Comparative evaluation of human placental extract for its healing potential in surgical wounds after orthopaedic surgery: an open, randomised, comparative study.

The study was conducted to compare the efficacy and safety of topical application of purified extract of human placenta (placentrex gel) versus povidone iodine for its wound healing potential after orthopaedic surgeries. In this open, comparative, randomised study, 79 patients above 18 years of age undergoing elective clean and uncontaminated orthopaedic surgery (open fracture reduction, spine surgery and debridement of wound) were enrolled in the study after obtaining written informed consent. Enrolled patients were randomised as per the PC generated randomisation chart (Rando 1.2, 2004) to receive either topical application of human placenta purified extract (PE) on the surgical wound or topical application of povidone iodine (PI) ointment on the surgical wound. Both preparations were applied topically on the surgical wound after the surgery, on days 3, 7 and on day 10, if required. Assessment of surgical wound was done after recovery from anaesthesia and on days 3, 7 and 10 based upon wound healing, physicians' global assessment of response to therapy (PGART) scale, pain and adverse effects. All 79 patients (40 PE and 39 PI) completed the study on day 10 as per the study protocol. Healing of the wound was observed in all patients. The number of patients reporting pain on days 3, 7 and 10 were similar in both PE and PI treatment (p, 0.527) groups. Wound induration was observed in 6 patients (15.00%) of PE and 15 (38.46%) of PI on day 7 (p, 0.041). None of the patients reported any side/adverse events during the study period. Purified placental extract and povidone iodine have comparative wound healing effects.

Transdiaphragmatic intercostal hernia due to chronic cough.

Intercostal transdiaphragmatic hernia is a rarely reported lesion. Trauma is the commonest cause. We report a 75-year-old man who presented with transdiaphragmatic intercostal hernia due to chronic cough. He recovered after surgical repair.

Bifid liver in a patient with diaphragmatic hernia.

Liver malformations including lobe and segmental abnormalities are rare. We report a 65-year-old lady with complaints of breathlessness and fullness after meals for two months. Investigations revealed a diaphragmatic hernia on the right side with a bifid liver; the right lobe of the liver was among the hernia contents. The lady is asymptomatic after surgical repair.

Clinico-pathological follow-up after total colectomy and straight ileo-anal anastomosis done for ulcerative colitis.

BACKGROUND: Restorative proctocolectomy is used as surgical treatment for ulcerative colitis. We have earlier documented adaptative changes in the terminal ileum after total colectomy, and straight ileo-anal anastomosis. AIM: To correlate the morphologic and functional changes in the ileal mucosa after total colectomy and hand-sewn straight ileo-anal anastomosis for ulcerative colitis. METHODS: Thirty consecutive patients (age range 15-50 years, 24 men) who had undergone total colectomy, rectal mucosectomy and hand-sewn straight ileo-anal anastomosis for ulcerative colitis were included in the study. These patients were followed up at 3-monthly intervals following surgery for two years and later once every year for a median duration of 9.5 (range 1-17) years. The clinical parameters studied were weight gain, frequency of stools, nature of stools, nocturnal stool frequency and need for antidiarrheal drugs. At each follow-up visit they were subjected to per rectal ileoscopy with ileal biopsy and barium enema. Ileal biopsy was analyzed histologically and histochemically. RESULTS: The clinical features improved over time, with average weight gain of 5 (range 1-7) Kg at one year. Frequency of stools decreased from 8-10 per day to 2-3 per day. The stools became semisolid and there was no need for antidiarrheal drug by the end of one year. All the patients showed adaptative changes in the ileum. The ileal mucosa was completely transformed into colonic type by the end of one year, colonoscopically (spacious lumen characteristic of colon), radiologically (disappearance of ileal characteristics with rectosigmoid-like appearance), histologically (blunting of villi with increase in goblet cells), and histochemically (sialomucin pattern to sulfomucin pattern). CONCLUSIONS: The ileum undergoes adaptative changes with corresponding improvement of clinical parameters over time, after proctocolectomy and ileoanal anastomosis for ulcerative colitis.

Self-bougienage: long-term relief of corrosive esophageal strictures.

BACKGROUND: Corrosive esophageal strictures require dilatation at frequent intervals. OBJECTIVE: To determine the efficacy of self-dilatation in treatment of corrosive esophageal strictures. METHODS: Retrospective analysis of data from 51 patients with corrosive esophageal strictures seen in a surgical unit. Eighteen patients underwent per-oral antegrade dilatation of stricture using gum elastic bougies (Group I); 15 patients underwent retrograde dilatation with endless string using an India rubber dilator devised at the authors' institution, followed by per-oral antegrade dilatation (Group II); 15 patients underwent retrograde dilatation followed by antegrade dilatation with endless string through esophagostomy (Group III). In three patients with stricture of the entire esophagus, endless string could not be passed; they were subjected to esophagocoloplasty. All patients were taught self-dilatation with gum elastic bougies as the final step, and were put on a progressive, domiciliary, self-dilatation program. Quarterly follow up was done for one year, to ascertain whether self-bougienage was being performed properly. RESULTS: All patients responded well to treatment, with significant relief of dysphagia and improvement in health and barium study findings. Six patients developed mediastinitis (3, 2 and 1 in Groups I, II and III, respectively) during initial dilatation; all improved with conservative management. Only one patient who failed to carry out self-bougienage had to be readmitted and retrained in the procedure, after which he remained asymptomatic. CONCLUSIONS: Patients with corrosive esophageal strictures can be treated with a long-term self-bougienage program, which avoids the need for frequent hospital admissions for esophageal dilatation.