The pride in British medicine that was established by this flagship-the first edition of the Oxford textbook of medicine-is rekindled by the second edition. Some rearrangement and expansion of sections have occurred. The first edition indicated that the book was intended for anyone studying or practising clinical medicine (as a first reference source for general practitioners and specialists) and this new edition amply fulfils that challenge. A section on primary care brings this discipline into its rightful place in such a textbook and helps to break down any artificial barrier that may exist between hospital and family practice medicine. One looks for updating between the two editions and apart from increase in size there are 'improvements' throughout-almost completely new and recent references in the section on pituitary and hypothalmic disorders, an account of CT scanning in pituitary and adrenal disease, developments such as magnetic resonance imaging included in the cardiovascular disease section. The section on respiratory disease has illuminating descriptions of the pathophysiology of the airways and gas exchange. The clinical section on asthma is updated to modern concepts. Rheumatology and connective tissue disorders is expanded from eight to 15 subsections. AIDS, dealt with in only three pages, may (one hopes) be in the end a true perspective or, alternatively, this field is changing so rapidly that we can await a major assessment of this condition in a third edition.

Oxford textbook of medicine

https://www.amjmed.com/article/S0002-9343(15)01032-3/pdf

Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

Objectives To describe our buried penis repair technique that includes penile release, tissue resection, wound closure, and penile reconstruction. Patients and methods In all, 73 patients were treated from 2007 to 2017. Patients can be categorised into five stages: Stage I, involves only a phimotic band; Stage 2, required excision of diseased penile skin with split-thickness skin grafting (STSG); Stage 3, requires scrotal excision; Stage 4, requires escutcheonectomy; and Stage 5, requires panniculectomy. Successful treatment hinges on adequate excision of diseased skin and de-bulking followed by replacement of deficient skin with STSG. Results In all, 36 of 73 (49%) patients had Stage 1-3 disease, whilst 37 of 73 (51%) were Stage 4-5. There were complications within the first 30 days in 44 of 73 (60%) patients. In all, 62 of 73 (85%) patients either had no complications or Clavien-Dindo grade I-II complications and nine (12%) had complications beyond 30 days. Only five of 36 (14%) patients with Stage 1-3 disease had complications. One patient developed recurrent phimosis. Conclusion The buried penis is a challenging surgical entity where conservative treatment will most likely lead to failure. Surgery is the only means for a lasting cure in these patients and should be used as a first-line treatment. One should expect complications postoperatively, especially within the first 30 days; however, these are mostly limited to Clavien-Dindo grade I-II complications.

Contemporary management of adult-acquired buried penis.

Abdominal gunshot wounds - A comparative assessment of severity measures

Peritonitis is defined as inflammation of the serous membrane that lines the abdominal cavity and the organs contained therein. Most cases of peritonitis are caused by an invasion of the peritoneal cavity by bacteria, so that when the term peritonitis is used without specification bacterial peritonitis is implied. Peritonitis is one of the most common infections, and an important problem that a surgeon has to face.

http://www.ijsrp.org/research-paper-0515/ijsrp-p4103.pdf

Evaluation of Prognosis in Patients’ with Perforation Peritonitis using Mannheim’s Peritonitis Index

OBJECTIVE: To identify the spectrum of diseases leading to acute abdomen in local population,
presenting in a surgical unit.
DESIGN: Retrospective study.
SETTING: Department of Surgery Unit-II Chandka Medical College Teaching Hospital Larkana.
DURATION: A period of three years, from July 2004 to June 2007.
PATIENTS AND METHODS: All patients presenting with non-traumatic acute abdominal pain
were included in the study. Patients presenting with gynecological and urological causes were
excluded. Their presentation, diagnosis and management were recorded from their case files
and OT registers.
RESULTS: During the period under review, a total of 586 patients presented with non-traumatic
acute abdomen; of which there were 412 (70.30%) males and 174 (29.69%) females, with a male
to female ratio of 2.3:1. The highest incidence of acute abdomen 163 (27.81%) was found in patients
of 21-30 years age group, followed by under 20 age group 150 (25.59%) and 30-40 years
age group 101 (17.23%). The most common cause of acute abdomen was acute appendicitis accounting
for 205 (35%) admissions. These patients were mostly young males in teens and twenties.
Intestinal obstruction was second leading cause accounting for 167 (28.5%) cases and this
affected more commonly the middle aged persons. Five hundred and twelve (87.37%) patients
were treated successfully and discharged home while 3% left against medical advice. Mortality
was 9.55% and it was highest in patients presenting with perforation peritonitis.
CONCLUSION: The most common cause of acute abdomen in this study was acute appendicitis
affecting young population. This was followed by intestinal obstruction and gut perforation.
Acute cholecystitis commonly affects the middle aged, post-menopausal women. Pancreatitis is
a rare cause of acute abdomen in this area.

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdomen

Objective: To determine the number of hospitalized patients at risk for developing venous thromboembolism (VTE) / deep vein thrombosis (DVT), identifying the most common risk factor and to document the use of thromboprophylaxis. Study Design: Observational and cross-sectional study. Place and Duration of Study: Chandka Medical College Hospital, Larkana, from October to December 2011. Methodology: A total of 170 patients underwent this study and these included 51 (30%) from general medical, and 119 (70%) from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest PhysiciansACCP. Results: Out of 170 patients, 91 were male and 79 female with mean age of 39 ± 16 years. According to ACCP criteria for VTE risk assessment, 20% (n=34) patients were identified to be at low risk, 20% (n=34) at moderate risk, 47.65% (n=81) at high risk and 12.35% (n=21) at very high risk of developing VTE. The commonest risk factor significantly identified was immobility (54.7%, p < 0.005), followed by advancing age (41.17%, p < 0.005) and obesity (18.23%). The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% (n=98/119) and in medical patients advancing age 45% (n=23/51). Only 6 (3.5%) patients received thromboprophylaxis, all were surgical patients of very high-risk category. Conclusion: Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis.

/pdf/venous-thromboembolism-vte-risk-assessment-in-hospitalized-fb8xqr0dt6.pdf

Venous Thromboembolism (VTE): Risk Assessment in Hospitalized Patients

OBJECTIVE: To study the pattern and outcomes of firearm injuries at Department of Surgery during 3 years. DESIGN: Retrospective study. SETTING: Department of Surgery, Unit II, Chandka Medical College Teaching Hospital Larkana. DURATION: Three years, from July 2004 to June 2007. PATIENTS AND METHODS: Record of all firearm injury cases, who presented during study period, was analysed. Data were collected on printed proforma from indoor patient record (case file) and operation theatre record. Demographic data, clinical presentation, site and frequency of injuries, investigations including radiology, operative findings, and postoperative course were the variables of study. RESULTS: Out of 282 firearm injured patients, 258 were males and 24 were females, with male to female ratio of 10.7:1. The age ranged 12-80 years. Ninety-nine (33.68%) patients had injuries to abdomen only and 72 (25.53%) to chest only, while 72 (25.53%) patients had multiple injuries including injuries to abdomen. One-hundred and twelve (39.71%) patients underwent Laparatomy (including patients with multiple injuries), 66 (23.40%) required chest intubations. Twohundred and forty-four (86.52%) patients were cured and discharged. Seven (2.48%) patients were referred to other departments like Orthopaedics and Neuromedicine and 14 (4.96%) to other hospitals with advanced patient care facilities. Mortality rate was 6%. CONCLUSION: The firearm injury is common in 20-39 year old males. The most common site of injury is abdomen. The commonly injured intra-abdominal organ is bowel followed by liver and kidney, while most commonly injured extra-abdominal organ is lung.

Pattern of Firearm Injury and Outcome

According to Courvoisier's law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation. Conversely, the causes other than stone (principally tumours), would result in the distension of gallbladder, felt on abdominal palpation. However, in Courvoisier study of 109 cases of dilatation of gallbladder, 17 were due to impacted stones. Therefore, Courvoisier concluded that dilatation of gallbladder was rare with stones obstructing the common bile duct. Despite this fact it is always assumed that the palpable gallbladder is due to malignancy (pancreatic or periampullary etc.). Here, we report a rare case of palpable gallbladder in a jaundiced patient due to multiple cholelithiasis and a large choledocholithiasis causing obstruction of CBD.

Courvoisier's law revisited.

OBJECTIVE: To find out the changing trends in topography of peptic ulcer perforation. DESIGN: Retrospective. SETTING: Department of Surgery, Unit II Chandka Medical College Teaching Hospital Larkana DURATION: From July 2004 to June 2007 (3 years). PATIENTS AND METHODS: The age, sex, clinical presentations, treatment options and operative findings of patients, who presented with perforated peptic ulcer were studied from their case files, and data were analysed. RESULTS: Out of 86 patients, 81 were males and 5 were females with a male to female ratio of 16.2:1. The prevalence of perforation was highest in patients of 40-59 years of age. Seventy-six patients underwent emergency explorative laparotomy. Among these, 70 patients had gastric and 6 had duodenal ulcer perforation, resulting in duodenal to gastric ulcer ratio of 1:11.5. Repair with Omentopexy was the procedure employed. CONCLUSIONS: Peptic ulcer perforation is most common in the stomach of middle aged man.

Quratul-ain Soomro

Papers

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdomen

Venous Thromboembolism (VTE): Risk Assessment in Hospitalized Patients

Pattern of Firearm Injury and Outcome

Courvoisier's law revisited.

Changing Trend in Topography of Peptic Ulcer Perforation