Comparative study of efficacy of continuous versus partial interrupted method of midline laparotomy wound closure for contaminated cases of typhoid perforation

Background: The controversy exists in the literature about the best method of midline suturing in contaminated cases like typhoid, tuberculosis and old traumatic intestinal perforations

Objective: To compare the laparotomy wound closure techniques in contaminated cases of typhoid perforation regarding burst abdomen and wound dehiscence

Methodology: This was randomized control type of study in which all the patients fulfilling inclusion criteria were included. This study was conducted in surgical ward of Bahawal Victoria Hospital Bahawal Pur. The cases with minimal peritoneal contamination, planned laparotomies for benign abdominal lesions/ tumours and simple, non contaminated laparotomies were excluded from this study. All the cases were initially received in the general surgical emergency department and later referred for surgical consultation. A detailed history and clinical examination was conducted by two general surgeons. All the included patients had an acute presentation and required immediate intervention. The data was noted on a proforma. All included patients were divided in two groups; A and B. Patients of both groups were equal in number i.e fifty patients in each group. Patients of group A underwent continuous method of closure and patients of group B underwent interrupted closure. Outcome parameters included were time required for closure and postoperative wound dehiscence

Results: Regarding the results of study the difference in wound dehiscence was significant [ p<0.05] between the two groups, group A, 22% and group B, 4%. Results about time required for closure found less than 30 minutes 92% in group A and 62% in group B, the difference was statistically insignificant [p >0.05]

Conclusion: Continuous method has advantage of being faster and time saving but in regarding the wound dehiscence in contaminated cases it was found that more patients, with continous closure has dehiscence

Comparison of stapled versus Milligan Morgan hemorrhoidectomy in hemorrhoids surgery

Background: Hemorrhoids are very widespread disease that cause pain by thrombosis, fear by bleeding and be a burden by pruritus

Objective: To compare the outcome in terms of bleeding, hospital stay, post operative pain and fecal incontinence among patients with 3[rd] and 4[th] degree hemorrhoids after stapled and Milligan Morgan techniques

Methodology: Study design: Quasist Expermintal study. Setting: Surgical unit-II Bahawal Victoria Hospital Bahawalpur. Study duration: From 1[st] June 2008 to 30[th] April 2009. Study Subject: 60 patients of 3[rd] and 4[th] degree hemorrhoids were included in this study and were divided in two groups A and B having 30 patients each. Patients of group A were treated by stapled and group B were treated by Milligan Morgan technique. Patient were followed up for 24 to 72 hours after operation and then weekly for two weeks on outdoor basis for assessment of outcome variables as relief of symptoms and development of complication. The data was entered and analyzed by SPSS version 10

Results: After treatment 28 [93%] patients of group A and 15 [50%] of group B has got relief from bleeding and other symptoms. 18 [60%] patients of stapled techniques group had hospital stay of 2 or <2 days. Only two [7%] patients of group A developed postoperative hemorrhage and a ligation of spurting vessel done, but 12 [40%] patients of the group B were found with post operative bleeding and intervention was done. Post operative pain requiring analgesia developed in 10 [33%] patients of group A and in 17 [56%] patients of group B. No. patients of any group developed fecal incontinence after treatment

Conclusion: Stapled hemorrhoidectomy has given very good results in relief of symptoms. Stapling technique can also result in severe pain, bleeding, fecal incontinence and other complications, but the chances of complications are less. Due to good relief of symptoms and less complications stapling technique should be the treatment of choice

Depression in medical in-patients

This study was conducted to detect the prevalence of depression in medical inpatients staying for more than one week in the hospital and to assess the possible role of depression in prolonging the stay of the patients in the hospital. Two hundred and ninety eight patients with over a week stay in the hospital were screened for probable depression during three months with Hospital Anxiety and Depression Scale [Depression Subscale] and consequently they were assessed by two psychiatrists twice at 1 week interval with clinical interview and Hamilton Depression Rating Scale. Final diagnosis was made by using the ICD-30 diagnostic criteria. Depression in some form was detected in 39.26% of the total patients including major depression in 9.73% of the total patients. The hospital stay of the patients showed significant relation with depression. The substantial prevalence of depression with its significant association with longer hospital stay in medical inpatients requires greater cognizance and attention by simple screening instruments like HADS and subsequent liaison with the psychiatrist in selected cases for its appropriate management. This may help in improving the patient's physical and psychological health and reducing the hospital stay and costs. Future sound methodological studies are needed to explore the possible therapeutic and economic benefits of screening the patients in the medical wards for depression

Effects of instant smoking on cardiovascular parameters in non smokers

Tobacco smoke is a dangerous substance with more than 200 known poisons. Every time a young smoker lights up his cigarette he is being injured to some degree by inhaling these poisons. In present study comparison was made on cardiovascular parameters between regularly smoking and non-smoking students during and after the cigarette smoking

Effect of aspirin on vaso active substances of cardiovascular tissues of rabbit

Aspirin has been used in several diseases [Saeed and Suria, 1984] including inflammatory conditions of cardiovascular system [Eadie, 1983]. The primary mode of action of aspirin is very well established through prostaglandins. In this presentation the action of aspirin has been evaluated on the quantities of vasoactive substances like catecholamines, 5-HT and histamine in cardiovascular tissues of rabbit by fluorimetry. The role of these substances in producing inflammatory conditions is very well documented. Significant reduction of the above mentioned vasoactive substances is observed in some cardiac tissues and blood vessels after the week long oral administration of aspirin