Congenital duodenal obstruction

Background/ Purpose: Congenital duodenal obstruction is a frequent cause of intestinal obstruction in the newborn. This study aimed to analyze various factors affecting the outcome of these cases at our institution

Materials and Methods: Seventy one cases of congenital duodenal obstruction were included in this retrospective review. Each case was studied as regard to: age at presentation, gestaional age, clinical data, other associated congenital anomalies, cause of obstruction, management, and outcome. Patients with abdominal wall defects [omphalocoele, gastroschisis] and diaphragmatic hernias were excluded from the study

Results: The causes of duodenal obstruction were: duodenal atresia [n= 37], duodenal diaphragm [n= 12], malrotation [n= 14], and annular pancreas [n= 8]. Age ranged from 2 days to 24 months. Bilious vomiting was the main presenting symptom. Plain radiography was the most valuable diagnostic tool in all cases except malrotation and partial obstruction. Gastrointestinal [GIT] contrast study was very valuable in that later group. Overall mortality was 15 cases [21.1 %]. The causes of deaths were: prolonged gastric stasis and neonatal sepsis[n= 7], other associated cardiac anomalies [n=5], and extensive bowel gangrene due to neglected volvulus neonatorum[n= 3]

Conclusion: This study showed that [1] the diagnosis of congenital duodenal obstruction is still delayed in many patients referred to our institutions.[2] early postoperative survival is still far from ideal ; [3] the mortality is related to delayed presentation, associated cardiac defects, and prolonged gastric stasis; and [4] late complications are more common than previously expected

Local and systemic effects of plain and antibiotic impregnated anterior nasal pack

Seventy two patients with anterior nasal packs were studied clinically, radiologically and microbiologicall. Twenty four patients had their packs impregnated with antibiotic ointment; 24 patients had systemic ampicillin as prophylactic antibiotic and 24 patients had no local or systemic antibiotic. Systemic antibiotic did not change the incidence of postoperative infection or bacteraemia but the conversion produced in nasal flora seems to be dangerous. On the other hand, local antibiotic ointment resulted in less annoying postoperative symptoms and favourable conversion of nasal flora. So, systemic prophylactic antibiotics lack proof of effectiveness except in patients susceptible to bacterial endocarditis

Comparative study of homologous dura mater and autologous temporalis fascia in tympanoplasty

Tympanic membrane perforations in 50 patients were closed using autograft temporalis fascia and homograft dura mater. The graft uptake rates were 88% and 76% for the dura and temporalis fascia respectively. The postoperative hearing gain was similar in both grafts. The dura mater seems to be more resistant to infection, much easier to handle and is instantly available