Resection of metatarsal head for treatment of resistant non ischaemic neuropathic diabetic foot ulcers: a prospective comparative study of 40 patients

The aim of my study is to assess the surgical technique of metatarsal head excision as an initial step in the treatment of non ischaemic neuropathic trophic foot ulcers of diabetic patients and to compare it with the non operative conservative treatment lines as regard rate of wound healing, postoperative complications and the development of new or recurrent ulcers and the incidence of major amputations during the period of the study. Forty diabetic patients with non ischaemic neuropathic foot ulcers were enrolled during this study. The patients were divided into 2 equal groups. All the patients were assessed clinically, full laboratory investigations, all had palpable peripheral pulses and clinically non infected trophic ulcers on the sole of the foot. Group A patients weod of 14.6 months which is statistically significantly less than group [B] patients at a percentage 33% with a mean fellow up period of 5 months. Metatarsal head excision for neuropathic diabetic foot ulcer would be advocated as a method of treatment as this technique is safe, facilitates closure of the lesion, helps to control infection and prevents countless and costly amputations

Randomized clinical trial of circumferential stapled anoplasty versus conventional hemorrhoidectomy: a prospective study of 42 patients

The present study was designed to compare stapled hemorrhoidectomy with Milligan -Morgan hemorrhoidectomy with regard to operating time, postoperative pain, hospital stay, early post operative complications, costs, time to return to normal working activities, and finally the late follow up results. Forty-two patients with symptomatic third-and fourth degree hemorrhoids were enrolled by my study at Ain-Shams University hospital between January 1999 and December 2000. All were subjected to thorough clinical examination, proctoscopy, sigmoidoscopy to exclude associated ano-rectal disorders and routine laboratory investigations. Patients were divided into 2 groups. Group A had Stapled hemorrhoidectomy and Group B had conventional Milligan Morgan open hemorrhoidectomy. Visual analogue pain score [VAS] was used to asses postoperative pain, at the time of first motion and daily until the end of the first week, operating time, hospital stay, any post operative complications were recorded a symptom severity score was used to follow up patients by the end of 6 months after treatment. In my study there was a non-significant difference in the mean age of patients between the 2 groups as well as in the clinical presentation and gender [P> 0.05] mean operating time was less for group A patient [P< 0.05]. Comparing the total pain scores [visual analogue score added to the composite pain score] for the 2 groups showed that the total pain score was statistically significant less for the stapled group [A] versus the open hemorrhoidectomy group B patients P = 0.003. Postoperative hospital stay was significantly less for group A patient range [0-3] days versus group [B] patients [range 0-12 days]. Group [A] patients resumed their normal working activity after a median of 5 [range 1-16] days compared to patients of group [B] after 13 days [range 3-25] days which is statistically different significantly [P = 0.04]- comparing the results of the two groups by the end of six-months depending on the symptom severity score, there was no statistically significant difference between the 2 groups with no records of staple line stenosis or anal strictures. Stapled hemorrhoidectomy is safe, effective, causes minimal pain, shorter hospital stay and earlier return to normal working activities in comparison to the open hemorrhoidectomy. This technique also costs the patients more money because of the cost of the device

Management of acute sigmoid volvulus; one stage versus two stages procedures

In a prospective comparative study, 14 patients [group A] with acute sigmoid volvulus had a primary resection of the redundant sigmoid colon with an immediate anastomosis after intraoperative colonic irrigation and 12 patients [group B] had conventional resection of the redundant sigmoid colon and double barrel colostomy in the left iliac fossa, followed by revision that was preceded by conventional bowel preparation. The results of this study suggested that the resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage was a safe procedure