use of surgery in displaced scapular neck fractures

To evaluate the use of surgical management in displaced scapular neck fractures. 14 adult male patients [average age 34 years, range 19-44] with displaced scapular neck fractures were treated by open reduction and internal fixation in Al-Jahra Hospital, Kuwait from April 2000 to January 2004. Patients' clinical and radiological results were analyzed retrospectively. The average follow-up was 20 months [range 6-30 months]. Anatomical or near-anatomical reduction of the fracture with excellent clinical function was obtained in 12 patients [86%] and with good functional outcome in 2 patients [14%]. One patient with associated head injury developed heterotopic ossification connected to the lateral border of the scapula. The results of this report show that open reduction and internal fixation of grossly displaced scapular neck fractures are the treatment of choice for these injuries to restore the normal biomechanics of both glenohumeral and scapulothoracic joints and allow favorable clinical outcome

Surgical treatment for ipsilateral fractures of femoral neck and shaft

To review the primary and the final results of surgical management of ipsilateral femoral neck and shaft fractures. Seventeen patients [2 female, 15 male, average age 37 years, range 20-60] with ipsilateral femoral neck and shaft fractures were treated by compression plate fixation for the femoral shaft fractures and dynamic hip screw or cannulated cancellous screw fixation for the neck fractures in Al-Razi and Al-Jahra Hospitals, Kuwait, from March 1996 to June 2002. The clinical and radiological primary and final results were analyzed retrospectively. The average follow-up for the primary outcomes was 3.6 years [range 2-6 years]. 100% union of the femoral neck fractures, 0% osteonecrosis of the femoral head and 77% union of the shaft fractures were achieved. Complications of femoral shaft fractures, nonunion and metal failure, occurred in 4 [23%] patients and postsurgical infection occurred in 1 patient. At the final follow-up, 15 [88%] patients achieved good clinical outcome and 2 [12%] had fair outcome. Our results show that compression plate fixation for the femoral shaft fracture and dynamic hip screw or cannulated screw fixation for the neck fracture in combination injury is a reliable and adequate technique

Post-liver transplant infections

Post liver transplant infection is a problem to diagnose and treat. 87 liver transplant received by 86 patients are included in this study. The type of organism, time of infection is demonstrated. We could not correlate infection to age, sex, operative complications, type of biliary reconstruction and type of immunosuppression. Our results are shown in this study

Surgery of secondary hyperparathyroidism

Seventy-Five patients with renal insufficiency with secondary hyperparathyproidism [including 13 patients with functioning renal transplants] were operated upon. The three major indications for surgery were bone pain, abnormal serum calcium and pruritus. Total parathyroidectomy with autotransplantation was performed in 39 patients [52%], subtotal thyroidectomy in 20 patients [27%] and total parathyroidectomy in 16 patients [21%]. Total parathyroidectomy with autotransplantation provides the best symptomatic relife from secondary hyperparathyroidism

inhibition of liver regeneration by somatostatin infusion and its reversal by pancreatic polypeptide and hepatocyte-stimulating substance

Several hepatotrophic hormones are known to be involved in initiating and potentiating the hepatic proliferative response to injury or hepatectomy. Little is known, however, about factors promoting termination of the regenerative response when the liver is restored. Because somatostatin [SRIF], isolated from gastric pancreatic and portal circulation, is an inhibitory hormone, we attempted to evaluate is potential role in regulating liver cell regeneration. We also studied the relationship of SRIF to insulin, glucagon, pancreatic polypeptide, and hepatocyte-stimulating substance on regenerating the liver following extended hepatectomy in rats. Male Sprague-Dawley rats were either sham-operated [n = 6] or subjected to 68% hepatectomy [n = 35]. Subcutaneous infusions of either saline or hormones were started 18-24 h preoperatively and continued until sacrifice 24 h following hepatectomy. At sacrifice, peripheral blood was obtained to determine serum insulin, glucagon, and SRIF levels. Liver regeneration was assayed by measuring the incorporation of radiolabelled thymidine into hepatocyte DNA. Liver regeneration was significantly [P<0.01] inhibited by SRiF Glucagon or glucagon and insulin combined did not reverse this effect. Insulin and glucagon levels were not significantly influenced by SRIF infusion. Pancreatic polypeptide and hepatocyte stimulating substance were both able to reverse the inhibitory effect of SRIF on liver regeneration and at the same time caused serum glucagon levels to increase and serum insulin levels to decrease. Thus SRIF inhibits liver regeneration after hepatectomy either by acting directly on the hepatocytes or via other factors which are not insulin and glucagon. Pancreatic polypeptide and hepatocyte stimulating substance reverse SRIF mediated inhibition of liver regeneration, possibly by changing insulin and glucagon levels, although other mechanisms may be involved

Why elective cesarean section is safer than emergency cesarean section

The elimination of caesarean section [CS] operations from the practice of obstetrics is unthinkable. Nevertheless, attempts must be made to reduce its complications. One contributing factor, among others, leading to an increasing rate of complications is the performance of the operation under the stress of an emergency situation. Therefore, it is recommended that the proportion of cases done electively be increased. A retrospective analysis of 532 C.S. operations performed in one year revealed a high percentage of emergency cases [74.2%] relative to the total. In contrast, elective cases represented 25.8% only. The rates of maternal and perinatal morbidity and mortality were also significantly higher in the emergency than in the elective operations