Neonatal jaundice: the surgical viewpoint.

There is good evidence that neonatal hepatitis, biliary hypoplasia, biliary atresia and choledochal cyst are different stages of one disease process for which the term infantile obstructive cholangiopathy has been suggested. Thanks to the work of Kasai and the operation of hepatic portoenterostomy the surgical outlook has greatly improved, although in North America it still leaves much to be desired. One cannot procrastinate too long in the hope that the patient's condition will improve spontaneously, because the surgical results are much better when the operation is performed before the patient is 10 weeks old. This article outlines the steps that should be followed in investigating neonatal jaundice, the nonsurgical measures that can be taken in an attempt to reverse or alleviate the underlying condition, and the specific role of the pediatric surgeon in the management of choledochal cyst and biliary atresia.     

Psychiatric morbidity in a general practice in an Indian city

Psychiatric morbidity in an Indian general practice was studied using the 12 item version of the General Health Questionnaire to screen 882 patients who represented 9000 consecutive adult patients attending the practice. The questionnaire was valid with a cutting score of 1/2 when compared with section 1 of the standardised Indian Psychiatric Survey Schedule. The probable prevalence of psychiatric morbidity was 35.9%. The general practitioner identified only about 25% of patients. Five of the 12 questions on the General Health Questionnaire had a higher discriminatory capacity, and the performance of the patients on these five questions was valid when compared to section 1 of the Indian Psychiatric Survey Schedule.     

Cytology in surgical practice

Early cytological diagnosis in a patient presenting with acute abdominal pain averted laparotomy and expedited successful management. The place of cytological diagnosis in patient management is discussed.     

Undergraduate general practice teaching in Australasian medical schools: the student viewpoint.

A survey was conducted to find what type of general practice teaching is offered to Australasian undergraduates. Of 11 medical schools, one had no pretence at general practice teaching, four had very inadequate and six had sufficient courses devoted to the subject. Comments on the place of general practice teaching in the medical curriculum are added. An attempt is made to summarize student expectations.     

Suicide: an Indian perspective

Suicide, as an issue, has attracted the attention of society since time immemorial. Its situation in India and the socio-demographic variables have been discussed along with management profile. The education of physicians and general practitioners in suicide prevention has been stressed.     

Learning curves in surgical practice

Learning curves are often referred to in the context of medical education and training, though their trajectories and natures are a matter of debate. The origins of this concept derive from industry and its relevance to contemporary medicine and surgery remains controversial. We describe the history, derivation, character and possible mechanisms to deal with the implications of learning curves in the current climate of clinical governance and modernizing medical careers.     

Chikungunya epidemic: an Indian perspective

Chikungunya, caused by the chikungunya virus, recently emerged as an important public health problem in the Indian Ocean Islands and India. In 2006, an estimated 1.38 million people across southern and central India developed symptomatic disease. The incidence of the disease may have been higher but may have been underreported due to lack of accurate reporting. First isolated in Tanzania in 1953, the chikungunya virus belongs to the family Togaviridae (single-stranded RNA alphaviruses) and has 3 distinct genotypes: East African, West African and Asian. Previous outbreaks in India (1963 and 1973) were caused by the Asian genotypes, but the 2005 epidemic in the Indian Ocean islands and the 2006 epidemic in India have been attributed to the East African genotype. The virus is transmitted to humans by the bites of mosquitoes of the species Aedes aegypti and A. albopictus. Researchers speculate that mutation of the virus, absence of herd immunity, lack of vector control, and globalization of trade and travel might have contributed to the resurgence of the infection. Chikungunya is characterized by high fever, severe arthralgia and rash. Although viral diagnostics (culture, serological tests and polymerase chain reaction tests) can be used to confirm the infection, these tests are not accessible during outbreaks to the majority of the population. The disease is a self-limiting febrile illness and treatment is symptomatic. As no effective vaccine or antiviral drugs are available, mosquito control by evidence-based interventions is the most appropriate strategy to contain the epidemic and pre-empt future outbreaks.     

Caudal anesthesia in pediatric surgical practice

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.     

Multispecialty surgical conditions in general practice

OBJECTIVES: To report the incidence of multispecialty surgical conditions in patients presenting to a procedural general practice. DESIGN AND SETTING: A more than 18-year survey (1 August 1983 - 31 January 2002) of the surgical records of a general practitioner-surgeon in an urban general practice. PARTICIPANTS: 211 patients each with multiple, elective, surgical problems (mostly non-major) treated at one operation. RESULTS: The 211 patients represented 9.03% of the practitioner's elective, non-referred, general practice surgical workload. Two separate procedures were performed at one surgical episode for 155 patients (73.5%), three separate procedures for 53 patients (25.1%), and four separate procedures for three patients (1.4%). Having all surgical conditions treated in a single episode resulted in considerable savings in time, convenience and expense for both the patient and the health care system. CONCLUSION: There appears to be a place, at least in our major cities, for an appropriately trained and recognised general surgeon, to service patients with more than one minor condition requiring surgery.     

古印度传统医学伦理思想的反思

从传统印度医学中总结出其特定的医学伦理思想，分析其伦理思想的特性，吸收古印度传统医学伦理思想的合理内核，在医疗活动中注重医技与医德的双重作用，凸现现代医疗条件下合作的重要性，关注礼仪在医疗活动中的应用。