Prenatal ultrasonography in rural hospitals.
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Canada↗
Biomedical subjects
F Christian
Publications and source records attributed to F Christian.
Open heart surgery in an HIV-positive patient.
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Adult↗
Tracheoesophageal fistula in AIDS: stent versus primary repair.
Tracheoesophageal fistula arising secondary to Mycobacterium tuberculous infection in AIDS patients is extremely rare. We describe a case with a fistula lesion that initially failed to close using a four-drug antituberculosis regimen. The original lesion closed following placement of an esophageal stent. However, the stent migrated, causing an iatrogenic tracheoesophageal fistula that needed surgical repair. Tracheoesophageal fistula (TEF) is an uncommon clinical condition, most frequently arising as a sequelae to esophageal malignancy. Iatrogenic injury to the membraneous trachea secondary to cuffed endotracheal or tracheostomy tubes in the presence of an in-dwelling nasogastric tube and corrosive burns, accounts for most of the remainder of occurring fistulas. Infections such as candidiasis, syphilis, and tuberculosis are also known to cause this condition. We report stent migration with perforation and subsequent TEF formation in an HIV-positive patient who originally had stent placement for a tuberculous tracheoesophageal fistula.
AIDS-Related Opportunistic Infections↗
Selective conservatism in the management of penetrating abdominal bull-gore injuries.
In a retrospective analysis it was found that not all patients with penetrating bull-gore injuries of the abdomen need exploration by formal laparotomy. A policy of selective conservatism was followed in the management of 18 out of 20 patients with bull-gore injuries of the abdomen in whom peritoneal breach was established either on presentation or by digital exploration of the wound. Formal laparotomy was reserved for specific clinical indications. Out of the 18 cases, 14 (78 per cent) were successfully treated non-operatively with wound excision, simple closure of the wound, and careful repeated clinical evaluation. There was no mortality in this group. Four cases (22 per cent) were explored; three of these had indications for exploration on presentation and the fourth was explored 4 days after admission. The latter was the only death that occurred in the series; the cause of death was probably pulmonary embolism. Omental and/or bowel evisceration occurred in 11 out of 18 cases (61 per cent). However, this was not considered an indication for exploration and all 11 cases were treated by simple replacement of omentum or bowel into the abdominal cavity. Penetrating abdominal bull-gore injuries can be managed safely by a policy of selective conservatism, reserving formal laparotomy for specific clinical indications.
Abdominal Injuries↗
A simple scoring system to reduce the negative appendicectomy rate.
In a controlled, prospective study the following five criteria were used for the diagnosis and management of acute appendicitis: abdominal pain; vomiting; right lower quadrant tenderness; low grade fever (< or = 38.8 degrees C); and polymorphonuclear leucocytosis (TC > or = 10,000 with polymorphs > or = 75%). The aim of the study was to reduce the negative appendicectomy rate. If four out of five or five out of five criteria were present on admission, appendicectomy was carried out. On the other hand, if three out of five criteria were present on admission, the patient was subjected to active inpatient observation until either the development of the fourth criterion, when appendicectomy was performed, or until the patient recovered and the condition did not progress beyond the third criterion. Generalised peritonitis due to a perforated appendix was excluded from the study. Over a 1-year period, 58 patients (M:F = 45:13) were entered into the study. Appendicectomy was carried out in 46 (80%) of patients; of these, 32 patients (70%) were operated on soon after admission. The remaining 14 (30%) were operated on after a period of inpatient observation decided the development of the fourth criterion. A total of 12 patients (12/58 = 20%) did not undergo operation. The control group consisted of 59 patients upon whom appendicectomy was carried out by another surgical unit over the same 1-year period. The negative appendicectomy rate in the trial group was 6.5% (3/46), whereas in the control group it was 17% (10/59) (P < 0.05). We conclude that the use of a simple scoring system can significantly reduce the negative appendicectomy rate.
Acute Disease↗
Panic disorder in cardiac outpatients.
The prevalence of and nature of panic disorder were investigated in an ambulatory cardiology practice. Questionnaires about panic symptoms were mailed to 414 patients, and possible or definite panic disorder was found in 104 of the 310 respondents. Interviews with 52 of the 104 patients substantiated diagnoses of panic disorder, for a prevalence of 9.2% of the total sample population of 414. Comparison of patients grouped by duration of panic disorder revealed that long-duration panic disorder had its onset before age 30 and followed a chronic course. Short-duration panic disorder developed at an older age following the appearance of cardiac disease.
Anxiety Disorders↗
Ventricular entrapment of a Swan-Ganz catheter: a technique for nonsurgical removal.
Entrapment of a balloon-tipped flow-directed catheter by atrial sutures during open heart surgery is a rare but serious complication. Several methods have been used to free such catheters with nonsurgical techniques. A case of entrapment in the right ventricle after repair of a ventricular septal defect is presented and a method for percutaneous removal described.
Aged↗
Diverticular disease in an indigenous African community.
Sixteen cases of diverticular disease of the colon occurring in an urban hospital in Ghana are described. Ten of the patients had diffuse diverticulosis affecting the greater part of the colon. Apart from a high incidence of presentation with rectal bleeding the disease shows no particular differences in manifestation from what is encountered in the advanced countries. Sixty per cent of the patients belonged to the higher social classes, but all had lived on traditional African high-residue food. Other factors as yet unknown may contribute to the pathogenesis of this disorder.
Aged↗