Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

Clinical presentation of hypothyroidism: a study of 50 cases

Background: When the thyroid gland does not produce and release enough thyroid hormone into your circulation, it is known as hypothyroidism. Your metabolism becomes slower as a result. Hypothyroidism, also known as an underactive thyroid, can make you feel exhausted, put-on weight, and have trouble with cold weather. In utero, throughout infancy, during youth, or even during maturity, it may begin to develop. The frequency of unanticipated overt hypothyroidism varies from 1 to 18 cases per thousand persons when accompanied by biochemical and clinical symptoms of hypothyroidism. The aim of the study was to observe the various clinical presentations of hypothyroidism Methods: This cross-sectional observational case-based study was conducted at the institute of nuclear medicine, Dhaka medical college hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2005 to July 2005. A total of 50 patients attended at the study place during the study period who were biochemically hypothyroid were included in the study. Results: The age range of the patients was 13 months to 54 years with a mean age of 29.5 years in this series. The majority of the patients were between 20 to 49 years of age. Female comprises 80.0% in comparison to 20.0% of male cases of hypothyroidism. Spontaneous primary (idiopathic) hypothyroidism (90.0%), post-radioiodine therapy, and post-ablative hypothyroidism were the most important causes of hypothyroidism in this series. Most typical symptoms and signs of hypothyroidism were found in this study. The most common symptoms were generalized weakness, lethargy, slowness of activities, impairment of memory, loss of scalp hair, somnolence, dry skin, puffiness of the face, constipation, weight gain, hoarseness of voice, swelling of the body, decreased sweating and paraesthesia. Cases of idiopathic hypothyroidism and other types had similar symptoms. The mean duration of symptoms before medical consultation was 2.9 years. Dry and coarse skin topped the list of physical findings and was present in 60.0% of the cases. Other findings in order of frequency include goiter (56.0%), puffiness of the face (38.0%), cold and thick skin (44.0%), thick tongue (24.0%), peripheral edema (24.0%), Anemia (20.0%), pallor of the face (12.0%), bradycardia (08.0%), thick lips (4.0%), ascites (2.0%) and pericardial effusion (2.0%). Conclusions: Although in the present series a limited number of patients were included, it encompassed varieties of cases. Moreover, an attempt was made to evaluate the common presentation, age incidence, sex distribution, and laboratory status of hypothyroidism in our country, giving more emphasis on clinical findings.

Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region / Critérios clínico-epidemiológicos e preditores de sobrevida do câncer retalentre egípcios na região do Delta

Abstract Background Colorectal cancer represents a global health problem. Rectal cancer in particular is increasing and is believed to carry a unique epidemiologic and prognostic criteria. Method We herein study retrospectively the data of 245 patients from a tertiary center in Egypt. Clinico-epidemiologic criteria and predictors of survival are analyzed. Results The disease affects younger population without sex predilection. Prognosis is affected by age, nodal status, metastasis, and bowel obstruction. Conclusion Rectal cancer has unique criteria in the Egyptian population. A national population based registry is recommended to delineate the nature of the disease in Egypt.

Resumo Introdução O câncer colorretal é um problema de saúde global. A incidência de câncer retal, em particular, está aumentando; acredita-se que esta neoplasia apresente critérios epidemiológicos e prognósticos únicos. Métodos O presente estudo avaliou retrospectivamente os dados de 245 pacientes de um centro terciário no Egito. Critérios clínico-epidemiológicos e preditores de sobrevida foram analisados. Resultados A doença afeta a população mais jovem, sem predileção por sexo. O prognóstico é afetado pela idade, estado nodal, metástase e obstrução intestinal. Conclusão O câncer retal apresenta critérios únicos na população egípcia. Recomenda-se um registro nacional de base populacional para delinear a natureza da doença no Egito.

Laparoscopic colorectal cancer resection with natural orifice specimen extraction: a prospective study / Ressecção laparoscópica do câncer colorretal com extração de espécime em orifício natural: um estudo prospectivo

ABSTRACT Introduction: Laparoscopic colorectal resection is more and more being employed in the daily oncology practice. Natural orifice techniques to obviate the need for a specimen extraction incision are evolving. Materials and methods: We studied transanal and transvaginal specimen extraction after laparoscopic colorectal resections prospectively in 16 patients. Results: The technique was successfully implemented in 75% of the cases. The site of the tumour and the patient age were the significant predictors of the technique success. Conclusion: The technique is reproducible and can be more widely adopted.

RESUMO Introdução: A ressecção colorretal laparoscópica está sendo cada vez mais empregada na prática diária de oncologia. Observa-se uma evolução nas técnicas que usam orifícios naturais de modo a evitar a necessidade de uma incisão para extração de espécimes. Materiais e métodos: O estudo avaliou prospectivamente a extração transanal e transvaginal de espécimes após ressecções colorretais laparoscópicas em 16 pacientes. Resultados: A técnica foi implementada com sucesso em 75% dos casos. A localização do tumor e a idade do paciente foram preditores significativos de sucesso da técnica. Conclusão: A técnica é reprodutível e pode ser mais amplamente adotada.

Epidemiology and survival of colon cancer among Egyptians: a retrospective study / Epidemiologia e sobrevida para o câncer de cólon entre egípcios: estudo retrospectivo

ABSTRACT Introduction: Colorectal cancer is the 4th commonest cancer in the world. Studies had shown different tumor behavior depending on the site, pathology and stage. However the characters of Egyptian colon cancer patients are not well addressed. Method: Computerized registry of a tertiary cancer hospital in Egypt was searched for colon cancer cases. Demographic, pathologic and treatment data were collected and analyzed using SPSS program. Results: About 360 colon cancer patients attended our center in the last 12 years. Tumor characters showed great diverse from that of developed countries, with especially different prognosis and survival. Conclusion: Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this.

RESUMO Introdução: Câncer colorretal é a quarta neoplasia mais comum a nível mundial. Estudos demonstraram diferentes comportamentos do tumor, dependendo do local, da patologia e do estágio. Contudo, ainda não estão devidamente definidas as características dos pacientes egípcios com câncer de cólon. Métodos: Foi realizada pesquisa no registro computadorizado de um hospital terciário para pacientes com câncer, à busca de casos de câncer de cólon. Foi feita coleta de dados demográficos, patológicos e terapêuticos. Tais dados foram então submetidos à análise com o programa SPSS. Resultados: Nos últimos 12 anos, cerca de 360 pacientes portadores de câncer de cólon foram atendidos em nosso Centro. As características dos tumores demonstraram grandes diferenças em comparação com os achados de países desenvolvidos e, em especial, com relação ao prognóstico e à sobrevida. Conclusão: Os egípcios exibem características e comportamentos singulares com relação aos tumores, além de diferentes graus de cooperação com os regimes terapêuticos. Para que tais aspectos sejam sanados, há necessidade de mais estudos prospectivos multicêntricos, bem como de um aprimoramento das diretrizes terapêuticas para os egípcios.

Utility of Pap Smear Screening for Prevention of Cervical Cancer-A 3yrs Study from Rural Tripura-A Northeastern State of India

Background: Cancer cervix is a leading cause of mortality and morbidity among women worldwide. According to National Cancer Registry Program of India, cancers of cervix and breast are leading malignancies in Indian women. The morbidity and mortality could be significantly reduced with an active cervical smear screening programme. Objective: The study was done to evaluate the knowledge and attitudes of women about cervical smear testing, to establish a cervical smear screening program and to evaluate the cervical cytological abnormalities. It was done to determine the applicability, limitations and utility of this screening in a district hospital. Materials and Methods: A total of 287 married women were included in our study. Knowledge about Pap smear testing was determined through printed questionnaires. Pap smear screening was performed on every woman in our study group. Detailed clinical data and cytology reports were noted in a proforma. Results: About 92% women of our study group had never heard or undergone Pap smear screening before. Maximum number of patients was in 4th decade. Of the 287 smears, 276(96.16%) were adequate. Normal smear were 78(27.18%), inflammatory 168(58.54%), whereas epithelial cell abnormalities were seen in 26(9.05%) cases. The 26 abnormal cases comprised of 17(5.92%) cases with ASCUS, 5(1.74%) cases of LSIL, 1(0.35%) cases of HSIL, 3(1.04%) cases of squamous cell carcinoma. Conclusions: Epithelial cell abnormality in our study group was less than Western countries. There is poor knowledge about Pap smear screening. Pap smear study can be easily done through a chain built between the primary health care unit and district hospital and laboratory

Results of internal fixation of distal humeral articular fractures in old age, study of 10 cases

In elderly patients the tolerance of elbow joint to immobilization is very poor and stiffness develops easily, so conservative treatment is not suitable method for intraarticular fractures of the distal humerus. Although open reduction and internal fixation is the treatment of choice for these fractures in adults, in elderly patients disagreement remains on how to treat these fractures. Also the reports on the functional results after internal fixation of these fractures in elderly patients are rare. The purpose of this study is to evaluate the results of open reduction and stable internal fixation for treatment of intra-articular fractures of distal humerus in elderly patients above 60 years old. 10 patients with 10 intr a-articular fractures of distal humerus. The average age was 63 years [ranged 60-73 years]. There were sex females [60%] and four male [40%]. The right side was affected in seven patients [70%] and left side in three patients [30%]. The fractures were classified according to the AO/ASIF classification. There was one fracture [10%] type B1, four fractures [40%] type C1, three fractures [30%] type C2 and two fractures [20%] type C3. All the patients were treated by open reduction and internal fixation through a posterior approach. The average follow up period was 18 months [ranged 12-32 months] During it the patients were examined both clinically and radiographically for union of the fractures, Post-traumatic arthritis, range of motion, the elbow and forearm, muscle strength, degree of pain, return to previous activities. The final results tuere evaluated according to the Mayo Elbow scoring points system. Average time to union were 3.5 months [ranged 2-4.5months]. Four patients [40%] had Post-traumatic arthritis of the elbow [three patients with mild degree and one patient with severe degree]. The motion at the elbow was mainly affected, the median arc of flexion/ extension was 1000 [ranged 600-1300]. The forearm motion was not affected and it was near normal in all of the cases. The final clinical results were excellent in three patients [30%], good in five patients [50%], fair in one patient [10%], and poor in one patient [10%]. Open reduction and internal fixation of distal humeral intra-articular fractures in elderly patients can achieve excellent and good results in majority of the patients. Advancing age is not a contraindication for open reduction and internal fixation of these fractures

Modified extension block pinning for large mallet fractures

Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial Twenty one mallet fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction are treated with an extension block pin and transarticular fixation of the distal interphalangeal joint. The average patient age was 26.8 years and the average fracture size was 40.5% of the joint surface. The average delay after injury was 5.6 days [range, 0-14 days] Average time to fracture union was 32 days. The average active flexion of the distal interphalangeal joint was 81.2° and the average extensor lag was 1.4°. There were no major complications. Using the established outcome criteria for mallet injuries, 95.2% had excellent or good results. This surgical technique resulted in rapid fracture union with only minor complications and has excellent functional outcome

Closed retrograde locked nailing of the diaphyseal humeral fractures

Locked intramedulary nailing of humeral shaft fractures combines the advantages of intramedulary nailing with the added fixation of locked principles allowing for the extension of indications of interlocked nailing as in comminuted fractures. Also the interlocking nailing is superior to plating of diaphyseal fractures as it is a load sharing and control of bending stresses. In addition, the closed technique preserves the soft tissue blood supply and the fracture haematoma preserving the biologic process of fracture healing undisturbed. With retrograde technique most of the complications related to the shoulder joint and rotator cuff violation can be avoided. Fourteen patients with humeral shaft fractures had been treated by retrograde closed locked nailing using interlocking humeral nails. The average follow up period was four months [range from 3 to 10 months]. The average healing time of all fractures was eight weeks. After consolidation, the elbow function was excellent in twelve patients [85.7%], the shoulder function was excellent in thirteen patients [92.9%]. The functional end results were excellent in nine patients [64.2%], good in three patients [21.4%], fair in one patient [7.1%], and poor in one patient [7.1%]. Two patients [14.2%] had postoperative radial nerve palsy. There was comminution at the fracture site in three cases. There was one case [7.1%] of deep infection. Two patients [14.2%] had shortening and one case [7.1%] had varus deformity. There were no cases with implant failure. We concluded that closed retrograde locked nailing of fractures of the humeral shaft is an excellent method of fixation with added benefit over antegrade nailing that it does not affect the shoulder movement or disturb the rotator cuff insertion site

Arthroplasty of the trapeziometacrpal joint. A study of 36 cases

This retrospective study was done during the period 1998 - 2002 to evaluate two types of surgeries for symptomatic osteoarthritis of the trapeziometacarpal joint at the base of the thumb in 36 hands. There were 19 females and 7 males. Follow up period ranged from 18 to 39 months [mean 32 months]. The study reviewed fifteen [41.7%] hands treated by tendon interposition arthroplasty with ligamentoplasty and twenty one [58.3%] hands treated by silicone replacement arthroplasty. The clinical outcome was measured depending on the assessment of pain, function, movement and strength. Radiologic follow up was done for proximal shift of the thumb metacarpal as well as signs of implant instability or wear. For this short term follow up, there was no significant difference regarding the power, movement, or function between either groups. In the tendon interposition arthroplasty group; pain relief was much better, no significant complications and the ultimate clinical score was excellent [36 points]. In the silicone replacement group; the clinical score was good [32 points] and complication rate was high with four implant dislocations [19%] and two symptomatic synovitis [9.5%]. Six hands of the silicone replacement group [28.5%] needed revision by removal of the implant while in the tendon interposition group no revision was needed

Emergence of multidrug-resistant Salmonella Gloucester and Salmonella typhimurium in Bangladesh.

Infections due to non-typhoid Salmonella, resistant to antibiotics, have recently emerged as an important health problem worldwide. Antibiotic resistance was studied by the disc-diffusion method among 3,876 (2.78%) non-typhoid Salmonella isolates cultured from 139,279 faecal samples in a diarrhoea treatment centre in Dhaka, Bangladesh, during 1989-1996. Of 499 salmonellae isolated in 1989, serogroup C (1.12%) was the most common, followed by Salmonella Typhi (0.72%) and serogroup B (0.71%). Isolation rate of serogroup B increased significantly to 2.18% (p < 0.01) in 1992 compared to 0.56% in 1991, 2.86% in 1995, and 2.48% in 1996. Serotyping of 194 serogroup B isolates revealed Salmonella Typhimurium (52%) and Salmonella Gloucester (45%) as predominant serotypes. Resistance to ampicillin (A), chloramphenicol (C), and trimethoprim-sulphamethoxazole (Sxt) (R type-ACSxt) increased to 89-100% during 1992-1996 from 20-28% during 1989-1991 (p < 0.01) among S. Typhimurium and S. Gloucester isolates. In 1993, 8-10% of the strains of both the serotypes, resistant to ampicillin, chloramphenicol, and trimethoprim-sulphamethoxazole, acquired resistance to ceftriaxone (Cr) (R type-ACSxtCr), which increased to 85-92% in 1996 (p < 0.01). All were susceptible to ciprofloxacin. A 157-kb conjugative plasmid transferred R type-ACSxt from both the serotypes to Escherichia coli K-12. The findings of the study suggest the emergence of multidrug-resistant S. Gloucester and S. Typhimurium for the first time as a significant health problem in Bangladesh, and surveillance is essential to monitor the resistant non-typhoid Salmonella and identify its sources and modes of transmission.

A review of 5153 treated psychiatric patients--a five year retrospective study.

From the present study several important observations may be made. It has been observed that illiterate and poor people with agricultural background are increasingly becoming more aware of the availability of psychiatric treatment facilities. Acceptance of treatment offered by mental hospital is greater in spite of prejudice and stigma against mental diseases. Chances of availing treatment facilities for mental diseases were better in cases of educated, economically independent and non-agricultural workers than the illiterate, economically dependant and agricultural workers. Women are not having equal opportunity for treatment facilities though they suffer from psychotic disorders equally as men; this reflects the present socio-cultural attitudes. Age pattern of patients suffering from mental diseases in this country was different from western countries. Duration of stay in the hospital and rate of improvement were comparable to other centres.