Category: Medicine

Doctor left a towel inside me, says 65-year-old. and from msn

Leaving behind instruments and gauze pieces after operation is certainly not a healthy practice. Besides being an extra burden for the patient; the doctrine of Res Ipsa loquitor applies with regard to negligence by the medical practitioner. Ordinarily acts of omission and comission need to be proved in court by expert evidence in court to determine negligence by a doctor but this need not be proved in case ” res ipsa loquitor” i.e “the thing or fact speaks for itself”. The reason for this post is this in todays news with regard to removal of ‘Sponge’ from a patient’s abdomen at a prominent institute.

A patient underwent open cholecystectomy (removal of gall bladder for stones) and complained of constant pain with purulent discharge. Investigations revealed a left over towel used for packing which was subsequently retrieved.

Now this is one of those cases when the surgeon will have to throw in his towel! The rule applies when (i). in the absence of negligence the injury would not have occured. (ii). the doctor had exclusive control over the injury producing agent. (iii). the patient was not guilty of contributory negligence.

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.

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
examine)

• 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.

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.