Typhoid perforation still a common problem: situation in Pakistan in comparison to other countries of low human development

The objective of this study was to analyze the present situation of typhoid perforation and the factors behind the still common occurrence of the disease in our country. The study was conducted with the collection and retrospective analysis of the data of typhoid perforation treated in surgical unit III of Nishtar Hospital, Multan from January 1998 to September 2000. All the patients were received and operated upon in emergency ward of the hospital, after initial resuscitation as necessary investigation. Primary closure of perforation or primary exteriozation as loop ileostomy were the surgical options adopted. Among 31 patients, 25 were male and 7 female, with a male to female ratio of 3.57:1. Majority of patients were 15-30 years of age. Twenty six [81.25%] were from remote rural areas while only 6 [18.75%] were city dwellers. One patient expired before operation and 30 underwent exploratory laparotomy. Overall expiry rate was 12.5%. Wound infection and burst abdomen were the major post operative complications responsible for prolonged hospital stay. The factors leading to occurrence of typhoid perforation were identified as, lack of civic facilities like clean drinking water and sewage disposal, poverty, poor yield of primary health care system causing a delay in diagnosis and atypical presentation of typhoid and perforation due to the emergence of multi drug resistant strains of salmonella typhae. The results of the study were similar to those of Indian studies but better than African studies.The situation warrants attention of health care providers and policy makers

Surgical intervention in acute limb ischaemia-two year experience in a surgical unit of Nishtar Hospital, Multan

This study was done to see the possibility of salvage of limb, by surgical intervention from the time of presentation after acute vascular occlusion. Fourteen patients were dealt with, suffering from acute limb ischaemia during 1st two years 1996-97 in surgical unit-ll. Limb salvage by surgical intervention in 14 patients in surgical unit-ll, Nishtar Hospital, Multan. Thromboembolism, fogarty catheter. Fourteen patients were admitted in emergency, in 2nd Surgical unit during 1996-97 with acute limb ischaemia, 11 [78.57%] were male and 3 [21.43%] were female. Majority of them were above the age of 40years. Operation was performed urgently in emergency theatre in all of them. Atheroembolectomy was done in all the patients. In one patient [7.1%], vein patch angioplasty was done. Fasciotomy was performed in 7 [50%] patients. In 2 [14.2%] patients, above knee amputation had to be done and in 1 [7.1%] gangrenous toes were amputated. Best results can be achieved only when the patient is diagnosed properly and immediately transported to the referral hospital. Proper equipment and all the possible sophisticated technical facilities should be available. Multi-disciplinary teams including vascular surgeon, vascular radiologist, cardiologist and general physicians should be available. All medical practitioners [not only the surgeons] should be informed about the acute limb ischaemia, importance of early and correct diagnosis as well as the critical time for referring the patient to proper hospital