role of gastrografin in early prediction and management of adhesive small bowel obstruction

In adhesive small bowel obstruction [ASBO], the early recognition of complications and the optimal period of conservative treatment are essential. This study sought to determine whether oral gastrografin followed for 24 hours can be a reliable indicator of the need for operation and whether it has a therapeutic effect in cases of ASBO. Seventy-two patients who suffered from ASBO without clinical evidence of strangulation were randomized into a control group [32 patients], who were treated with conventional methods, and a gastrografin group [40 patients] who were treated with gastrografin administered orally or through the nasogastric tube. Serial plain abdominal X-rays were taken 4, 8, 16, 24 hours later. Subsequent X-rays were cancelled if an earlier X-ray showed gastrografin reaching the colon. The following variables were examined: time to resolution of obstruction, the need for operation, and hospital stay.In the gastrografin group, the contrast material reached the colon within 24 hours in 28 patients [70%]. These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the 1[st] 24 hours in 12 patients [30%], operation was performed in 10 of these patients. In the control group, 18 patients [56.25%] were treated successfully with non-operative method in the 1[st] 24 hours and 11 patients treated operatively later on. Mean timing of the 1[st] stool was 2.27 days in the control group and 0.81 days in the gastrografin group [p<0.005]. Mean hospital stay for the patients who respond to conservative treatment was 6.25 days and 3.1 days in the control and gastrografin groups respectively [p<0.005]. No gastrografin related complications were observed. Oral gastrografin significantly prompts the resolution of ASBO and shortens hospital stay. All patients with evidence of gastrografin reaching the colon within 24 hours were treated successfully with non-operative methods. Failure of gastrografin to reach the colon within 24 hours is an indication for prompt surgical intervention

Initial experience with lymphatic mapping for breast cancer

Sentinel node detection enables the definition of the most relevant draining lymph nodes of a tumor. The goal of this study was to evaluate technical feasibility of sentinel node detection in breast cancer and its predictivity of axillary node status. Twenty patients with early breast carcinoma were included in this study. Modified radical mastectomy was done for all patients. Lymphatic mapping procedures were performed by injection of patent blue dye in the peripheral portion of the tumor preoperatively .Sentinel lymph nodes were successfully identified in 17 of the 20 cases [85%] In the final histological examination, 15 [88.2%] of the 17 patients where sentinel nodes were identified, were histologically positive. The sentinel node was falsely negative in one case, yielding an accuracy of 94.1%. Sentinel node was the only site of metastases in 3 [20%] of 15 cases. Lymphatic mapping technique proved feasible, successful and the histology of the sentinel node can accurately predict the status of the remaining axillary lymph nodes

Subfascial endoscopic division of perforating veins in chronic venous insufficiency: a single port technique

Subfascial endoscopic perforator surgery [SEPS] is a minimally invasive procedure alternative to conventional techniques for incompetent calf perforators to minimize the high incidence of postoperative wound complications. This study was undertaken to assess the results of subfascial endoscopic perforator surgery [SEPS] in twenty patients, 16 males and 4 females, with chronic venous insufficiency [C.V.I] from December 1997 to February 1999. Ten patients [50%] were presented by active ulcers, four patients [20%] had recently healed ulcers and six patients [30%] with lipodermatosclerosis. We used a single port technique for clipping and division of medial perforating veins. Concomitant removal of the superficial veins was performed in twelve patients. The number of incompetent perforating veins interrupted endoscopically per leg ranged from 2 to 5 [a mean of 3.2] and operative time ranged between 40 to 80 minutes [average 52 minutes]. Complete ulcer healing occurred in eight of ten initially ulcerated limbs at a mean of 6 weeks post operative, while ulcer size decreased by at least 50% in two patients. In patients with healed ulcer and lipodermatosclerosis the pain and heaviness in the leg resolved or decreased significantly. In conclusion, subfascial endoscopic perforator surgery [SEPS] seems to be a safe technique with favorable early results

Hepatic ischaemia/reperfusion injury: effect of intermittent versus continuous hepatic pedicle clamping [experimental study]

Intraoperative bleeding is a major complication of liver surgery. Temporary occlusion of the hepatic inflow has been used to reduce intraoperalive bleeding, but the hepatic injury caused by reperfusion after ischaemia is still a problem. This study was conducted to evaluate the effect of intermittent and continuous hepatic pedicle clamping on free radical production, endothelial derived relaxing factor [nitric oxide], blood glutathione as well as hepatic enzyme, alanine aminotransferase [ALT]. Fifteen dogs were included in this study; 5 dogs were used as control, 5 dogs were subjected to continuous hepatic pedicle clamping [CHPC] to produce ischaemia for one hour and the last 5 dogs were subjected to the same period of ischaemia but through intermittent [4 cycles, of 15 minutes plus 15 minutes reperfusion in - between] hepatic pedicle clamping [IHPC]. The results showed that CHPC for 60 minutes produced a significant increase in lipid peroxides and liver enzyme ALT and a significant reduction in nitric oxide and glutathione, on the other hand, IHPC produced a significant increase in lipid peroxides, insignificant reduction in nitric oxide and glutathione and the leakage of liver enzyme was insignificantly increased, when compared to control group While IHPC produced a significant reduction in lipid peroxides and ALT, significant increase in NO and insignificant increase in total glutathione, when compared to [CHPC. So IHPC is less harmful to the liver especially when the duration of reperfusion between the four cycles of ischaemia is 15 minutes We can conclude that for a better postoperative hepatic surgery prognosis, intermittent hepatic pedicle clamping technique is recommended, a long duration of hepatic ischaemia is surgically required, to attenuate the free radical production and to reduce liver damage

Cholecystectomy with and without drainage

Drainage after cholecystectomy remains routine despite the lack of scientific supportive data. Now there are increasing reports omitting drainage of gall bladder bed, and showing lesser complications. In this study, 90 patients who had straight forward cholecystectomies for chronic calcular cholecystitis were studied in three groups using corrugated rubber drain, closed system drainage, and no drains. The incidence of both wound infection and chest infections was higher in the corrugated rubber drain group, less in closed system drainage group and lesser in non drainage group. The number of subhepatic collections detected was higher in patients who received a drain. The postoperative hospital stay was longer in the patients with drains. Results showed clear advantage of the undrained group over the other two groups. It was concluded from this study that the use of a drain after uncomplicated cholecystectomy serves no useful purpose and is potentially harmful