Bilateral breast abscess: a rare complication of enteric fever.

Breast abscess is usually caused by Staphylococcus aureus in pregnant or lactating females. Salmonella spp. is occasionally associated with abscess formation in various organs, but breast abscess is a very rare complication. In enteric fever dissemination to multiple organ systems following bacteraemia can lead to localized abscess. We report a case of bilateral breast abscess due to Salmonella Typhi in an unmarried 35-year-old female without any predisposing conditions. She presented with fever and painful swelling of both the breasts. S. typhi was isolated from both breasts. Such rare cause must be suspected in females without any evident predisposing factors for effective management.

The fire is both “a blessing & scourge to the mankind”.

Man has always needed fire either to prepare his food to satisfy his hunger or to induce warmth during winters. Simultaneously he is constantly exposed to the hazards of burns, which begins right from the day one of his life, when the maternity nurse gives him the first hot water bath. That is why it is said, “The fire has been both a blessing and scourge to the mankind”. The present study was conducted in department of forensic medicine PDU Medical College, Rajkot during the period from Nov. 2004 to Oct. 2005 with a view to study the profile of burn cases brought for the post mortem examination. All the data related to age, sex, marital status, type and manner of burns with area involved, and survival time were recorded with detailed autopsy examination and subsequently analyzed statistically. We reached at a conclusion that majority of the victims were married females of younger age group between 20-40 years, with an extensive accidental flame burns.

Renal transplant in hepatitis B and C positive patients--a ten years experience.

OBJECTIVE: To determine the outcome of renal transplantation in hepatitis B (HBsAg) and C (HCV antibody) positive end-stage renal disease (ESRD) patients. MATERIAL AND METHODS: In past ten years, out of 245 live renal transplants performed 33 (13.63%) (mean age 36.5 +/- 10.7 yr.) recipients tested positive for HBsAg and/or HCV Ab. Eighteen were HCV Ab positive, 10 HBsAg positive and five both. Two HBsAg positive cases transplanted elsewhere and followed up at our centre were also included. Pre-transplant, thirteen patients had elevated serum alanine aminotransferase (serum ALT). Of these 13, 10 patients were subjected to liver biopsy. Seven showed changes of chronic hepatitis (CH) while three were normal. Seven patients with CH on liver biopsy and three who refused biopsy but had elevated serum ALT were treated with interferon (IFN). In all ten cases there was normalization of serum ALT and six patients (2 HCV and 4 HBV) even became sero-negative. RESULTS: The actuarial 1, 5 and 10 year patient survival was 94.28%, 85.71% and 85.71% and the graft survival was 88.5%, 77.1% and 77.1%, respectively. Infection was the commonest causes of death and rejection was the commonest cause of graft loss. Post-transplant, one patient, (HCV antibody positive) died of fulminant hepatic failure and eleven patients developed elevated serum ALT levels which normalized in six recipients after lamivudine therapy and in four cases on their own. CONCLUSION: Our study shows that the patient and graft survival in hepatitis seropositive recipients is similar to non-hepatitis recipients. Most patients maintain stable liver function over a follow up period of six months to ten years. Lamivudine therapy is effective and safe in post-transplant period.

Dual kidney transplantation--a solution for less than ideal brain dead donors.

For renal transplantation, an elderly cadaver donor is often rejected because of the relatively poor long-term graft survival. Considering that a number of potential recipients are waiting for a renal transplant, dual kidney transplantation would be a more appropriate approach in this situation. We report one such case with a successful outcome.