Pedicled omental transfer for ischaemic limbs--a 5-year experience.

Chronic occlusive arterial diseases form a single largest entity amongst the peripheral vascular diseases. Current operative methods available for improving circulation often elicit poor results and the patient has to undergo an amputation. The technique of pedicled omental transfer has given hope of saving such unsalvageable limbs. Although symptomatic and clinical improvement has been reported by this method of "biological by-pass revascularisation", there are no simple, objective and easily reproducible tests to assess improvement in circulation. In this study pulse oximetry and stress testing have been used to assess revascularisation. This study comprised 56 patients (78 limbs) suffering from chronic occlusive arterial disease, spanning a period of 5 years. Patients were investigated and subjected to pedicled omental transplantation (omentopexy). Symptomatological assessment showed improvement in intermittent claudication in about 85% of patients, relief from rest pain in 86% and healing of chronic ulcers in 73% of patients. Objective tests of stress testing and pulse oximetry also showed improvement in circulation. Relief from ischaemia was more in cases of Buerger's disease (TAO) than in cases of atherosclerosis obliterans (ASO).

Prognosis in intra-abdominal sepsis.

Peritonitis is a common surgical problem with a high mortality rate. Recent advances have not brought down the mortality rate. Eighty six patients with intra-abdominal sepsis were studied for factors affecting prognosis. The factors which significantly affected prognosis were: duration of illness, source of infection and APACHE-II score. Further, among the factors contributing to APACHE II score, statistical analysis using logistic regression identified some factors which individually affect outcome. Our results indicate that mortality rate is high in patients with long duration of illness, postoperative peritonitis and organ system insufficiency.