Presentation of abdominal tuberculosis to general surgeons

Abdominal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. A total of 24 patients with abdominal TB who presented to general surgeons over a 9-year period have been reviewed. Most (92 per cent) of these patients were Asian; only one had a past history of pulmonary TB. The most common presenting complaint was abdominal pain in 21 patients (88 per cent) with the associated symptoms of weight loss in 18 (75 per cent), anorexia in 15 (62 per cent) and night sweats in 13 (54 per cent). A tissue diagnosis was obtained in 18 patients (75 per cent) and 17 patients (71 per cent) underwent laparotomy. These results show that the diagnosis of abdominal TB is still difficult to establish, and that many patients undergo laparotomy despite the existence of less invasive diagnostic procedures.

Reduction of thrombus formation in vivo using a thrombolytic agent targeted at damaged endothelial cells

Endothelial damage in saphenous vein harvested before coronary artery and peripheral vascular surgery has been well documented. Autogenous saphenous vein grafts are subject to early thrombotic occlusion, a process that is related to injury of this endothelial monolayer. A monoclonal antibody that binds to areas of endothelial damage (P14G11) and a non-specific immunoglobulin G (IgG) have been linked to urokinase. These conjugates were investigated in vivo using a rat vena cava model. The P14G11-urokinase conjugate significantly reduced thrombus formation compared with controls and non-conjugated urokinase (P < 0.02). No reduction in thrombus formation was seen with the IgG-urokinase conjugate. This shows that thrombus formation after endothelial damage in an in vivo model can be reduced with a targeted thrombolytic agent. Conjugates such as this may have a role in preventing early thrombotic occlusion in vein grafts.

Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis

The accurate clinical diagnosis of acute appendicitis is difficult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.

Peripheral tuberculous lymphadenopathy: a review of 67 cases

Peripheral tuberculous lymphadenopathy is the commonest form of extrapulmonary tuberculosis. Sixty-seven patients with peripheral tuberculous lymphadenopathy who presented to general surgeons and underwent lymph node biopsy between 1979 and 1989 are reviewed. Fifty-four patients (81 per cent) were of Indian subcontinent ethnic origin and 13 (19 per cent) were of white ethnic origin. The sites most commonly affected were the cervical lymph nodes. Biopsy specimens obtained by open operation were sent for microbiological examination in all but 13 cases, of whom seven were patients of white ethnic origin. Tuberculous lymphadenopathy remains an important differential diagnosis of cervical lymphadenopathy and it is essential that peripheral lymph node biopsies are examined both histologically and microbiologically.

A case of dextrocardia with normal situs

We report here a case of dextrocardia with normal situs in an 81-year-old man who died from non-pulmonary causes. Removal of the chest wall revealed a large, but otherwise anatomically normal, left lung occupying the entire left hemithorax and extending across the midline to overlap the left border of the heart which was positioned in the right hemithorax. The gross anatomy of the heart was normal save its position and the presence of only 2 pulmonary veins. Dissection of the heart showed all chambers in their classically described position, and there were no valvular defects. The anatomy of the great vessels was also normal. The right lung was hypoplastic and lay posterior to the heart. This lung lacked any lobular structure, but the presence of carbon particles throughout it suggested that it was capable of normal inflation.

Insight of first-year medical students into their future working conditions

In the light of recent publicity in the media, and a Private Members Bill in the Houses of Parliament, a multiple choice questionnaire was designed to ascertain the insight of first-year medical students at Leicester Medical School into their career structure and future working conditions. The results obtained were surprising in that they indicated an almost total lack of knowledge among the medical students about the profession into which they had just entered, and to which they had made a lifelong commitment.