Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused by gasforming uropathogens. It is a rare condition, usually occurring in diabetic patients. Mortality rates in medically managed patients are as high as 70-90 %. It should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is diagnostic and is the method of choice for diagnosis and follow-up. Both physicians and surgeons should be aware of this rare condition which might present to the physician as fulminant urinary tract infection in an uncontrolled diabetic patient, but which might warrant urgent surgical intervention by way of an emergency nephrectomy. We report a 60-year-old diabetic woman who presented with urinary infection and sepsis. Initially she was managed conservatively, but had to be taken up for emergency nephrectomy in view of her worsening condition. We review the clinical presentation, radiological diagnosis with characteristic CT scan pictures, and the management of this rare condition.
The diagnosis of acute appendicitis still remains an enigma for the surgeon. The Mean Platelet volume is known to be a marker determined from megakaryocytes during platelet production, which is associated with platelet function and activation. The mean platelet volume (MPV) decreases in acute inflammatory conditions like acute appendicitis due to increased consumption and sequestration of platelets in the vascular segments of inflamed bowel. In our study of 213 patients, the MPV was determined and was found to be low (< 7.6fL) in 176 patients (82.6%) out of which 175 patients were having features of acute appendicitis on histopathology. Therefore in a patient with a provisional diagnosis of acute appendicitis, a low MPV (<7.6fL) can be taken into consideration along with total leucocyte count with suspected acute appendicitis.
Skin cancers account for less than 1 % of all malignancies in India. Squamous cell carcinomas occurring over the waistline due to tying of cotton cloth called dhoti in males and sarees in females are predominantly seen in traditional Indian population. On wearing of these clothes for years, there is a constant irritation which produces depigmentation, glazing of the skin, acanthosis, scar formation, and later on malignant transformation. Presenting a case of a 65-year-old male with 7 × 5 cm ulceroproliferative growth over the right waistline with a history of prolonged use of dhoti. Wide local excision of the growth with 2-cm margin and primary closure of wound by mobilizing the skin was carried out. Histopathology showed well-differentiated squamous cell carcinoma. The patient is clinically disease free after postoperative follow-up of 1 year.
Hydatidosis is a zoonosis caused by the larva of a tapeworm, Echinococcus granulosus. The liver is the most commonly affected solid organ in which a cystic lesion with two layers of an outer pericyst and an inner endocyst is produced. There have been only a few reports in the literature of fat within a hydatid cyst. One case series described fat-fluid levels due to communication with the biliary tree and one report described a single case of a hepatic hydatid cyst containing small globules of fat. This report describes three patients with hepatic hydatid cysts with small globules of fat within detected on computed tomography and, through a review of literature, attempts to understand the pathogenesis of intracystic fat without imaging evidence of rupture into the biliary tree.
Background: Trauma and Injury Severity Score (TRISS) designed by Major Trauma Outcome Study (MTOS) in United States, is commonly used for outcome prediction in polytrauma patients. It determines the probability of survival (PS) of a patient from the Injury Severity Score (ISS) and Revised Trauma Score (RTS) using TRISS methodology.Methods: A total number of 136 patients presenting within 24 hours of trauma that were admitted were included in the study. The probability of survival was calculated using TRISS index (RTS, ISS, and age combination index). The predicted probability of survival and that of death among the study subjects were calculated using TRISS. A cut off 0.5 or lesser of TRISS score was taken as death and above 0.5 as survival status.Results: The mean TRISS among males and females were 86.12±21.76 and 79.49±27.70 and based on TRISS score the expected deaths were predicted to be 11.03%. But, in actual, the deaths were 23.52% showing a negative correlation with TRISS score in our set up thereby indicating a need to improve emergency facilities for trauma patients.Conclusions: TRISS methodology when applied to our setup predicted fewer deaths as compared to the actual deaths and also did not accurately predict the survival in the trauma patients.
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