Medicine Today 2009 Volume 21 Number 02 Page 38-42 DOI: http://dx.doi.org/10.3329/medtoday.v21i2.12478

Abstract

Actinomycosis is a very rare disease caused usually by one of a group of oppurtunistic otherwise harmless commensals that may be complicated by one or more of another group of co-pathogens. Because of its rarity, there is a chance of missing its diagnosis & proper treatment leading to substantial morbidity & mortality. Maltreated patients are at risk of developing life threatening complications. This article is intended to review the present status of aetiology, pathology, clinical features, complications & management of actinomycosis. Keywords Actinomyces israeli; Actinomyces gerencseriae; Actinomyces naeslundii; Actinomyces odontolyticus; Actinomyces viscosus; Actinomyces turicensis; Actinomyces meyeri; Propionibacterium propionicus; Peptostreptococcus; Actinobacillus actinomycetemcomitans; Prevotella; Fusobacterium; Bacteroides; Staphylococcus; Streptococcus; Enterobacteriaceae; actinomycetes. DOI: 10.3329/medtoday.v22i1.5606 Medicine Today Vol.22(1) 2010. 43-47

Endometriosis affecting the skin is a very much rare surgical entity encountered almost exclusively in women of childbearing age. It commonly presents as a discoloring painful cutaneous swelling, the pain being most commonly a cyclical one occurring during menstrual bleeding. It often needs histopathological examination to arrive at a correct diagnosis. Otherwise, the diagnosis is usually presumptive from typical and atypical presentations and other supportive imaging investigations. Wide surgical excision is the gold standard curative treatment of choice. Nonsurgical treatment includes use of such hormonal agents as danazol or leuprolide, oral contraceptive pills, etc. which can’t definitely cure the patient from this nonfatal ailing disease. All other examples of benign and malignant cutaneous swellings like desmoid tumors, fibro-histiocytoma, dermatofibroma protuberans, papilloma, melanoma, visceral malignancies and many other types of fibromatosis are to be included in the differential diagnosis. These patients with cutaneous endometriosis need to be additionally evaluated for endometriosis elsewhere in the body especially in the pelvis and the abdomen proper, though no other tissue like brain, lungs, liver etc. are not immune to it. In women of childbearing age with abdominal or pelvic wall masses or an area of soft-tissue thickening at cross-sectional imaging in or very close to previous surgical scars, endometriosis is to be strongly suspected by the consulting radiologist. Imaging investigations like CT, USG, and especially, MRI may help in the diagnosis of scar endometriosis, but it is only the biopsy that is definitely confirmatory. KYAMC Journal. 2022;12(04): 243-249

Appendicitis has its acute, subacute, recurrent and chronic forms. Appendicitis is commonly predisposed to and precipitated by a single or a combination of multiple discrete factors like obstruction of lumen, ischemia from thromboembolic episodes, infection or idiopathic etc. Typically, it starts as umbilical or peri-umbilical or midline abdominal dull aching pain that soon gets localized in the right iliac region. Movements worsen the pain. Other typical features include nausea, vomiting, anorexia, pyrexia, preference to lie down with or without curling up, chills, constipation, diarrhea, fever, shaking etc. The atypical symptoms of appendicitis include a dull or sharp pain anywhere in the abdomen, back, rectum, painful urination, bloating, flatulence, generalized abdominal tenderness, distension simulating acute intestinal obstruction, enlarging abdominal mass with or without overlying skin erythema, normal bowel movements, normal vital signs and even with no pain, no nausea, no vomiting no pyrexia or no weight loss. These atypical symptoms very often misguide the primary care physicians and the surgeons resulting in failure of diagnosis putting the patients to the risks of life-endangering complications. Diagnosis of appendicitis in absence of typical features are to be made from pre-occupied knowledge and clinical suspicion with or without the help of biochemical and/or imaging studies. Early and timely diagnosis and appropriate treatment are essential to save the life and to reduce the morbidity as well. Appendicitis should be thought in all cases of abdominal pain irrespective of its type and location, as must meningitis be thought in all cases of headaches. KYAMC Journal.2021;12(02): 101-106