Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one. Adult intussusception is less than 0.1% of all hospital admissions. Non-specific symptoms often delay the diagnosis with most cases diagnosed only after emergency laparotomy, hence the need for imaging as a screening investigation. The gold standard is computed tomography with the limitations of cost, radiation and contrast hazards. Our suggested initial screening tool is ultrasound. the aim of this study was to evaluate the sensitivity of ultrasound in diagnosing this rare entity. Thirteen patients (2013 to 2019) in a single tertiary care hospital diagnosed as “intussusception” were analysed. They were initially diagnosed by ultrasound and confirmed by CT or intra-op as needed. There were no exclusion criteria. The mean age was 50. There were 6 males and 7 females. Ultrasound sensitivity was 72%. Symptoms were variable. 100% had abdominal pain (1 day to 2 years duration). 69% had Intestinal obstruction. The most common type of adult intussusception observed was ileo-ileal (39%). The least common noted was gastro-jejunal (8%). The most common treatment was resection and anastomosis (77%). 3 cases were managed conservatively successfully. The biopsy was mostly benign (54%), 3 were malignant (23%) and 3 were unknown as they were not operated (23%). Our suggested initial screening is ultrasound with a fairly good sensitivity (72%). The upcoming improvement in technology can raise this sensitivity even further. The management protocols, biopsy findings, and clinical findings are however subjected to discretion.
Neuropathic ulcers pose a global burden carrying a risk of amputation of 15-46 times especially in developing countries. These ulcers are mainly managed with offloading techniques. In this study we share our experience of using an easy to use, cost effective method the Suvidha offloading dressings in terms of its acceptability and effectiveness in managing these cases. A prospective case series of 83 patients with mean age 58 years, managed with Suvidha offloading dressing in our institution from 2016 till 2019, excluding patients with ABI less than 0.4 and Wagner 4 and 5. They were reviewed after 6 months/SOS. Ulcer measured 1×1 to 4×4 cm, was present most commonly in the mid foot and least commonly in the lateral aspect of the foot. 53 cases were Wagner grade 2 and 9 cases Wagner grade 3. Forty cases were initially infected, 29 cases had a deformed foot, 5 cases needed interval wound debridement. The duration of ulcer healing was 2 weeks for 1×1 cm great toe ulcer, to 12 weeks for the 4×4 cm mid foot ulcer. All 83 patients were followed up for 6 months. 5 ulcers recurred. The patient satisfaction was measured by a 5-points Likert scale with a mean value of 17.4 out of 20. The Suvidha offloading footwear is a cost effective, easily replicable and efficient dressing requiring only the readily available dressing materials, with good healing rates, good patient satisfaction and adapted for developing countries. The results are comparable with other methods of offloading practiced worldwide.
Background: Diagnostic Laparoscopy provides us with good view of whole peritoneal cavity there by clinching diagnosis. In General population Appendicular pathology is the leading etiology of non specific abdominal pain, it is about 33%, followed by adhesion 23%,positive outcome in 1 month follow up period is 80%,in 3 months follow up period 90% patients got complete relief. Patients and Methods: Clinical material for this study was obtained from 50 patients with abdominal pain for three months or more where other clinical symptoms and investigations are not conclusive, attending the Out Patient Department and admitted to Rajah Muthiah Medical College and Hospital, willing for diagnostic laparoscopy. The overall efficacy and outcome of this work includes finding the etiology of Non specific abdominal pain, thereby making a definite diagnosis and to assess the response to treatment in relieving pain after three months. Results: Appendicular pathology is the leading etiology of Non specific abdominal pain. Diagnostic laparoscopy help us to initiate appropriate treatment in this difficult patient group and positive outcome of pain relief (relief/reduction of pain after diagnostic laparoscopy) was observed in 90% of patients. Conclusion: Diagnostic laparoscopy is a safe, relatively cost-effective and efficient method for finding out the etiology of chronic abdominal pain and to provide specific interventions.
Introduction: The Circle of Willis (COW) is a large arterial anastomotic ring present at the basal cistern of the brain, uniting the internal carotid and the vertebro-basilar system. Sir Thomas Willis was the first to describe the importance of the circle in maintaining collateral flow. It was observed that there is very little mixing of blood between the collateral branches of the circle. These collaterals may however open up during occlusive episodes of the proximal feeding vessels or in case of severe stress such as stroke and traumatic brain injury (TBI) in order to maintain metabolic activity in the brain. This phenomenon is affected to various degrees in the presence of anomalies. The prevalence of anomalies of COW in the general population is up to 75.72% was demonstrated in other studies. Materials and Methodology: This is a cross sectional observational study. 20 consecutive patients above 18 years of age succumbed to isolated TBI who were subjected to medico-legal autopsy in our hospital were included. The anomalies were classified as per the criteria laid down by Stojanovi´c et al. Results: 9 Normal variants (Type A) of COW (45%) was found. The most common type of anomaly was Type C which was noted in 4 cases (20%). Conclusion: Anatomical variations of COW has proven association in the areas of stroke, aneurysm, migraine, carotid endarterectomy and ageing brains. Further studies are needed to determine whether the anomalies of COW really contribute to the mortality in TBI.
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