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Complications of colostomy.

SummaryA review of 200 colostomies showed that the incidence of complications was 11 per cent. Prolapse was the most common complication. Indications for colostomy and factors resulting in complications are mentioned. Technics that may prevent or reduce the incidence of complications are briefly discussed.

Management of Spontaneous Pneumothorax

Recurrence is the most common complication of spontaneous pneumothorax. Open thoracotomy with resection of obliteration of blebs and parietal pleurectomy provides the best protection against recurrence. Twenty-seven consecutive patients underwent open thoracotomy for recurrent pneumothorax with no mortality and minimum morbidity and have remained free from recurrence. We believe that thoracotomy should be more widely used in the treatment of what is called spontaneous pneumothorax, since this treatment may remove the real cause of the disease.

A giant sigmoid diverticulum: Report of a case

SummaryThe case of a patient with a giant diverticulum is reported, with a brief review of the literature. The patient was 71 years old when he developed abdominal pain on straining. The diverticulum was diagnosed by x-ray and treated by segmental resection of the involved area of the colon. The patient is now leading a normal life.

Surgical Management of Concomitant Carotid and Coronary Artery Occlusive Disease

The management of concomitant coronary and carotid disease is controversial. We report our experience of simultaneous coronary artery bypass surgery and carotid artery endarterectomy on 70 consecutive patients (34 males and 36 females) with a mean age of 68 years. The oldest patient was 91 years old. The average percent of carotid artery stenosis was 86% (range 60%–99%). The average number of grafts per patient was 3.35 (range 1–6). Two patients experienced postoperative strokes (2.86%), 1 had a perioperative infarct (1.42%), and 4 died in the hospital (5.7%). The simultaneous approach offers the advantage of shorter hospital stays, decreased anesthesia exposure, and significant cost savings. The causes of death include stroke, renal failure, and bowel infarction. This review indicates the simultaneous approach has a higher incidence of adverse outcomes compared with elective carotid endarterectomy or elective coronary artery bypass surgery. These patients, however, are at significantly higher risk due to their poor medical conditions, extensive atheromatous disease, and often emergent medical condition.

Contemporary management of life threatening complications of pneumonectomy

Material & Methods: Present the situation of a patient 52 years old, with good life style non-smoker, no coffee drink, non-alcohol consumption, with normal weight of the body mass, who had an episode of paroxysmal atrial fibrillation, who didn’t came in sinus rhythm after therapy with Cordarone I.V. The heart ultrasound was normal without clots in the left atrium. Thyroidal hormones levels were normal and thyroid ultrasound was normal as well. Electric shock was performed but without any result. The patient follows therapy with beta-blocker but remain in atrial fibrillation. For this reason decided to perform ablation surgical procedure to revue in sinus rhythm. After the surgical procedure remained also with beta-blockers drugs 2X50 mg/day but for a short period of time was in sinus rhythm and again revue in atrial fibrillation under therapy. For this reason performed again ablation surgical procedure follows also therapy with beta-blocker after that and the sinus rhythm was present for a short period of time. In this time appear two episodes of paroxysmal atrial fibrillation under medications and decided a third surgical procedures of ablation but during surgery procedure was induced atrial fibrillation and needs anti-arrhythmic therapy I.V. to become in sinus rhythm and after that remain on beta-blocker drugs in sinus rhythm during therapy. After two months the patient develops again atrial fibrillation under antiarrhythmic therapy. Of course, this surgical procedure appears with all the good intentions for the patients to try solving the real cause of the problem – ectopic foci – but these must to can be localized first and we must to take into account also the risk of myocardial fibrosis induced. One thing is certain that repeated surgeries through ablation process are themselves risky and can become a risk factor for subsequent episodes of atrial fibrillation. Sometimes the surgical procedure itself can induce this rhythm disorder. Moreover mechanical process of the atrium, with intent to destroy ectopic foci can affect healthy myocardial tissue, which can then generate new ectopic foci, plus they can induce atrial myocardial fibrosis.Method: This prospective study was done at cardiology unit of Ayub Teaching Hospital, Abbottabad. Patients presented to emergency department with ST elevated Myocardial Infarction, who were not treated with primary angioplasty but thrombolysed with streptokinase, were recruited. ECG was acquired at baseline and at 90 minutes post streptokinase administration. Patients were divided into two groups: Group A having ST segment resolution after thrombolysis with streptokinase and the Group B having no resolution. These patients were followed up throughout the hospital stay for complications which were Arrhythmias, Cardiogenic Shock, Acquired VSD, Aneurysm and death.

Carotid Endarterectomy: Outcome of ''Old-Fashioned'' Approach

The purpose of this study is to assess the 30-day postoperative incidence of death, myocardial infarction, stroke, wound complication, and cranial nerve damage after carotid endarterectomy using induced hypertension (systolic pressure > or = 160 mmHg), selective shunting, and primary closure. We retrospectively analyzed the records of 206 patients who underwent a total of 239 carotid endarterectomy surgeries between January 2002 and August 2009 to identify the impact of selective shunting and primary closure on morbidity and mortality. Two hundred thirty-nine surgeries were performed on 206 patients. The study population was 55% men and 45% women with average age of 67 years (range 33-85 years). Of these patients, 181 had hypertension (88%), 82 had diabetes (40%), 73 had peripheral vascular disease (35%), 107 had coronary artery disease (52%), 142 had tobacco abuse (69%), and 146 had dyslipidemia (71%). Twenty-six patients (13%) presented with history of stroke, 77 (37%) with transient ischemic attack (TIA), 14 (7%) with amaurosis fugax, and 108 (52%) were asymptomatic. The average internal carotid stenosis was 74% as indicated by duplex, computed tomography, magnetic resonance imaging, or angiogram. Of the 239 surgeries, 3 (1%) required patch closure, and 7 (3%) required shunt. Thirty-day postoperative complication rates are as follows: stroke, 3 (1.3%); TIA, 4 (1.7%); bleeding, 5 (2.1%); superficial wound infection, 2 (0.8%); heart attack, 1 (0.4%); cranial nerve injury, 0; and hospital death, 0. One patient (0.4%) died at home from an unknown cause. In conclusion, carotid endarterectomy with selective shunting and primary closure is a safe and effective surgical means of preventing stroke.

Embolic Arterial Occlusion

Embolic arterial occlusion is a common vascular surgical problem whose incidence1,5 appears to be increasing. This apparent increase in incidence has been attributed to better diagnosis and a larger number of elderly patients with cardiovascular diseases. There are many sources and causes of emboli in the arterial system:

Giant Pulmonary Cyst Surgery

Giant pulmonary cysts, often developing as a major complication of emphysema, seriously interfere with breathing mechanics. This report describes the results in 35 patients with giant pulmonary cysts who underwent surgical excision. A case report involving a 26-year-old coal miner with bilateral bullous emphysema is also presented.