Peritoneal encapsulation - an unexpected cause of acute intestinal obstruction.

Peritoneal encapsulation (PE) is a rare congenital anomaly that is formed due to an accessory peritoneal layer encapsulating the small bowel. Kinking of bowel within the accessory peritoneal layer or adhesions between the bowel loops and the peritoneal layer causes symptoms ranging from colicky abdominal pain to rarely intestinal obstruction. Cleland was the first person to have reported this condition as early as 1868 and since then only around 30 cases have been reported. Here, we present a case of acute intestinal obstruction in a 22-year-old woman. Imaging showed dilated bowel loops confined to the centre of the peritoneal cavity. Intraoperatively it was seen to be a case of peritoneal encapsulation. The small intestine was freed and accessory layer excised. This report is to demonstrate this rare congenital anomaly.

An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital.

OBJECTIVE: To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. PLACE AND DURATION OF STUDY: Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. MATERIALS AND METHODS: This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. CONCLUSION: IRC is a safe, simple and effective procedure for early hemorrhoids without any complications. IRC is nowadays the world's leading office treatment for hemorrhoids. IRC is a better option than the surgical treatment as it is easy, well tolerated, and remarkably complication-free. In our study, we have not used any course of antibiotics. In the management of early hemorrhoids, IRC should be considered as a simple trouble-free and painless option.

Primary tuberculosis of the breast presented as multiple discharge sinuses.

Breast tuberculosis is a rare form of tuberculosis (TB). It is mainly classified as primary and secondary forms. Primary form is rare. We are reporting a case of primary TB breast with history of breast lump and multiple sinuses. TB was diagnosed on FNAC. Patient was put on anti-tubercular drugs.

Enucleation of the solitary epithelial cyst of pancreatic head in an adult: a case report and review of the literature.

Solitary true pancreatic cyst is a rare entity, and only a few cases are reported in the literature. We report a case of a 35-year-old woman who had a cyst in the head of the pancreas and gall stones and presented with complaints of pain in the epigastric region. The patient underwent open cholecystectomy with aspiration of the pancreatic cyst at some other private hospital. After 4 months, she presented to us with no relief in pain. Repeat contrast-enhanced computed tomography of the abdomen showed recurrence of the cyst. The patient underwent enucleation of the cyst at our hospital. During a 2-year follow-up after the enucleation, she remained asymptomatic.

Successful repair of tubercular tracheal stenosis: a rare case report.

OBJECTIVE: We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management. CASE REPORT: A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed. CONCLUSION: Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment.

Bilateral breast carcinoma- a rare case report.

We are presenting a rare case of bilateral breast cancer. A 65-year-old female reported to us with complaint of lump in the left breast. There was positive family history. The patient was diagnosed with carcinoma breast of left side on edge biopsy and of right side by ultrasonography, which was confirmed on fine needle aspiration cytology. At the time of admission, ultrasonography of the abdomen and right breast were normal. After 1 month, the patient was readmitted with redness over the inner quadrant of the right breast skin.

An unusual case of chest wall desmoid tumor.

Desmoid tumor of the chest wall are uncommon fibromatous tumors characterized by their local invasion and frequent recurrences. Extra-abdominal sites are mainly the shoulder girdle, the pelvic girdle and distal ends of the lower limbs. The chest wall represents 8-10% of cases and the tumor is exceptionally intrathoracic. We present here a rare case of a large desmoid tumor of left antero-lateral chest wall. In the presented case, wide excision of the tumor and chest wall reconstruction was done. There was no recurrence in 3 years of follow up.

Positive life orientation and recovery from myocardial infarction.

The study examined the relationship between positive life orientation (PLO) and recovery from a recent myocardial infarction (MI), i.e. heart attack. PLO was defined as a predisposition to selectively focus one's attention on the brighter side of any situation. An 11-item measure of PLO was developed. Seventy male patients of first MI receiving treatment at a local government hospital were interviewed twice, 4-5 days after their first heart attack (time 1) and a month after their first heart attack (time 2). The interview schedule consisted of measures of PLO, perceived recovery, expected recovery, helplessness, personal control and mood state. At time 1 all these measures were administered but at time 2 measures of only PLO, personal control, perceived recovery and mood state were administered. In addition, the attending doctor assessed the patients' medical recovery at time 1. Results showed positive correlation of patients' PLO scores with their medical recovery, perceived recovery, expected recovery, personal control and mood state but negative with helplessness. PLO scores were not influenced by patients' age, education, or income. Patients' scores on PLO at two time points were not significantly different and were positively correlated. Their scores on sense of personal control and perceived recovery increased significantly at time 2. Significant intercorrelations among variables, under study, often reduced to insignificance on partialling out PLO. PLO, thus emerged as an important factor in recovery from MI.

Ovarian torsion: diagnosis by color Doppler ultrasonography.

BACKGROUND: Ovarian torsion, although a rare gynecologic emergency, is a threat to women of all ages. Traditionally, ultrasonography and laparoscopy facilitated early diagnosis and treatment of this condition. This case report highlights the usefulness of color Doppler ultrasonography in the diagnosis of ovarian torsion. CASE: A 25-year-old patient who conceived after ovulation induction was treated conservatively for mild ovarian hyperstimulation and threatened abortion. She subsequently underwent selective first-trimester multifetal reduction and was admitted and treated for suspected pelvic infection. On the 17th post-procedure morning, ovarian torsion was diagnosed using color Doppler ultrasonography. CONCLUSION: Because gynecologists face serious management dilemmas when confronted with ovarian torsion, this technique of using color Doppler ultrasonography should provide a highly specific finding in complete ovarian torsion, aiding the clinician in prompt diagnosis and treatment.

Beliefs about the world and recovery from myocardial infarction.

Seventy male, Hindu Myocardial Infarction (MI) patients were interviewed twice--4 to 5 days after their first heart attack (Time 1) and a month after their first heart attack (Time 2). The patients' beliefs about the world (world beliefs), about the causes of the disease (causal beliefs), and about the factors contributing to their recovery (recovery beliefs) were measured. Each category of beliefs was concerned with three domains: karma, God, and just world (or self). The patients' physical and psychological recovery was evaluated. World and recovery beliefs were intercorrelated, but these beliefs were only weakly correlated with causal beliefs. Furthermore, world beliefs and recovery beliefs were positively associated with recovery from MI at both Time 1 and Time 2. Attribution of causality to God was negatively correlated with medical recovery, perceived recovery, and mood state at Time 2. This trend was in the reverse direction for attribution of causality to self.

Selective reduction of multifetal pregnancies in the first trimester using colour Doppler ultrasonography.

In pregnancies with multiple gestation, an adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. Although there is a good deal of information about multifetal reduction in triplets and quadruplets and even quintuplets, there is very little on sextuplets, and virtually nothing on septuplets. Among the different techniques proposed for selective termination, two approaches have been more widely adopted: transcervical aspiration and transabdominal needling of the embryo using grey scale ultrasonography, but as yet there is no report on multifetal reduction using colour Doppler ultrasound. A method for selective termination of multiple pregnancy using transabdominal colour Doppler ultrasonography has been described here for the first time in a case of septuplets.