A Case of Intestinal Perforation

So this 24 year old is brought by his relatives and neighbours at 2.00 am on a hot muggy july night. He was having fever for last 15 days and complains of increasing pain in abdomen since last five days. He was looking worse than before so they brought him to the hospital emergency. The patient is obviously in pain with sweat covering his forehead holding his stomach. Look for his radial pulse; hardly palpable. His arms and legs are cold and clammy-of couse – he is in shock. His abdomen is tense and tender. He is suffering from peritonitis and that is most likely due to perforation in his gut. X-ray of abdomen shows presence of free gas under the diaphragm confirming the clinical impression.


 This requires an urgent operation- a laparotomy  to repair the defect. So on to the operating table after preparation  (will be subject of another post). Abdomen is full of gut content with foul smell. The mess is cleaned and peritoneal cavity washed with warm saline. Rent in the ileum is repaired and abdomen closed after inserting a drain. Keep fingers crossed in the post operative period as the patient recovers and improves in the next 4 to 5 days. A seemingly simple task with many a pitfalls successfully completed. 

President retires.

President A P J Abdul Kalam is remitting office today. I really admire his enthusiasm for work and the fact that he made himself so approachable. He brought grace and respect for a position which is largely ceremonial in Indian Republic. Hear what Rajdeep Sardesai has to say about him.

He may be belittled by the ‘caste based politicos’ but his succession was characterized by blatant display of what is wrong in this country’s politics.

Absent Testes

Saw a fifteen year old boy brought by parents because he had developed ‘hernia’. On history and examination what was found was that he had absent testes on both sides, with a largish lump in the right groin and a smaller swelling present in left superficial inguinal ring area. What he was suffering from was bilateral undescended testes with some tumour in the right side.

So how is an undescended testicle treated?

The most important risk factor is undescended testicle (cryptorchidism). In male babies inside the womb, the testicles develop
inside the abdomen. They usually move down into the scrotum at birth, or within the first year of life. If they move down later, or need surgery to bring them down, this is called undescended testicle. A large Swedish study found that if surgery is done to bring the testicle down before the age of 13, the risk of testicular cancer is about twice that of the rest of the population. But if the operation is not done until 13 or older, the risk is increased about 5 times.

So the current recommendations for undescended testes presenting after puberty are

• “Younger than 32 years with a unilateral undescended testis – Orchiectomy

• Older than 32 years with a unilateral undescended testis – Close observation
and physical examination (orchidopexy vs orchiectomy if difficult to

• Any man with bilateral undescended testes – Bilateral testicular biopsy and orchidopexy.”

In case of an adult with an undescended testicle, moving the testicle to the scrotum probably won’t improve testis’ ability to make sperm. So in adult men, an undescended testicle is usually just taken out. Doctors often don’t do anything about an undescended testicle in men over 40.

Further information from wikipedia.

Follow up to previous post

In case you were wondering what happened to this boy who performed caesarean section read the followup in Hindustan Times-
The Tamil Nadu government has ordered an inquiry into the alleged incident of a 15-year-old boy performing a caesarean section surgery, an official said on Thursday.
In April, Dileepan Raj, a Class X student, performed a caesarean section operation under his parents’ supervision at the Mathi Surgical and Maternity Hospital in Manapparai, about 450 km from the state capital Chennai.
Dipeean’s parents K Murugesan and Gandhimathi are medical practitioners and wanted him to enter record books as the youngest surgeon in the world. read further
A really sorry state of affairs. The boy’s parents are in custody and he himself granted bail by the juvenile justice board. Like all legal affairs in our country rest assured that this case will drag on and on. more

Epidemic just round the corner

Kerala is in the throes of Chikungunya fever outbreak with the state government enlisting the help of Army and Navy not just for the management of affected patients but also in municipal areas. Further information regarding the disease itself can be found here while more information regarding the continued spread can be read here.
To complicate matters further Chikungunya infection is misleading doctors in the diagnosis of dengue fever, which shares similar symptoms.Aedes aegepti- the Vector

Suitable boy too!

After dropping Dav Whatmore from the post of coach the BCCI was left red faced when first choice Graham Ford declined the position citing family concerns. Not only that! Emburey who also had appeared for the position passed up with the irrefutable logic that he wasn’t prepared to be made the scapegoat for the poor Indian bowling lineup. The BCCI which was sitting smug in the belief that they will have no problem in filling up the post is now searching for alternatives. I wonder if they will have the gall to approach Whatmore again!
The Indian team is seeing changes with Virendra Sehwag being dropped from both test and one dayers following strings of poor show. Bhajji and Munaf will also be playing as stay at home cricketers!
Ahh! and one more thing Cricinfo.com
will be managed by same people as those managing ESPN and ultimately everything is in control of Disney

A Suitable Boy

The BCCI continues to search for a suitable coach for the indian cricket team. Former Bangladesh coach Dav Whatmore was tipped to succeed Greg Chappell but now the field is open once more (inside story anyone?). Ranatunga and South African Graham Ford are other candidates being considered for the post. Whosoever will be filling Chappell’s shoes will have a tough job dealing with a team in disarray what with a number of players being out of form. Apparently Gavaskar is more in favour of Sri lankan Arjun Ranatunga as the next coach. read at HT

Graham Ford

Back to pavilion

UK was a favourite destination for a large number of medical graduates from our country. With changes in the political and economic environment in the UK and with the increase in number of graduates within the UK their ‘services’ are no longer required. And they are being ‘relieved of their burden’. After investing a large amount and time along with missed oppurtunities back home; they will have difficult time indeed. A part of the story from rediff
Going to UK is not an easy decision and the present decision and subsequent court ruling is going to be hard on their medical careers.The logic of the changes put forth by Health Minister Lord Warner in March 2006 virtually precludes any relaxation. He said: “We now have more than 117,000 doctors working in the NHS, 27,400 more than in 1997, as well as record levels of doctors in training in UK medical schools.
More from HT

Flash in the pan

After winning the first test match against the proteas, the men in blue were back to their dismal self losing the next two matches without much fight. They started the third test quite well but the urge of shooting themselves in foot was too much to resist; losing the match by five wickets! And to add insult to the injury apparently they are being billed for the revelry after their first win. Guru Chappel is rightly miffed with all his plans for the forth coming world cup collapsing in front of him. He was heard darkly muttering these words “Looking at the tour as a whole, there are more questions than answers. Over the next week or so, when we get back to India and have a chance to digest what’s happened and discuss and debrief, we’re going to have to make some decisions on which direction we go. There will be a few guys under a bit of pressure, there’s no doubt.” full story here
In deep water