Reconstruction of contracted eyelids: outcome of different procedures of surgery

To evaluate the different procedures of the reconstruction of post traumatic eyelids contractures with regards to the functional and cosmetic results. Descriptive case series. Department of Plastic and Reconstructive Surgery at Jinnah Post Graduate Medical Centre [JPMC] Karachi, from 2003 to 2008. All patients admitted with eyelids contractures were included. A detailed history was taken. Examination of eyes were done, which included visual acuity and near vision test. Test for tear formation, staining of the cornea for any ulcer or rupture of cornea due to injury, were also performed. Priority was given to vision restoration. Culture and sensitivity of discharge from eye, if any, was also done. Patients were subjected to different surgical procedures. There were total of 30 patients with 16 males and 14 females. The age of the patients ranged from 7 years to 58 years. Excision of lesion and primary closure was done in two patients [6.6%], rotation advancement flap in two [6.6%], release and medium thickness grafting in thirteen [43.3%], release and Wolfe grafting in eight patients [26.7%] and Z plasty in five [16.7%] cases. Medium thickness skin graft is preferred in up to [3/4th] loss of eyelid thickness and primary closure is appropriate where up to 25% loss is found

Acute cholecystitis of something else?

A retrospective analysis of the accuracy of clinical diagnosis of acute cholecystitis was carried out over a period of one year. Of 128 patients clinically diagnosed as having acute cholecystitis, 94 [72%] had the diagnosis confirmed by investigations. 24 patients had other diagnoses and in 12 patients no diagnosis could be found. 452 patients were admitted as emergencies during the trial period with an acute abdomen and none was considered to be acute cholecystitis on clinical grounds. Of these, 26 patients [5.7%] had acute cholecystitis as the final diagnosis after investigations. Acute cholecystitis can mimic and can in turn be mimicked by other conditions in sufficient numbers to justify careful investigations

Nonoperative management of retained common bile calculi with mono-octanoin

In six patients who had undergone cholecystectomy and choledochotomy with retained common bile duct calculi, mono-octanoin was infused at the rate of 1 to 4 ml per hour through the T-tube under manometric control. In five of six patients the calculi fragmented, diminished in size, and flushed out through the ampulla into the duodenum. In one patient, Dormia basket extraction of calculi through the T-tube tract was required. Postoperative mono-octanion infusion through the T-tube is a convenient and effective method to deal with retained common bile duct calculi rich in cholesterol