cent and 78 per cent, respectively. The diagnostic usefulness of the white-cell count is reduced in the presence of coexisting conditions such as cirrhosis and HIV infection, both of which are associated with an increased incidence of abdominaltuberculosis. In patients with cirrhosis and AIDS the response of white cells is poor and the total white blood-cell count is often within the normal range. Another characteristic of tuberculous ascites is high total protein, usually 2.5 g/dl or more, and the serum ascitic fluid albumin gradient (SAAG) is less than 1.1. However, high total protein is seen in several conditions, and the sensitivity, specificity, and diagnostic accuracy of this test for tuberculosis are only 65, 78, and 74 per cent, respectively. As with the white blood-cell count, the protein content of ascitic fluid in cirrhotic patients with peritoneal tuberculosis is significantly lower; the concentration is less than 2.5 g/dl in 30 to 50 per cent of patients, and the SAAG is highly variable. Other biochemical tests, such as lactate dehydrogenase (elevated to over 90 units/I), low pH, and an ascitic fluid:blood glucose ratio of less than 0.96, are usually positive in tuberculous ascites, but these tests are non-specific and of little diagnostic value 12 .
According to Shukla 1988 the incidence of abdominaltuberculosis is high in India. But recent literature indicates that the disease is also prevalent all over the world (Chen ws Taiwan 1992). Shafer RW New York reports those 47 cases in 1983 and 113 cases in 1988. In GovernmentRajajiHospital, Madurai, Tamilnadu over 24 months of study, 60 cases are reported in various surgical units and treated as inpatients. In United Kingdom the frequency has recently increased due to arrival of Asian immigrants (VK Kapoor and L.K. Sharma 1988).
There is no clear evidence that abdominaltuberculosis requires longer treatment, but the numbers of patients in the reported series are too small for clinical trials. One study showed only 53% of patients were being treated as recommended.  Compliance with treatment is the major problem which is the main determinant of treatment outcome.  The levels of some acute phase proteins (C-reactive protein, ceruloplasmin, haptoglobulin, and α1-acid glyco- protein) usuallyfalls after successful treatment which may be useful for monitoring .  Complications reported other than drug toxicity following treatment. A distal common bile duct stricture producing Jaundice was observed following treatment of duodenal tuberculosis.  Small-bowel perforation isalso reported. 
Latika Mohan, Nitu Roy and Yogesh Singh (2015) conducted descriptivestudy to assess the sensitivity, specificity, and predictive value of EEG, 50 consecu- tive children with febrile seizures attending the pediatric OPD of a tertiary care hospi- tal, EEG was carried out on two occasions. First EEG was done within one week Par- oxysmal EEG abnormalities were present in 54% of children. Validity measures of EEG in febrile seizures were found to have 90% sensitivity, 70% specificity, 72% positive predictive value and 88% negative predictive value within 95% confidence interval, and concluded EEG is useful as a diagnostic and prognostic tool in febrile seizures and can provide information regarding presence of abnormalities, degree of encephalopathy and electrographic features but like all diagnostic tool it is not fully infallible and requires further alternative diagnostic and clinical support.
Ulcerative tumors are self-descriptive; scirrhous tumors infiltrate the entire thickness of the stomach and cover a very large surface area. Scirrhous tumors (linitis plastica) have a particularly poor prognosis, and commonly involve the entire stomach. Although these latter lesions may be technically resectable with total gastrectomy, it is common for both the esophageal and duodenal margins of resection to show microscopic evidence of tumor infiltration. Death from recurrent disease within 6 months is common.
This is to certify that this dissertation titled “A COMPARITIVE STUDY ON DIATHERMY Vs SCALPEL SKIN INCISIONS IN ABDOMINAL SURGERIES IN GOVERNMENTRAJAJIHOSPITALMADURAI” submitted by Dr. ARUN GURU K to the faculty of General Surgery, The Tamil Nadu Dr. M.G.R. Medical University, Chennai in partial fulfilment of the requirement for the award of MS Degree Branch I General Surgery, is a bonafide research work carried out by him under our direct supervision and guidance from September 2017 to September 2018.
These hernias may occur after large surgeries such as intestinal or vascular (large arteries, and veins) surgery, or after smaller surgeries such as an appendectomy or an even through the small scar of a laparoscopy wound. Surgical correction of Incisional hernias is usually recommended, as they carry a potential risk of becoming strangulated at the opening in the abdominal wall and having their blood supply cut off. If this happens it becomes a medical and surgical emergency.
Left thoracoabdominal esophagogastrectomy uses a contiguous abdominal and left thoracic incision, through the eighth intercostal space. Mobilization of the stomach for use as the conduit is performed as described previously, and esophagectomy is accomplished via the left thoracotomy. Esophagogastric anastomosis is performed in the left chest, usually just superior to the inferior pulmonary vein, although it may be performed higher if the conduit is tunneled under the aortic arch. This approach may be used for lesions in the distal esophagus.
It is a form of cutaneous tuberculosis occurring in young adults which starts as cutaneous nodule which gradually turns into ulcer. The ulcer remains active in periphery and spreads outward’s. Whereas in the center, they gradually heal. Due to its destructive nature, it is called ‘Lupus’ which means ‘wolf’. Squamous cell carcinoma may grow from the scar of lupus vulgaris to form Marjolins ulcer.
Title: Psychiatric morbidity among alcoholic patients in psychiatric OPD at GovernmentRajajiHospital, Madurai. Objectives: To assess the psychiatric morbidity among alcoholic patients in psychiatric OPD. To associate the psychiatric morbidity among alcoholic patients in psychiatric OPD with their socio demographic variables Hypotheses: There is statistically significant relationship between the psychiatric morbidity and alcoholism among alcoholic patients. There is statistically significant association between the psychiatric morbidity among alcoholic patients with their selected socio demographic variables Methodology: Non experimental descriptive design was used, 100 Alcoholic patients were selected by non-probability (consecutive) sampling and assessed through Mini International Neuropsychiatric Interview tool. Results: The study revealed that majority of the Alcoholic patients had various psychiatric morbidity. Conclusion: The study findings evidence that psychiatric morbidity is common in people with alcohol dependence and need integrated strategies for the identification and management of both alcohol dependence and co morbid psychiatric disorders .
They are anterior rami of lower six thoracic and first lumbar nerves. They pass between internal oblique and transversus abdominis muscle. The thoracic nerves are the lower five intercostals and sub costal nerves and first lumbar nerve is represented by ilio- hypo gastric and ilio-inguinal and genito-femoral nerve. They supply the skin of anterior abdominal wall, the muscles and parietal peritoneum. The lower six thoracic nerves supply the rectus muscle and pyramidalis. The ilio-inguinal nerve supply a portion of internal oblique muscle and accompanies the spermatic cord through external inguinal ring. It supplies the skin of medial thigh proximal to inguinal ligament, root of penis and upper anterior scrotum. In females, the nerve exits the external inguinal ring and supplies the mons pubis and labia majora. The genital branch of genito-femoral nerve exits the pelvis through the deep inguinal ring and continues with the spermatic cord supplying the cremastric muscle. It innervates the antero-lateral part of scrotal skin.
Common general postoperative complications include atelectasis, pneumonia, orthostatic hypotension, decreased cardiac output and stroke volume, urinary retention, negative nitrogen balance, depression and sensory deprivation, decrease tissue sensitivity to insulin, deep vein thrombosis, constipation and fecal impaction, loss of muscle tone and decubitus ulceration in the dependent areas that is subjected to pressure due to prolonged bed rest. Early postoperative ambulation has been practiced on the surgical services since August 1944. There were 500 abdominal surgery cases compared with the 500 similar cases, they were left in bed to the 10-14 days. The study group allowed walking as early as possible. The control group were not ambulated and used for comparison. In ambulated group there was a total 43 postoperative complications as compared with 93 for non-ambulated. Incidence of broncho pneumonia has been reduced from 6% to 3%, atelectasis from 1.2% to 0.4%, phlebothrombosis from 2.4% to 1% in ambulated group.
Title: Memory impairment among severe hypothyroid patients in endocrine OPD at Govt. RajajiHospital, Madurai. Objectives: To assess the level of memory impairment among male and female severe hypothyroid patients in endocrine OPD at GRH Madurai. To associate the level of memory impairment among male and female severe hypothyroid patients in endocrine OPD at Govt. RajajiHospital, Madurai and their selected socio demographic and clinical variables. Hypotheses: There is a significant association between the level of memory impairment among male and female severe hypothyroid patients in endocrine OPD at Govt. RajajiHospital, Madurai with their selected socio demographic and clinical variables. Methodology: Non experimental (descriptive) research design was used, 100 severe hypothyroid patients were selected by Non-probability (consecutive) sampling and assessed through PGI memory assessment tool. Results: The study revealed that majority of subjects in male 15 (60.00%) and in female 42 (56.00%) had above average memory and is associated with T4 level respectively. Conclusion: The study finding evidenced that severe hypothyroid patients had varying level of memory impairment, females had more memory impairment comparing with male severe hypothyroid patients.
Senya C et al (78) in 2003 reviewed 381 HIV-infected patients admitted to a public hospital in Phnom Penh, Cambodia over last 6 months. They found that the in-hospital mortality rate was 43.6%. Approximately 50% of patients had two or more concurrent illnesses. Very advanced HIV disease was common in their study, with CD4 cell counts below 10 cells/mm cube in 43.2%. Only 28.3% of the patients had documentation of their HIV infection prior to hospitalization. Chronic diarrhoea was the most frequent opportunistic illness (41.2%), followed by tuberculosis (26%), cryptococcal meningitis (12.6%), Pneumocystis carinii pneumonia (8.4%), and encephalitis (4.7%). Chronic diarrhoea and tuberculosis were the most important opportunistic infections observed in HIV-infected hospitalized patients in Cambodia.
Normally, the stomach is relatively free of bacteria and other microorganisms because of its high intraluminal acidity. Most persons who experience abdominal trauma have normal gastric functions and are not at risk of bacterial contamination following gastric perforation. However, those who have a preexisting gastric problem are at risk of peritoneal contamination with gastric perforation. Leakage of acidic gastric juice into the peritoneal cavity often results in profound chemical peritonitis. If the leakage is not closed and food particles reach the peritoneal cavity, chemical peritonitis is succeeded by gradual development of bacterial peritonitis. Patients may be free of symptoms for several hours between the initial chemical peritonitis and the later occurrence of bacterial peritonitis. The microbiology of the small bowel changes from its proximal to its distal part. Few bacteria populate the proximal part of the small bowel, whereas the distal part of the small bowel (the jejunum and ileum) contains aerobic organisms (e.g., Escherichia coli) and a higher percentage of anaerobic organisms (e.g., Bacteroides fragilis). Thus, the likelihood of intra- abdominal or wound infection is increased with perforation of the distal bowel.
According to various studies of the hydatid disease it is dearly proved that the majority of cases show hydatid in the liver (first filter) by spleen and then only other abdominal organs like Kidney, Peritoneum, etc., In this series, males are affected slightly more than the females. ESR is elevated only in 35% of cases. There is also a generalized. Eosinophilia in 85% of cases in this series. Hydatid cysts can occur in any age group. In other series disease is not recorded below 3 years of age. In this series the minimum age was 23 years maximum age was 65 years and the average age was 39.5 years. In this series all the patients had definite contact with pet dogs.
intra-abdominal operations performed at Long Island Jewish Medical Centre, Among these 31 patients i.e. 1% developed fascial wound dehiscence, serosanguious drainage was noted from the wound prior to the dehiscence in 21 patients (67%), disruption occurred on average 11.1 days postoperative. During 5 year period from Jan 1989-Dec. 1992, 48 patients developed wound dehiscence after midline laparotomy at Oulu University Hospital. Two patients (4%) died within 30 days and 3 (6%) within 90 days after discharge. Mean hospital stay was 25.15 days. There were 31 (65%) patients with pre-operative hypoalbuminemia. Other risk factors included anaemia, malnutrition, chronic lung disease and
Of the 4 patients with stab injuries there were associated organ injuries. One patient had a stab in the left loin, had abdominal guarding and an emergency lapartotomy was done. There was a partial thickness tear in the descending colon which was sutured and on mobilizing the descending colon, the ureter was found completely torn – primary anastomosis was done with a Double J stent. Patient had an uneventful recovery.
4. Accumulation of bile due to biliary leakage from some unknown duct leading to Waltman-Walter syndrome, manifested by upper abdominal pain or chest pain associated with tachycardia and a persistent low blood pressure. If there is any suspicion, an urgent ultrasound scan followed by emergency re-exploration of the abdomen is carried out.
In this study diagnosis of chronic pancreatitis is based on the thorough history, physical examination laboratory data or imaging abnormalities. Imaging methods done in this study were plain abdominal radiographs which revealed the presence of focal or diffuse pancreatic calcifications in 25 to 30% of the cases, transabdominal ultrasound which showed pancreatic duct dilatation irregularly of main pancreatic duct, loss or reduction of pancreatic parenchymal echogenicity, calculi and calcifications. CT scan abdomen findings showed pancreatic duct dilation, calcification and cystic lesions.