ABSTRACT
Perianal abscess and fistulas are frequently encountered in our surgical practice; however, very little has been written about them. The clinical effectiveness of pus swabs for microbiological analysis during incision and drainage of perianal abscess is controversial. Its cost implication is often overlooked. To assess whether the culture of pus swab following incision and drainage of perianal abscess has any significant impact on surgical outcome and on early anticipation of development of fistula in-ano in our local population. A non-probability sample, total coverage multicenteric cross-sectional study. All consecutive cases of incision and drainage of perianal abscess between November 2008 and June 2011 were enrolled into our study after acceptance of a pre-given informed consent. Out of 76 patients with perianal abscess included in the study only 62 patients were available for the final assessment [9 F: 53 M; age range: 18-63 years; mean +/- SD: 37.66 +/- 10.67]. Median follow-up was 2 months irrespective to culture result. The mean hospital stay was 1.44 days, and is affected by the presence of associated illness [p=0.02]. Skin flora organisms, heavy mixed growth of both skin flora and intestinal organisms, and no bacterial growth were isolated from 75.8%, 12.9% and 11. 3% respectively. Fistula in-ano developed in 16.7%, 83.3% and 0% respectively. 83.3% of fistula developed in the group of patient who presented >/= 10 days, which is statistically found to be significant p=0.003.Fistula was developed in 7.1% [4/56] of patients who were treated under general anaesthesia, and in 33. 3% [2/6] of patients who were treated under local anaesthesia. The preliminary findings suggest that microbiological results have correlation with presence of fistula in-ano. The result warranted us to submit pus swabs from perianal abscess for assessment as it affect clinical effectiveness of treatment, and that culture of pus in perianal abscess is an essential part of its management
ABSTRACT
Chronic subdural haematoma [CSDH] is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November 2006. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences