Sternoclavicular disease is not uncommon in the UK. It can present with pain in the shoulder, neck or anterior chest wall, and may be underdiagnosed. Our results do not show a link with acne or pustulosis. Features of spondyloarthropathies, such as sacroiliitis and HLA-B27 positivity, were rare in this survey.
Background: Over decades the treatment of acute pancreatitis remains debatable with no common consensus on treatment guidelines, with some workers using octreotide infusion and some workers only relying on fluid therapy and symptomatic management. This is the first of its kind double blinded comparative trial between omega 3 fatty acid infusion versus octreotide infusion and its response in cases of acute pancreatitis.: Our aim is to study the efficacy of omega 3 fatty acid infusion and set a new treatment protocol in cases of acute pancreatitis with the use of omega 3 fatty acid infusion in all admitted cases of acute pancreatitis unless otherwise contraindicated.Methods: This is the first study where a doubled blinded randomised control trial was undertaken in proven cases of acute pancreatitis and patients were given omega 3 fatty acid infusion and octreotide infusion and the observations were documented and followed upon.100 cases of proven acute pancreatitis were randomised with double blinded closed envelop method. 50 cases were given omega 3 fatty acid infusion and other 50 were given octreotide infusion and the clinical response, symptomatic improvement was assessed and compared using BISAP and Marshal scoring systems and lipase levels. Chi Square test was used along with unpaired t test and p value was obtained in both groups.Results: Omega 3 fatty acid infusion was found to be highly significant as compared to octreotide in cases of acute pancreatitis in terms of clinical improvement, reduced hospital stay, reversal of organ dysfunction and SIRS.Conclusions: Omega 3 fatty acid infusion is the future in cases of acute pancreatitis which is cheap and easily available with no side effects and reduces the morbidity and mortality in acute pancreatits with reduced hospital stay in turn resulting in overall reduced medical expenditure.
IGG4 sclerosing mesenteritis is a very rare occurrence in the elderly which is often missed or undiagnosed. We present a very rare case of 70-year-old female who presented with vague abdominal discomfort associated with a huge intra-abdominal mass of size 18 cm*10 cm hard in consistency in the left hypochondrium slightly extending into the left lumbar region not associated with any bleeding per rectum, anemia, constipation, or features suggestive of obstruction. Diagnostic dilemma was established when contrastenhanced computed tomography abdomen revealed neoplasia of the transverse colon with luminal narrowing, fine-needle aspiration cytology of the mass revealed desmoid tumor, and colonoscopy revealed no luminal narrowing or mass lesion. Hence, the appropriate treatment plan the intraoperative challenges, and geriatric outcomes were taken into consideration.
Introduction: Diverticulitis of the appendix is a rare clinical finding which is often confused with acute or chronic appendicitis. It is rarely diagnosed pre-operatively and is usually identified during or after appendectomy. It has a higher risk for perforation in comparison with appendicitis and may be associated with an underlying malignancy.
Case report:A 40 yr old male presented to the casualty with complaints of pain abdomen since 1 day, associated with 3 episodes of vomiting with localised tenderness and guarding in the right lower quadrant of the abdomen. On ultrasonography, a non-compressible tubular blind structure with minimal free fluid was identified, indicating acute appendicitis and the patient was prepared for an open appendectomy. Intraoperatively, appendix was found to be inflammed with an outpouching noted at its antimesenteric border, 1cm distal to the base. The tip of this outpouching was perforated (Fig 1 and 2). An appendectomy was performed and specimen sent for histopathological examination. On HPE, the outpouching was diagnosed as a true diverticulum of the appendix. The diverticulum as well as the appendix was found to be inflamed.
Conclusion:This case report highlights the symptomatology, atypical patient demographics that should raise the suspicion of Diverticulum of appendix. Although the definitive treatment in both conditions is same, diverticulum of appendix is associated with unique risks and complications. The importance of a thorough radiological assessment would prove valuable in differentiating between the two entities.
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