Hand sepsis in patients with diabetes mellitus

To report on the clinical presentation and possible risk factors leading to hand sepsis, amputation, management, and outcome in diabetic patients presenting to a multidisciplinary diabetic center in Khartoum, Sudan. This is a retrospective descriptive study of all diabetic patients presenting with hand sepsis between September 2002 and March 2008 to Jabir Abueliz Diabetic Centre [JADC] in Khartoum, Sudan. A hundred and nineteen diabetic patients with hand sepsis were managed in JADC. The causative agent was unknown in 48.7%, and due to trauma in 42.9%. The most common presentation was cellulitis in 36.1% of patients and deep seated abscess in 29.5%. In 22.7% there was significant sensory neuropathy with loss of perception to 10 gm monofilament nylon. An associated foot ulcer was present in 13.4% of patients. One or more digits amputation was carried out in 17 [14.3%] of patients and hand amputation was unavoidable in 2 [1.7%]. Complete healing with good function was achieved in 79%. There was no mortality in this series. Hand sepsis in diabetics is a serious complication, but with early presentation to a specialized diabetic care facility, satisfactory outcome could be achieved

Major lower limb amputation in diabetics

Lower limb amputation is one of the most feared complication of diabetes mellitus. It is associated with a high mortality rate and a considerable loss of walking ability and independence among survivors. This study was set to review the indications and outcome of major lower extremity amputation [LEA]. This is a prospective hospital based study conducted in Khartoum Teaching Hospital and Jabir Abu El Iz Diabetic Centre [JADC] during the period of July 2002 to January 2003. Consecutive seventy diabetic patients who underwent major LEA during the study period were included. Their age ranged between 35-92 years with a mean age of 61 years +/- 12. The male to female ratio was 1.5:1. Ninety six percent [96%] had Type 2 diabetes mellitus. Fifty two patients [74%] had transtibial amputation and 18 [25%] had transfemoral amputation. The indications for major LEA were intractable sepsis in [80%], foot gangrene [44%] and extensive tissue loss [18%]. The most frequently encountered post-operative complication was wound infection in 11 patients [15.7%] followed by ischaemia of the stump in 6 patients [8.7%]. The rate of postoperative complications was significantly higher in patients who underwent transfemoral amputation. Transtibial is the main type of major lower extremity amputation. The most common indication of major LEA is intractable sepsis, followed by gangrene of the foot then various combinations of sepsis, gangrene and extensive tissue loss. Transfemoral amputation is associated with higher rates of complications, re-operation, delayed healing and mortality

Gastric cancer in Khartoum; presentation and management

Gastric cancer is a dreadful killer worldwide. There is enormous variation in the occurrence of the disease throughout the world. Only scarce data is available about the features and the prognosis of the disease in Africa. This study was conducted to determine clinicopathological characteristics, and the treatment outcome of patients with gastric malignancy in Sudan. A prospective descriptive study of 105 patients presented with gastric cancer over 2 year period in a general surgical unit in Khartoum Teaching Hospital [KTH]. The mean age at presentation was 57 years [range 23-78 years], and most of patients were males [80%]. The most frequent mode of presentation was epigastric pain [90%], loss of weight [90%] and anorexia [70%]. Upper gastric tumor location accounted for 42%. Histologically; carcinoma accounted for 100 cases, lymphoma in 3 and leiomyosarcoma in 2 cases. Adenocarcinoma was the most frequent [94%], well differentiated adenocarcinoma and intestinal type were also commonest varieties [31%] and [17%] respectively. Most of the patients had blood group O[+] [50%]. Palliative resection was attempted in 48 patients [45%] with a survival duration of 14 months compared with 5 month for those who had no resection [n=20]. Morbidity rate was significantly higher in the resection group compared with non-resection group, [18.8%] and [4.2%] respectively, while the mortality rate showed no difference, [15.9%] and [14.6%] respectively. Patients satisfaction was significantly better in the resection group. Gastric cancer is a disease affecting younger males presenting very late where palliative resection is an option in 45% of patients with satisfactory outcome and a mean of 14 months survival

Surgery for bullous lung disease: a case report

We present a patient with giant right apical bulla compressing the whole lung and multiple numeous small bullae in the rest of the middle and lower lobe. The patient presented with worsening shortness of breath, compromised pulmonary function tests and typical chest CT finding. She was managed successfully with right postero-lateral thoracotomy, excision of the giant bulla and pleurectomy. This case demonstrates that giant bullectomy and pleurectomy could produce significant and immediate functional improvement without complication

Presentations of agenesis of the hemidiaphragm in an adult

A 67-year-old man presented with chest tightness and vomiting of one-week duration. On physical examination bowel sounds were heard on the left chest. Plain chest x-ray, barium swallow, and CT scan suggested gastric volvulus with diaphragmatic hernia. At laparotomy there was complete agenesis of the left hemidiaphragm with no diaphragmatic remnants seen and no associated lung hypoplasia. This is an extremely rare condition and careful assessment is needed to differentiate between diaphragmatic hernia and agenesis of the diaphragm as more cases could be diagnosed in the future as a result of good perinatal care of agenesis of hemidiaphragm AHD and long term survival to adulthood

Anastomotic esophageal leak due to Taenia saginata following esophagectomy for esophageal cancer

A 50-year-old female with squamous cell carcinoma of the lower third of the esophagus underwent an esophagectomy via laparotomy and right thoracotomy. She developed a major anastomotic leak on the third postoperative day. The chest tube slipped out on the 10th postoperative day and a segment of Taenia saginata tapeworm came out through the tube drain site and was extracted. She was given praziquantel tablets treatment; after which the leakage dropped dramatically and ceased completely after one week. Patients scheduled for esophagectomy who experienced recurrent abdominal pain in areas endemic with a tapeworm need to be screened for taeniasis before surgery

large giant cell tumor of the sacrum. Advantage of an abdomino-sacral approach

We report a case of giant cell tumor of the sacrum, presenting with sacral pain, swelling, and change of bowel habits. Rectal examination revealed a huge retrorectal mass fixed to the sacrum but not to the wall of the rectum. Abdominal ultrasonography, computed tomography CT scan, and magnetic resonance imaging MRI showed a huge pelvic mass invading the sacrum. Exploration via posterior sacral approach was not successful due to both, extensive bleeding and difficult accessibility. Re-exploration was carried out 2 days later with the patient in lithotomy position. Using abdomino-sacral approach the mass together with part of the sacrum and the whole coccyx were excised. Histopathology reported giant cell tumor of the sacrum with no evidence of mitosis. The patient was symptomless 12 months after surgery and on follow up

Calculus within an anal fistula tract in a diabetic patient

A non-insulin dependent diabetic patient with a chronic anal fistula underwent fistulectomy. At operation a calculus was discovered. The patient had an uneventful recovery and healing of the wound in 4 weeks duration. The only case reported previously was in a nondiabetic patient and interestingly from this department