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H S Walia

Publications and source records attributed to H S Walia.

11 recordsLinked to original sources
PubMed1994

Unusual presentations of abdominal tuberculosis.

OBJECTIVE: To review unusual presenting features and diagnostic difficulties of abdominal tuberculosis in an endemic region. DESIGN: Retrospective clinical study from 1984 to 1989, illustrated by case reports. SETTING: A single hospital in Kuwait. PATIENTS: Fifty patients with abdominal tuberculosis established by the standard histologic and bacteriologic demonstration of acid-fast bacilli or tuberculous granulomas. MAIN OUTCOME MEASURES: Site of disease and unusual features at presentation. RESULTS: Tubercular lesions are most commonly seen in the ileocecal region. They are also common in the ileum but are less common in the appendix and jejunum. Involvement of the ascending colon, rectum and upper gastrointestinal tract is rare. Abdominal tuberculosis presents in many ways depending on the degrees of ulceration, fibrous healing, infection and caseating abscess formation. CONCLUSIONS: Abdominal tuberculosis should be considered in immigrants from regions where this disease is endemic who present with abdominal signs and symptoms. Imaging studies, endoscopy and laparoscopy may preclude laparotomy for the diagnosis of abdominal tuberculosis. Antituberculosis chemotherapy is the mainstay of treatment.

Abdomen↗
PubMed1990

Cholesterol granuloma of the peritoneum.

Cholesterol granulomas are common in the mastoid region but have rarely been reported in other areas. The authors report the case of a 40-year-old man who had a cholesterol granuloma of the peritoneum. They discuss the morphology of the condition and the difficulties of diagnosis. It is likely that chronic or recurrent inflammation plays a major role in the pathogenesis and that, when dealing with such lesions preoperatively or intraoperatively, a radical approach may not be necessary.

Adult↗
PubMed1990

Abdominal tuberculosis.

Forty-two cases of abdominal tuberculosis seen between June 1984 and June 1988 at Amiri Hospital in Kuwait were reviewed retrospectively. The clinical diagnosis was correct in only 35%. Nine patients presented as an emergency, but in none was a diagnosis of tuberculosis considered. Abdominal pain and tenderness were the commonest clinical findings; "doughy abdomen" and a mass in right iliac fossa were uncommon. Thus, symptoms were vague, signs nonspecific and investigations nonpathognomonic. In spite of this, abdominal tuberculosis should be considered in any patient who has obscure abdominal symptoms, weight loss and lethargy. Laparoscopy and colonoscopy with biopsy for histologic and bacteriologic study led to a definitive diagnosis in 66% of cases, obviating the need for exploratory laparotomy in many. Histologic examination was the surest way to establish the diagnosis.

Abdomen↗
PubMed1990

Rational approach to therapy in splenic abscess.

Intrasplenic abscess is an uncommon but potentially lethal condition. Seven cases of splenic abscess were seen between 1985 and 1988. There are no specific clinical findings; symptoms and signs of fever, abdominal pain and tenderness were present in all seven cases but were only helpful in diagnosing splenic abscess in three cases. Computed tomographic scanning probably at present offers the most direct way of evaluating the spleen and making an early diagnosis. Splenectomy was done in three cases and antibiotics were used in four cases with equally successful results. Contrary to the prevalent opinion, we believe that medical management is an important addition to the surgeon's armamentarium and offers a viable alternative in selected cases of splenic abscess. A successful outcome is dependent on a high degree of clinical alertness, an aggressive diagnostic approach and prompt effective treatment.

Abscess↗
PubMed1988

Eosinophilic enteritis with perforation.

A case of eosinophilic granuloma of the gastrointestinal tract with free perforation is described. The authors believe this is the first such case to be published. The patient, a 60-year-old woman, had no history of allergy. At laparotomy, 100 ml of pus was aspirated. A 42-cm section of small bowel, containing multiple punched-out ulcers, was excised. The mucosa and submucosa of the operative specimen were edematous; there was a moderate inflammatory infiltrate containing numerous eosinophils and neutrophils. The lesion appeared to represent a local reaction to some antigen with resultant eosinophilic infiltration.

Enteritis↗
PubMed1987

Fungal mastitis. Case report.

Fungal (cryptococcal) mastitis in a young woman seemed to be a systemic manifestation of the infection, since it recurred contralaterally within 4 months. Diagnostic problems are discussed. Only two previous reports of deep mammary mycosis were found. In addition to excision, ketoconazole is recommended to prevent recurrence or serious complications.

Adult↗
PubMedDate not supplied

Anterior lesser curve seromyotomy with posterior truncal vagotomy versus proximal gastric vagotomy: results of a prospective randomized trial 3-8 years after surgery.

In a prospective randomized trial, anterior lesser curve seromytomy with posterior truncal vagotomy (ASPTV, n = 50) was compared with proximal gastric vagotomy (PGV, n = 50). Most of our patients were young men with ASA grade I risk, and 80% were expatriates. They were followed up for 3 to 8 years after surgery. The mean reductions of basal acid output (BAO) and insulin-stimulated peak acid output (IPAO) were 85% and 88%, respectively, soon after surgery for both ASPTV and PGV groups. These values remained at 70% and 60% of their preoperative level for 1 year. Good to excellent results (Visick I and II) were recorded in 76% of cases in both groups. The recurrent ulcer rate was 14% for PGV and 12% for ASPTV. This trial suggests that for the treatment of duodenal ulcer ASPTV is as good an operation as PGV.

Adult↗
PubMedDate not supplied

Acute pancreatitis in a low alcohol-consuming community.

The case records 50 patients with abdominal pain and hyperamylasemia were studied in detail. Ten cases of gallstone induced hyperamylasemia, in which no evidence of pancreatitis was found at operation, were excluded. The etiological factors in the remaining group of forty cases of acute pancreatitis, in a community practicing alcohol abstinence, were reviewed. Both alcoholic and idiopathic pancreatitis were insignificant factors in the etiology of acute pancreatitis. Eighty percent of cases of acute pancreatitis were due to biliary tract disease. A younger age-group and female preponderance, as well as biochemical evidence of cholestasis, was observed in this group. An inverse relationship between preoperative serum amylase levels and the severity of the disease was noted. A more aggressive diagnostic work-up is, however, warranted to identify these cases, for which early surgery is advocated. There was no mortality in operated cases of biliary pancreatitis.

Acute Disease↗
PubMedDate not supplied

Gall-bladder interposition: a rare anomaly of the extrahepatic ducts.

Abnormalities in bile ducts pattern occur frequently enough to merit importance during cholecystectomy. A patient with anomalous insertion of both hepatic ducts into the gall-bladder with the cystic duct replacing the common bile duct is described. This case, and related anomalies of the bile ducts, are sufficiently important for us to ascertain their location and pattern prior to removal of the gall-bladder. Inadvertent injury to a normal or aberrant bile duct can result in morbidity and even mortality. Knowledge of the embryogenesis of these anomalies helps in the understanding of the location and pattern of these malformations. Almost all of these unusual bile duct arrangements can be recognised by following the rules of meticulous dissection and accurate knowledge of these anatomical aberrations.

Adult↗