Managing small intestinal obstruction: a Sheikh Zayed Hospital experience

Managing intestinal obstruction continuous to challenge surgeons all over the World. Between January 2001 to December, 2004, 54 patients with maw to female ratio of 1.8:1 and mean age of 51 presented with small bowel obstruction. They were divided in to two groups; group A and B. Group A comprised of 30 patients [55%] and were managed conservatively. Whereas group B had 24 patients [44%] who required surgery. Conservative management was observed for 12 to 36 hours and beyond this time patients were explored in the face of deterioration. In group a, 83% patients had history of previous surgery whereas 17% patients had no prior surgical intervention. In group B 38% patients had abdominal surgery in the past whereas 62% had no previous surgical intervention. Predominant symptoms of bowel obstruction were abdominal pain, [100%] constipation [60%] and vomiting [48%]. Common causes of obstruction were post-operative adhesions 38% [n=7] obstructed hernias 25% [n=6] ileoceacal tuberculosis 21% [n=3] intestinal ischemia 8% [n=2] and ceacal carcinoma 8% [n=2]. Two patients died to septicemia, subsequent to anastomotic leak. We conclude that adhesive bowel disease and obstructive external hernias are the commonest causes of small bowel obstruction. A good clinical acumen and repeated clinical examinations are necessary to avoid the stage of bowel gangrene while managing small intestinal obstruction

Effect of fresh and freeze dried human amniotic membrane on quantitative bacterial courts in burn wounds

Amniotic membrane in fresh or freeze dried from has been used at times in the management of burn wounds as a biological dressing. One of the qualities with which it is credited [by virtue of animal studies] is the reduction of the bacterial count of burn wounds. The present study was designed to test this claim in human burn wounds in a prospective controlled trial. Acute burn cases matched for age, sex and burn extent were randomly assigned to three group i.e. fresh membrane freeze dried membrane, and saline soaked gauze. The wound was tangentially excised and four biopsy samples one from each corner of the test site were taken on day zero, two, four and six. Each sample was weighed, homogenized and inoculated on blood agar plates. Colony counts were made at 24 hours. The results revealed that in the membrane groups by day four a decrease in the bacterial count begins which by day six becomes statistically significant as opposed to the controls [saline soaked]. The bacterial counts showed no statistically significant difference between the fresh and freeze dried membrane group. We conclude that amniotic membrane in either or properly prepared and used can contribute in diminishing the bacterial colonization of burn wounds of moderate extent [2-40% total body surface area]

Method of obtaining and preparation of fresh human amniotic membrane for clinical use

Amniotic membrane was obtained from 36 mothers seronegative for hepatitis B surface antigen and syphilis, undergoing caesarean section. Membrane was separated from placenta and was washed first with saline and then saline solution containing penicillin. The processed membrane was found to be sterile and useable for up to one week. Of 36 placentas obtained, 33 were utilized in 22 patients, with no history of penicillin allergy, as biological dressing In acute burns. Each patient received three applications of membrane one every other day, over a period of six days. This method of obtaining amniotic membrane was simple and more practical for maintaining the biological effectiveness of membrane, as shown by quantitative reduction of bacterial counts in burn wounds

Colorectal cancer[A clinico-epidemiological study]

A retrospective review of 45 cases of colorectal cancer managed in the Department of Surgery, Shaikh Zayed Hospital, Lahore from January, 1987 to May, 1990 is presented. Mean age was 45 years, which was 10-15 years younger than that reported from the West. Male to Female ratio was 4:1, showing much higher male preponderance than reported earlier. Twenty nine percent of the cases were younger than, 39 years and 30% cases presented with bowel obstruction. Overall operability was 96% with 78% undergoing curative resection. Remarkable feature was zero mortality and low complications; particularly anastomotic failure of 3.3%. Over 90% of the patients are alive after a follow-up of 2-30 months

Surgery for colorectal cancer

The present study is a retrospective review of 45 cases of colorectal cancer managed in the Department of Surgery Sheikh Zayed Hospital, Lahore from January 1987, to May 1990. Mean age was 45 years [range 17-72 years] which was 10-15 years younger than that reported from the west. Male to female ratio was 4:1, showing much higher male preponderance than reported earlier. 29% of the cases belong to the group, [39 years or less]. 30% of the cases presented with bowel obstruction. Overall operability was 96% with 78% undergoing curative resection, which is encouraging. Remarkable feature is zero mortality and low complications. [particularly of anastomotic failure of 3.3%]. Over 90% of the patients are alive a follow-up [2-30 months]

Surgical treatment of ascites, with peritoneovenous shunt

At Shaikh Zayed Hospital, during the past one year, Leveen peritoneovenous shunt has been used to palliate three patient with ascites due to portal hypertension refractory to medical measures. Standard procedure of shunt placement was adopted as described by Leveen et al in 1974. Peritoneovenous shunt functioned well in all the three patient providing good palliation. Two patients were followed upto 14 weeks, the third patient did well upto the 2nd week, when he was lost to follow-up we have found the procedure simple and very effective. The preliminary reports is presented alongwith a brief review of the subject

Sugarcane juicer injuries: a retrospective study and plan of management

The subject of wringer-roller arm and hand injuries has been relegated to the background in the litera-ture and standard textbooks of surgery of the past couple of decades. One device that continues to produce considerable mutilation by its wringer or roller action in this part of the world is the common sugarcane juicer. Hand injuries produced include skin avulsion, crushed tendons, nerves and vessels and comminuted fractures of small bones of hands and wrist. Surgical care of such hands should be carrid out in a properly equipped operating room. Observance of principles of surgical toilet, adequate debridement, periodic inspection of the wounds, elevation of the Limb, early resurfacing of lost skin, reconstruction of tendons, nerves and bones and intensive physical therapy are needed to obtain the best results in a hand injured by sugercane juicer Amongst 59 mutilated hands seen during 28 months, 39% were due to roller machine injuries, 74% of these being sugarcane juicers. Half of the patients were between the ages of 14-24 years. Only 4 of 23 hands [17%] functioned normally after treatment while 44% became practically useless as assessed at the end of 2 months to 2/2 years of follow-up

Pigmentary response of skin to chemopeel: a controlled study of phenol and trichloracetic acid applications

Chemopeel is a process in which chemical solutions are used on the skin with the intention of eliminating fine wrinkles, solar keratosis and certain other superficial dermatoses. A study was conducted on 10 volunteers, 4 females and 6 males, with phenol 48% on one side and trichloracetic acid 27% on the opposite side of the mastoid region. Color changes were observed for a period of upto 16 weeks. Scab fell off in 8.2 +/- 1.7 days with phenol and 10 +/- 2.5 days with trichloracetic acid [TCA] indicating a deeper burn with TCA. No hypertrophic scarring occurred. With both modalities, color returned in the majority of cases by 16 weeks but 40% of phenol and 20% of TCA group were still lighter-complexioned than their normal color at the end of the study. Females tended to get significantly lighter than males, with both chemicals and ethnic origin of the patient had no influence on the outcome

Human amniotic membrane as a versatile biological dressing: a preliminary report

The subject of human amniotic membrane as a biological dressing is reviewed and experience of four wounds, three from acute burns and one from trauma is presented. Freeze dried amniotic membrane was used as the material for application next to the wound after the usual surgical cleansing. This process was repeated daily or on alternate days depending on the individual response. Beneficial effects noted included reduction of pain, promotion of healthy granulation and increased tendency of graft take in acute burns. In the chronic post-traumatic ulcer the treatment was not as effective in reduction of bacterial counts as a topical antibiotic [soframycin] used in an adjacent area of the same wound. Its trial as a biological dressing in burns merits consideration in view of this preliminary trial

Latissimus dorsi - a very versatile flap for reconstruction

The latissimus dorsi myocutaneous flap is useful in a number of situations. Experience with use of this flap in six patients, the anatomical basis of the flap, and its advantages are described