Association of abnormal foot angles and onychocryptosis.

OBJECTIVES: To find if there is any association between the abnormal interphalangeal (IPA) and/or hallux valgus angles (HVA) and onychocryptosis. MATERIALS AND METHODS: Eighty consecutive patients with proven ingrowing toenail of all grades had their interphalangeal and hallux valgus angles of the great toe been measured on a stress view standing radiograph, and compared with a control group of normal people. RESULTS: The mean age (SD) of our patients was 20 (6.4) years. Males are affected more than females. Lateral edge ingrowing was found in 85% of patients. The percentage of abnormal HVA in the diseased toes (60%), was significantly higher than that in contralateral toes (30%) (p<0.0005) and in normal controls (12%) (p<0.0005). Similarly, the percentage of abnormal IPA in the diseased toes (85%) was significantly higher than that in the contralateral toes (50%) (p<0.0005) and in normal controls (25%) (p<0.0005). CONCLUSIONS: Abnormal interphalangeal and hallux valgus angles or lateral deviation of the distal phalanx significantly associated with onychcryptosis.

Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND AND PURPOSE: Studies have shown the safety and effectiveness of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC). Our aim was to establish the outcome of LC in patients with AC on the basis of duration of the attack before surgery took place, the type of gallbladder inflammation, and patient sex. PATIENTS AND METHODS: All 204 patients at Princess Basma Teaching Hospital who underwent LC for AC by the authors between September 1994 and June 1999, were retrospectively reviewed. They were categorized into Group I, where surgery took place within 72 hours of the acute attack (N = 78; 54 women and 24 men), and Group II, if later than that (N = 126; 70 women and 56 men). Gallbladder pathology was classified as gangrenous, empyema, edematous, mucocele, or AC along with contracted fibrosed gallbladder. RESULTS: Conversion to open cholecystectomy was needed in 12% of the total series. In Group I, 3.8% of the patients needed conversion compared with 16.7% in Group II patients (P = 0.01). Also, 4% of the female patients needed conversion compared with 24% of the male patients (P = 0.000). There was an association between the pathological type of AC and the likelihood of conversion (P = 0.002), conversion being least common in those with mucocele and most common in those with empyema and gangrene. The median operation time was 75 +/- 36 minutes, but the operation time for Group II patients was significantly longer (P = 0.001) than in Group I patients. Operation time in the male patients was significantly longer than in the female patients (P = 0.000). There was no statistically significant difference in the duration of hospital stay in the two groups or in men and women. There were no deaths or main bile duct injuries in the series. In successful LC, missed stones occurred in 3.3% of the patients. Bile collection, which was treated by open surgery, developed in one female patient. CONCLUSION: Laparoscopic cholecystectomy is a reliable and safe modality for the management of AC. It was not associated with an increased incidence of bile duct injury in this series. It should be the first choice before resorting to open surgery. Factors associated with increased conversion include delay in surgery of more than 3 days from the acute attack and certain pathology, with conversion being more likely in empyema. Conversion also was more likely in male patients.