ABSTRACT
Background: Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Materials and methods: Patients underwent emergency explorative laparotomy for hollow viscus perforation surgery in general surgery department was included in present study. Edge biopsy specimen was sent to histopathological examination. All patients were tested for widal positivity and were started on anti- salmonella treatment if it was positive. Based on intra- operative finding and histopathological reports, ATT was started for those who are positive for tuberculosis. All patients were monitored in the post-operative period for complications. All patients were followed up for a period of six months. Results: A total of 60 patients with Ileal perforation were included in the study of which 50 were males and 10 were females accounting for 83.33% and 16.67 % respectively. The most common symptom was pain abdomen which was present in all the patients (100%). The next common symptom was vomiting seen in 44 out of 60 patients (73.33%) followed by fever seen in 38 out of 60 patients (63.33%). Absent bowel sounds was found in 36 out of 60 patients (60%). Air under diaphragm on erect X-ray abdomen was found in 56 patients (93.33%). Conclusion: Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests are expensive. And administration of ATT helped to treat the patients successfully. A high index of suspicion for intestinal tuberculosis is needed in patients who are on immunosuppression.
ABSTRACT
The tumescent technique of liposuction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to liposuction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in liposuction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine- induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness. Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the liposuction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia. Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits liposuction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 ųg/ml 1 hour after completion of the infiltration.
ABSTRACT
Post mastectomy seroma remains an unresolved quandary as the risk factors for its formation have still not been identified. Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. Various techniques and their modifications have been practiced and published in English literature, but there seems to be no consensus. In this article, all aspects of seroma formation from pathogenesis to prevention including drug therapies have been discussed.