Incidence and management of intestinal perforation in typhoid: a prospective, observational study

Background: Intestinal perforation is a common surgical problem, which need proper attention. Typhoid is the most common cause of bowel perforation. With the concept of a correct diagnosis of perforation in reference to its etiology and further study of etiological factor (typhoid) in relation to epidemiology, surgical treatment and outcome, the present study has been undertaken.Methods: It is a prospective, observational study in which 50 cases of enteric perforation admitting in SMS Hospital at JAIPUR were observed. All patients of enteric perforation peritonitis were evaluated by detailed history, clinical examination and radiological as well as laboratory investigations. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality data were observed.Results: Mean age of patients was 26.38 years. Male to female ratio was 4:1. Enteric perforation is more common in patients with poor nutritional status and rural area. Primary repair of perforation was done in patient with small perforation with relatively healthy bowel, while ileostomy was done in patients with large perforation of longer duration, multiple perforations and edematous bowel with necrotic patches. Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (33.3%) and lowest in patients in which exteriorization of the perforation as loop ileostomy was done (10.3%).Conclusions: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.

PALS Update 2010.

During the past decade, guidelines for cardiopulmonary resuscitation have focused on the importance of high quality CPR. The purpose is to temporarily maintain a circulation to vital organs until specialized treatment is available. In, essence, it has been a revolution in pediatric resuscitation in terms of “coming full circle” to the 1960s when basic CPR was first developed. A fifth component to the pediatric chain of survival has been added with emphasis on integrated post cardiac arrest care. With mounting scientific evidences, American Heart Association published new Pediatric Advanced life support 2010 guidelines in accordance with the established five yearly cycle of guideline changes.

Reversible Posterior Leucoencephalopathy Syndrome in Post Streptococcal Glomerulonephritis.

Reversible posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible encephalopathy, with radiological findings that mainly involve the white or grey matter of the parieto-occipital lobes. We report a case of post streptococcal glomerulonephritis presenting as reversible leukoencephalopathy syndrome. Immediate control of hypertension resulted in rapid and complete neurological recovery.

Spinal cord hamartoma with pseudopancreatic cyst.

A 2-year-old boy presented with weakness of both lower limbs with bladder and bowel involvement and history of frequent falls. Magnetic resonance imaging of the spine revealed a T2 altered signal intensity enhancing mass lesion seen in the spinal epidural space extending from sixth cervical to fourth thoracic vertebrae, which was compressing the adjacent spinal cord. Histopathology of the lesion was suggestive of hamartoma. A brief review of the literature including its embryogenesis is discussed here. The child subsequently developed pseudopancreatic cysts possibly because of repeated falls leading to blunt trauma abdomen.

Child abuse: inflicted traumatic brain injury.

We report a one year old boy with clinical and neuroimaging findings of inflicted traumatic brain injury. The clinicians often overlook this form of physical abuse. The family structure also plays an important role in neglecting this form of problem.