A perforated appendix: should we drain?

The effectiveness of intraperitoneal drain was studied on patients undergoing appendicectomy for perforated appendicitis. Randomly 40 patients were allocated with drainage by corrugated rubber drains and 46 patients were without drainage. There were 5 deaths in the series, out of which 4 (10%) were in the drainage group and one (2.2%) in the group without drainage. The incidences of major wound sepsis, paralytic ileus, intraperitoneal abscess and urinary infection were observed in 55%, 42.5%, 12.5% and 15% respectively in drainage group and 50%, 28.3%, 21.7% and 15.2% respectively in non-drainage group. Occurrence of subphrenic abscess (7.5%), burst abdomen (5%) and faecal fistula (5%) were confined to drainage group only.

Management of oral cancer in late stages: a review.

Sixty cases of oral cancer (2 were of stage II and other 58 were of stage III and stage IV) were treated and observed over a period of 2 years. In patients of oral cancer with bone involvement and mobile cervical nodes (44 cases) local excision which included partial or hemimandibulectomy with radical neck node dissection was performed. Out of these 44 cases, 18 cases received radiotherapy pre-operatively and 26 cases postoperatively. Better results were observed in these cases. When the growth was inaccessible and/or nodes were fixed (13 cases) radiotherapy was found to be suitable. Fistula formation and reconstructive flap necrosis were common following surgery after radiotherapy. Combined modalities of treatment with pre- and postoperative radiotherapy and radical neck node dissection showed excellent results (86.4%) in majority of cases. The remaining one patient received chemotherapy and local excision was performed in 2 cases.

Toxicity and side-effects of combination chemohormonal therapy of advanced breast cancer.

Seventy-five female patients suffering from advanced breast cancer were treated with toilet mastectomy, radiotherapy and oophorectomy (if premenopausal) or tamoxifen therapy (if postmenopausal) as well as chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil and prednisone. The most common side-effects of combined chemohormonal therapy were gastro-intestinal (nausea, vomiting, rarely diarrhoea) in 43 patients (57.3%), followed by alopecia in 23 patients (30.6%), myelosuppression in 12 patients (16%), extravasation and thrombophlebitis in 7 patients (9.3%), and mucositis and oral erythema in 3 patients (4%). Side-effects of tamoxifen therapy such as vaginal discharge, bleeding, hot flushes were encountered in 10 patients (13.3%). Hypercalcaemia, tumour flare and hepatic, renal, cardiac, pulmonary and neurological toxicities were not encountered. Improvement of 10-30% in Karnofsky performance status was noted in responders while 20-30% deterioration was observed in non-responders. Combination therapy was mostly well tolerated, side-effects were few and toxicities were temporary and reversible.

Abdominal suture proctopexy for complete prolapse of rectum.

Eighteen patients, 13 males and 5 females, with complete rectal prolapse have been treated by suture proctopexy during the period 1987-1989 with no operative mortality and very little morbidity. There was only one case of recurrence during a 3-year follow-up for which a repeat identical procedure was successful. There was some disturbance in faecal continence pre-operatively in 14 cases, of whom, 13 cases were improved by suture proctopexy. There was no significant change in bowel habit postoperatively, with the exception of 2 patients who had constipation postoperatively but one reverted to normal on re-education of bowel habit. All the patients had normal urinary and sexual function. This relatively simple procedure was well tolerated by the patients.

Evaluation of different surgical procedures in filarial lymphoedema of lower extremity.

Ninety-six cases of different stages of lymphoedema of inferior extremity were taken for study. Twenty-four patients with early lymphoedema (stage II) were subjected to lymphonodovenous shunt (LNVS) operation; 54 patients of late lymphoedema with skin changes (Stage IV) were subjected to Charles' operation and 18 patients with late lymphoedema without skin changes (stage III) were subjected either to Sistrunk's or Thompson's operation. All the results were studied, evaluated and compared. The cases subjected to LNVS operation had a rapid relief of lymphoedema in the early postoperative period followed by slow reduction. Patients subjected to Charles' operation had immediate volume and circumference reduction and take up of skin grafting was 84%. The cases subjected to Thompson's operation did not have satisfactory reduction in volume and circumference postoperatively. There were a few minor postoperative complications in all these procedure, infection being most notable in those who had undergone Charles' operation. It is concluded that while excisional surgery, such as Charles' operation becomes necessary for late stages of lymphoedema, which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.

Conservative surgical management of intestinal tuberculosis.

Forty-seven proved cases of intestinal tuberculosis admitted to the surgical ward of MKCG Medical College, Berhampur from 1985 to 1987 were subjected to laparotomy. The common pathology found were tubercles over the peritoneum, multiple strictures of intestine, ileocaecal mass, perforation of the intestines, bands and adhesions and mesenteric node involvement. The patients with acute abdomen were operated in emergency and rest as an elective procedure. Conservative surgeries like stricturoplasty, local intestinal resection, perforation closure, by-pass procedures and local ileocaecal resection were done in most of the cases and only in 2 cases right hemicolectomy was done. Biopsy was taken from the viscera, peritoneum and mesenteric nodes. Postoperative mortality was 6.4%, mostly due to toxaemia and fluid and electrolyte imbalance. Postoperative complications in most of the cases were wound infection. All were given a short course of antituberculosis regimen containing INH, rifampicin and ethambutol. Patients were followed up to one year and definite improvement was noted.

Pattern of paediatric solid malignant tumours in southern Orissa.

Twenty-nine cases of solid malignant tumours in paediatric age group were studied. The incidence of different tumours in order of frequency were lymphomas (37.9%), Wilms' tumour (24.1%), neuroblastoma (17.2%), soft tissue sarcoma (10.4%) and rare tumours (10.4%). Maximum number of tumours occurred in 1-5 years' age group. Male predominance was noted (male:female as 2.2:1). Among the lymphomas, non-Hodgkin's lymphoma outnumbered Hodgkin's lymphoma. Left kidney affection was seen more than the right kidney among cases of Wilms' tumours. Neuroblastomas presented commonly as abdominal masses. All the 3 cases of soft tissue sarcomas were embryonal rhabdomysoarcomas. Rare tumours encountered in the study were ovarian tumours (arrhenoblastoma), endodermal sinus tumours and hepatoblastoma.