Management of oesophageal leak and perforation by temporary metallic stents: a local experience

Seven patients with oesophageal perforation were studied. Three patients were due to anastomotic leakage in the right chest following oesophagogastrectomy for carcinoma. Two patients following injection scierotherapy for oesophageal varcices. A child following extraction of a foreign body by a rigid scope, and one patient following dilatation of a benign oesophageal stricture. In all patients, the metallic stent insertion stopped the leakage and healed the rent. There were no major complications and one patient with carcinoma died 2 weeks later from an unrelated cause

risk factors for development of a diabetic foot in asymptomatic diabetics

Neuropathy, ischaemia and foot deformities are the main predisposing factors for development of a diabetic foot. Screening asymptomatic diabetics may reveal early preventable predisposing factors of foot ulceration. One hundred diabetics presenting to Jabir Abu Eliz Diabetic Centre [JADC] for routine follow up at the medical clinic were studied. The feet were examined for neuropathy, ischaemia and deformities. Patients were educated about the significance of these findings and were instructed about foot care and wear as required. The mean age was 55 +/- 12 yrs and M:F ratio was 1:2. Sixty percent of patients had diabetes over 10 yrs and 90% were Type II Diabetes mellitus. Sixteen percent of patients had relative lower limb ischaemia as shown by an ankle/brachial index [A:B index <0.9] and 50% had sensory neuropathy. More than 50% had foot deformities. There are significant findings in asymptomatic diabetics related to the development of the diabetic foot. All patients attending a diabetic clinic should be screened for predisposing factors leading to the development of the diabetic foot and counseled. It remains to be seen how future follow up will results in better care and outcome in those patients

Acute gangrene of the hand following accidental intra-arterial injection of phenergan

this is a report of 4 cases of gangrene of the hand following the accidental intra-arterial injection of phenergan. Patients and in three of the patients, the phenergan was given as an anti-emetic for vomiting accompanying malaria. In the fourth patient, it was given as a sedative for a psychiatric patient having a violent episode. in three of the patients who were alert at the time of the injection there was immediate burning sensation at the injection site down the forearm, pain in the hand, and numbness and tingling. In the fourth patient, who was less alert, there was an uncomfortable sensation in the forearm and hand. Two of the patients required amputation at the distal forearm. One patient required amputation at the interphalangeal joint. The fourth patient required amputation at the terminal phalanx of the index finger. Conclusions: inadvertent intra-arterial injection of phenergan is associated with severe complications