The peculiar phenomenon of paradoxical progression during the treatment of central nervous system tuberculosis is discussed. A few cases with this phenomenon were reported in the past, and the authors have treated four such cases. During the treatment for tuberculous meningitis, the four patients developed new lesions, mainly in the form of tuberculomas, which progressed for some time and later regressed. In all these cases the initial drug regimen was not changed, except for the addition of steroids for a short period at the time of deterioration. All four patients underwent ventriculoperitoneal shunt insertion during the course of treatment. The authors discuss the significance of the changes in the lesions and management of such cases, and review the literature.
ABSTRACT:The model era of Laparoscopic Surgery has evoked remarkable changes in approaches to surgical diseases. The trend toward minimal access surgery (MAS) has prompted General surgeons to scrutinize nearly all operations for possible convention to Laparoscopic techniques.
Background: Pain abdomen accounts for about 14.2% of all emergency hospitalization. Many patients remain undiagnosed even after excluding the common disorders by meticulous investigations. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis. The current study aimed at comparing the role of laparoscopy in management of surgical causes of acute and chronic pain abdomen.Methods: A prospective study was done in 168 adult patients attending tertiary care hospital, selected by convenience sampling method. After clinical examination and relevant investigation, patients in need of diagnostic and therapeutic laparoscopic management were included in study. Laparoscopic findings and postoperative status of patients, with acute and chronic pain abdomen were compared with relevant statistical tests.Results: Mean age of patients was 35.8 years. Majority of the patients were females (58.3%). 41.1% and 58.9% patients had acute and chronic pain abdomen, respectively. Though more patients with chronic pain abdomen (58.9%) underwent laparoscopy when compared with acute pain abdomen (41.1%) it was not statistically significant, also post-operative status though found to be better in patients with chronic pain abdomen was not statistically significant.Conclusions: Though prevalence of laparoscopic intervention and better outcome was found more in patients with chronic abdominal pain in the present study it was not statistically significant.
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