Ingrown toe nail is one of the commonest foot lesion affecting young individuals. The recurrence rate with a variety of treatment modalities continues to be quite significant. Hence the need to develop a comprehensive combination therapy to reduce the recurrence rate. Onychocryptosis or ingrown toe nail is a common and painful form of nail disease. It affects adolescents and young males very commonly. A combination therapy comprising of wedge resection of the nail, matricectomy, phenol cauterization and wedge excision of hyper granulations for recurrent advanced presentation of ingrown toe nail is presented. A 32-year-old male with a history of recurrent ingrown toe nail, operated twice previously presented with an advanced stage of ingrown toe nail. Hypertrophic granulation tissue covered both lateral and medial nail plates. The patient was treated with an integrated surgical approach comprising of wedge resection of medial as well as lateral border of nail ensuring removal of spicules on either side, followed by wedge resection of underlying nail bed. This was followed by phenol cauterization and elliptical excision of hypertrophic granulations. The predisposing factors, natural history and treatment modalities are discussed. Combination therapy is a safe and the best option for recurrent ingrown toe nail. It can also be used as a form of primary treatment in fresh cases to prevent recurrence.
Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed. Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of treating empyema thoracis in children in resource- poor settings and can reduce the need for invasive interventions.
Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.
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