Sixty-six patients were selected as high-risk cases of duodenal ulcer perforation. After resuscitation with intravenous fluids and nasogastric suction, a widebore percutaneous intra-abdominal drain was put in under local anaesthesia. There were three (4.5%) deaths; 58 (87.8%) patients improved satisfactorily. High-risk peptic ulcer perforation patients can be managed by putting in an intra-abdominal drain supported by conservative treatment.
Visceral leishmaniasis (Kala-azar) is endemic in many countries including Bangladesh. Clinical presentation of visceral leishmaniasis in children and adult may vary and at time may simulate many tropical and hepatobilliary diseases. Jaundice and ascites is not common in some patients. In this series of eleven cases Jaundice, splenomegaly, hepatomegaly and ascites are present in 55%, 100%, 91%, 27% of cases respectively. So, Kala-azar should be kept in mind while dealing with cases of many such clinical findings. Â DOI = 10.3329/jom.v8i1.1374 J MEDICINE 2007; 8 : 14-16
Fifty patients with leishmaniasis cutis were treated with 250,000 units of monomycine intramuscularly every 8 hours and 0.5 g of methyluracil orally twice daily for a total period of 10 days. The follow-up study of all the patients for a period of 12 months showed persistent effectiveness of the treatment without the appearance of any sign and symptom of the so-called metaleishmaniasis (leishmaniasis recidivans). This paper highlights our results of treatment of leishmaniasis cutis, especially the rapid reduction of inflammatory reaction, quick regression of the skin process, and the rapid formation of scar without significant cosmetic effect in comparison with the data available in the literature.
The sentinel lymph node (SLN) is defined as the first node(s) receiving lymphatic drainage from a primary tumour. A promising alternative to axillary lymph node dissection (ALND) is sentinel lymph node biopsy. SLN biopsy has been introduced as a technique to identify axillary lymph node most likely to contain tumour cells metastasizing from a primary carcinoma of breast. Several methods of identifying the SLN exists, including the use of radioactive tracer, lymphazurin dye or combination of the two via intraparenchymal and/or intradermal, peritumoral or periaerolar injection sites. Intraoperative evaluation of SLNs are done by performing FS(Frozen Section) on all the lymph nodes after serially sectioning them at 3-4mm intervals; at least 2 levels are cut of all the sentinel lymph nodes. In addition, touch preparation cytology(TP) smear may also be made for evaluation. The limitations of SLNB is that a proportion of patients who have metastasis limited to the SLN can be predicted when there is a combination of tumour size <1.0cm, the absence of lymphovascular invasion and micrometastatic disease (<0.2cm) in SLN. However for patients with large breast cancer, the role of SLNB is controversial. Early studies of SLNB in large breast cancer patients demonstrated a high (8-18%) false negative rate, with the accuracy worsening with the increasing size. Excision of SLNs have an extremely low morbidity and a high degree of staging accuracy. A tumour-free SLN virtually excludes lymphatic involvement of the entire regional lymphatic basin. More than 50 observational studies of SLNB validated by a back up ALND demonstrate that SLNB is feasible, accurate and suitable for virtually all patients with operable clinically node negative disease. Sentinel lymph node biopsy not only provide prognostic information, but also aims to guide adjuvant therapy without the untoward side effects of complete axillary dissection.
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