ABSTRACT
Diaphragmatic hernia (DH) usually occurs in childhood; however, in adult it is uncommon. Most common aetiology of DH in adult is trauma while spontaneous DH is a rare entity accounting for <1%. The management is primarily surgical repair in the form of open or laparoscopic approach; the later has been associated with low morbidity, mortality and excellent long term outcomes with low rate of recurrence. In this case series, confirmation of the diagnosis was done by CT scan and by laparoscopy in all the patients; laparoscopic repair was performed in all the patients along with thoracoscopic aid in two cases. We found that minimal access techniques can be safely done in DH; in conditions when the herniated content are difficult to get reduced laparoscopically alone, a simultaneous thoracoscopy has helped in great deal in reducing the content and completing the procedure entirely by minimal access techniques. This gives all the advantages of minimally invasive approach like less postoperative pain, shorter hospital stay, quicker recovery and low recurrence rate; provided tissue repair is done in tension free manner by an experienced laparoscopic surgeon.
ABSTRACT
Introduction: Non-resolving or slowly resolving pneumonia is not uncommon, affecting 10–20% of patients admitted withcommunity-acquired pneumonia (CAP). Non-resolving pneumonia is a challenging clinical problem. Incidence of non-resolvingpneumonia was found to be 10–15% among hospitalized patients with CAP and of them 6% developed progressive pneumonia.This study aims to evaluate the patients of non-resolving or slowly resolving pneumonias to establish the cause of it.Methodology: It is a prospective, observational study taken up by the Department of Pulmonary Medicine of SVS MedicalCollege and Hospital, Mahabubnagar, Telangana. All the enrolled cases of non-resolving or slowly resolving pneumonia whichsatisfy the inclusive criteria were taken into the study from June 2017 to December 2018. A total of 28 patients were satisfyingthe inclusion criteria and were further studied for evaluating the causative factors. The study was started after taking the approvalof the Institutional Ethics Committee, SVS Medical College and Hospital, Mahabubnagar, Telangana.Observation and Results: The mean age of the patients was 48.2 years. Of 28 patients, 18 (64.2%) were male and 10 (35.7%)were female with a male:female ratio – 1.8:1. Fever (81%) and cough (86%) were the most common symptoms. Smoking wasthe most common comorbidity noted (60.7%) followed by alcoholism (46.6%), diabetes (39.28%), hypertension (25%), andchronic obstructive pulmonary disease (21.4%). The most common cause of non-resolution of pneumonia in this study wastuberculosis 11 (39.28%) followed by bacterial pneumonias 9 (32.1%) which were caused by drug-resistant organisms. Othercauses were malignancy 6 (21.4%), foreign body 1 (3.57%), and fungal pneumonia 1 (3.57%).