma and collecting system are usually secondary to microbial infections . Interstitial renal inflammation caused predominantly by bacterial infection, is nowadays recognized as a non specific histopathological change that can occur due to various immunologic, congenital, or toxin induced lesions that develop in the absence of bacterial infection. Urinary Tract Infection (UTI) is considered as an inflammatory response of the urothelium to microbial invasion . UTIs exist as one of the most prevalent microbial diseases in the society with a substantial financial burden. Spectrum of infectious disease process in the kidney presenting as acute inflammatory lesion commonly encountered in urological practice include Acute Pyelonephritis, Focal and multifocal bacterial nephritis, Renal cortical abscess, Perinephric abscess, Emphysematous Pyelonephritis, Pyonephrosis. AIMS OF THE STUDY: 1. To analyse the risk factors predisposing the acute inflammatory lesions in kidney . 2. To evaluate the factors determining their clinical course – Recovery from disease / Nephrectomy 3. To discuss the management options and factors influencing their success. MATERIALS AND METHODS 1. Study Group : Patients who were admitted with features of acute renal inflammation at Kilpauk Medical College Hospital and Government Royapettah Hospitals , Chennai. 2. Study Design : Prospective clinical study. 3. Period of Study: January 2012 - January 2013. 4. Total number of cases : 30 patients. 5. Data Analysed : Risk factors, Clinical manifestations, Laboratory Investigations, Imaging Studies, Therapeutic interventions , Final outcome , Follow up. Inclusion criteria : Patients presenting with acute onset Flank or Loin pain , Fever with chills, with or without lower urinary tract symptoms. Radiological evidence of Renal inflammatory pathology. Exclusion criteria : Patients unwilling to undergo intervention as a part of therapy Study Protocol Diagnosis of renal inflammatory lesions was made by Complete History (which included enquiry on predisposing risk factors ) , Clinical Examination and confirmed by imaging studies. DISCUSSION: Inflammatory lesions of kidney commonly encountered in urological practice are secondary to infectious processs although a variety of immunologic, congenital, metabolic or toxin induced diseases can present as renal inflammation. The inflammatory process may be acute usually following a bacterial infection ( Bacterial nephritis ) and includes spectrum of clinical entities, progressing from mild acute pyelonephritis to renal abscesses or emphysematous pyelonephritis. Inflammation as a chronic process occur as a consequence of either infection superadded on structural and functional abnormalities such as vesicoureteral reflux disease or reactivation of latent infection with organisms like Mycobacterium tuberculosis. There are no specific symptoms for chronic pyelonephritis until it produces renal insufficiency, and then the symptoms are similar to those of any other form of chronic renal failure. The severity of the renal infection depends on the virulence factors of the offending agent and the strength of host defence mechanisms. We conducted this study to analyse the host factors that influences the clinical course and the final outcome of acute inflammatory pathology. CONCLUSION: Diabetes is the most common predisposing risk factor for the occurrence of acute inflammatory lesion of kidneys in our study . • Concomitant presence of diabetes and urolithiasis confers higher incidence of severe renal parenchymal damage leading to nephrectomy • The presence of an altered mental status at presentation ,poor glycemic control ( increased HbA1c levels ) , increased serum creatinine , thrombocytopenia and presence of hydronephrosis at presentation are associated with higher need for nephrectomy in our study • Type of renal lesion at presentation significantly influence the therapeutic option excised and the need for performing nephrectomy. • Our study shows no significant association with age, gender ,laterality of lesion , haemodynamic instability at presentation , leukocytosis, positive urine culture and bacteraemia with the occurrence of nephrectomy

Contamination spatio-temporelle d’origine hydrique de l’oued Boufekrane dans la région de Meknès-Tafilalt (Maroc)

L’objectif de la présente étude est d’identifier l’origine et le degré de la contamination bactérienne instantanée des eaux courantes de l’oued Boufekrane de la région Meknès-Tafilalet (Maroc). Pour cela des analyses bactériologiques ont été réalisées sur sept sites de prélèvement qui couvrent l’oued Boufekrane. Le suivi spatio-temporel des coliformes totaux (CT), coliformes fécaux (CF), streptocoques fécaux (SP), anaérobie clostridium sulfito-réducteurs (ACSR) et flore mésophile totale (FMAT) montre que la charge bactérienne de ces germes dépasse largement les normes marocaines et les directives de l’organisation mondiale de la santé (OMS). Il a révélé au cours de la période 2009-2010, une variabilité spatio-temporelle des quatre saisons en temps sec et en temps de pluie par l’influence importante du type d’occupation des sols et des phénomènes de lessivage sur la composition bactériologique de l’oued. L’analyse en composantes principales (ACP) montre une forte corrélation spatio-temporelle entre les stations-mois et la contamination microbienne. Le test de Duncan montre un effet hautement significatif (p<0,001) entre la localisation des stations et les saisons. Il nous permet de conclure que les sites sont caractérisés en amont par une forte pollution en nitrates et une faible contamination en matière fécale, alors qu’en aval, les eaux de l’oued sont caractérisées par une forte contamination fécale et par une faible pollution en nitrates. © 2013 International Formulae Group. All rights reserved.Mots clés : Oued Boufekrane, bactériologie, nitrates, contamination fécale, effet sanitaire, ACP

Chemical Additives for Corrosion Control in Desalination Plants

The addition of chemical additives has been considered as a standard operation in water treatment systems. This chapter discusses the chemical additives used for the control of corrosion in desalination systems. Specifically, corrosion inhibitors for various metallurgies, biocides, and oxygen scavengers are covered. The pros and cons of the additive chemicals have been highlighted. The need to utilize green corrosion inhibitors based on plants and ionic liquids materials have been emphasized. This class of materials are environmentally friendly, cheap, and readily available

Study the performance of the organic membrane ultrafiltration on whey treatment

Treatment of whey using the organic membrane processes namely ultrafiltration (UF) was investigated to recover the proteins for re-use. Membrane module was tested in batch mode operations and multi-stages operations employing the influence of the pH and temperature. The performance of ultrafiltration membrane can be characterized permeate flux and membrane retention, these parameters are determined by pH and temperature. The influence of these parameters on whey protein concentrate is also measured.nbspThe permeate flux and the protein content in the permeate and in the concentrate fractions were measured during the experimental runs. By comparing the separation behavior of the membrane for the two separation modes it was found that the investigated membrane produced the best results from the point of permeate flux, VRF and protein content in multi-stage modes in optimal condition (pH=6.5 and Temperature 50degC). The filtration characteristics were obviously influenced by the process parameters