Typhoid perforation; primary closure vs ileostomy

Typhoid fever is an infectious disease caused by a bacterium salmonella typhi. The spread of infection is usually by an oro-fecal route. Food handlers are a major source of spread in developed countries. In undeveloped countries like ours, contamination of drinking water and edibles are the major source. Infected shellfish are occasionally a source of an outbreak. To review the present practice of managing patients with typhoid perforation and comparison between the primary closure and exteriorization. Surgical Unit-II, Nishtar Hospital, Multan. Two years. Sample size 50 patients. A total of 50 patients were finalized for the analysis. There were 14 females and 36 males [1:2.5]. The age ranged from 18 years to 35 years, the mean age was 28 years. In patient who underwent ileostomy, death occurred in 3 cases [10%]. Most of the patients belonged to low socioeconomic class. Delay in reaching the hospital was significant for several re asons including transportation and pretreatment at peripheral private hospitals. 46 patients presented after 48 hours of perforation [92%]. In cases with good reserves and earlier hospitalization primary repair is certainly the procedure of choice

"Sooner the better" it is true for peripheral vascular injury a study of 100 cases at Nishtar hospital, Multan

A descriptive study of 100 cases to compare the early intervention [within 6 hours] with late intervention in outcome of peripheral vascular injury conducted in Nishtar Hospital, Multan over a period of 2 years extending from December 2001 to December 2003. No age was found to be safe yet peak occurrence was noted in 21-40 years of age i.e. 66%. Out of 100 cases of peripheral vascular injuries 82 patients [82%] were male and 18 patients [18%] were male. Firearm injury was seen in 61 cases [61%] of peripheral vascular injury. Second common cause was road traffic accidents i.e. 25%. Most of the cases of peripheral vascular injury reached hospital within 6 hours. Cases of peripheral vascular injury from area were 70 [70%] whereas from urban areas only 30 [30%] cases were seen. Revascularization was restored within 6 hours in 50 patients and none of them required amputation. Forty-five reached hospital between 6-12 hours and 15 patients [33.3%] required amputation whereas 5 patients arrived hospital beyond 12 hours and 4 patients [80%] of them required amputation. All cases of peripheral vascular injuries should be surgically explored. Every effort should be made to achieve revascularization within 12 hours. Patients presenting late or with crush injury should undergo amputation

Layered closure versus mass closure a study of 50 cases at Nishtar hospital, Multan

A comparative study of 50 cases to compare the number of complications after layered closure with mass closure in major abdominal operation conducted in surgical Unit-II, Nishtar Hospital, Multan extending over a period of 3 years from January 2000 to January 2003. In group-A 17 [70%] were male and 8 [30%] were female. In group-B 16 [64%] were male and 9 [36%] were female. Age of the patients varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] were from elective operation and 17 [68%] from emergency. In group-A 6 [24%] had midline incision while 19 [76%] had paramedian incision. In grup-A clean wound wee 12 [48%] and clean contaminated were 13 [52%]. In group-B clean wounds were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patients with chest infection, 2 [8%] with hemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [8%], biliary tract 6 [245], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscence occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength

Comparison of incidence of injury of hollow viscus versus solid organs in blunt abdominal trauma

Fifty patients were chosen for this study who were between 13-50 years of age and had only abdominal injury; laparotomy was done in all the cases. Road side accident was the major cause in 48% patients of blunt abdominal trauma followed fall height, animal kicks, direct blow and fall of heavy objects. Most of the patients injured were males [82%]. Diagnosis was made on clinical grounds in 72% patients. Diagnostic peritoneal lavage was done in 38% cases. Its accuracy was 89.5%. Solid organs were injured more but intestine was the commonest organ [22%]. Reason for the slight disparity between the percentage of organ injury in this study and international studies is prolong transit time taken by the patients to reach the hospital. Average transit time was 18 hours. Since intestinal injuries were not immediately fatal whereas splenic and hepatic injuries were many times fatal before they reached the hospital; this explains the higher incidence of intestinal injuries in this region

Sooner the better: it is also true for perforated duodenal ulcer; a study of 100 cases at Nishtar hospital, Multan

A retrospective study of 100 cases to describe the effect of perforation on operation interval on the prognosis of perforated duodenal ulcer was conducted in surgical wards of Nishtar Hospital, Multan. An overall mortality of 16% in 100 patients who under went surgery. Mortality occurred only in group-B and C. Interval between perforation and operation increases the hospital stay like group-A patients stayed in hospital for 8 days, patients of group-B who stayed in hospital for 10 days, whereas stay of group-C patients was 23 days. Number of complications in patients presenting with delay were much more than in patients presenting early. Morbidity also rises with delay. Patients with perforated duodenal ulcers should be operated as soon as possible. Simple closure of perforation is simple and safe wit hrelatively low mortality and short stay in hospital

Mini-cholecystectomy versus standard cholecystectomy

Gall bladder diseases are very common and their established treatment is cholecystectomy. Removal of the gall bladder can be accomplished with less amount of trauma depending upon the approach to gall bladder area [laparoscopic, mini-cholecystectomy and conventional cholecystectomy]. Study included two hundred patients who were randomized after informed consent into two groups; group-I [100 patients] and group-II [100 patients] and they were respectively subjected to mini-cholecystectomy and standard cholecystectomy. Results showed same operative time with its added advantage of lower analgesic requirements, shorter hospital stay, and early return to work and reduced early and long term complications in patients who underwent mini-cholecystectomy as compared to standard cholecystectomy. In conclusion, mini-cholecystectomy is better alternative to standard cholecystectomy where laparoscopic facilities are not available because it does not need specialized training and costly equipment along with acquisition of new skill

Use of 12.5 mm poly venyl ethylene [Pve ] hose pipe as a traction stent for palliation of dysphagia in advanced/ inoperable carcinoma esophagus

From March 2000 to November 2003, 39 PVE funneled hose pipe pieces were inserted as esophageal stents in 27 males and 12 females with mean age of 60 years [range=42-82 years]. Average hospital stay was 7 days [range = 5-20 days]. Procedure related morbidity was 40% while mortality was 10.25%. There was little effect of age, sex, type and level of tumor on morbidity and mortality. In patients who could be discharged home, dysphagia score improved form average of 4.2 to 2.5. Average post procedural survival was 4.2 months. 7 [20%] patients required readmission for stent malfunction. Only five of them required a second procedure to re-establish the passage. Slipping of stent occurred in only one case where a second stent was inserted. Our technique for manufacturing and insertion of the stent is described. Review of literature and a discussion to support our practice is included. We conclude that although self expanding metallic stents are the current gold standard world wide for palliation of dysphagia due to advanced carcinoma of esophagus, a molded PVE stent can be used in place of conventional traction and pulsion tubes where affordability is a problem. Using the described technique a reliable relief of dysphagia with acceptable morbidity and mortality rates can be achieved

Diagnosis of deep vein thrombosis in the leg by using colour coded duplex sonography

Deep Vein Thrombosis [DVT] is regarded rare in Asia. There is no documentation of the incidence of DVT in Pakistan. Clinical diagnosis of Deep Vein Thrombosis is inaccurate. Venography is the most reliable method of diagnosis, but it has several disadvantages. Many noninvasive diagnostic methods have therefore been developed in the past decade. Of these only duplex sonography has comparable accuracy. We studied 100 cases of suspected DVT by using, color coded duplex sonography. We report the results of a prospective study in patients with suspected deep vein thrombosis evaluated by both color coded Doppler sonography and venography. We conclude that color coded duplex sonography is a highly accurate, simple, non-invasive method for detecting femoropopliteal thrombosis. Additional venography is not necessary. Its value in diagnosing isolated calf vein thrombosis remains to be established