ABSTRACT
Introduction: Amoebic liver abscess is an inflammatory space-occupying lesion of the liver caused by Entamoeba histolytica.Trophozoites after lodging in sufficient numbers in venules lead to thrombosis and infarction and microabscesses formationand thence amoebic abscess. Fever and pain right upper quadrant are very common.Aims and Objectives: The aim of the study was to review the contemporary management of amoebic liver abscess.Materials and Methods: This hospital based observational study for 100 patients was performed in the Surgery Departmentin SGT Medical College, Budhera, Gurugram, Haryana. A detailed history and focussed clinical examination and requiredinvestigations were done. Patients were divided into three categories according to sizes of abscesses, <5 cm, 5–8 cm, and>8 cm. In Category I, patients were treated with metronidazole 40 mg/kg body weight in three divided doses. If toxemia wasthere, then metronidazole 100 ml, IV 8 hourly was given for 3–4 days and switched onto oral metronidazole. In CategoryII, if a trial of conservative treatment for 3 days did not relieve the symptoms, and in Category III, ultrasound-guided pigtailcatheterization was done.Results: In our study, maximum patients were between 21 and 60 years of age. Male:female ratio was 4.55:1. Patients presentedwith fever, pain right hypochondrium, and hepatomegaly. Liver enzymes were elevated. Total lymphocyte counts were raisedand serum albumin was decreased in some patients.Conclusion: Due to our concrete planning and meticulous care at every step, there was lack of infection at the port site ordeep-seated, and there has been no failure of resolution, no hemorrhage, recurrence, pleural complications, and fever andthere has been no death in our series.
ABSTRACT
Introduction: Urolithiasis is a very common problem present. About 70% of all ureteric stones are found in the lower third ofureter. Many factors affect the modality of treatment such as setup available, type, size of stone and expertise of the surgeon.Extracorporeal shock wave lithotripsy and ureteroscopy and removal of stone are very effective, but they require the help ofanesthetist. Ureter is to be stented, and the stent has to be removed later on. They are very costly and not without complications.Many pharmacological agents have been used for the expulsion of ureteric stones, for example, diclofenac, alkalizers, ketorolac,nifedipine, deflazacort, prazosin, silodosin, and tamsulosin.Materials and Methods: This prospective observational study was conducted in the Surgery Department at SGT MedicalCollege. A total of 100 patients of distal ureteric stones of sizes 4–10 mm were taken in this study, divided into two groups of50 patients each. Group I patients were given tamsulosin 0.4 mg and deflazacort 30 mg once in a day, Group II patients weregiven tamsulosin 0.4 mg once in a day. Treatment was for 10 days.Results: In Group I, the stones were expelled in 38 (76%) patients, while in Group II, 26 (52%) patients passed stones. Thisis statistically significant with P = 0.038. The median time for stone expulsion was 3 days in Group I and 11 days in Group IIwith P = 0.032.Conclusion: We have evaluated that medical expulsive therapy using tamsulosin alone is also effective and can be used inpatients where steroids are contraindicated, but by adding deflazacort, it becomes very effective for management of distalureteral calculi.