Are scolicides truly scolicidal [challenging traditional medical teaching]

Traditional medical teaching states that:- a scolicide should be injected into the hydatid cyst cavity to destroy scolices prior to cyst removal, yet we noticed a relatively high recurrence rate in our series of 13.3% in spite of that and the careful meticulous surgical technique. We looked thoroughly into the causes, and we discovered that scolicides may not be always scolicidal, thus challenging traditional medical teaching; and that injecting a scolicide into the cyst cavity prior to its removal is not the most important step to decrease recurrence rate, but the controlled evacuation of cyst contents in an isolated field. We also concluded that a recurrent hydatid cyst is not necessarily due to spillage of cyst content which have not been destroyed by the presumed scolicide at the time of surgery, as in 25% of our patients, the recurrent cyst was far away from the site of the previously removed hydatid cyst, thus the seed of another cyst might have been present at the time of removal of the previous hydatid cyst, but it was too small then to be detected clinically, ultra sonographically, or intra operatively; thus it is actually not a true-recurrent cyst, but another metachronous cyst. The literature have also been reviewed

Chilaiditi syndrome [Hepato diaphragmatic Colonic Interposition]

This is a case report of a rare anomaly where the colon is interposed between the diaphragm and the liver usually asymptomatic and found incidentally on roentgenograms. No treatment is required for the asymptomatic case. The literature have also been reviewed

upside down pylorus

A 40 year old clerk presented with chronic abdominal pain and dyspepsia ultrasonography showed a thick walled gall bladder with gall stones, barium meal examination showed an upside-down pylorus, a pylorus which is below, to the left, and anterior to the normal position of the pylorus. This was an incidental finding and had no practical significance as the symptoms resulted from chronic calculous cholecystitis. Such a positional anomly of the pylorus is congenital. The literature have also been reviewed

Symptomatic and asymptomatic gastric diverticula

Gastric diverticula are uncommonly encountered during upper gastro-intestinal barium series, with the Juxta-cardiac site being the site of predilection. Many are asymptomatic, but some are symptomatic. We present examples of both, with histo-pathological proof. The literature have also been reviewed

Pleomorphic malignant fibrous histiocytoma

A 63 year old lady presented with a huge rapidly growing left upper abdominal wall tumor of one year duration, and a pleomorphic high grade sarcoma. Total excision was performed with closure of the abdominal wall defect using a synthetic prolene mesh. Histopathological examination of the excised tumor proved it to be a pleomorphic malignant fibrous histiocytoma. The literature have also been reviewed

Cholelithiasis and cholecystitis: a personal experience with 150 cases

A retrospective study was performed on one hundred and fifty cholecystectomies performed over the last few years in Public and private Hospitals by one Consultant Surgeoh. All data were analysed; and those showed a female: male ratio of 4:1, and a peak age of 41-50 years. 13.7% of Cholecystectomies had exploration of the common bile duct; 72.7% of them were jaundiced, and 27.3% of those who had common bile duct exploration were not jaundiced choledocho-duodenostomy or a sphincteroplasty was performed when exploration of the common bile duct was negative showed sludge only, or there was a very large number of very small stones. 90.7% of Cholecystectomies were for calculous cholecystitis, and 9.3% were for acalculous cholecystitis. Diagnosis of acaluculous cholecystitis was made by ultra sonography and oral cholecystography. with 21.4% of them having a Hida-hepatobiliary scintiscan as well. All 9.3%. of cases of acalculous cholecystitis had a histopathological confirmation of chronic acalculous cholecystitis. 18.7% of patients had acute cholecystitis at operations with 39.3% of these patients with acute cholecystitis having empyema of the gall bladder; all of these patients were treated by cholecystectomy, and none of them had a cholecystostomy. of the 136 patients with calculous cholecystitis, 19.9% had a solitary stone and 32.4% had 2-10 stones; the highest number of stones was 250. 49.2% of stones were less than one centimeter in size; with the biggest stone being 4.5 cms in size. In 14% of cases, two different sizes of stones were encountered in the gall bladder and in 5.2% of cases, three different stone sizes were encountered. Unlike what is expected of "mixed stones" they were not the commonest gall stones in this study constituting only 30.9% of cases with " cholesterol stones" constituting 40.4% of cases. "Pigment stone" constituted only 8.8% of stones; with " combined stones" constituting 17.6% of cases. 2.7% of patients had carcinoma of the gall bladder all occuring in patients with calculous cholecystitis, with a female: male ratio of 1:1., motality was 1.3%, and 1.3% had liver cirrhosis with secondary gall stones. The literature have also been reviewed

Gastrointestinal malignancies

Forty one cases of gastrointestinal malignancies were dealt within a two-year period; 16 cases were gastric carcinoma [39%] and 13 were cases of cob-rectal carcinoma [31.7%]. This is in contrast to developed countries, where colorectal carcinoma rather than gastric carcinoma is the leading gastrointestinal malignancy. All operable cases of gastric carcinoma were lymph node positive and thus had a poor prognosis, while only seven out of thirteen cases, of colo-rectal carcinoma were lymph node positive. Thus around half of these had a favorable prognosis; most cases of colo-rectal carcinoma occurred in the bilharzia-endemic South. Chronic irritation coupled with altered immune response are probably responsible. The literature is also reviewed

Missed swabs and instruments

Swabs and instruments are liable to be missed during an operation despite every precaution. Missed swabs commonly produce symptoms by setting up local infection due to disintegration of cotton; however, missed surgical instruments which are sterile and inert rarely produce infection, and may remain a symptomatic for years. A review of the clinical and medicolegal aspects is made, with a review of the literature

Irritable bowel syndrome: Iraqi pattern

This is retrospective study on 310 patients with the Irritable Bowel Syndrome in a developing country. Those patients constituted 26.1% of Gastro-intestinal disease patients. 63.9% of patients were 21-40 years old 68.1% were males and 31.9% were females abdominal pain constipation flatulence and mucus discharge were the commonest symptom-complex. As to the clinical types of irritable Bowel Syndrome 53.9% were of the constibation type 14.9% of the diarrheal type and 31.6% of the constibation/ diarrhea type. The mean duration of symptoms was 4.7 years and 83.6% of patients admitted to a direct relation between their symptoms and stress. 94.1% of those who accepted to undergo investigations had either a normal barium enema or suggestive radiological features of the Irritable Bowel Syndrome. 5.9% of barium enemas showed diverticulae; all such patients were above 40 years of age, and had a long history of the condition.Analysis of these results with comparison to other series, and a review of the literature is made

Peptic ulcer disease: Iraqi pattern

A retrospective study was performed on 131 patients with "chronic active peptic UIcer",97.7% had chronic active duodenal ulcer while 2.3% had chronic active gastric ulcer 75% were 20-40 years old, with a male: female incidence of 3.3:1. Hunger and nocturnal epigastric pain were the most dependable symptoms in the diagnosis of duodenal ulcer. Ulcer crater on a barium meal roentgenogram was a direct sign of duodenal ulcer. Indirect or secondary radiological signs under went upper gastrointestinal endoscopy. An Iraqi pattern for peptic ulcer disease was identified with clear-cut variations from other patterns with possible explanations. A review of the Iiterature is undertaken

Minimal bleeding prostatectomy

A study was performed on thirty patients who underwent retro pubic prostatectomy; fifteen of them through a transverse prostatic Capsular incision, and another fifteen through a vertical prostatic capsular incision which cause less interference with the vertically running blood vessels. This Modification reduced intra and postoperative bleeding by about "25%". Such a vertical Capsular incision can also be extended easily into the urinary bladder on need, and was associated with a shorter period of postoperative catheterisation and hospitalisation. Thus, we recommend using vertical capsular incision instead of the classical transverse one due to the above mentioned advantages, the literature is also reviewed

Breast tuberculosis

Tuberculosis of the breast is comparatively rare even in countries where pulmonary tuberculosis is considered prevalent. It is associated with active pulmonary tuberculosis or secondary to tuberculous mediastinal lymphadenitis. The diagnosis rests on bacteriological and histopathological examination. This report describes three cases of breast tuberculosis with a review of the available literature, and it presents the first case in which a breast tuberculosis developed in a male

one-stage operation for soft-tissue missile wounds

Two hundred war-injured patients missile-inflicted soft-tissue injuries underwent a one stage operation of primary wound exision with primary suture and drainage instead of the classical two-stage operation of primary wound excision and delayed primary suture. The results in terms of morbidity [mainly septic complications] and mortality are no different from those having a two-stage operation. The two-stage operation was established in the pre-antibiotic era when debridement in its original meaning was practiced-a lesser procedure than today's wound excision. It is believed that with the available antibiotics, appropriate wound exision and pressure irrigation, a one-stage procedure with all advantages is preferred. The results of this study give support to such a policy