Delayed presentation of vernix caseosa peritonitis

INTRODUCTION

Vernix caseosa peritonitis (VCP) is a rare and poorly recognised condition resulting from a sustained foreign body reaction to the vernix caseosa of the baby. This case-based review aims to highlight its importance for any medical team managing patients with peritonitis who have undergone a recent Caesarean section.

CASE REPORT

A 31-year-old woman presented 5 weeks after a Caesarean section with symptoms and signs of peritonitis.

CONCLUSIONS

Laparotomy and peritoneal lavage is the mainstay of treatment for VCP. Knowledge of the condition may stop inadvertent resection of normal intra-abdominal organs. Greater awareness of VCP is required to ensure earlier recognition as patients can recover well following timely operative intervention.     

Risk factors for development of dehydration in children aged under five who have acute watery diarrhoea: a case-control study

Objective: To identify risk factors for development of dehydration in under five year olds with acute watery diarrhoea.Design: Hospital based unmatched case-control study.Setting: Diarrhoea Treatment Unit, Government Medical College Hospital, Nagpur, India.Participants: The study included 387 cases of diarrhoea having severe or moderate dehydration and 387 controls suffering from diarrhoea with mild or no dehydration.Risk factors: The study included infancy, female sex, religion, residing in urban slums or rural area, under nutrition, cessation of breast feeding during diarrhoeal episode, fluid intake decreased/stopped during diarrhoea, ORS not received, home available fluids (HAF) not received, both ORS and HAF not received, non-washing of hands by mother before preparation of food, after defaecation, after disposal of faeces, history of measles in the previous six months, frequency of stools >8/d, frequency of vomiting more than twice per day and temperature more than 99°F, as risk factors for development of dehydration.Statistical analysis: Univariate analysis included OR, 95% CI for OR and Chi-square test. Multivariate analysis was carried out by unconditional multiple logistic regression (MLR).Results: This study identified the significance of infancy, religion, severe undernutrition, non-washing of hands by mother before preparation of food, frequency of stool >8/d, frequency of vomiting >2/d, history of measles in previous six months, withdrawal of breast feeding during diarrhoea, withdrawal of fluids during diarrhoea and not giving ORS, HAF or both during diarrhoea, in the outcome of development of moderate or severe dehydration.Conclusions: Timely intervention in the preventable risk factors included in this study may prevent the development of moderate or severe dehydration in the children suffering form acute watery diarrhoea.     

Pulmonary nodules studied by computed tomography

The authors analyzed 177 pulmonary nodules using thin-section computed tomography (CT), calculating the representative CT number (RCT#) from a computer printout. None of the 96 malignant nodules had an RCT# greater than 151 H. Of the 81 benign nodules, 14 were shown to be calcified by conventional radiography and had an RCT# ranging from 763 and 1,023 H. Thirty had an RCT# greater than 200 H; this included 24 which showed no calcification on conventional tomograms. The remaining 37 benign nodules had an RCT# less than 200 H; 6 of them were hamartomas, including 2 which were diagnosed as such due to their fat content.     

Laparoscopic partial nephrectomy with saline-irrigated KTP laser in a porcine model

PURPOSE: To evaluate the feasibility of using the potassium titanyl phosphate (KTP) laser to perform laparoscopic partial nephrectomy in a porcine model, with saline irrigation to reduce intraoperative smoke formation. MATERIALS AND METHODS: A high-power (80 W) KTP laser was used without hilar occlusion in 14 laparoscopic partial nephrectomies in four pigs. During laser discharge, the cutting plane was irrigated continuously with saline. RESULTS: Thirteen partial nephrectomies were completed. Hemostasis was obtained without the need for any non-laser techniques. Only minimal smoke was produced, not affecting visibility or the progress of surgery. Histologic examination of the resection margin showed only minimal tissue destruction. One procedure failed because the laser fiber broke and occluded the suction during the operation. The mean partial nephrectomy time was 13.14 minutes (range 7-19 minutes) with a mean estimated blood lost of 28.57 mL (range 5-80 mL). The mean saline irrigation used for each operation was 2600 mL (range 1500-3400 mL), and the amount of saline drained out was 1700 mL (range 900-3200 mL). CONCLUSION: Laparoscopic partial nephrectomy using the 80 W KTP laser is feasible and effective in the porcine model. Saline irrigation dramatically reduces smoke formation. The technique is deserving of clinical studies after the laser-application device and suction irrigation are refined.