ABSTRACT
A woman in her mid-30s presented to our 30-bed healthcare centre with extensive burns, hours after falling into a shallow pit of burning dried tea leaves. On arrival, there was no evidence of airway compromise. She was fully conscious but had signs of shock and hypovolemia. Forty-five per cent of the total body surface area was burned, including the face, neck, thorax, abdomen, upper limbs and thighs. The family refused referral to a burns centre and insisted on continuing treatment at our facility. Our hospital, not equipped to manage burns, was adapted to deliver effective, immediate care. After initial stabilisation, the patient was unwilling to remain hospitalised because of her husband's employment commitment. Subsequently, we were notified that the patient died within 1 month of discharge. This article highlights the importance of burns care facilities in rural India and the impact of a failure to access quality health on outcomes.
Subject(s)
Burns , Humans , Female , Burns/therapy , Adult , India , Fatal Outcome , Rural Health Services , Burn UnitsABSTRACT
This data article provides an extensive dataset obtained from finite element (FE) simulations of microbond (MB) tests. The simulations cover a wide range of structural effects and artifacts that influence the results of the MB tests. A total of 432 simulations were performed,taking into account the various factors such as blade geometry and position, plastic behaviour of thermoset and thermoplastic droplets, material properties of the fibres, residual stresses, fracture modes at interfaces, and FE mesh sensitivity analysis. Each FE simulation consists of blade reaction force, blade displacement, fibre displacement, fibre strain and various energy metrics such as interface strain energy, total strain energy, damage energy and plastic dissipation energy. For ease of reference, the individual data files are organised in a systematic naming sequence based on the simulation matrices, detailing the specific abbreviations for each file. A user-friendly interface is also provided to read and visualisethe data from the output files in relation to the simulation matrix. For more information on the interpretation and analysis of this data, please refer to a research article entitled "Mutual dependence of experimental and data analysis features in characterization of fibre-matrix interface via microdroplets (R. Dsouza et al., 2023)".
ABSTRACT
A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence associated with pain. There were no other symptoms to suspect bowel pathology. On examination, he was found to have a tender mass in the retro-rectal plane without any evidence of rectal mucosal irregularity. He underwent an MRI of the pelvis, which showed a well-defined T2 hyperintense partly cystic lesion in the presacral region abutting the mesorectal fascia and a normal prostate gland. With a suspicion of a tailgut cyst or a duplication cyst, he underwent an excision of the presacral mass. Intraoperatively, there was a 2 × 2 cm well-defined firm, cystic lesion anterior to the fifth sacral vertebra and coccyx. The lesion was adherent to the mesorectum and was excised. On histopathology, there were features of muscular stroma and bilayered glandular epithelium with clear cytoplasm conclusive of a benign ectopic prostate.
Subject(s)
Choristoma , Magnetic Resonance Imaging , Prostate , Humans , Male , Prostate/pathology , Prostate/diagnostic imaging , Prostate/surgery , Choristoma/surgery , Choristoma/diagnosis , Choristoma/diagnostic imaging , Diagnosis, Differential , AdultABSTRACT
Diversion colostomy plays a crucial role in the management of carcinoma rectum in low- and middle-income countries as significant number of patients present with partial intestinal obstruction. The aim of this study was to compare laparoscopic and open approaches for fecal diversion done in patients with adenocarcinoma of the rectum as a pretreatment procedure. The primary end point of our study was time to initiation of neoadjuvant chemo radiation. It was a retrospective study that included all patients diagnosed to have carcinoma rectum and underwent a pretreatment fecal diversion between 2012 and 2014. A total of 55 patients underwent pretreatment diversion colostomy of which 33 were performed via the laparoscopic approach while 22 had open diversion. The time for initiation of neoadjuvant therapy was shorter in the laparoscopic group compared to the open approach (16 days vs. 20.5 days, P = 0.31). The study concluded that pretreatment diversion colostomy using the laparoscopic approach was a safe option in low- and middle-income countries as it was associated with faster recovery and early initiation of neoadjuvant therapy in patients with partially obstructed locally advanced carcinoma rectum.
ABSTRACT
Phyllodes tumour is a rapidly growing neoplasm with a propensity to involve the entire breast tissue. In large tumours, the treatment comprises a wide local excision or a mastectomy. A woman in her 20s from rural India presented with complaints of a recurrent left breast lump. The lump progressed to a large size, limiting her social activities and causing depression. On examination, she had a mass occupying almost the entire left breast, with stretched skin, dilated veins and pressure necrosis. There were no palpable axillary nodes. She was offered a wide local excision and reconstruction with a latissimus dorsi pedicled flap. After much discussion and clarification of some misconceptions around breast reconstruction, she underwent the planned surgery. This was followed by adjuvant radiation therapy as the histopathology was consistent with a complex phyllodes tumour with close margins. She was well at 1-year follow-up and led a good family and social life. Breast conservation and reconstruction are seldom offered as part of cancer treatment in India. All women should be offered surgical options that are oncologically safe while preserving body image, and hence healthcare providers must work towards breaking the barriers that prevent breast reconstruction.
Subject(s)
Breast Neoplasms , Mammaplasty , Phyllodes Tumor , Breast Neoplasms/surgery , Female , Humans , Mammaplasty/methods , Mastectomy/methods , Phyllodes Tumor/pathology , Surgical Flaps/blood supplyABSTRACT
Especially the applications of fibrous composites in miniature products, dental and other medical applications require accurate data of microscale mechanics. The characterization of adhesion between single filament and picoliter-scale polymer matrix usually relies on the experiments using so-called microbond (MB) testing. The traditional MB test systems provide unitary data output (i.e., converted force) which is enigmatic in resolving the fracture parameters of multi-mode interface cracks. As a fundamental basis, the momentary reaction force and respective local strain at the location of a non-ambiguous gradient are needed for a mechanical analysis. In this paper, a monolithic compliant based structure with an integrated Fiber Bragg Grating (FBG) sensor is developed and analysed. The stiffness of the compliant structure is estimated by using mathematical and finite element (FE) models. Qualification experiments are carried out to confirm the functional performance: MB testing of synthetic (carbon and glass) and natural (flax) single filaments are successfully performed. Quasi-static and dynamic analysis of the MB testing is carried out by using the FE method to interpret the response of the compliant structure. The developed strain-sensing CBPM-FBG holder shows excellent sensitivity during the MB tests for both synthetic and natural filaments, even at a low filament diameters as low as [Formula: see text], making the monolithic compliant structure the first instrument capable of force-strain data output for bonded filament-droplet specimens.
ABSTRACT
We describe a 68-year-old postmenopausal woman who presented with a history of rapidly enlarging lumps in both breasts. Though the breast lumps appeared suspicious on ultrasonography, the core biopsy was reported to be benign. In view of the clinical and radiological suspicion of malignancy, she underwent a diagnostic excision of both the lumps, the histopathology was consistent with mammary hibernoma. To the best of the authors' knowledge, this is the first report of a bilateral mammary hibernoma in an elderly postmenopausal woman. Given the clinical presentation, it is important to differentiate mammary hibernoma from carcinoma breast, which is a more common condition in this age group. However, preoperative diagnosis is challenging in view of the lack of definitive radiological and histological features. Although benign, hibernoma may have a propensity for local recurrence and, therefore, complete surgical excision remains the mainstay of treatment.
Subject(s)
Breast Neoplasms , Lipoma , Aged , Breast/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Female , Humans , Lipoma/diagnostic imaging , Lipoma/surgery , Neoplasm Recurrence, Local , Ultrasonography, MammaryABSTRACT
BACKGROUND: Arterial revascularization is seldom considered as a treatment option in thromboangiitis obliterans (TAO) due to diffuse segmental involvement of medium- and small-sized extremity vessels. Although typical angiographic features include bilaterally symmetrical involvement of infrapopliteal vessels, larger vessels too can be affected. Similarly, there could be distal target vessels feasible for revascularization. This study was conducted to describe the patterns of arterial involvement in TAO and assess the feasibility of revascularization. METHODS: The study was approved by the Institutional Review Board and research ethics committee of Christian Medical College, Vellore (IRB no: 12034). A retrospective study was conducted in the Department of Vascular Surgery, Christian Medical College, Vellore, India, between January 2009 and December 2018. There were 329 patients who fulfilled the clinical criteria for TAO of whom 83 had an angiogram done. These 83 patients formed the study cohort. RESULTS: Large vessel involvement was seen in 56.6% of patients and 79.5% of patients had at least one or more distal target artery feasible for revascularization. The anterior tibial artery and peroneal artery were the most common target vessels that were patent for revascularization. Of the 22 patients who underwent revascularization (16 bypasses and six angioplasties), the patency rate was 64.8% and the limb salvage rate was 80.9% at the end of 6 months. CONCLUSION: The study shows that one-third of our patients with TAO have a distal target artery feasible for revascularization. As most of the affected patients are in the economically productive age group, every attempt should be made to salvage the limb with revascularization for which the use of angiography should be more liberal.
Subject(s)
Thromboangiitis Obliterans , Arteries/diagnostic imaging , Arteries/surgery , Feasibility Studies , Humans , India , Ischemia/surgery , Limb Salvage , Retrospective Studies , Tertiary Care Centers , Thromboangiitis Obliterans/surgery , Treatment Outcome , Vascular PatencyABSTRACT
Adenocarcinoma of the bowel is a dreadful sequelae of inflammatory bowel disease that can be difficult to diagnose and has been shown to have poor prognosis. The diagnosis is often made on histopathological examination of the resected specimen for what is suspected to be an exacerbation of the underlying intestinal Crohn's. A 39-year-old woman who was being treated for small bowel Crohn's disease for 4 years presented with features of intermittent intestinal obstruction that was refractory to medical therapy. A contrast CT of the abdomen was suggestive of ileocaecal Crohn's disease, and colonoscopy revealed a stricture at proximal transverse colon with multiple superficial ulcers. She underwent a mesentery sparing right hemicolectomy and had an uneventful recovery. The biopsy, however, was reported to be moderately differentiated adenocarcinoma stage T3N0 with a harvest of four pericolic nodes. Adjuvant chemotherapy was advised, which she deferred. Ten months later, she presented to the emergency room with features of intestinal obstruction. Contrast CT of the abdomen showed thickening at the anastomotic site with intestinal obstruction. On exploratory laparotomy, tumour recurrence was noted at the site of the anastomosis and diffuse peritoneal metastasis. A palliative diversion ileostomy was done due to inoperable obstructing disease. She was then given palliative therapy and subsequently succumbed to the illness. The inclusion of mesentery with the resected specimen in Crohn's disease has been a debate over many years. Since the preoperative diagnosis of carcinoma of the bowel in Crohn's disease is challenging, all ileocolic resections should be radical as done in oncological resections. This would yield better oncological safety and may improve survival rates.
Subject(s)
Adenocarcinoma/surgery , Cecal Neoplasms/surgery , Crohn Disease/complications , Ileal Neoplasms/surgery , Adenocarcinoma/etiology , Adult , Cecal Neoplasms/etiology , Female , Humans , Ileal Neoplasms/etiologyABSTRACT
A 67-year-old man with diabetes and hypertension presented with complaints of abdominal pain and lower back ache for 7 months, with intermittent episodes of fever. On examination, there was an expansile mass in the upper abdomen with bruit on auscultation. He also had tenderness in the L1-L2 vertebral space with paraspinal fullness, causing painful restriction of lower limb motor functions but without affecting sensation. On evaluation, he was found to have an abdominal aortic aneurysm with infective lumbar spondylodiscitis. The aspirate from the paravertebral infected tissue and cultures from blood grew Pseudomonas aeruginosa, a rare causative agent of mycotic aortic aneurysm. Whether the infective spondylitis spread to the abdominal aorta causing the mycotic aneurysm or vice versa is a dilemma in such a case. However, the mainstay of treatment remains adequate source control and repair of the aneurysm with appropriate antibiotic therapy. Our patient received intravenous antibiotics for P . aeruginosa based on sensitivity, following which he underwent debridement of the infective spondylodiscitis with aneurysmorrhaphy. He had an uneventful recovery and was well at 3-month follow-up.
Subject(s)
Aneurysm, Infected/microbiology , Aortic Aneurysm, Abdominal/microbiology , Ceftazidime/therapeutic use , Pseudomonas Infections/complications , Spondylitis/microbiology , Aged , Aneurysm, Infected/therapy , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Abdominal/therapy , Humans , Male , Pseudomonas aeruginosa , Spondylitis/therapyABSTRACT
A 26-year-old man who was previously well presented to the emergency in septic shock. He had a preceding history of fever, right upper abdominal pain and jaundice. On examination, there was tenderness over the right hypochondrium and epigastrium, without features of generalised peritonitis. His blood tests were suggestive of sepsis with deranged liver function tests. CT scan of the abdomen showed multiples abscesses in various segments of the liver and a thrombus in the inferior venacava, without any other intraabdominal focus of infection. The abscess was aspirated under sonographic guidance, and the cultures grew Streptococcus constellatus species of S. milleri group (SMG). He received crystalline penicillin, based on culture sensitivity and underwent drainage of the abscess. There was a clinical improvement and he was subsequently discharged in a stable condition. On 3 months follow-up, there was a complete resolution of the liver abscess and normalisation of the liver function tests.
Subject(s)
Liver Abscess, Pyogenic/diagnosis , Streptococcal Infections/diagnosis , Streptococcus constellatus/isolation & purification , Abdominal Pain/etiology , Adult , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Diagnosis, Differential , Drainage , Fever/etiology , Humans , Jaundice/etiology , Liver Abscess, Pyogenic/complications , Liver Abscess, Pyogenic/diagnostic imaging , Liver Abscess, Pyogenic/therapy , Male , Streptococcal Infections/complications , Streptococcal Infections/diagnostic imaging , Streptococcal Infections/therapy , Tomography, X-Ray ComputedABSTRACT
The external oblique musculo-aponeurotic complex is an important contributor to the strength of the inguinal canal. The present case report describes the bilateral absence of the external oblique muscle in a patient. A 40-year-old male patient presented with a history of intermittent lower abdominal pain for 15 years which had increased over the past 2 years. Abdominal examination revealed bilateral reducible, incomplete, direct inguinal hernia. Elective bilateral Lichtenstein's mesh hernioplasty was planned for the patient. Intraoperatively, there was no evidence of the external oblique aponeurosis and the spermatic cord was noted deep to the membranous fascial layer. The inguinal ligament was thin and atrophic and was attached to the pubic tubercle medially and anterior superior iliac spine laterally. There was no evidence of any superior aponeurotic connection to the inguinal ligament. A postoperative ultrasound examination of the abdomen confirmed the bilateral absence of the external oblique musculo-aponeurotic complex. The isolated absence of the external oblique musculo-aponeurotic complex in adults is an exceedingly rare anomaly. The possibility of such an anomaly should be considered in patients without other risk factors for hernia.