MISCELLANEOUS DISEASES

PROLAPSED INTERVERTEBRAL DISC 

If the prolapsed disc is pressing on nerve roots causing severe sciatica .With the passage of time,the nucleus pulposis rearranges itself around the nerve roots thereby, releasing the pressure on the nerve root and promoting recovery.

FRACTURE NECK FEMUR

If untreated  May heal if the patient rests with fractured ends in opposition OR

patient may simply learns to walk in such a way that the greater trochanter rests on the acetabulum and provides support taking the weight of that side like walking stick.

AVASCULAR NECROSIS OF THE FEMUR HEAD

It is because of interrupted blood supply to the femur head because of fracture or steroids or thrombosis leading to infarction of the head and at a later stage fracture develops through the necrotic bone causing collapse of articular surface in turn causing Osteo Arthritis of the hip joint.  After a few years, new bone may form on the surface of original trabeculae within the femoral head thus strengthening the weight-bearing surface.

DEEP VEIN THROMBOSIS & PULMONARY EMBOLISM.

Under 40 years of age, only less than 10% patients undergoing surgery get DVT in calf veins and over 40 years, only less than 40% of patients get calf vein thrombosis.  80% of Pulmonary Embolisms are clinically silent.  The incidence of fatal pulmonary embolism in the high risk group is only 1-5% and is more common only from proximal veins like the femoral veins where incidence of DVT is 1/4^th –1/8^th that in the calf.  Small emboli pass unnoticed in the pulmonary circuit.  There is an abundance of mast cells in connective tissues surrounding the pulmonary capillaries.  Large amounts of Heparin is physiologically released from these abundant cells to prevent extension of small clots which physiologically embolise in the slowly flowing venous blood. Larger emboli give rise to pulmonary infarction with pleurisy.  Only massive emboli block outflow to the right ventricle and cause haemodynamic collapse.

BENIGN PROSTRATIC HYPERTROPHY

This is due to outlet spasm and Detrusser paresis due to withholding urine for long periods.  Oedema (Prostratic) due to congestion or infection and increased acidity of the urine may also play a role and hypertrophied prostratic gland need not be solely blamed for the retention.  The bladder muscle hypertrophies and can push the urine out with greater force.

ACUTE ABDOMEN

For e.g. Perforated Gastric ulcer, acid escapes into the peritoneal cavity causing severe irritation.  The peritoneum then secretes alkaline fluid and neutralizes the acidity relieving the irritation.  The omentum actually moves to the site of perforation and seals it.  Such a process also occurs in case of acute appendicitis.

FRACTURES

In addition to the ability to unite fractures, the body is capable of tremendous musculo skeletal adaptability. In one case of an osteoporotic supracondylar fracture humerus where infection caused adhesive arthrodesis of the elbow joint.  Non-union of the fracture created a new hinge joint above the fused elbow enabling the patient to use flexion and extension movements.

INGUINAL HERNIAS

10% of normal adults have Inguinal Hernias In  most cases (80%) only Omentum which plugs the orifice and prevents the intestine from coming   in  and prevents complications of Obstruction and strangulation.

HEART-LUNG MACHINE

A significant proportion of patients suffer from brain damage due to the procedure of cardiopulmonary bypass via the HLM, 4% of which is permanent.The CT scan show spongy brai tissues after the operation , & the retinoscopy show blocked retinal vessels.