Evaluation of the results of endoscopic treatment of obstructive jaundice performed by surgens

Fifty patients with obstructive jaundice were studied with ultrasonography [US]. CT scanning [CT] was performed in 33 patients. Next, all patients underwent ERCP. Percutaneous transhepatic cholangiography [PTC] and drainage [PTBD] were performed in 12 and 9 patients, respectively. The results revealed that there were 20 patients with choledocholithiasis, 22 with malignant obstruction and 8 with miscellaneous cases. ERCP was more sensitive in diagnosing choledocholithiasis than US or CT [100%, 80%, and 83%, respectively] Sensitivity for diagnosis of malignant obstruction was 95% for CT, 82% for ERCP, and 45% for US. Endoscopic stone removal was successful in 85% of patients with choledocholithiasis. Stents were inserted in 70.5% of patients with malignant obstruction. Overall success of PTC and PTBD were 92% and 80%, respectively. Minor bleeding during sphincterotomy occurred in 11 patients. In conclusion, this study demonstrated the safety and acceptable success rate of ERCP performed by surgeons and therefore, supports its use as the initial treatment modality in obstructive jaundice

outcome of multidisciplinary approach to mangled extremity

Mangled extremities are associated with high rate of amputations and non-functional limbs. Factors responsible for such poor outcome were studied. Thirty patients with mangled extremities underwent vascular reconstruction, orthopedic fixation and soft tissue coverage sequentially, as required. Vascular injuries were treated using autogenous vein, primary repair, ligation and observation. Fracture fixation of 26 extremities included closed management [17 fractures and 2 dislocations], external or internal fixation. Twenty-eight patients had soft tissue injuries that required primary closure. Split-thickness skin grafts, fasciocutaneous flaps, muscle flaps and a fasciocutaneous and a muscle flap. Two out of 14 nerve injuries were successfully repaired early. Functional limb salvage was achieved in 23 patients. Two non-functional upper extremities resulted from non-repairable nerve injuries. Two amputations resulted from none or failure of revascularization. Three patients died from associated severe head injuries. Successful salvage of mangled extremity can be achieved by implementing a multidisciplinary team approach

Initial experience and short term outcome of open tension - free mesh ingninal hernia repair

This study reported an initial experience and short-term outcome of open tension free mesh hernia repair. Thirty male patients underwent open tension-free inguinal hernia repair at El-Minia University Hospital using polypropylene [prolene] mesh. The mean patient age was 43 years [range 21 - 65]. Twenty-eight patients were operated for the first time, whereas two patients were operated on for recurrent hernias. Twenty-five hernias were indirect inguinal hernias. All patients had unilateral hernias. The mean operative time was 35 min [range 30-40]. The mean length of hospital stay was 1.5 days. Eighteen patients were discharged on the first postoperative day, nine patients were discharged on the second day, while three patients stayed in the hospital for three days because of wound infection. Four patients developed wound hematoma. Twenty-nine patients experienced mild pain that was effectively alleviated with the non-narcotic analgesic, while only one patient had moderate pain that required a single dose of narcotic analgesic. Three patients had mild urinary retention that was treated conservatively without the need for catheterization. No recurrence was noted during a follow-up period of 18 to 24 months. This initial experience confirmed the safety and simplicity of open tension-free mesh inguinal hernia repair with low rate of recurrence