BACKGROUNDThe application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. The optimum level of negative pressure appears to be around 125 mmHg below ambient and there is evidence that this is most effective if applied in a cyclical fashion of five minutes on and two minutes off. It is believed that the negative pressure assists with removal of interstitial fluid, decreasing localised oedema and increasing blood flow. This in turn de creases tissue bacterial levels. Additionally, mechanical deformation of cells is thought to result in protein and matrix molecule synthesis, which increases the rate of cell proliferation. Despite the significant costs involved, the technique is said to compare favourably in financial terms with conventional treatments in the management of difficult to heal wounds.
BACKGROUNDAcute appendicitis is one of the most common cause of acute abdomen and surgical emergencies. Failure to make an early diagnosis converts acute appendicitis to perforated appendicitis, a disease with potential complications including wound infection, pelvic abscess, portal pyaemia, septicaemia, and death. Our objective of the study is whether proper clinical examination along with clinical scoring pattern coupled with cost-effective radiological investigations help to improve the diagnosis as confirmed later by operative and histopathological examination to recognise patients without appendicitis to have an alternative diagnosis in these patients with right lower quadrant of abdomen.
BACKGROUNDDiaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma; however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. A comprehensive literature search was performed using the terms "delayed presentation of post-traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture." The diagnostic and management challenges encountered are discussed together with strategies for dealing with them. We have focussed on mechanism of injury, duration, presentation and site of injury, viscera l herniation, investigations and different approaches for repair. We intend to stress on the importance of delay in presentation of diaphragmatic rupture and to provide a review on the available investigations and treatment methods. The enclosed case report also emphasizes on the delayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayed diaphragmatic rupture. 1,2,3
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