Appendicular mass, early exploration vs conservative management

Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. A comparison of conservative treatment versus early surgical exploration of appendicular mass. Experimental study. Two years study from December 2003 to November 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I [Early exploration] and group II [Conservative treatment] each containing 30 patients. A comparison of outcome between two groups was done statistically by applying student Chi-square test. There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admission were less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Early surgical exploration of appendicular mass is safe and cost effective

Fragility hip fractures

Fragility fractures, the major clinical problem have increased in recent decade due to any increase in expected age. There is a tremendous economic burden to manage this problem, the disability increased from 20% before hip fracture to 50% after this even if managed properly. Fragility hip fracture is associated with a 20% reduction in expected survival in best hands. To study the incidence; types of fractures; treatment options and their outcome. A retrospective study. Armed Forces Hospital Southern Region Khamis Mushayt, Kingdom of Saudi Arabia. From April 1996 to April 2006. 300 patients were included in the study, both males and females above the age of sixty years presented in Emergency Room with hip fractures due to minor or trivial trauma. Diagnosis was based on clinical and radiological grounds. Additional investigations were made when and where indicated to confirm diagnosis and to assess the patient form anesthesia and surgical point of view. Internal fixation was the main treatment to see the ultimate outcome. The incidence of fragility hip fractures increased with age. Sixty percent of the victims were females. The incidence increased with every passing year being 15% in the last year of study. 93% of the fractures were of intertrochanteric type and fixed with engineered metallic device [DHS]. Prevention or delay osteoporosis should be the main objective. Once there is fragility hip fracture internal fixation is the appropriate treatment