Bacteriological study of diabetic foot infection in Egypt

Foot infections are one of the major complications of diabetes mellitus and are a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. A prospective study of 75 patients with diabetic foot infections admitted to Al-Azhar university hospitals was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Overall, 40 [54%] patients had subcutaneous infections, 22 [29%] had infected superficial ulcers, seven [9%] had infected deep ulcers involving muscle tissue, and six [8%] patients had osteomyelitis. A total of 99 pathogens were isolated. Forty percent of patients had polymicrobial infection, 39 [52%] had single organism infections, and six [8%] had no growth. Gram-negative bacteria [67%] were more commonly isolated compared with Gram-positive bacteria [30%]. The three most frequently found Grampositive organisms were Staphylococcus aureus [10.2%], Streptococcus pyogenes [7.1%] and methicillin-resistant S. aureus [7.1%], and the most common Gram-negative organisms were Pseudomonas aeruginosa [19.4%], Klebsiella pneumoniae [15.3%], and Acinetobacter spp. [10.2%]. Vancomycin was found to be the most effective against Gram-positive bacteria, whereas imipenem and amikacin were most effective against Gram-negative bacteria on antibiotic testing. Forty percent of diabetic foot infections were polymicrobial. S. aureus and P. aeruginosa were the most common Gram-positive and Gram-negative organisms, respectively. This study helps us to choose empirical antibiotics for patients with diabetic foot infections

What to do for accessory breast tissue in the axilla?

Supernumerary nipples and breast tissue often are dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. It is currently recommended that all accessory breasts be removed surgically but complications following this procedure have been poorly documented. This prospective study was to determine the optimum management of axillary accessory breast tissue. A total of 25 patients, who presented with axillary accessory breasts were subjected for excision. There were 16 [64%] patients bilateral, 5 [20%] unilateral right and 4 [16%] patients unilateral left. Fifteen [60%] patients presented with cosmetic disfigurement while 5 [20%] patients presented with pain and discomfort the remaining 5 [20%] patients complaining of anxiety. The postoperative outcome shows wound infection in 2 [8%] patient, postoperative pain in 2 [8%] patient, seroma in one [4%] patient, bad scar in one [4%] patient and incomplete removal in one [4%] patient. The excised specimens included normal breast tissue in 20 [80%] women, fibrocystic disease in 2 [8%] women, duct ectasia in 2 [8%] women and fatty tissue in one [4%] women. In conclusion, accessory breast tissue in the axilla better removed surgically but can be associated with significant minor morbidity

Role of glyceryl trinitrate 0.2% ointment in the wound healing post open haemorrhoidectomy

Open haemorrhoidectomy may be associated with delayed wound healing which increase the postoperative pain and discomfort. This study assessed the effect of glyceryl trinitrate [GTN] 0.2% ointment on the wound healing after open haemorrhoidectomy. Sixty patients, 41 [68.3%] males and 19 [31.7%] females, aged between 25- 60 years [median 42 years] presented with symptomatic haemorrhoids included in this study. The patients divided into two groups; group I, 30 patients received the GTM ointment post open haemorrhoidectomy, and group II, 30 patients received no local medications postoperative. There were no statistically differences in sex, age, degree and number of haemorrhoids, duration of surgery and hospital stay. 13 patients of the GTN group showed complete epithelialization 3 weeks after surgery while only 6 patients showed this in the control group. There were no complications requiring stoppage of the ointment. GTN 0.2% ointment can be used post-open haemorrhoidectomy to accelerate the wound healing

Role of surgery for chronic groin pain by inguinal neurectomy

Inguinal nerve entrapment is a debilitating post operative problem. Fifty patients were treated for inguinal nerve entrapment including 26 men and 24 women with an average age of 45 +/- 14 years Most patients had inguinal hernia repairs or Pfannenstiel incisions. Mesh was found in 27% of patients. Symptoms included pain [100%] radiation of pain to the thigh and/or genital area [59%], and postural pain [59%]. Diagnosis was made by physical examination, postural maneuvering, and inguinal nerve block. Proximal nerve resection was followed by polyester ligature and absolute alcohol application to prevent neuromas. Eight percent of patients had minor complications. Total pain relief was attained in 72% of patients, partial relief in 25%, and no relief in 3%. Two patients complained of numbness postoperatively. Multifactorial analysis showed recurrent hernia repair as a significant predictive factor

Mini laparoscopic cholecystectomy: a better outcome

The outcomes after traditional laparoscopic cholecystectomy [LC; one 10 mm port, one 12 mm port and two 5 mm ports] and mini laparoscopic cholecystectomy [MLC; three 3mm ports and one 12mm port] for gall stone disease were compared. The study was a randomized, single blind trial comparing LC with MLC. The randomization period was from February 2003 to December 2004. Two groups of patients underwent the surgery, 48 underwent LC and 47 underwent MLC. Patients were randomized by means of a blind envelop system just before surgery. The groups were matched for age, sex and preoperative characteristics. Median [range] operating times for LC and MLC were similar 45 [20- 120] and 50[20-170] mm. respectively. Intraoperative and postoperative complication rates, the time for the patient to resume walking, eating and passing stools, and median hospital stay were the same in the two groups. The level of post operative pain was lower in the MLC group at 1 h, 3h, 6h, 12h and 24h. Patients who had MLC received fewer injections of analgesic [p=0.036] and more patients in this group expressed satisfaction with the cosmetic result [p= 0.001]. MLC took a similar time to perform and caused less postoperative pain than the standard laparoscopic procedure. Reducing the port size further enhanced the advantages of laparoscopic over open cholecystectomy

cutting seton technique for management of high perianal fistula

Seton technique have been used for treatment of high perianal fistula for thousands of years with successful results. This prospective study reports the results of the cutting seton technique in addition to distal fistulotomy for treatment of high perianal fistula. Twenty two patients, 17 [77.3%] males and 5 [22.7%] females, aged between 20 and 57 years [median 35.5 years] presented with high perianal fistula included in this study. While the patients in the lithotomy position, injection of methylene blue followed by probing was done, care was taken not to do false passage. Subcutaneous track was bayed open till anal sphincter complex, the anoderm and the mucosa overlying the fistula was incised, 2 Nylon No 1 sutures were passed through the fistula and tied over the sphincter complex. The ties were tightened every two weeks in outpatient clinic postoperatively. Thirteen [65%] patients had a normal postoperative continence but 7 patients [35%] had postoperative incontinence [4 patients [20%] incontinent for gases, 2 patients [10%] incontinent for liquid stool and one patient [5%] incontinent for solid stool]. Six patients had been completely recovered and one had permanent incontinence. All fistulae were healed from 10 to 20 weeks [median 14 weeks]. There were two fistulae recurrence during the study period, one was treated successfully by the same procedure