six months evaluation of the trauma admissions in Assiut University Hospital

This study was done in Assiut University Hospital from January 1994 till the July 1st, 1994 and included all patients admitted in the trauma unit. The study aims at evaluation of the magnitude of this problem and proceeding to further evaluation of the needs of that center. This study included 1178 cases with 777 [66%] males and 401 [34%] females. The type of trauma varied, but it can be collectively classified into five categories. The major cause is falling from a height: 696 cases [59%], the second is road traffic accidents: 351 cases [29%], the third is fire injuries: 31 cases [2.6%], the fourth is stab wound injuries: 27 cases [2.3] and lastly other causes which account for 6.3% of the causes. Age and sex incidence varied in each type of trauma

Evaluation of the benefit with adjuvant post-operative radiotherapy for rectal carcinoma

The study included 85 cases of cancer rectum. Their ages ranged from 15 to 75 years with mean age of 45 years, higher incidences were present in 3rd and 5th decades of life. Male to female ratio was 1.7: 1. The main presenting symptoms were: Bleeding per rectum in 40% of cases, tenesmus in 28% of cases and changes of bowel habits in 15% of cases, but more than one symptom were present in the majority of cases. The lesions were lower 1/3 in 60 patients [70.59%] a middle 1/3 in 15 cases [17.65%] and upper 1/3 in 10 cases [11.76%]. The commonest pathological type was adenocarcinoma with variable grade of differentiation [60 cases]. Abdominoperineal resection was done in 65 patients [70.47%] and anterior resection was done in 20 cases [23.53%]. Cases randomly assigned to either surgical resection with adjuvant postoperative external radiotherapy to a dose of 5000 Gy/5 w/25 ttt, 46 cases [45.12%], or surgical resection alone 39 cases [45.88%]. The follow up period was between 6 months to 2 years in both groups. Local recurrence occurred in 21 cases [24.71%], distant metastases in 12 cases [14.12%], concomitant local recurrence and distant metastases in 8 cases [9.41%]. Survival disease free period was reported in 44 cases [52%] with higher incidence in case treated by postoperative radiotherapy but the difference was statistically nonsignificant. So, postoperative radiation therapy alone can not be justified as a routine in management of resectable rectal carcinoma, but could be used as an adjuvant to surgical resection with little benefit due to late presentation of cases

Experience with post cholecystectomy obstructive jaundice

13 cases of post cholecystectomy obstructive jaundice were the material of this work. They were operated upon in Assiut University Hospital in the period from January 1991 to May 1992. 11 cases were referred from other hospitals and 2 were from Assiut University Hospital. 10 cases were females and 3 were males. Their ages ranged from 25 to 70 years. The lapse of time between cholecystectomy and the development of jaundice ranged from 3 days to 6 months. All of the 13 cases were subjected to full clinical and laboratory investigations to exclude hepatitis and hepatocellular failure and to assess, the liver function. Ultrasonography for all cases and C.T. scan were done for 3 cases. ERCP was not done because it is not available in A.U.H. The cause of post-operative obstruction was found to be missed stone in the common bile duct in 4 cases, ligation of the common duct with silk suture in 4 cases, injury of the common duct in one case which presented with collection of bile in the peritoneal cavity, a missed-stone in the cystic duct stump which was parallel to the common hepatic duct in one case. A reformed stone in the common bile duct in one case. A missed towel in the porta hepatis was found in one case, In the last case the cause of obstruction was cancer head of pancreas which was not detected at the time of the operation for cholecystectomy and the patient came back with jaundice 3 months after cholecystectomy. Correction of post cholecystectomy obstructive jaundice was in the form of re-exploration of the biliary passages and dealing with the cause. Removal of stone or ligature, repair of the injured duct over T shaped tube, and choledechonastomy in the case of cancer head of pancreas. From this we can say that the majority of post operative obstructive jaundice can be avoided by careful pre-operative evaluation, proper operative technique, good idea about the anatomy of the biliary tract with its anomalies, and above all the use of intraoperative cholangiography