The changing survival scenario in gangrenous sigmoid volvulus: a four-decade study.

There is a suspicion that mortality in gangrenous sigmoid volvulus has considerably declined over the recent years. This study was aimed to assess if this is a genuine trend, applicable to the patients, of this study too, and to identify factors responsible for the change, if any. Seventy-eight patients operated for gangrenous sigmoid volvulus, in the last four decades of the just gone century, were analysed. Nine clinical parameters were studied to identify factors responsible for mortality and to see if there was a change in clinical presentation in the later decades. Mortality in the 4 studied decades varied between 15.4% and 65%. Differences were significant (p<0.05) only between the decades of the seventies and eighties and between bunched pre 1980 (48%) and post 1980 (20%) decades. A sea change in survival scene occurred at the end of the decade of the seventies. The change was not accompanied by a concomitant improvement in clinical presentation (p>0.05). Two facts which could explain improved survivals in the post. 1980 period were, the increased recognition of gangrene extending beyond the area of constriction and improved survival after primary anastomoses (p<0.05). These indicated a more accurate assessment of viability and the distance between the cut bowel ends, a stricter selection of cases for primary anastomosis and using Hartmann operation in doubtful situations. Mortality in gangrenous sigmoid volvulus, without knotting in the Indian population has genuinely declined from over 50% in an earlier time to 20% in the later 20 years of the last century, the watershed in the changed scenario being the year 1980.

Histamine and mast cell study in the gastric tissue of south Indian patients suffering from duodenal ulcer with pyloric stenosis.

Patients undergoing surgery for pyloric stenosis secondary to duodenal ulcer were the subjects for the study. Two pieces of full thickness gastric wall (all coats) were obtained at laparotomy. The pieces were immediately split into two halves. One of these was used for histamine assay where as the other was used to study the mast cell population. Histamine content and mast cell population was found to be less in gastric mucosa of our patients as compared to values from normal human gastric mucosa. There was lack of correlation between mast cell population and histamine content which suggests that there could be some other storage sites for histamine.