Pithy Loquacity

Month: July 2007

  • 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
    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.

  • 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