Conventional dressing versus early exposure after major abdominal surgeries

Nowadays, it is recognized that the management of surgical wounds may be planned to leave the wound exposed, and there is no need for its covering. The aim of the present study was to compare the conventional dressing versus early exposure after major abdominal surgeries. This was clinically tested at "the general surgery units" of the Medical Research Institute Hospital, at Alexandria University. The study comprised 50 adult patients with major abdominal surgeries with clean closed and sutured surgical wounds. The patients were divided into the exposure and the conventional group. Data of the study was collected using a tool named "the surgical wound assessment sheet". Two parts was included in the tool, one of them is personal and clinical data, and the other is wound observation and follows up. The clinical data was divided into three items; preoperative, Intraoperative and postoperative data. The second part of the tool consisted of wound observation and follow up. Surgical wound care and assessment, and wound culture were carried out for both groups. Results of this study revealed that the surgical wound healing among the exposure group patients was better than that in the conventional group. A higher non statistical incidence, of surgical site infection [SSIs], among the conventional group subjects, was detected. Surgical wound healing, among the exposure patients was better than that in the conventional. The early exposure method in clean closed surgical wound care is recommended. Further studies are suggested for testing the early exposure method in larger and different surgical samples

Small diameter partial portacaval shunts SDPPCS: short term efficacy and outcome

Partial portacaval shunts, are distinct in concept and hemodynamics from selective and total shunts. The aim of this work was to evaluate the small diameter partial portacaval shunt operation [DDPPCs] as a definitive management for patients with bleeding esophageal varices from schistosomal hepatic fibrosis and portal hypertension. Thirty-three patients were studied. All patients were prepared for elective partial portacaval shunting using the eight mm. Polytetraflouroethylene [PTFE] Gortex graft. The preoperative work up included full hematological studies, liver and renal function tests, upper Gl endoscopy, with confirmation of variceal grade, abdominal coloured Duplex of the portal [P. V.], splenic [S. V.], and inferior vena cava [I. V.C.], all stigmata of amoniacal encephalopathy were looked for. Fourteen cases [42.42%] were of child's class A, and nineteen [57.57%] were of class B. Oesophageal varices were revealed in all cases with Grades III and IV in 69.69% of cases, and risk signs in 84.84% of cases. The mean diameter [D] of portal vein was 17.3+11 mm. The flow [F] in the portal vein was hepatopetal in all cases with a mean of 2.38+0.64L/minute. All patients after being subjected to SDPPCS operation were followed up for a period that ranged from 15 to 38 months. Postoperative findings, as well as data after one month and one year follow up are presented in this work. The shunt was completed successfully in 30 out of 33 patients, inspite of some operative difficulties which were found in 12 cases. There was no operative mortality. The early mortality rate [30 days after the operation] was 6.06% early thrombosis rate was 9.99%, and late occlusion rate was 3.3%, and rebleeding occurred in 2 cases 6.06%. The varices were down graded in 19 patients and disappeared in 6, while six patients refused follow up endoscopic evaluation. The flow in the shunt was directly visualized in 11 patients with a mean flow of 1.12+0.32 L/Min and 1.73+ 0.26 L/Min one month and one year respectively. The portal vein showed post operative hepatopetal flow that was reduced to 1.59 +/- 0.65 L/Min, and 1.12 +/- 0.51 L/Min one month and one year respectively. This reduction was mainly in the cephalic portion of the vein in comparison to increased flow in the caudal portion. The flow in the I. V.C was increased to 3.2 +/- 0.67 and 3.6 +/- 1.25 post operatively one month and one year postoperatively. There were no cases of hepatic encephalopathy

Hypoxia during endoscopic retrograde cholangiopancreatography. a place for oxygen therapy

Patients who undergo flexible endoscopy suffer from periods of low oxygen saturation which may present a risk for the development of complications. The aim of this study was to evaluate the effect of oxygen therapy on lowering the number of patients who suffer from periods of low oxygen saturation during ERCP through a randomized controlled clinical trial. A pilot study was first done to determine the number of patients who suffer from hypoxia during ERCP. Accordingly 100 consecutive patients were randomized to either receive supplemental oxygen therapy [3 litres / min] through nasal prongs or to receive no therapy. The oxygen saturation and the pulse rate of each patient was measured before, at start and during ERCP by means of a pulse oximeter attached to the right index finger. Oxygen therapy significantly reduced the number of patients suffering from hypoxia [Fisher's exact test: p<0.05]. Severe levels of hypoxia increased significantly in the group of patients not receiving oxygen therapy in comparison to pre-ERCP state [Fisher's exact test: p<0.05]. The average oxygen saturation level was significantly higher during ERCP in the group of patients receiving oxygen therapy [Mann-Whitney U test: p<0.05]. Patients are at risk of developing hypoxia during ERCP. Supplemental oxygen therapy reduces this risk and should be routinely supplied to all patients during ERCP