Evaluation of the role and type of drains in simple thyroid surgery

This study was performed to determine the role of the neck drainage after subtotal thyroidectomy in patients with simple nodular goiter and it's impact on the patients as regards, postoperative pain, hospital stay, and wound complications. Forty five patients, from the Department of Surgery, Medical Research Institute, Alexandria University, underwent subtotal thyroidectomy and were randomly divided into three equal groups using closed envelope method. In Group A [n-15] a corrugated rubber drain was used, Group B [n-15] a closed suction drainage was used and in Group C [n-15], no drainage was used. Assessment of the postoperative pain and local wound complications was done using the visual analogue scale and clinical and ultrasound examination respectively. There was no statistical difference among the three groups as regards wound hematoma, wound infection or hospital stay. The postoperative pain was least in Group C showing a significant statistical difference among the three groups. In wound closure without drain is the most acceptable method when hemostasis is perfect. If complete hemostasis cannot he achieved, passive drainage is recommended

Small diameter partial portacaval shunts SDPPCS: short term efficacy and outcome

Partial portacaval shunts, are distinct in concept and hemodynamics from selective and total shunts. The aim of this work was to evaluate the small diameter partial portacaval shunt operation [DDPPCs] as a definitive management for patients with bleeding esophageal varices from schistosomal hepatic fibrosis and portal hypertension. Thirty-three patients were studied. All patients were prepared for elective partial portacaval shunting using the eight mm. Polytetraflouroethylene [PTFE] Gortex graft. The preoperative work up included full hematological studies, liver and renal function tests, upper Gl endoscopy, with confirmation of variceal grade, abdominal coloured Duplex of the portal [P. V.], splenic [S. V.], and inferior vena cava [I. V.C.], all stigmata of amoniacal encephalopathy were looked for. Fourteen cases [42.42%] were of child's class A, and nineteen [57.57%] were of class B. Oesophageal varices were revealed in all cases with Grades III and IV in 69.69% of cases, and risk signs in 84.84% of cases. The mean diameter [D] of portal vein was 17.3+11 mm. The flow [F] in the portal vein was hepatopetal in all cases with a mean of 2.38+0.64L/minute. All patients after being subjected to SDPPCS operation were followed up for a period that ranged from 15 to 38 months. Postoperative findings, as well as data after one month and one year follow up are presented in this work. The shunt was completed successfully in 30 out of 33 patients, inspite of some operative difficulties which were found in 12 cases. There was no operative mortality. The early mortality rate [30 days after the operation] was 6.06% early thrombosis rate was 9.99%, and late occlusion rate was 3.3%, and rebleeding occurred in 2 cases 6.06%. The varices were down graded in 19 patients and disappeared in 6, while six patients refused follow up endoscopic evaluation. The flow in the shunt was directly visualized in 11 patients with a mean flow of 1.12+0.32 L/Min and 1.73+ 0.26 L/Min one month and one year respectively. The portal vein showed post operative hepatopetal flow that was reduced to 1.59 +/- 0.65 L/Min, and 1.12 +/- 0.51 L/Min one month and one year respectively. This reduction was mainly in the cephalic portion of the vein in comparison to increased flow in the caudal portion. The flow in the I. V.C was increased to 3.2 +/- 0.67 and 3.6 +/- 1.25 post operatively one month and one year postoperatively. There were no cases of hepatic encephalopathy

Renaissance of small diameter partial portacaval shunt: experience, outcome and survival in Egyptian schistosomal portal hypertensive bleeders

The objective of this work was to evaluate specifically the surgical experience, portal haemodynamics, clinical outcome and survival in Egyptian schistosomal portal hypertensive bleeders after the small diameter partial portacaval shunts [SDPPCS]. This prospective study included fifty-six patients out of two hundred and fifty-four patients with schistosomal hepatic fibrosis, portal hypertension, and splenomegaly and complicated by bleeding oesophageal varices. All patients belonged to class A or B of Pugh modification of Child-Turcotte classification of cirrhosis. All patients were studied preoperatively with endoscopy and color duplex. All patients showed a preoperative haemodynamics pattern with hepatopedal flow. The fifty-six patients were prepared for elective small diameter partial portacaval shunt, SDPPCS, using the 8 mm, non-compressible polytetrafluoroethylene [PTFE] graft, Gore-Tex, W. L. Gore and Associates, Inc., Elkton, Md.].Postoperative duplex study was repeated one month, six months, and one year after operation. The portal flow cephalad and caudal to shunt site were measured, shunt patency was directly visualized, and flow in IVC cephalic to shunt in the intrahepatic portion was measured. Postoperative endoscopic evaluation, every three months during the first year, then every six months afterwards, to assess the downgrading of varices. One-three years of follow-up were the time allowed before reporting the final results. The episodes of variceal bleeding, ascites and encephalopathy were recorded for all patients. Twenty-one cases [37.5%] belonged to child s class A, and thirty-five cases [62.5%] were class B. SDPPCS was abandoned in 5/56 [8.9%]. Causes of operative failure in graft replacement were: adhesions due to previous cholecystectomy in 1/56 [1.8%], very thin walled PV in 1/56 [1.8%], very small PV < 10 mm in 3/56 [5.35%], extensive collaterals around the PV in 2/56 [3.58%], and medially displaced PV with inability to dissect a sufficient segment in 1/56 [1.8%]. Complications: were in the form of PV thrombosis in 1/56 [1.8%], IVC thrombosis in 1/56 [1.8%], shunt thrombosis in 2/56 [3.58%], and transected CBD in 1/56 [1.8%]. SDPPCS permitted sufficient volume of prograde flow of portal blood to the liver leading to maintenance of liver functions and low incidence of encephalopathy. SDPPCS resulted in progressive diminution of the size and grade of esophageal and gastric varices, as well as, disappearance of risk signs, thus guarding against rebleeding. There was statistically significant difference in downgrading of esophageal and gastric varices and improvement of gastropathy. SDPPCS resulted in improvement in hematological abnormalities with significant increase of blood elements, especially for thrombocytopenia. SDPPCS resulted in significant decrease in splenic size and splenic congestion. There was no operative mortality. Survival after SDPPCS was 91.07%. Shunt was patent in 49/51 patients [96%]. Three patients [5.357%] complained of mild encephalopathy after SDPPCS. Small diameter partial portacaval shunt [SDPPCS], using 8 mm PTFE graft, is feasible technically and is effective in controlling bleeding esophageal bleeding with preservation of a prograde hepatic portal flow, that preclude encephalopathy, in Egyptian schistosomal portal hypertensive bleeders. It could be considered as an alternative to difficult cases meant for DSRS, or shunt procedures in splenectomized patients

Correlation between serum levels of triiodothyronine [T[3]] and thyroxin [T[4]] and severity of clinical manifestations of uncontrolled thyrotoxicosis

The present study was carried out on 30 patients with uncontrolled thyrotoxicosis. Twenty seven patients [90%] were female and three [10%] were male. Their ages ranged between 17 and 56 years with a mean age of 36.6 years. Results revealed a significant correlation between the mean serum level of total triiodothyronine [TT3] and some, but not all, symptoms and signs of thyrotoxicosis. No significant correlation was found with respect to total thyroxin [TT4] level. A significant direct positive correlation was found between Wayne's score and the serum levels TT3 and TT4 [p<0,05]. An inverse relationship existed between serum levels of thyroid stimulating hormone [TSH] and those of TT3 and TT4 [p<0.05]. Fine needle aspiration cytology [FNAC] was not conclusive in pre-operative diagnosis of the disease as compared to post-operative paraffin section biopsies