Exploratory laparotomy in chronic non-specific pain abdomen in lieu of therapeutic and diagnostic aspect: a prospective non randomized trial on 40 patients

Background: A significant number of patients attending surgical or medical out doors and clinics of prominent doctors, we find them having thick record files visiting from one doctor to another. Majority of such patients diagnosis remain “chronic pain abdomen” in spite of all possible investigations and all sort of recent and ancient medicines. Aim of this study is to analyze the diagnosis and therapeutic value of exploratory laparotomy.Methods: A prospective non randomized study was done on 40 patients who follows our strict criteria and in spite of all relevant investigations’ diagnosis remain chronic nonspecific pain abdomen (CNSPA). Exploratory laparotomy was done and findings were recorded and analyzed to see its diagnostic and therapeutic value.Results: Patients of appendicular (maximum 27.5%) and tubercular disease present within one year of first appearance of pain whereas those having bands and adhesions after two years. Overall exploratory laparotomy was diagnostic and therapeutic in 80% patients.Conclusions: In selected patients of CNSPA exploratory laparotomy is therapeutic in 87.5% and diagnostic in 92.5% patients.

Oleothorax: Review of Literature; Report of a Case Study and a Potential Treatment for Multi-Resistant Tuberculosis (MRTB)

An 83 year-old-female died of dementia with history of no previous disease. On dissection, paraffin was found in the right pleural cavity, indicated that the person received therapy for cavitary tuberculosis in the 1940s or1950s but no gross evidence of pulmonary or pleural tubercular disease was identified in the patient. Literature review on oleothorax indicated several reported complications of oleothorax. This case notes the lack of any apparent complications caused by oleothorax. In this paper, we present a case and outlines the importance of oleothorax in the medical history of tuberculosis, and as a potential treatment for multi-resistant tuberculosis (MRTB).

Prevalence and Clinical Characteristics of Mycobacterial Diseases in the Barletta-Andria-Trani Province, Italy (2005–2013)

Tuberculosis remains one of the major worldwide problems regarding public health. This study evaluates the burden of this disease in the BAT Province of the Apulia region (Italy); 12,295 patients were studied, including 310 immigrants. Tubercular disease and mycobacteriosis were found in 129 patients. The number of new TB cases/year ranged from three in 2005 to 12 in 2009. TB was more frequently localized in the lung (70.5%). 14.4% of cases were institutionalized patients for severe neurological and/or psychiatric disease. The database evidenced certain aspects of our study population: the large number of TB patients institutionalized between natives, but no larger presence of TB among HIV-positive patients in immigrants compared to Italians. Our findings should help to redefine the alarm regarding the spread of an epidemical form of TB but also to present certain criticisms regarding patient management (especially immigrants) regarding costs, hospitalization, and difficulty of reinstating the patient in the community. Further our data underscore the importance of prevalence of TB in bedridden, institutionalized patients.

A Review of the Cancer Statistics in England and Wales and in Scotland between 1891 and 1927

That the number of deaths ascribed to cancer has steadily increased within recent years no one will deny, but as to the causes which have produced the increase there is not the same unanimity of opinion. Thirty years ago cancer did not rank very high in the list of fatal diseases. In 1899 the total number of deaths from cancer amongst persons in England and Wales was 26,325 as against 60,659 allocated to tubercular disease. Nowadays, “the old order changeth yielding place to new.” According to the most recent statistics issued by the Registrar-General, in 1929, the number of deaths assigned to cancer was 56,896 and to all forms of tuberculosis 37,990. In view of this large increase in the number of deaths allocated to cancer it seemed of interest to review the cancer statistics of the last thirty years in this country and in Scotland. No investigation of this nature would be complete without first drawing attention to the very important work already done by Dr Stevenson in the Annual Reports of the Registrar-General, particularly the report for 1917 in which he examined the incidence of cancer in particular sites. The statistics of cancer in Scotland have not, until recently, received quite the same amount of attention as those of England. In a paper read to the Medical Association in Edinburgh and afterwards published in the Journal of that society, Dr Dunlop, the Registrar-General, gave a detailed account of the mortality, according to sites, between the years 1911 and 1928. He compared the actual numbers of deaths in 1920–2 and in 1928 with the numbers that might be expected to occur on the basis of the cancer mortality in age groups which prevailed in 1910–12. His method of analysis conforms partly to that of indirect standardisation.

The Relation of the Tubercle Bacillus to Lymphadenoma

IN 1913, Fraenkel and Much1 inoculated monkeys, guinea-pigs, rabbits and dogs intraperitoneally with large quantities of material obtained from two cases of Lymphadenoma, no accompanying tubercular disease being demonstrable. The material was broken down with antiformin, and as a result of the injections, the guinea-pigs died within three months. The authors state that besides finding extensive tubercular disease, there were hard, white nodules, the size of a cherry stone, on the serous coverings of the stomach and mesentery. Also, in addition to genuine tubercular disease of the lymphatic glands, they found giant cells, not of Langhans' type, as well as a stroma rich in fibriles, similar to what is found in Lymphadenoma. The nodules on the serous surfaces showed a picture corresponding to the terminal fibrous stage of a lymphadenomatous focus, with a scarcity of cellular elements.