Parenteral sulbactum and ampicillin in general surgery

Thirty six patients [24 males, 12 female; mean age 42 years] hospitalized to undergo incision and drainage for documented or suspected surgical infections were treated with a combination of sulbactam and ampicillin. Mean daily dose employed was 1.25 gm sulbactam and 2.5 gm ampicillin given intravenously for a mean treatment period of 10 days. A clinically satisfactory response [cured plus improved] was achieved in 78% of patients with a response rate of 100% in cases of non-perforated appendicitis, sepsis traumatic wound infections and cellulites. Ninety two percent of the pathogenic bacteria isolated from infecting sites in 11 patients, were found sensitive to sulbactam/ampicillin. Complete to partial elimination of bacteria was recorded at the end of study in 82% of these patients. The results of this study indicate that sulbactam/ampicillin is an effective and well tolerated agent for the treatment of surgical infections requiring parenteral antibiotic therapy

Empyema thoracis

A study of 54 cases of empyema thoracis is presented which were managed by the department of surgery at P.I.M.S. from January 1989 to June 1991. The males outnumbered females [74%] and 37 patients had right sided involvement [69%]. All the cases had established chronic empyema thoracis. 5 patients had associated broncho-pleural fistula. Surgery was performed in 48 cases including 24 decortications 9 pneumonectomies and 4 lobectomies. The results in operated cases have been encouraging

Closed mitral commissurotomy [CMC]

Like any other developing country, Rheumatic heart disease is one of the leading cardiovascular problems in Pakistan. Mitral valve is the most frequently affected valve and takes a more fulminant course than in the west. There are only three cardiac surgical centres dealing with cardiac problems, in Pakistan in a country of 120 million population. They are already overburdened and are unable to cope up with the large number of patients visting them. Therefore, cardiac patients presenting with pure mitral stenosis with pliable valve are being operated by closed mitral commissurotomy in general surgical units even without the facilities of cardiopulmonary bypass. An example of which exists in the surgical centre Islamabad, where four female patients who presented with pure mitral stenosis and had a past history of rheumatic fever, underwent this operation successfully. This article throws some light over the role of closed mitral commissurotomy in patients presenting with pure mitral stenosis and updates the anatomy, pathophysiology, echocardiographic feactures and medical and surgical management of mitral stenosis

Oesophagectomy with and without thoracotomy for carcinoma of oesophagus

Between January 1988 and Decemberi 1989, 70 patients with carcinoma of oesophagus were seen in the Department of Surgery [Thoracic Clinic]. Of these 70 patients, 30 had unresectable tumours and received radiotherapy. Remaining 40 patients were selected for surgery. A combination of radiotherapy and surgery was used in 6 patients and in 5 chemotherapy was added. The majority [75%] had squamous cell carcinoma and other [25%] had adenocarcinoma. 50 percent had lower oesophageal lesion, 25% had middle lesions, 12.5% had upper oesophageal lesions and 12.5% had lesions involving the cardia. Stage I was assessed in 7.5%, stage II in 15%, stage III in 27.5% and stage IV in 50%. Blunt oesophagectomy without thoracotomy was performed in 15 patients with carcinoma involving various levels of the oesophagus [5 cervicothoracic, 6 middle third and 4 distal third including cardia]. Oesophageal resection and reconstruction was performed in a single stage. The continuity of alimentary tract was restored by anastomosing cervical oesophagus to the stomach, which was positioned in the posterior mediastinum, in the original oesophageal bed. There were no deaths directly related to the technique of blunt oesophagectomy. Average intraoperative blood loss was 1250ml. Complications in these patients included pneumothorax [4], transient hoarseness [2], pleural effusion [2], anastomostic leak [2] and subphrenic abscess [1]. The 3 deaths were due to pneumonia [2] and pulmonary embolism [1]. In the remaining 25 patients, standard oesophagectomy with a thoracotomy was performed. A comparison of the results obtained with these two techniques of oesophagectomy was made. It was found that blunt oesophagectomy is safe and is far better tolerated physiologically than the combined transthoracic and abdominal operations

Emergency surgery of ruptured abdominal aortic aneurysm

A case review of ruptured abdominal aortic aneurysm is presented. The patient was admitted to the hospital for elective resection of the abdominal aotic aneurysm. While he was admitted, the aneurysm ruptured. This was diagnosed both on the clinical grounds and the serially falling haematocrit. An emergency operation was undertaken. The aortic and left iliac aneurysms were resected, with replacement by woven dacron bifurcated Y graft. Catastrophic backbleeding from the lumbar arteries was challenging. The ultimate outcome of operation was encouraging, except a small postoperative leak from the anastomosis with the right femoral artery, which was then dealt with successfully

Non-operative treatment of acute appendicitis

In this retrospective study, 300 patients of acute appendicitis treated conservatively are reviewed. Patients were seen in the emergency department and diagnosis was based upon history, physical findings, and investigations. All patients were admitted in the ward, had antibiotics [various regimens] and close clinical observation. 284 patients [95%] responded to conservative management. 6 patients needed emergency appendicectomy. 55 patients came with recurrence of symptoms in the follow up period. Out of these 55, only 18 patients needed appendicectomy. Finally the pathologic basis of the conservative treatment and results of this study are discussed