The efficacy of tamsulosin in lower ureteral calculi.

CONTEXT: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). AIMS: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. SETTINGS AND DESIGN: We conducted a comparative study in between watchful waiting and MET with tamsulosin. MATERIALS AND METHODS: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. STATISTICAL ANALYSIS: Independent 't' test and chi-square test. RESULTS: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. CONCLUSIONS: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

Surgical infections: a microbiological study.

Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51), secondary peritonitis (n=25), necrotizing fascitis (n=22) and wounds with devitalized tissues (n=19) were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32). The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%), necrotizing fascitis (75%) and wounds with devitalized tissues (66.7%) were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1%) and cefuroxime (70.8%). For Gram-negatives (Klebsiella spp., E. coli and Proteus spp.), the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2%) and ciprofloxacin (35.2%). The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%), followed by Klebsiella spp. (33.3%), Proteus spp. (33.3%), E. coli (22.2%), and S. aureus (12.5%). All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%). Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

Surgical infections: a microbiological study

Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51), secondary peritonitis (n=25), necrotizing fascitis (n=22) and wounds with devitalized tissues (n=19) were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32). The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80 percent), necrotizing fascitis (75 percent) and wounds with devitalized tissues (66.7 percent) were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1 percent) and cefuroxime (70.8 percent). For Gram-negatives (Klebsiella spp., E. coli and Proteus spp.), the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2 percent) and ciprofloxacin (35.2 percent). The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9 percent), followed by Klebsiella spp. (33.3 percent), Proteus spp. (33.3 percent), E. coli (22.2 percent), and S. aureus (12.5 percent). All the anaerobes that we isolated were 100 percent sensitive to metronidazole and chloramphenicol, followed by clindamycin (95 percent to 100 percent). Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

Thoracic injuries requiring tube thoracostomy and abbreviated injury scale-85.

Abbreviated injury scale-85 (AIS-85) has been found to be an excellent tool to rapidly and accurately assess and scale the severity of thoracic trauma and to predict prognosis and outcome. Availability of condensed charts of AIS-85 have made its application in clinical practice easy and quick. Even paramedical personnel can be trained to use this scale to compare the data.

A safe technique of major mammary duct excision.

The classical Hadfield's operation for duct ectasia/periductal mastitis results in nipple anaesthesia in most women and nipple/areola necrosis in some patients. To obviate these two complications we have modified the technique of major duct excision. The incision is given over only one-third of areolar circumference and no areolar flap is raised. In the 17 women treated by this technique the cosmetic results were good in all of them with no nipple/areola necrosis. The nipple sensation was preserved in all cases. There was only one case of recurrence of nipple discharge. The technique offers a safer alternative to the classical Hadfield's operation.

A new incision for intra-oral access without lip split.

A non-lip-splitting approach to the oral cavity is described, using a curved incision through the angle of the mouth along the inferior buccolabial sulcus. The incision provides good access to the entire oral cavity and heals efficiently with good cosmetic results. It is suited to patients who require excision of the oral commissure.

Value of precraniotomy shunts in children with posterior fossa tumours.

Seventy children with posterior fossa tumours treated over a period of 6 1/2 years were studied. Most patients presented in the late stage of disease. Sixty-four required insertion of a precraniotomy shunt for one or more of the following: persistent vomiting, severe headache, dehydration, poor general condition, failing vision, altered sensorium, marked periventricular lucency, and brain stem involvement deferring total removal of the tumour. Insertion of precraniotomy shunt improved the general condition and signs and symptoms of increased intracranial pressure. It also provided a lax brain during definitive surgery and a smooth postoperative course. Shunt-related complications, consisting of block and/or infection, were observed in 21 patients. It was concluded that precraniotomy shunt is important in the management of children with posterior fossa tumours in developing countries where these patients present in the late stage of disease.