Comparison between the diagnostic values of serum inflammatory markers, interleukin-6 and C-reactive protein in detection the severity of acute appendicitis

The aim of this study was to compare the diagnostic values of serum inflammatory markers, C-reactive protein [CRP] and interleukin-6 [IL-6] in detection the severity of acute appendicitis. This is a prospective study from December 2008 to March 2009 included all patients who had appendectomy in Department of Surgery. Al-Kindy Teaching Hospital - Baghdad/ Iraq. Serum for estimating levels of C-reactive protein [CRP] and interleukin-6 [IL-6] was taken pre-operatively. Depending on the macroscopic evidence during the operation and the histopathological examination of the specimens, the patients were separated into 3 groups, group one with negative appendectomy [normal appendix], group two with non-complicated acute appendicitis [catarrhal, suppurative], and group three with complicated acute appendicitis [perforated, angrenous]. The histopathological results were correlated with CRP and IL-6 values statistically. A total number of 50 patients were included in this study, 28 males [56%] and 22 females [44%]. The mean age was 23 years [ranged from 7 to 50]. On the macroscopic evidence during the operation and the histopathological examination of the specimen, there were 7 patients [14%] in group one, 29 patients [58%] in group two, and 14 patients [285] in group three. Serum IL-16 and CRP values gave true negative results in 6% and 10% respectively, true positive results in 82% and 32% respectively, false negative results in 82% and 32% respectively, and false positive results in 8% and 4% respectively. Therefore, in the present study the sensitivity, specificity, and accuracy of serum IL-6 were calculated as 95.34%, 42.85%, and 88% respectively, and the sensitivity, specificity, and accuracy of CRP values were calculated as 37.20%, 77.42%, and 62% respectively. Laboratory results should be considered to be integrated within the clinical assessment. If used critically, CRP and IL-6 can provide surgeons with complementary information in discerning the necessity for urgent operation

modification of the Paul-Mikulicz procedure in the surgical treatment of sigmoid colon volvulus

A modification of the classical Paul-Mikulicz procedure has been used in the emergency surgical treatment of sigmoid volvulus in number of cases at Al Kindy Hospital in Baghdad, Iraq. These cases are presented in order to demonstrate the advantages of this modification among other surgical approaches for volvulus. This prospectie study was conducted at Al Kindy Teaching Hospital in Baghdad, Iraq between December 2000 and January 2004. The modification consistis of fashioning the colostomy by suturing the adjacent mucosa of the two limbs together without placing sutures in between the deepest, approximated, antimesenteric borders. Final closure of this colostomy was similar to that of loop colostomy closure. All the colostomies were closed intra-peritoneally. This modification was used in eleven patients with sigmoid volvulus who required emergency surgical interference, five females [45.45%] and six males [54.54%] with a median age 58 years [range 48-65]. Only one patient [9.09%] developed wound infection and another patients [9.09%] developed a mild degree of colostomy retraction. All patients underwent colostomy closure six weeks later with uneventful recovery. This modification has been used successfully in the emergency surgical treatment of sigmoid volvulus in this series

Evaluation of the risk factors in abdominal wounds dehiscence

Postoperative abdominal wound dehiscence is still a great surgical problem. Though it is not very common, but may cause a serious complication leading to death. To evaluate risk factors associated with postoperative abdominal wound dehiscence. Thirty-seven patients, 25 males and 12 females, with postoperative abdominal wound deniscence [burst abdomen] were identified during the period from Jan.2000-Dec.2002. On evaluation of these cases we stressed on the associated risk factors that might participate in the development of such complication, these are [1] Hypoalbuminemia [2] Anemia [3] Malnutrition [4] Chronic lung disease [5] Emergency surgery [6] Surgeon's experience [7] Repeated vomiting [8] Prolonged intestinal paralysis [ileus]. [9] Repeated urinary retention [10] Increased coughing [11] Local wound infection. We grouped the patients accordingly to the number of risk factors. Group [1] with no risk factor, group [2] with one risk factor, group [3] with two risk factors, group [4] with three risk factors, and group [5] with four or more risk factors. The majority of patients had one or more of risk factors. Two patients 5.4% with one risk factor, five patients 13.5% with two risk factors, nine patients 24.35% with three risk factors, twenty patients 54.05% had four or more risk factors and one patient 2.7% had no risk factors. No statistical differences in the increased tendency to postoperative abdominal wound dehiscence with the increased number of risk factors among the first three groups, but group four with the 3 risk factors was significally different [P value< 0.01], the same applied for group five too. No differences in the approach of the operation, whether median or Para median incisions, were related to the development of burst abdomen. The majority of burst abdomens were noticed to follow emergency operations 86.5% as opposed to cold operations 13.5%. Special attention should be paid for patients who had, at least, three risk factors for the development of burst abdomen; such patients should be considered for non-absorbable tension suture