Upper gastro-intestinal hemorrhage in Upper Egypt [El-Minia] an endoscopic survey of 142 cases

One hundred and forty two [142] consecutive patients with upper gastrointestinal haemorrhage [UGIH], admitted to Menia University Hospital over the 3-year period 1989-91, were studied prospectively. The mean age was 41 years, the male: female ratio was 3:1, causes of bleeding were most common oesophageal varices causing 43% [61 cases], followed by bleeding duodenal peptic ulcers 21.1% [30 cases], and 8.5% [12 cases] from gastric ulcer, drug induced bleeding lesions forming 7.1% [10 cases]; [9 cases] had erosive mucosal gastritis 6.3%, and [20 cases] 14% had additional causes. Forty three patients [30%] had operations with an overall mortality of [14%] 6 cases, while 22 cases [22%] of the unoperated patients died. The prognosis of the oesophageal varices depends on liver function, with mortality 19%. While the overall mortality in the peptic ulcer group is low [7%], the presence of stigmata of recent haemorrhage is associated with a high risk of rebleeding

Incidence and management of bile reflux in cases of duodenal ulcer and after operations of vagotomy with gastrojejunostomy drainage

Duodenogastric bile reflux [DGBR] is reported to be increased in patients with duodenal ulcer [DU] and following gastrojejunostomy drainage operation after vagotomy [GJV]. The pH, total bacterial counts, total and free bile acids were measured in gastric juice aspirated, hourly for 24 h, in 36 patients with [DU], 37 patients with a [GJV] performed for [DU] and in 27 healthy [normal] controls. Intragastric pH was significantly higher in the [GJV] group during the day [P<0.001] and at night [P<0.001], compared with [normals] and the [DU] group. There were no differences between [DUs] and normal patients. Bile acid concentration in the gastric juice were not significantly different between [DU] and control groups over the 24 h. Median and range values were 0.14 [0.06-0.52] mol/L[-1] in [DU] patients and 0.14 [0.05-0.67] mmol/L[-1] in the [normals]. However, total bile acid concentrations were significantly greater in the [GJV] group 0.23 [0.04-0.84] compared with [DU] or controls. [P=0.04, P=0.02] our data nicley support the role of [GJV] in the pathogenesis of [DGBR], deoxycholic acid was detected in significantly greater amounts in [GJV] subjects than controls [P<0.001] or [DU] subjects [none detected]; and may be important in the pathogenesis of bile reflux. The management of such cases [GJV] were, by urgent and continuous removal of the bile which accumulated and crusted over the gastric mucosa, gastric rest for certain period, till accomodation takes place

Midline and paramedian incisions in the elective and urgent laparotomies: comparative study

The lateral paramedian incision has been devocated as the strongest incision for abdominal surgery. We have evaluated this incision and compared it with midline incision without closure of the deep peritoneal layer. All 206 patients undergoing laparotomy in the surgical unit from 1988-1990 both elective and emergency cases, were included. In patients undergoing laparotomy through unscarred tissue, a lateral paramedian incision was performed and they were randomize to have either the paramedian incision [n=77] or midline incision [n=78]. Patients in whom the laparotomy was performed through a previous incision [n=51] were excluded from the trial. The rectus sheath was closed with monofilament nylon in all cases. Patients were assessed for wound integrity during the immediate postoperative period and at 1, 3,6 and 12 months after operation. There have been no cases of burst abdomen in paramedian incision while two cases [2.6%] occurred in midline incision. One case [1%] of incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed, seven [9%] incisional hernias have occurred in patients underwent midline incision. We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare. While these complications were significantly larger in midline incisions

Prevention of postoperative infections in general surgery, convenience of single dose of ceftriaxone

In order to compare the efficacy as well as the side effects of two cephalosporins with different half-lives, a randomized clinical trial has been conducted from October 1988 till January 1991. 200 consecutive nonseptic operations in abdominal, soft tissue and plastic surgery, have been separated into 2 groups, each given a different cephalosoporin. Group I [n = 100], 1 single operative dose of 2 g Ceftriaxone [Rocephin], given intravenously during the operation. Group II [n = 100], 3 doses of 2g [6gm] Cefoxitin [mefoxin], given intravenously 1 dose [2 gm] 1 hour preoperatively, [2 gm] given during the operation and [2 gm] 6 hour after the operation. Due to its much longer half-life than most cephalosporins, ceftriaxone needs only to be given once daily. This single dose of [2 g] appears as efficient in prevention of postoperative infections as cefoxitin with a dosage three times higher. Serious side effects in patients treated with ceftriaxone were not encountered, ceftriaxone was at least as efficient in prohylaxis as cefoxitin. The convenience of being able to give ceftriaxone as a single dose at the beginning of the operations and its cheapness, added up to it a clinically worthwhile superiority

significance of timing of administration of antibiotic as prophylaxis during appendectomy

In prospective study involving 132 emergency appendicectomies, the use of cephradine [velosef] and metronidazole [Flagyl] was assessed. Patients were randomized into three groups, to receive a single dose of either cephradine 2 g i.v. alone, metronidazole 1 g orally alone; or both antibiotics of the same doses with the premedication [as prophylaxis] and the different times of intake being recorded. Serum drug levels were measured and peritoneal swabs taken. Wounds were inspected regularly for signs of sepsis and patients were closely questioned at follow-up. Twenty three patients were excluded [1 of severe mental and physcial retardation, 5 misdiagnosis, 2 protocol violation, 5 normal and 10 perforated]. This left [109] cases, 34 in group one, 36 in group two and 39 in group three. 6 wound infections occurred [5.5%], represented as 1 in group one [2.94%], 3 in group two [8.33%] and 2 in group three [5.13%]. There was no great difference between each of the three groups, indicating that there is no advantage in combining these antibiotics. Cephradine appears to have sufficient activity both against aerobic and anaerobic organisms to reduce the wound infection rate to a low level. Timing of administration is particularly important for adequate serum drug levels to be present in over 90% of patients at the time of surgery. One must operate within 45 minutes if intravenous cephradine is used and wait at least two and a half hours if oral metroindazole is used. 2 of the 6 infections were deemed preventable on the basis of drug levels

Comparative study between proximal gastric vagotomy and truncal vagotomy with drainage in treatment of gastric ulcer

Truncal vagotomy with drainage operation [TV+D] takes the upper hand in its results over the proximal gastric vagotomy without drainage operation [PGV]. The comparison had been done between 23 patients of both groups with follow up 5 years later after the operations. The complications of the first technique [TV+D] is significantly very low with high rate of cure

Colon diverticulosis is not uncommon in Egypt

Colon diverticulosis is not uncommon in eastern world and in our country as previously believed. In our study there was a significant percent [5%] of that disease in our patients suffering from colonic diseases, sixty percent of them presented with the risky complications of such disease. So early clinical discovery of the disease was associated with safe and curative surgery, with low mortality: while in complicated cases the results were less efficient. This indicates early investigations by barium enema, occult blood, sigmoidoscopy and colonoscopy in our patients suffering from colonic troubles