A Study Of Intestinal Obstruction Conservtive Vs Surgical Management

INTRODUCTION: Intestinal obstruction can be defined as impairment to the abnormal passage of intestinal contents that may be due to either mechanical obstruction or failure of normal intestinal motility in the absence of an obstructing lesion.The causes of a small bowel obstruction can be divided into three categories: extra luminal, intrinsic, Intraluminal. METHODOLOGYThis is a retrospective observational study. All patients presenting to the Emergency and Out-Patient Department of surgery unit with features of intestinal obstruction were screened to identify the patients with AIO. RESULTS AND DISCUSSIONIn this study total 60 no. of pt. were evaluated during the period of January 2017 to June 2018. From these 60 pts. 22 pts. managed conservatively where as 38 pts. were managed surgically. Overall mean age group of these pt. was 54 and M:F ratio was 1.3:1. Male has higher incidence than female .Among these pts. abdominal pain and vomiting are more common symptom than obstipation .Among this 60 patients, 20 patients had previous abdominal surgery, 16 patient had exploratory laparotomy for abdominal trauma , perforation, gynaec procedure , appendicitectomy, etc. 4 patient developed features of obstruction following laproscopic T.L. among these 6 patients were managed conservatively and 14 patient undergo surgery.Mean duration for surgically managed was 2.8 days. Mean duration for conservatively managed patients was 2.9 days. Among the surgically managed pts. 14 had adhesions, 11 had stricture, 8 had obstructed hernia, 1 had intussusception, 4 had abdominal TB. Surgical procedures were done according to the cause of the obstruction.History of abdominal surgery was found to be more frequent in whom obstruction was relieved conservatively.

Surgical outcomes for perforated peptic ulcer: a prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant; and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes.Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia; Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality.Results Median age was 33 years and 85 were males. A majority of the patients (70) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35. Median length of stay among survivors was 16 days; and death occurred at median 1 day after admission. Long symptom duration and age 30 years of age were significantly associated with in-hospital mortality on univariate (? = 2.60 [0.18-5.03]; p = 0.035) and multivariate testing (? = 2.95 [0.02-5.88]; p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series; surgical treatment for perforated peptic ulcer disease carried a high mortality; and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries

Manifestation of tuberculosis in HIV/AIDS patients and its relationship with CD4 count.

Background: Tuberculosis (TB) is said to be one of the commonest opportunistic infection among human immunodeficiency virus (HIV) seropositive. Varied clinical manifestations have been observed according to immune status of HIV positives. Aims & Objective: The present study aims to relate the clinical, radiological and laboratory profiles of patient with HIV/TB co-infection and its correlation with CD 4 count. Material and Methods: Seventy adult TB patients having confirmed HIV seropositivity were included. A detailed history, physical examination, laboratory and radiological investigations were carried out. Results: Maximum numbers of patients were from age group of 21–40 years. Commonest mode of HIV was heterosexual route (80 %). Male: Female ratio was 4:1. Most of the patients (45.71%) were labour workers, followed by housewife (20%), sales man (18%), textile worker (8.8%), and transport driver (8.8%). Fever (75.71%), weight loss (68.57%) and decrease appetite (65.57%) were predominant symptoms. Pulmonary TB (PTB) was found in 24.28% patients, while extra-pulmonary TB (EPTB) in 75.72% patients. Most of Pulmonary TB had CD 4 count > 180, while in extra-pulmonary TB most of patients had CD 4 count < 180. Commonest form of EPTB was disseminated TB (30%) followed by abdominal TB (21.42%), tuberculous lymphadenopathy (12.85%) and CNS tuberculosis (4.28%). Positive smear for acid-fast bacilli (AFB) was found in 17.14% patients of PTB. The mean CD4 count at presentation were 214 cells/μl, 182.47 cells/μl, 175.22 cells/μl and 54.66 cells/μl in tubercular meningitis, abdominal TB, tuberculosis lymph node TB and disseminated TB respectively. Conclusion: HIV/TB co-infection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transmission. Sputum smear AFB test positivity is low in TB patients having HIV. Disseminated TB is common in advanced HIV cases as CD 4 count decreases.

A study of relation of stature and percutaneous ulnar length.

Introduction: Stature of an individual is one of the most important characteristics of identification which is required in medico legal practice quite often. There is direct relationship between anthropometric characteristics and sex, shape and form of an individual. Stature estimation is usually based on measurement of long bones. Ulna is a very useful bone for this purpose. Material and Methods : In this paper, attempts are made for the estimation of the stature of native of Gujarat state at Smt NHL Municipal medical college, Ahmedabad using “Percutaneous ulnar length” in year 2010-2011. Four hundred and fifty ( 450 ) healthy adults ( 245 Males and 205 Females) aged between 17-30 years who are medical students, paramedical students and staff members of Smt. N.H.L. Municipal Medical College, Ahmedabad were studied and measurement of stature and percutaneous ulnar length was done for each of them. The ulnar length was measured from tip of olecrenon process to the distal margin of the head of ulna (palpable on the dorsum of the wrist) with forearm flexed and semi pronated and the hand in the neutral position. Observation and Results : We found that the difference in age of Males and Females was statistically not significant with p>0.05 but the difference in Mean stature between Males and Females and the difference in Mean Ulnar length between Males and Females was statistically highly significant (p<0.001).Simple linear regression equations are derived in the study for estimation of height of Males and Females based on length of Ulna.Conclusion : It was concluded that the estimation of Stature among the population can be carried out using measurements of Ulna and there is positive correlation between Stature and Length of Ulna in a particular population.