Management of ascites due to gastrointestinal malignancy

Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduce mobility. There are many potential lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephritic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascetic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available

Malignant otitis externa or diabetic ear- Al Nahdha management protocol. Why it should be treated aggressively?

Malignant Otitis externa is an unusual but serious and potentially fatal condition. This is a study of 29 cases of malignant otitis externa admitted in our institution between January 1995 and December 2003. In this article a classification system defining the extent of disease, management protocol, indications for hyperbaric oxygen therapy, and overall effectiveness of treatment are reviewed. Correlating clinical, radiological, technetium 99 [Tc99] and gallium67 [Ga 67] scintigraphic findings and early therapeutic response, the disease was staged into stage I [mild], ll [moderate] and stage III [severe]. 15 patients of stage I disease were successfully treated with monodrug therapy- third generation cephalosporin [ceftazidime] only. Five patients of stage II disease were treated with parenteral ceftazidime and amikacin for 4-6 weeks. Of the remaining 9 cases with stage III disease, 6 were successfully treated with combination of antipseudomonal antibiotics [ceftazidime/ piperacillin and amikacin] for 8-12 weeks and adjuvant hyperbaric oxygen therapy. Site of granulations in the ear canal seems to be indicative of stage of the disease. 26 cases [89.7 percent] were treated successfully and are free of disease. Three patients [10.3 percent] died of disease recurrence. The presence of associated facial nerve involvement alone does not seem to be a poor prognostic sign. A new staging system is proposed and a guideline for therapy according to the stage of the disease is discussed

Primary repair Vs ileostomy in patients with typhoid perforation

This is prospective study conducted in the department of Surgery, Mayo Hospital, Lahore over the period of four years. Comparative data was compiled on 100 patients divided in two equal groups. Efficacy of two operations was assessed in terms of morbidity and mortality. The final results were conclusive enough to show the benefits of ileostomy over the primary repair in cases of typhoid perforation

Nasal endoscopic repair of cerebrospinal fluid rhinorrhea

The management of cerebrospinal fluid [CSF] rhinorrhea is a complex and challenging problem. Its management has historically plagued the neurosurgeon and the otolaryngologist. Majority of these cases are secondary to blunt head trauma which fortunately respond well to conservative medical management. However some cases of traumatic CSF rhinorrhea and all cases of non-traumatic [spontaneous] rhinorrhea need surgical repair. Surgical approach for repair of CSF rhinorrhea had traditionally been intracranial and requires frontal craniotomy. Such intracranial repair is still favored at many institutions despite its inherent morbidity. Extracranial non-endoscopic techniques have been previously described but have not gained wide acceptance. Recently, intranasal endoscopic repair has been reported with comparable success rates. This retrospective study consists of 4 cases of CSF rhinorrhea seen in al Nahdha hospital. These patients underwent nasal endoscopic repair to control their CSF leak and were followed for more than 12 months. The surgical technique, results of procedure and relevant literature are discussed here