Role of drains in cases of peptic ulcer perforations: comparison between single drain versus no drain

Background: Peptic ulcer perforation is one of the commonest causes of peritonitis and needs immediate surgical intervention after prompt resuscitation if mortality and morbidity are to be contained. Aims and objectives of the study was to compare role of Intra-abdominal drains prophylactically after plugging of these perforations single drain or no drain.Methods: In this study, we compared the relative safety and efficacy of putting single drain prophylactically near operation site or in natural abdominal fossae (hepato-renal pouch or sub hepatic) and no drain in cases of peritonitis due to peptic ulcer perforation. Study was done on 60 patients (one drain put in 30 patients Group A and no drain was put in other 30 patients of Group B). We handle the perforation after thorough peritoneal lavage with warm saline and metrogyl. All the perforation was closed by Grahm’s Patch.Results: No significant difference between drain and non-drain group as far age and sex concerned. Significant difference was seen in operative duration, hospital stay, wound dehiscence and post-operative fever, intraperitoneal collection or abscess formation. So use of drains are not effective in preventing post-operative infection rather there are chances of its blockage due to debris, intestine or omentum and tubes itself are source of infection as foreign body and there are chances of migration of bacteria from exterior to peritoneal cavity via these drains.Conclusions: Non drainage of peritoneal cavity after peptic ulcer perforation surgery is an effective method to reduce operative duration, hospital stay and wound dehiscence and post-operative pyrexia.

An Adult Male Presenting with a Left Gluteal Region Hemangioma – An Unusual Site.

The word “hemangioma” comes from the Greek haema- (αιμα), “blood”; angeio (αγγειο), “vessel”; -oma (-ωμα), “tumor”. A Hemangioma is a benign and usually selfinvoluting tumor of the endothelial cells that lines blood vessels, and is characterized by increased number of normal or abnormal vessels filled with blood. It usually appears in the initial weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas have completed involution by age five, 70% by age seven, and most of the remainder by age twelve years1. In more severe cases hemangiomas may leave residual tissue damage. In infancy, it is the most common tumor 2.

Duxorubicin-induced cardiotoxicity.

The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side-effects associated with the intensive anticancer treatment. Cardiotoxicity of anticancer drugs is a serious problem. It is defined, by the National Cancer Institute, as the “toxicity that affects the heart.” This definition not only includes a direct effect of the drug on the heart, but also an indirect effect due to enhancement of hemodynamic flow alterations or due to thrombotic events. Cardiotoxicity can develop in a subacute, acute, or chronic manner. The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Anthracyclines, such as doxorubicin (DOX), cause serious cardiac side-effects. Acute tachyarrhythmias and acute heart failure (HF) may occur after high doses, but these reactions are now rare due to changed dosage schemes (e.g. slower infusion) with the aim to prevent this. However, the sub-acute or chronic cardiac effects of anthracyclines remain a clinical problem. Clinically, anthracycline induced cardiotoxicity manifests itself as left ventricular failure, which develops insidiously over months to years after completion of the anthracycline based chemotherapy and may result in congestive HF. The mechanism of anthracyclin induced cardiotoxicity is not totally unraveled. It is likely that the decline in myocardial function is related to apoptosis of cardiac myocytes that occurs apparently at random in the myocardium. Anthracyclin induced formation of reactive oxygen species (ROS) in the presence of intracellular iron, impaired homeostasis of intracellular iron and calcium (that may facilitate the apoptosis induced by the ROS) have been put forward as mechanisms. Cardiac protection can be achieved by limitation of the cumulative dose. Further, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity.

Persistent Vitellointestinal Duct Causing Small Bowel Obstruction - A Rare Entity.

Vitellointestinal {omphalo-mesenteric (OMD)} duct connects the developing mid-gut to the primitive yolk sac, provides nutrition to the embryo and remains patent and connected to the intestines until the fifth to ninth week of gestational period. Varied remnants of the vitellointestinal duct have been reported. The present case report describes a completely obliterated fibrous remnant of the duct. The remnant presented as a thick cord extending from the umbilicus towards the terminal part of ileum with a Meckel’s diverticulum. Herein, we report a case of 20 yr old male who presented with the features of small bowel obstruction due to completely obliterated fibrous remnant of the duct which is a rare entity. Although persistent omphalomesentric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

Unifocal bony lesion of langerhans cell histiocytosis of tibia in a child mimicking osteomyelitis : A diagnostic challenge.

Langerhans cell histiocytosis (LCH) is a rare proliferative histiocytic disorder of unknown etiopathogenesis. The clinical presentations range from unifocal or multifocal bony lesions to disseminated form of the disease with multiorgan involvement. The unifocal bony lesion (Solitary eosinophilic granuloma) carries a good prognosis. We report such a case of unifocal bony lesion of LCH involving tibia in a 8 years old female child. The clinical and radiological manifestations were non specific, enlightening the suspicion of osteomyelitis. A curettage excision biopsy was performed which on microscopy revealed sheets of eosinophils in milieu of Langerhans cells, giant cells, lymphocytes and plasma cells. Langerhans cells showed strong immunoreactivity for S-100 and CD1a antigen thus establishing the diagnosis of LCH. LCH of long bones may be a rare entity but it must be kept in mind as a differential diagnosis whenever a child presents with features of osteomyelitis.

Status of Vitamin C and Vitamin E in Acute Pancreatitis and their Prognostic Significance

Experimental and clinical studies have provided some support for the concept that oxidative stress is the common pathway for initiation of acute pancreatitis. Ascorbic acid (vitamin C) and alpha tocopherols (vitamin E) are the key anti- oxidants in human blood plasma. In present study our aims was to measure the levels of Vitamin-C & Vitamin-E (Alpha- Tocopherol) in patients of acute pancreatitis and to compare the levels with control group as well as to assess the prognostic significance of Vitamin-C & Vitamin-E levels in acute pancreatitis in relation to Ranson’s criteria. Serum levels of vitamin C & E were measured in 50 cases having acute pancreatitis and 20 controls having pain abdomen of non pancreatic origin. Levels of vitamin C and vitamin E were compared with the controls and were correlated to the severity of disease according to Ranson’s criteria. The difference in the levels of vitamin C between the study group and the control group was statistically nonsignificant at the time of admission and at 48 hours. However the difference was statistically significant at 7 days. The difference in the levels of vitamin E between the study group at the admission is statistically non-significant when compared to the levels in the control group at the time of admission, at 48 hours and at 7 days after the admission. No correlation was found between the levels of vitamin C and vitamin E at the time of admission, at 48 hours and at 7 days with the severity of disease according to Ranson’s score. There is an initial fall in the levels of vitamin C with the rising trend towards the end of the 7 days period. The levels of the vitamin E had rising trend towards the end of the 7 days but no statistically significant initial fall in the levels as compared to the control group. Levels of vitamin C and vitamin E have no prognostic significance in the cases of acute pancreatitis.