Age-related clinical and microbiological characteristics of enteric fever in India

A retrospective, hospital-based study at Safdarjang Hospital, India, was undertaken between January 1999 and December 2003 to estimate age-related epidemiological, clinical and microbiological characteristics in enteric fever cases. A total of 750 blood-culture-proven cases of enteric fever were studied. The majority of cases occurred in children aged 5-12 years and 24.8% of cases were in children up to 5 years of age. Salmonella serotypes showed an age-related predilection, with paratyphoid fever more common in adults. Classically-described clinical features of the disease were comparable among patients under and above 5 years of age. Hepatomegaly, anaemia and complications in general were more frequent in children up to 5 years of age. The antimicrobial resistance pattern, irrespective of Salmonella serotype, did not reveal a statistically significant difference across age groups for the different antibiotics tested. Multidrug resistance was seen only in Salmonella enterica serotype Typhi but not in S. Paratyphi A isolates. However, resistance to nalidixic acid was comparable in both serotypes. Age-related differences of serotype isolation rates, clinical presentation and associated complications are noteworthy for better case management and policy planning. More epidemiological studies regarding reasons for age-related differential serotype patterns would enable and guide public health strategies to contain enteric fever in endemic locations.     

Is Collagen a Good Banding Material for Outlet Control of Vertical Gastroplasty? Preliminary Study in Pigs

Background: To maintain the long-term effects of a gastric bariatric operation, bands are often placed to control the restriction. Erosion into the gastric wall by these devices remains a problem. A soft resiliant prosthesis of animal origin, constituted by a network of non-absorbable collagen fibres, may be a solution to this problem. This study assessed, in a porcine model, the histological reaction of the gastric wall following apposition of a band of porcine collagen (Pelvicol^?, Bard). Methods: 15 female pigs weighing on average 21 kg underwent vertical banded gastroplasty (VBG). Stoma control was achieved with a band of porcine collagen (2 cm wide, 7 cm long and 2 mm thick). The pigs were sacrificed 1 month after VBG, and histological analysis was performed at a macroscopic and microscopic level. Results: There was no peri-operative death, although 2 pigs died in the postoperative period (the first case developed a bowel fistula and sepsis, and the second pig died of unrelated causes). There were 2 additional morbidities (gastric fistula on the linear staple-line away from the Pelvicol^? band) that led to an early euthanasia of 2 pigs. Post-mortem macroscopic analyses in the remaining 11 pigs did not reveal migration of the device, and there was no tissue reaction on postoperative microscopic analyses. 10 of the pigs had lost weight at 1 month, averaging 3.42 kg. Conclusion: Porcine collagen appears to be an effective and safe alternative to the current methods of control of pouch outlet. The flexibility and homogeneity of this prosthesis may be useful to limit the risk of erosion of the gastric wall. Although these properties have been assessed in pelvic operations in humans, this work needs to be studied in a prospective long-term study in humans.     

Transperitoneal, transmesocolic approach for laparoscopic excision of an extra-adrenal pheochromocytoma

Laparoscopic surgery is an established treatment modality for adrenal disease, especially pheochromocytomas. We describe the successful excision of an extra-adrenal pheochromocytoma using a novel transperitoneal, transmesocolic approach. The tumor was located inferior to the left renal hilum in the para-aortic region and was found bulging through the descending mesocolon at laparoscopy. The tumor was removed without mobilization of the descending colon.     

Unusual presentation of isolated sacral tuberculosis

Tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain X-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. Early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.     

Monitoring hepatic and renal function

Liver disease represents a serious risk factor for patients requiring anesthesia and surgery. Even subclinical liver disease increases perioperative morbidity and mortality. Perioperative renal dysfunction and failure have similar implications. Thus, detection of early hepatic and renal dysfunction and monitoring of their progress is essential. This article discusses methods for monitoring hepatic and renal function in patients who have high risk for liver or renal injury in the perioperative period.     

Resection arthroplasty: when enough is enough

Resection arthroplasty following THA is rarely performed but occasionally indicated. It is a relatively low risk procedure and generally is a much shorter operative procedure associated with fewer perioperative complications compared to major revision procedures. Results are extremely variable. With all of the arthroplasty and bone graft options available for hip joint reconstruction, resection arthroplasty rarely is performed as a definitive procedure. It is, however, the best option for selected patients.