BACKGROUNDThe application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. The optimum level of negative pressure appears to be around 125 mmHg below ambient and there is evidence that this is most effective if applied in a cyclical fashion of five minutes on and two minutes off. It is believed that the negative pressure assists with removal of interstitial fluid, decreasing localised oedema and increasing blood flow. This in turn de creases tissue bacterial levels. Additionally, mechanical deformation of cells is thought to result in protein and matrix molecule synthesis, which increases the rate of cell proliferation. Despite the significant costs involved, the technique is said to compare favourably in financial terms with conventional treatments in the management of difficult to heal wounds.
BACKGROUNDAcute appendicitis is one of the most common cause of acute abdomen and surgical emergencies. Failure to make an early diagnosis converts acute appendicitis to perforated appendicitis, a disease with potential complications including wound infection, pelvic abscess, portal pyaemia, septicaemia, and death. Our objective of the study is whether proper clinical examination along with clinical scoring pattern coupled with cost-effective radiological investigations help to improve the diagnosis as confirmed later by operative and histopathological examination to recognise patients without appendicitis to have an alternative diagnosis in these patients with right lower quadrant of abdomen.
BACKGROUNDDiaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma; however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. A comprehensive literature search was performed using the terms "delayed presentation of post-traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture." The diagnostic and management challenges encountered are discussed together with strategies for dealing with them. We have focussed on mechanism of injury, duration, presentation and site of injury, viscera l herniation, investigations and different approaches for repair. We intend to stress on the importance of delay in presentation of diaphragmatic rupture and to provide a review on the available investigations and treatment methods. The enclosed case report also emphasizes on the delayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayed diaphragmatic rupture. 1,2,3
BACKGROUND The use of antibiotic prophylaxis for clean surgical procedure, such as inguinal hernia surgery is controversial. In modern surgical care, antibiotics are known to account for about 20% of total expenses during hospitalisation. In our country where the proportion of health budget to GDP is one of the lowest in the world, the amount of savings that can be obtained by reducing our over reliance on antibiotics will be enormous. MATERIALS AND METHODS This study includes 50 clean cases randomised to groups of 25 each. The study group will receive a single dose of antibiotic preoperatively, while the control group will receive 3 to 5 days of empirical antibiotic therapy. RESULTS In my study, the incidence of SSI was 0.5% in the control group and 0.75% in the study group which is not statistically significant as evidenced by the p value of 0.6 which is not significant. The incidence of SSI is comparable to the occurrence in other studies of similar nature. CONCLUSION Based on my study, I would like to recommend single dose antibiotic prophylaxis using appropriate antibiotics for all Class I and Class II cases. As per the study results, there is no significant difference in incidence of SSI when compared to the traditional regimes with the added advantage of significant reduction in hospital stay with its resultant savings in resources.
BACKGROUNDPerforated peptic ulcer or ileal ulcer is a serious complication of ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease and ileal ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with both ulcer perforations in our setting and to identify predictors of outcome of these patients.
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