“I am having vomiting two to three times a day since three days and discomfort in the upper abdomen”, was the complain of my patient.
There was no loose motion, fever and urinary problem. He was seen and prescribed medicines for gastritis one day back by my good friend, the medicine specialist. I thought he should remain in the treatment for some more time. So, I advised him to continue the same treatment and contact medicine specialist for further advice. At this point the patient says that he had a long standing inguinal hernia. Now, my surgeon mind became skeptical and alert to think that everything might not be well. I asked about the reducibility of the hernia, and very much to my expectation, it was not reducing since two days. So, that is the hazard of inguinal hernia. It, many a times becomes irreducible after coming out to the scrotal sac. Now, I examined the patient and found the irreducible hernia in the scrotal sac. But, to the good luck of the patient, it reduced with a little difficulty, aborting an emergency surgery. Now the patient gets relaxed so also me. The patient confesses that he had been advised earlier to undergo surgery, but it got delayed due to his bronchitis problem.
Chronic cough due to various chest diseases, and diseases like stricture of urethra or an enlarged prostate which increase resistance to smooth flow of urine, raise intra-abdominal pressure and the contents of abdomen may find their way out through a potential weakness in the abdominal wall, what is called inguinal canal. That is termed as inguinal hernia. The contents may get struck to the scrotal sac and become irreducible or obstructed warranting an emergency surgery to release the same. This is potentially a life threatening condition, if timely intervention is not done. The content may become dead, what is called gangrene. Now, as the patient is having an exacerbation of bronchitis, has been prescribed a course of antibiotics with an advice to keep the contents of hernia inside the abdomen and return for an elective surgery after the symptoms of bronchitis alleviates.
- Reseted Gross specimen of Breast Cancer.
There are minimal removal of breast tissue to total removal of tissue in breast cancer depending on the extent or stage of disease. You may go through the url to read more along with the quotes text.
http://www.mayoclinic.com/
Quoted.
“Who is mastectomy for?
Mastectomy is an effective treatment for breast cancer. Your doctor may recommended mastectomy over other treatment options — such as surgery to remove the tumor only (lumpectomy) plus radiation therapy — if:
- You’re in the first or second trimester of pregnancy, when radiation creates an unacceptable risk to your unborn child.
- You have two or more tumors in separate areas of the breast.
- You have widespread or malignant-appearing microcalcifications throughout the breast.
- You’ve previously had radiation treatment to the breast region.
- You have a strong family history of breast cancer.
- You carry a gene mutation that confers a high risk of developing another breast cancer.
You might also choose mastectomy if:
- You have a large tumor relative to the overall size of your breast. You may not have enough healthy tissue left after lumpectomy to achieve an acceptable cosmetic result.
- You have a history of connective tissue disease, such as systemic lupus erythematosus, and may not tolerate the side effects of radiation, particularly to the skin.
- The tumor is located beneath the nipple and may involve the nipple, making it more difficult to preserve the nipple and areola.
- You live a long distance from a radiation facility and being there every day for five to six weeks would be too large a hardship.
You may also consider mastectomy may if you don’t have breast cancer but are at high risk of developing the disease. This procedure, called preventive (prophylactic) or risk-reducing mastectomy, removes one or both of your breasts in hopes of preventing or reducing your risk of developing breast cancer in the future.”
I was very much surprised by seeing a boy tolerating the pain of shoulder dislocation for some hours. Dislocation of shoulder is a very painful condition. The person who has experienced it will only be able to understand the plight of the patient. It usually occurs due to a fall hitting the shoulder directly or fall on a out stretched hand. Some have inherent weakness in the ligaments and capsule of the joint, and dislocate is frequently called a recurrent shoulder dislocation. Some develop weakness around the joint in
some diseases like SLE or due to long term consumption of steroids. Sudden jerky movement of arm may dislocate it if one is prone for it.
It may be anterior or posterior type. Dislocation diagnosis is obvious from the clinical examination by observing the loss of convexity of shoulder joint. The axillary fold is also deformed. Some may fracture the humerus, the underlying bone along with the dislocation in a trauma. X-rays of the shoulder will prove the diagnosis.
The anterior shoulder can be reduced under a general anesthesia or under sedation. I prefer to do it under sedation, because calling the anesthetist and arranging operation theatre takes time in our set up. So, with a little discomfort the long waiting period can be cut short which in turn will cut short the plight of the patient. There are several methods to do it. I employ a method where the patient sleeps on his abdomen on a high table, hanging the limb down whose shoulder has been dislocated. A weight of about 10 kilograms is tied to the hand, and cares is taken so that the weight hangs freely and gives a continuous traction. Within a short time the contour of shoulder returns with a sound of reduction. And the patient is free of pain. He will express it with a relaxing moan. The shoulder will be immobilized at least for two weeks and some analgesic prescription will complete the treatment. Recurrent dislocation is treated by surgery.
The man was very much worried.” A bone was growing over the wrist since a few months” was his complain. The swelling was nearly circular, painless, almost defined boarders, does not move in any direction, hard to feel, almost fixed in the depth and was very slowly growing in size. So, he thought it to be a bony growth and must be dangerous.
I examined the swelling. It sits over the wrist with the characteristics as described above. Frequently I encounter this sort of complain. Mostly ladies are affected. This is also a beauty concern for them. Though most commonly seen near the wrist, it is also seen over the back of hand, forearm and near the tendons. That was diagnosed to be a ganglion.
A ganglion forms because of degenerative changes in the tissue covering of a tendon or that of a joint called synovial capsule. This may be termed as pseudoganglion or ganglion. When originates from the tendon sheath it is called pseudoganglion and when comes from the joint capsule is called a ganglion. A thick gelatinous material is found enclosed in a capsule. Many times the capsule is thin and sometimes it is thick. Diagnosed is based on clinical findings. Sometimes an x-rays examination is ordered to eliminate a bony growth.
The ganglion or the pseudoganglion is pressed hard so that it bursts and that gives a dramatic cure evidenced by sudden disappearance of the swelling. If thick walled it may not burst under pressure. In that case a wide bore needle is inserted into it and the gelatinous material is aspirated. Sometimes about 1 ml. of steroid is injected to the cavity. These procedures cure majority of patients. Sometimes larger ones require surgery by removing as much of capsule as possible. Ganglion is notorious for its recurrence. But it is an innocent disease.
There is a clicking sound while clinching fist and pain along a finger of hand. This is a sort of spot the diagnosis for medical persons. This is a condition involving flexor tendons of fingers. There are tunnels and tendon pulleys in the fingers, made up of collagen/fibrous tissue .The tendon pulleys pass through the tunnels and work to flex the fingers while forming a fist. If the tunnels constrict or the pulleys thicken they can not pass smoothly and while passing along the deformed part it passes with a clicking sound .And hence earns the name Trigger Finger. If it progresses at one stage the pulley does not pass, so the finger can not be bent.
It may occur as a part of a collagen disease or without a specific cause. At the preliminary stage I advice the patient for physiotherapy under warm saline water. It relieves of the symptoms many a times. If not I infiltrate local steroid and lastly go for surgery to release the tendon pulley .The surgery gives immediate success. Under a local anaesthesia and skin crease incision the constricting portion is divided to release the tendon .Antibiotics and rest prescribed for some time.After removal of sutures a physiotherapy is advised.
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