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. 
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).
Surgery is reserved for mechanical complications of tuberculosis or when medical therapy fails. Emergency surgery is indicated in the presence of acute complications such as free perforation of the bowel and severe intestinal haemorrhage. The most common indication for surgery is intestinal obstruction secondary to stricture formation. In these patients, unless there is complete obstruction, conservative management is advocated. If symptoms persist. elective surgery is performed at a later stage, with significantly less morbidity. Predictors for surgical intervention are long strictures (12 cm or more in length) and multiple areas of involvement. Other indications for surgery are bowel adhesions, intra- abdominal abscess due to a confined perforation, mesenteric abscess, and internal or external fistulas. Surgery is also appropriate if the diagnosis is in doubt and when malignancy cannot be ruled out with reasonable accuracy. 15, 29,30
In this study 2 patient died out of 11 – this patient had splenic injury with retroperitoneal hematoma with class – I injury to left kidney. Splenectomy was done and the kidney injury was managed conservatively. Patient died in the post operative period due to multiorgan dysfunction secondary to hypovolemic shock. The mortality rate was 12.5% which is very much acceptable. This is due to the early diagnois and early surgicalmanagement and quick and effective of hypovolemic in patients with penetrating injuries.
Transhiatal esophagogastrectomy is performed using abdominal and left cervical incisions. The mobilization of the stomach for use as the conduit is performed as in the Ivor-Lewis esophagogastrectomy. This procedure is completed via the abdominal incision, and the gastric conduit is drawn through the mediastinum and exteriorized in the cervical incision for the esophagogstric anastomosis. This approach may be used for lesions at any thoracic location; however, transhiatal dissection of large, middle esophageal tumors adjacent to the trachea is difficult and may be hazardous.
Normally there are three layers covering the abdominal contents. These include a thin inner sheet called the peritoneum, a thick middle layer of muscles and the third outer layer – the outer skin. An incisional hernia forms usually due to weakness of the thick layers of muscles. There are various factors that can lead to the weakness or hernia formation and these factors generally can be broadly looked at as –
As the study was conducted in a GovernmentHospital majority of the cases belonged to the low socioeconomic status accounting for 75% of the cases. The scenario is similar across India where majority of the population belong to the low socioeconomic group further contributing evidence of dietary role of carcinogens. Studies at Chennai and other parts of the country have shown consistent correlation between the lower socioeconomic group and higher prevalence of gastric cancer.
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 .
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.
In another study by Rithin Suvarna et al, 2%topicaldiltiazem was compared with that of 0.2% topical glyceryltrinitrate(GTN) in the management of chronic fissure in ano. Healing rate with topical Diltiazem (71.87%) was better than GTN (68.23%) with p valueof 0.0001, making it statistically significant. Also the major adverse effect was headache in both groups but with much lesser incidence in Diltiazem group (5.2% vs. 67%). Recurrence rate was also low in Diltiazem group (9.67% vs. 19.56%) suggesting that the topical Diltiazem was a better chemical agent with higher efficacy and lesser morbidity.
Dialysis does not hasten recovery from AKI. Similarly, there is no consensus on the optimal renal replacement therapy in AKI. The preferred mode of renal replacement therapy is an area of active research. The claimed superiority of the continuous renal replacement techniques remains unproven. Neither are there evidenced-based guidelines on the initiation of dialysis in AKI. Absolute indications for the commencement of renal replacement therapy include symptomatic uremia (asterixis, pericardial rub, encephalopathy) and acidosis, hyperkalemia, or volume overload that proves refractory to medical management. However, in clinical practice, most nephrologists initiate renal replacement therapy (RRT) before the onset of overt metabolic disarray when the need for renal support appears inevitable.
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.
Ewa Idvall.et.al, (2009) did a study on Pain experiences and non- pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents Tonsillectomy is one of the most common pediatric surgical procedures. This study aimed to investigate children’s experience of pain and the non-pharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analyzed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their ‘worst pain’ during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.
Thyroid hormone replacement should aim for a TSH- level within the normal range for patients requiring a suppressive dose for benign disease, less than 0.1mIU/L for low risk patients with thyroid cancer and 0.05mIU/L or slightly lower for all other patients with differentiated thyroid cancer. TSH should be assessed 5 to 6 weeks after a new dose is commenced to ensure the appropriate target level is reached. The pregnant women with a previous total thyoidectomy may require upto 25% more thyroid hormone replacement during pregnancy to achieve these TSH goals. Surgeons caring for patients with thyroid disease should be comfortable with managing the medical and surgical elements of these disease treatment and follow-up.
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.
This study includes all patients who reported to the departments of surgery, medical oncology, radiation oncology and surgical oncology at Govt. RajajiHospital who were diagnosed with oral cancer. The study was for a period of Twenty four months from Jan 2011 to Dec 2012. There was no specific selection criteria used to select cases; patients came to the departments either directly or were referred from other departments and other hospitals after malignancy was proven by histopathological examination. Diagnosis was confirmed by histopathological examination of specimen which was obtained by wedge biopsy of the ulcer/growth. Detailed history regarding number, duration of symptoms, habits like smoking, tobacco / pan chewing were obtained, baseline investigations like a complete hemogram, blood biochemistry, X-ray chest and X-ray mandible were done as required.
Pregnancy, cough, lifting heavy objects, obesity , constipation, prostration, chronic ascites, liver cirrhosis, malignancy, peritoneal dialysis causes raise in intra- abdominal pressure leading to the formation of hernia. Here the fascia transversalis and rest of the abdominal wall become passively stretched and thinned out. A decrease in oxytalan fibers and an increase in the amorphous substance of elastic fibers as function of age may be responsible for alterations in the resistance of transversalis fascia and highincidence of groin hernia in older men.
The treatment of choice for patients with esophageal cancer is controversial. Esophagectomy remains the standard of care; however, its role has been challenged due to the generally poor outcomes following surgical resection alone in patients who typically have locally advanced disease . A survey of community care practice patterns between 1988 and 1993 revealed an increase in the use of chemoradiotherapy relative to surgery as primary management of esophageal cancer.
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.
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