Conference Papers
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561
This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Dengue fever presenting as acute appendicitis(Sri Lanka Medical Association, 2007) Premaratna, R.; Bailey, M.S.; Fernando, M.J.; Rathnasena, B.G.N.; de Silva, H.J.INTRODUCTION: Dengue-fever (DF) is known to present with surgical emergencies, including acute pancreatitis and acalculous cholecystitis. CASE RECORDS: During 2006, 12 patients [5 males, mean age 28(SD 4.6) years] presented with features of acute appendicitis and were later diagnosed as having DF. Seven were admitted to surgical casualty and referred for medical opinion due to thrombocytopenia (one following appendicectomy). Five were first seen by physicians and referred for surgical assessment. The mean time from onset of fever to abdominal pain was 2.2 days (SD 0.9). Clinical features at presentation included: right iliac fossa tenderness in 12 (100%), rebound tenderness in 9 (75%), vomiting in 9 (75%), erythematous rash in 8 (67%), arthralgia/myalgia in 8 (67%), headache in 6 (50%), diarrhoea in 3 (25%) and palatal petechiae in 3 (25%). All patients had CRP <12 mg/1 and DF was confirmed on IgM/IgG ELISA (Panbio, Australia). Leucocytopenia and thrombocytopenia occurred in 8 (67%) and 10 (83%) on admission and in 11 (95%) and 12 (100%) during hospital stay. Seven (58%) had free fluid around the appendix on ultrasound scan. Histology in one showed non-specific lymphoid-follicular hyperplasia. Only one patient (who underwent appendicectomy) received IV antibiotics. The mean duration for disappearance of abdominal pain and severe tenderness from the time of first examination was 1.8 days (SD 1.3). Discharge diagnoses were: classical DF in 3(25%), DHF (platelets <100xl09/iitre) in 7(58%) and DSS in 2(17%). Conclusions: DF may present as acute appendicitis. An early blood count and C-reactive protein can help to differentiate dengue fever from acute bacterial appendicitis.Item Accidental scrotal burns due to paraquat while handling a patient with deliberate self-harm(Sri Lanka Medical Association, 2007) Premaratna, R.; Rathnasena, B.G.N.; de Silva, H.J.INTRODUCTION: The main risk of paraquat poisoning is from deliberate ingestion. Serious accidental or occupational poisoning is comparatively rare. We report two patients who had accidental exposure to paraquat resulting in scrotal burns in both, and systemic poisoning in one, while attending to a patient who had ingested paraquat for deliberate self harm. CASE REPORT: Two days after death of a patient who had ingested paraquat for deliberate self harm, his brother and a friend who had accompanied him to hospital presented with painful swelling of the scrotum. The brother had severe burns in the scrotal skin sparing the penile skin, and the friend had milder burns in the scrotum. The patient had vomited several times onto the laps of these two men while being brought to hospital in a vehicle. The brother developed mild derangements in hepatic and renal functions suggesting significant systemic absorption. His biochemical and clinical parameters returned to normal over the next 2 weeks on conservative management. In both these patients, the scrotal skin healed without scarring over the next 4 weeks after treatment with silver sulphadiazine local application and amoxicillin given orally. CONCLUSIONS: Precautions should be taken by persons attending to those who have ingested poison. This is especially applicable to patients who have ingested corrosive substances