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General Practitoner's Section
 
Can Palpation of Spleen be Better than Sonography?
OP Kapoor
 
 

Recently I had a remarkable experience. A patient was brought to me with history of two weeks’ fever and in one of the reports doubtful malarial parasites were reported. The patient wanted his blood tests to be done before coming to the clinic. Since the fever was of two weeks’ duration, in addition to blood tests, sonography of the spleen was asked for to see if it was enlarged. The report of the blood test was not available immediately, but the sonography report showed that the spleen was enlarged. The family doctor was very happy that his diagnosis of malaria was confirmed.

When I was examining this patient, I noted his toxic look and a coated tongue. When I palpated the spleen, it was so soft that I was sure it was a salmonella spleen and not malarial spleen. Next day, the blood culture report showed salmonella. Here was a case where I realized that palpation by physician scored over the probe of a sonologist!
 
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008
 
 

ADOLESCENT OBESITY IS ESTABLISHED IN CHILDHOOD

Persistent obesity in adolescents may be established well before the age of 11. Wardle and colleagues recruited more than 5800 pupils aged 11-12 years from 36 London schools and found 25% to be overweight or obese. Over the five years of follow-up, the prevalence of obesity increased at the expense of overweight, but the proportion of pupils with a body mass index within the healthy range stayed the same. Efforts to prevent obesity should therefore be targeted in the early years, say the authors.

BMJ, 2006; 332 : 1130.
 
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