Spaghetti wrist: management and outcome

To determine the outcome of emergency management of the spaghetti wrist. Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003. Patients and During this period, all patients of more than 12 years, with sharp clean cut volar forearm lacerations [spaghetti wrist] of <6 hours were included, with a follow-up of one year, clinically and with nerve conduction studies, where appropriate. Sensory and motor recovery was evaluated according to S0-S4 and MRC [medical research council] scale respectively. The power of first dorsal interosseous and adductor pollicis was used to monitor the recovery of ulnar nerve; and abductor pollicis brevis and opponens pollicis for the median nerve. The tendon recovery was evaluated by Strickland Adjusted System Score. This study comprised of 10 patients [M:F, 4:1], of 14 to 38 years [mean 22.9 years]. Injury was accidental in 70%; due to broken glass in 50% and kite string in 40%; involving right hand in 70%. 8.2 [4-12] structures per patient were involved. The injury involved median nerve in 70%, ulnar nerve in 60%, [30% had both nerves involved], flexor carpi ulnaris in 70%. There was predilection of injury for medial structures. In 80%, wrist flexors were involved, and all wrist joints recovered to the full range of movements and power. The ulnar nerve showed less total motor and sensory recovery than median nerve. However, sensory and motor recovery was good. Overall functional results were good and did not correlate with neurophysiological studies. Immediate primary repair is safe and has good outcome, which also depends upon good physiotherapy, close follow-up and patients compliance. Overall clinical and functional assessment is more appropriate than series of individual observations and neurophysiological studies

Amebic liver abscess: clinical presentation and diagnostic difficulties

To identify the symptoms and signs of amebic liver abscess [ALA] in our population in order to establish early diagnosis. Subjects and A prospective study was conducted in the Department of Surgery, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan, during the year 2000 to 2002 [2 1/2 years]. All patients with a confirmed diagnosis of A L A during this period were included in the study. The detailed history and relevant clinical data including investigations and daily progress were recorded on proforma, later analyzed and compared with other studies. Fifty-three patients with ALA, accounting for 0.5% of yearly hospital admission were included in this study. The age ranged from 10 to 60 years [mean 29 years]. The male to female ratio was 2.8 to 1. Upper abdominal pain occurred in 90%, right upper abdominal quadrant pain in 70%, radiation to tip of right shoulder in 10%, fever in 85%, co-incident diarrhea in 7.5% and concurrent pulmonary symptoms in 26%. The most common signs were tender hepatomegaly in 79%, and jaundice in 20.7%. Abscess ruptured in 3.8% due to delayed diagnosis, and ruptured despite treatment in another 3.8%. Diagnosis was missed in 28% of the patients particularly those with atypical presentations. Ultrasonography [US] was useful in diagnosing ALA. A L A has a highly variable presentation. Clinical diagnosis is difficult. Delayed diagnosis may result in rupture of abscesses. High index of clinical suspicion combined with US of abdomen is helpful in reaching an early diagnosis