Our experience in diabetic foot management

Diabetic foot constitues major surgical hospitalization among diabetics. This is also responsible for majority of non-traumatic lower limb amputations. Eighty one diabetic patients, with foot complications were admitted in Surgical Department of El-Thoura Teaching Hospital in a period of one year [from January to December 2010]. This is a retrospective analysis of diabetic foot patients. The mean age of the patients, was 56 years [varying from 29 to 73 years]; with male to female ratio of 1.9:1. The duration of diabetes in these patients ranged from 4 to 21 years. The overall amputation rate was 33.3%; of which, minor amputations were 28.3% and major amputations were 4.9% [above or below knee amputations]. Poor health awareness, elderly age, male prepondarance apart from inadequate facilities in our environment, were the most common risk factors, which were responsible for amputations in our study

Association of ano-rectal inflammatory bowel diseases with cases of fistula-in-ano-[a cross sectional hospital based study] at Al Thora Hospital, Al Beida

Incidence of Inflammatory bowel diseases at Libya is 0.9 to 3.6 / 100 000 population as per 2006 study. And extrapolated prevalence of Inflammatory bowel diseases at Libya is 11, 263 / 5.631.585 [1] Inflammatory bowel disease mainly constitute Crohn's disease, Ulcerative colitis, Intermediate colitis, and pouchitis. Perianal pathological problems are fairly frequent manifestation of Inflammatory bowel diseases. A study has been carried out at Al Thora Hospital, Al Beida, in last 5 years, from Jan 2005 to Dec 2009; about the association of ano-rectal Inflammatory bowel diseases with cases of fistula-in-ano

Surgical procedures for abdominal hydatid cyst: a mini-review

Hydatid disease [HD] may occur in any intra-abdominal organ and the liver is the most frequently involved. Surgery is the treatment choice for this disease. A retrospective study of 95 patients [64 female and 31 male, aged 5 to 82 years] with intra-abdominal HD. Eighty eight patients were symptomatic and the remaining seven asymptomatic. HD diagnosis was accomplished with laboratory tests, imaging techniques and serological tests. All of our material underwent surgical treatment, 61 patients by endocystectomy with drainage of the remaining cavity [by external tube or marscipulization], 23 by endocystectomy with obliteration of the remaining cavity [by omentoplasty or capitonnage] and 11 patients by cystectomy or organectomy [splenectomy, nephroectomy, cholecystectomy or cyst excision]. The morbidity rates were higher in drainage techniques compared with obliteration techniques or cystectomy [24.21%, 5.4% and 1.1 respectively]. Infections of the remaining cavity was the most common complications in 11 [11.6%] patients, followed by prolonged externqal drainage 7 [7.4%], biliary discharge 4 [4.2%] and recurrence 2 [2.1%] [table2]. Over all mortality rate 3.6%, represented by 3 patients died in our study, 2 of them due to septicaemia and one patient due to pulmonary embolism. Cysectomy and obliterating of the remaninig cavity [omentoplast and capitonnage] techniques could be advised for uncomplicated hydatid disease

brief discussion complications of thyroid surgery at El-Thoura teaching hospital

As every operation, thyroid surgery carries risk to complications, which may transient or permanent Objective of this study was to explore our expereince in thyroidectomy performed for seventy nine patients in General Surgical Departmen of El-Thoura Central Teaching Hospital El-beida, Libya, for a peroid of two years [from May 2003 to April 2005]. Twenty eight [35.4%] patients of them operated by lobo-isthmoectomy, 39 149.4%] sub-total thyroidectomy, 6 [7.6%] near total thyroidectomy, 4 15.1%] total thyroidectomy and the remaining 2 [2. 5%] patients by enculation of simple cyst Post-operatively; reccurent laryngeal nerve [RLN] injury and hypoparathyroidism were transient for a few months and were not common [3.6% and 2.5% respectively]. Wound infection occurred in two [2.5%] cases and hypothyrodism in one [1.3%] case. Severe primary heamorrhage was not developed in our material. Complications of thyroid surgery are fear to patient and surgeon; can be prevented or minimized when the surgery performed under optimal condition by an experienced hand surgeon with meticulous surgical techniques

Risk factors of appendicular perforation in El-Thoura hospital, El-Bieda-Libya

Retrospective study for patients who underwent appendectomy, for appendicitis in El-Thoura Teaching Hospital, EL-beida-Libya. between January to October 2005 to evaluate the affect of the age, and duration of the symptoms on appendicular perforation. A total of 176 patients; 100[57%] males and 76[43%] females with age ranged from 2 to 60 years [mean 22.7 years], presented with right iliac fossa [RIF] pain [100%], anorexia [86.9%], nausea [85.8%] and vomiting [61.9%]. RIF tenderness in [100%]and abdominal rigidity in [55.7%] of patients. Overall appendicular perforation rate was [18.8%] and tend to be higher in children less than 10 years and in adults above 50 years. also perforation rate increase with increasing time interval from onset of the symptoms to time of the operation. The age, late presentation and delay in time of operation are the most risk factors for appendicular perforation

Is a carotid artery stenosis effect on cerebro vascular reactivity

To assess the effect of carotid artery stenosis on cerebrovascular reactivity. A transcranial Doppler [TCD] velocimeter was used to measure middle cerebral artery blood flow velocity [Vmca] at rest and during breath holding bilaterally in 10 controls, in 14 patients with unilateral high grade [>75%] internal carotid artery [ICA] stenosis and in 10 patients with ICA occlusion. Breath holding index [B HI], calculated as the rate increase of the Vmca during breath holding, was taken as a measure of autoregulative reserve. There was shown a highly significant difference of BFII between the control group [40 +/- 6%] and stenosis group [17 +/- 5%] [p< 0.005] as well as between the control group and occlusion group [9 +/- 6%] [p< 0.001]. With TCD breath holding test, it is possible to identify patients with carotid lesions, who have decreased auto-regulative reserve

study of secondary bacterial peritonitis in El-Thoura Teaching Hospital-Albeida Libya

Secondary bacterial peritonitis [SBP] is one of the common surgical emergencies in the world [1,2]. Purpose of the present study was to establish the common cause of SBP in our environment. Prospectively; we studied ninety patients [age: 3 to 63 years] admitted to El-Thoura Teaching Hospital; Al-Beida- Libya, in the period from January to December 2005. Perforated appendicitis was found in 31 [34.4%], followed by; perforated peptic ulcer 25 [27%], acute pancreatitis 9 [10%], acute cholecystitis with peritonitis 8 [8.8%],small bowel perforations 8 [8.8%] [3 cases trauma, 2 ischemia, 2 Crohns disease and one case typhoid perforation], large bowel perforations 6 [6.6%] [3 cases trauma, 2 diverticulitis perforation, one case tumor]. We found that perforated acute appendicitis followed by peptic ulcer perforation is the most common cause of peritonitis in our environment. On other hand; this study abdominal trauma is the main cause of bowel perforation in our environment