Management of faecal fistula

To share our experience of management of faecal fistula so as to establish management protocol. A descriptive study. Department of surgery ward-2 of Jinnah Postgraduate Medical Center Karachi, from July 2002 to June 2005. Twenty seven patients with a diagnosis of faecal fistula were studied. Demographic variables cause and outcome were observed and recorded. A three staged strategy was employed in the management. Conservative management of fistula was based on TPN and bowel rest. There were 16 males and 11 females. Mean age was 36 years. Small bowel was the commonest site of fistulation [22] and intestinal tuberculosis was the most common cause. Eighteen were high output fistulas and 9 were of low output. One fistula was complex others were simple. Sixteen responded to the conservative management and their fistulae closed spontaneously. Eleven of them had small bowel fistulas with high output, 5 had large bowel fistulas with low output. Six patients underwent surgery after 4 weeks of conservative management. All had small bowel fistulas with high output. In 2 patients definitive surgery was done in the form of repair of intestinal leak and by-pass of obstructed segment. In 2 cases laparotomy and peritoneal lavage was done. Primary repair was done in 2 patients for high output fistula but lead to anastomotic leak. They were re-explored and exteriorization of loop was done but both died due to sepsis. Two patients underwent surgery after 6 weeks of conservative management 1 due to peritonitis secondary to anastomotic leak and exteriorization of loop was done and other operated for intra-abdominal collection. One patient was operated after 10 weeks of conservative management but deteriorated despite of all measures. There were five deaths 3 after surgery and 2 without any intervention, both of them were outside referrals. The outcome of faecal fistula depends on a host of factors. We recommend proper timing of intervention for a good outcome

outcome of darning method of inguinal hernia repair using polypropylene in Sir Ganga Ram Hospital, Lahore

To valuate the darning method of inguinal hernia repair with polypropylene. 300 patients of unilateral inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by standard procedure using No.1 polypropylene. Patients were operated under, spinal or general anesthesia. Patients were followed up at one week, six weeks and six months after operation for wound healing and complications. Out of 300 patients, ranging in age from 20 to 70 years, 250 patients were given spinal anaesthesia, 45 patients [20%] were operated under local anesthesia. 196 patients were discharged from the hospital on the following day. 3 patients went into urinary retention and one patient had large haemotoma requiring exploration. Recurrence rate was 1% [n=3]. Darning method of inguinal repair with polypropylene is a safe and cheaper method of hernia repair

Reaven's quartet [metabolic syndrome X]: a potent predictor of coronary events

Reaven's syndrome of the deadly quartet [Metabolic Syndrome X] of risk factors for coronary artery disease continues to attract attention. Whether or not insulin is atherogenic and hyperinsulinemia is the major link in this association, it subserves the importance of identifying and treating patients with varying degrees of glucose intolerance. This study confirms the presence of an adverse risk factor profile, and a clustering of risk factors in diabetics. Out of a total of 400 patients with coronary artery disease diabetes was present in 40 patients, hypertension in 120 patients, hypercholestrolemia in 100 patients and obesity in 96 patients. But the incidence of hypertension, dislipidemia and obesity in diabetics ranged from 70% to 90%. A similar profile was seen in the patients with impaired glucose tolerance. This clustering of adverse risk factors suggest that is a common link accounting for this cluster

Focal motor epilepsy: a case report

From this case report it is clear that a pathological condition serious enough to produce focal fits, can yet be so small initially, that it can be missed by such sensitive diagnostic procedures as the EEG and carotid - angiography. Therefore, if one has strong suspicion that inspite of all investigations proving inconclusive, all is not well beneath the surface, perseverance and re-investigation will usually prove fruitful