The prognosis and outcome of peritonitis depend upon the interaction of several factors, which includes` patient-related factors, disease-specific factors, diagnostic and therapeutic interventions. Categorizing patients into different risk groups would help prognosticate the outcome, select patients for intensive care and determine operative risk, thereby helping to choose the nature of the operative procedure, e.g. damage control vs. definitive procedure. Study population consisted of 80 consecutive patients with peritonitis secondary to hollow viscus perforation which were confirmed on emergency laparotomy. APACHE II score was assigned to all patients. Mean apache II scores in survivors were 7.5±5.3 and in non survivors 19.7±4.7. Of the 72 survivors, with mean of 7.5, 8 patients who died had a mean of 19.5, and again the difference between groups were significant (p< 0.0001). Based on APACHE II scores patients were divided into 3 groups with scores of <10, 11-20 and >20. The number of patients scoring less than 10 was 71(88.8%) of the study group. One patient with less than a score of 10 expired. 5 patients had scores in range of 11-20, 2 survived and 3 expired. 4 patients had scores more than 20 and all 4 patients expired.
To ascertain different etiologies for abdominal pain in dengue fever with their respective incidence and their management. Patients and Methods: Patients admitted with dengue fever (Confirmed by ELISA or NS1Ag) with pain abdomen in our hospital were included in the study. The cause of pain abdomen ascertained clinically and by following test: Pancreatitis -amylase, lipase, USG, CECT, Hepatitis -liver function test, Hollow viscous perforation Erect -X-ray abdomen, Cholecystitis -USG, Appendicitis -TLC, USG. Results: Out of total cases (n=214) included into the study features of acalculous cholecystitis were seen in 122 (58%) patients, pancreatitis in 24 (11.5%), appendicitis in 4 (1.9%), hepatitis: 27 (12.9%) non-specific in 33 (15.7%) patients. All of the patients were managed conservatively and regularly followed up till they became asymptomatic. None of the patients required any surgical intervention. All the patients responded well to conservative line of management and were discharged. Conclusions: Abdominal pain developing in dengue patients mimics many of surgical emergencies like cholecystitis, appendicitis, hepatitis, pancreatitis. Most of these patients respond well to conservative line of management with I.V fluids, antibiotics, analgesics without the need for any surgical intervention. Hastily taken decisions with operative management for such patients have led to serious consequences in the past. Our study supports conservative line of management in such scenarios and advocates avoidance of surgical option. Our study also throws light on the various modes of presentations, with their respective percentages.
Peritonitis involves the rapid removal of contaminants from the peritoneal cavity into the systemic circulation. It occurs because contaminated peritoneal fluid moves cephalad in response to pressure gradients generated by the diaphragm. The fluid passes through stomata in the diaphragmatic peritoneum and is absorbed into lymphatic lacunae. The lymph flows into the main lymphatic ducts via the substernal nodes. The resultant septicemia predominantly involves gram-negative facultative anaerobes and is associated with high morbidity. A prospective clinical study was conducted on 80 consecutive patients who presented to the surgical department of Hospital and Research Centre with peritonitis secondary to hollow viscus perforation. Study population consisted of 80 consecutive patients with peritonitis secondary to hollow viscus perforation which were confirmed on emergency laparotomy. In the study group of 80 patients, majority of the patients had duodenal perforation (40%). Highest survival rate was seen among duodenal perforation 32 of 32(100%) and the highest mortality was seen among patients with gastric, unknown and colonic perforations. The time of presentation of patients ranged from < 24 hours to 10 days. Most of the patients presented within 1-2 days. Mortality increased correspondingly with delay in presentation to the hospital. It was 25% for 1-2days, 62.5% for 3-5 days and 12.5% for 6 to 10 days. Delayed presentation was usually seen in cases of peritonitis secondary to appendicular perforation which had better prognosis compared to other hollow viscus perforation presenting late.
To evaluate and quantify the response to single cycle neo-adjuvant chemotherapy in stage IIB & IIIA breast cancer. Methods: A total number of 25 cases of breast carcinoma were selected for the study. All the patients diagnosed as breast carcinoma with stage IIB and IIIA and admitted in surgical wards were selected for this prospective study at R.L. Jalappa. Hospital and Research Centre, Tamaka, Kolar Attached To Sri Devaraj Urs Medical College between December 2013 and June 2015. Clinical tumor size was estimated before the start of chemotherapy (FAC regimen) and after an interval of 10 days by sonomammography. Results: In our study we found that there is decrease in tumor size in 16% of patients (i.e 4 patients among 25) in those who received single cycle neo adjuvant chemotherapy in patients with stage IIB and IIIA patients. With 95% confidence interval ranging from 6.40-34.65. This decrease in tumor size has resulted in down staging among three cases (Down staged from stage IIB to stage IIA). Conclusion:In our study we found that single cycle NAC does not decrease the tumor size in significant number. The decrease in tumor size was noticed in patients who had no nodal involvement and in multiparous women. Single cycle Neoadjuvant chemotherapy is preferred in patients who cannot take up 3 cycles of NAC. These patients can be tried with single cycle NAC which helps to halt the disease in tumor progression.
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