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.

Radioactive iodine therapy in Graves' hyperthyroidism: a prospective study from a tertiary referral centre in north India.

BACKGROUND: Radioactive iodine has gained widespread acceptance as the first-line therapy for Graves' hyperthyroidism and is the preferred treatment option in most situations. OBJECTIVE: A prospective study was conducted to look at the therapeutic practice of use of radioactive iodine in the treatment of Graves' hyperthyroidism, to determine whether the expected or desired therapeutic outcome is achieved. SETTINGS: A tertiary referral centre in north India, Delhi that caters to patients with thyroid disorders. METHODS: One hundred and seventy four consecutive subjects with Graves' hyperthyroidism, who were given radioactive iodine were followed up. RESULTS: There were 59 (33.9%) males and 115 (66.1%) females. The mean age was 41.8 +/- 9 years. The dose of radioactive iodine ranged from 2 mCi to 15 mCi and the mean dose administered was 5.2 +/- 1.9 mCi. After one year following radioactive iodine therapy, 29 (16.7%) subjects were euthyroid, 51 (29.3%) were hypothyroid and the remaining 94 (54%) had persisting hyperthyroidism. Those subjects with persisting hyperthyroidism at one year after radioactive iodine had received a significantly lower dose compared to the groups who had achieved cure (either euthyroidism or hypothyroidism). CONCLUSION: The study shows that the current practice of empirical low dose radioactive iodine therapy to avoid hypothyroidism results in majority of patients having persisting hyperthyroidism. There is a need to take a new look at the current practice to increase the cure rate.

Clinical, biochemical and cytomorphological observations in juvenile chronic lymphocytic thyroiditis.

OBJECTIVE: To determine the clinical, biochemical, ultrasonological and cytomorphological features in goitrous juvenile chronic lymphocytic thyroiditis(CLT). SETTING: Tertiary referral center for thyroid disorders. SUBJECTS: A total of 455 children were evaluated for goiter. Of these 122 children had features of CLT in FNAC and were further studied. METHODS: All subjects were subjected to detailed clinical examination. The thyroid functional status was assessed by estimation of serum concentration of thyroid hormones (thyroxine and triiodothyronine) and thyrotropin (TSH). In addition the antithyroid antibody titers were measured. Ultrasonological and cytomorphological characteristics in these patients were also evaluated. RESULTS: The mean age at presentation was 12.5 years (SD 3.93). The male: female ratio was 1:7.7. Thyroid functional status as assessed by serum thyroxine and thyrotropin levels revealed, euthyroidism in 67 (54.9%), hypothyroidism in 30 (24.6%), subclinical hypothyroidism in 22 (18%) and hyperthyroidism in 3 (2.5%). Thyroid antimicrosomal antibodies were detected in significant titers in 90 (73.8%) and antithyroglobulin was positive in 71 (58.2%). The positivity of the antimicrosomal and antithyroglobulin antibodies were much higher in subjects with hypothyroidism and was detected in 86.5% and 69.2%, respectively. The mean urinary iodine excretion was 74.1 micrograms/g of creatinine (SD 31.4) indicating mild iodine deficiency. Fine needle aspiration cytoloty (FNAC) revealed features of chronic lymphocytic thyroiditis. Hurthle cell changes was seen in only 12% of the cases. The epithelium was more often hyperplastic and vacuolation of the cytoplasm and peripheral vacuolations were seen frequently. Giant cells and epithelioid cells were seen in many cases. CONCLUSIONS: In any child presenting with firm goiter, a diagnosis of CLT should be excluded. Many subjects with juvenile CLT have biochemical evidence of hypothyroidism but only few symptoms or clinical features.

Thyrotoxicosis--treatment by I131 therapy and early prediction of hypothyroidism following this therapy.

This study was undertaken in 68 thyrotoxic patients to assess the predictive value of various post treatment biochemical and immunological tests for early hypothyroidism after I131 therapy and to determine whether pretreatment with carbimazole protects against post I131 therapy hypothyroidism. Early changes observed in serum T3, T4, TSH, thyroid microsomal and thyroglobulin antibody levels were found to be of no predictive value. A sharp increase in TRAb levels around 3 months following I131 therapy indicated that hypothyroidism was likely to occur as this rise reflected a greater degree of thyroid damage. Lower levels of thyroglobulin in patients who became hypothyroid by 12 months after treatment would support this view. Carbimazole pretreatment for eight weeks did not appear to protect against hypothyroidism, in our study.