New technology and innovation have allowed development of the new technique of direct phonoplasty under local anaesthetic. This combines the advantages of transcutaneous injection under local anaesthetic and direct injection under general anaesthetic, without their disadvantages.
A 25-year-old woman presented with lower abdominal pain precipitated by lifting some cushions. Following the initial episode, she noticed a bulge in the lower abdomen on standing, coughing and straining. She had not had any previous surgery. She had two children aged two and four. On examination, a very small umbilical defect was identified. In addition, a palpable swelling was noted immediately to the right of the linea
An unusual abdominal wall herniaAhmed R Ahmed, Anita Sharma, James Wellwood
Context:Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system.Aims and Objectives:The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases.Subjects and Methods:We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation.Results:A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%).Conclusions:About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.
A neonate presented with anemia, hyperbilirubinemia and bilateral flank fullness at 23 days of age. Ultrasound abdomen showed bilateral adrenal hemorrhage with intraperitoneal extension on the left side. This was managed nonoperatively and the hematoma resolved completely. Literature regarding this rare entity is described.
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