RESUMEN
The model of a 'reasonable doctor' has been quite successfully used to deliver justice in disputes involving medical negligence. However, many a times a doctor is held guilty of negligence when viewed through the narrow lens of an ideal 'reasonable doctor' and without looking into the circumstances under which he was working which could have actually led to the alleged act of negligence. This short write-up highlights the importance of applying this doctrine more reasonably in the best interest of all stake holders and the drawbacks of the doctrine of 'reasonable doctor' in adjudicating medical negligence cases with few international case laws.
Asunto(s)
Cristalino , Mala Praxis , Médicos , Masculino , Humanos , EscrituraRESUMEN
Complete sternal cleft is a very rare congenital midline defect of the sternum. It is not uncommonly associated with intracardiac defects. We report a case of a 2-year-old child with complete sternal cleft and tetralogy of Fallot who presented with cyanotic spells. The child underwent total correction, followed by chest wall reconstruction on the next day.
RESUMEN
Pure neural leprosy without cutaneous manifestations is a relatively rare manifestation of leprosy. It can present as a mono- or poly-neuritis with sensory and/or motor impairment. Neural leprosy may or may not be associated with thickening of the involved nerve. We report the case of a 14 year old boy with extensive ulnar nerve necrosis who was diagnosed to have tuberculoid leprosy. What makes this case unique is that we have here a case of pure neural leprosy with a single nerve turned 'necrotic'.
Asunto(s)
Lepra Tuberculoide/complicaciones , Nervio Cubital/patología , Neuropatías Cubitales/patología , Adolescente , Humanos , Masculino , Necrosis , Neuropatías Cubitales/etiologíaAsunto(s)
Traumatismos de la Pierna/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Arterias Tibiales/cirugía , Anastomosis Quirúrgica/métodos , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Puntaje de Gravedad del Traumatismo , Traumatismos de la Pierna/diagnóstico , Masculino , Microcirculación/fisiología , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tejidos Blandos/diagnóstico , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaAsunto(s)
Hernia/diagnóstico por imagen , Enfermedades del Yeyuno/diagnóstico por imagen , Errores Diagnósticos , Femenino , Gastroenteritis/diagnóstico , Humanos , Intestino Delgado/diagnóstico por imagen , Persona de Mediana Edad , Cavidad Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Cistoadenoma Mucinoso/patología , Neoplasias Retroperitoneales/patología , Cistoadenoma Mucinoso/diagnóstico por imagen , Cistoadenoma Mucinoso/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Fine needle aspiration biopsy (FNAB) of the thyroid is a simple and safe investigation. Dissemination of malignant cells during FNA for papillary thyroid carcinoma is extremely uncommon. CASE: We report a 49-year-old woman who presented with a multicystic goiter and palpable cervical lymph nodes. Three sessions of FNAB (a total of 12 needle passes) from a complex cyst overlying the thyroid isthmus using a 22-gauge needle failed to reveal malignant cells. Following the FNAs she developed a persistent discharging sinus at the needle insertion site. Exploration of the neck and histopathologic examination confirmed a well-differentiated papillary thyroid carcinoma infiltrating the skin and strap muscles at a single focus. Debulking surgery with adjuvant radiotherapy had a satisfactory outcome in our patient. CONCLUSION: Skin sinus formation might have been prevented in our case by using a needle with a caliber < 22 gauge and avoiding multiple sessions of aspiration of the same thyroid nodule.
Asunto(s)
Biopsia con Aguja Fina/efectos adversos , Carcinoma Papilar/patología , Bocio/patología , Siembra Neoplásica , Enfermedades de la Piel/etiología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Carcinoma Papilar/terapia , Femenino , Bocio/terapia , Humanos , Persona de Mediana Edad , Radioterapia Adyuvante , Enfermedades de la Piel/patología , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/terapia , Tiroidectomía , Tiroxina/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Patients with secondary peritonitis often require relaparotomy; however, there is no consensus about the criteria for selecting patients who would benefit from early relaparotomy. Our goal was to evaluate whether elevated intra-abdominal pressure (IAP) during the early postoperative period could predict the need for relaparotomy. METHODS: A total of 102 consecutive adult patients with acute intra-abdominal conditions were admitted for laparotomy. Seventy-eight patients, who were diagnosed with secondary peritonitis at index surgery, underwent serial measurements of IAP. The primary outcomes measured in the study were incidence of postoperative peritonitis and mortality. RESULTS: Thirty-two of 78 patients with secondary peritonitis (41%) developed elevated IAP postoperatively. Sixteen (20.5%) of 78 patients developed postoperative peritonitis. Twelve of these 16 patients (75%) with postoperative peritonitis had significantly elevated IAP (P = 0.002) during the immediate postoperative period. Regression analysis revealed elevated IAP (P = 0.055) to be third most predictive of postoperative peritonitis in patients who underwent laparotomy for secondary peritonitis, after septic shock at admission (P = 0.012) and POSSUM score (P = 0.018). CONCLUSION: Our study shows that development of elevated IAP during the early postoperative period can increase the risk of postoperative peritonitis. IAP measured during the immediate postoperative period can be used as a predictor of early relaparotomy.
Asunto(s)
Selección de Paciente , Peritonitis/cirugía , Adulto , Distribución de Chi-Cuadrado , Femenino , Humanos , Incidencia , Laparotomía , Modelos Logísticos , Masculino , Peritonitis/diagnóstico , Peritonitis/epidemiología , Peritonitis/etiología , Valor Predictivo de las Pruebas , Presión , Estudios Prospectivos , Reoperación , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Two cases of congenital teratoma were operated upon. In view of the high degree of organoid differentiation of the teratomas with rudimentary limbs, intestine, brain-like and pulmonary tissues, it was difficult to distinguish it from fetus-in-fetu. In the light of the data obtained and extensive review of related literature, we consider that fetus-in-fetu and teratoma may not be unrelated entities. Our cases support the view held that fetuses in fetu are highly differentiated teratomas.