Evaluation of best surgical procedures in typhoid perforation--an experience of 60 cases.
Department of Surgery, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
The results of treatment of 60 cases of typhoid perforation were reviewed over a period of 4.5 years. Closure of the perforation was the method of treatment in 28 (46.66%) cases and closure of the perforation with side-to-side ileotransverse anastomosis was done in 32 (53.33%) cases. Faecal fistula was the most severe post-operative complication following simple closure of the perforation, causing death in all patients and leading to a 25% mortality in those treated by this technique. No fistula was found following closure of the perforation with side-to-side ileotransverse anastomosis, leading to a much lower mortality of 6.22%. The overall mortality in this series was 15%. Apart from toxaemia, surgical failure was the main contributory factor to such a high mortality. In this series, closure of the perforation with side-to-side ileotransverse anastomosis was the better surgical procedure.
Endoscopic injection therapy for bleeding peptic ulcer using absolute alcohol.
Misra SP. Dwivedi M.
Department of Gastroenterology, MLN Medical College, Allahabad, India.
The injection of sclerosants and adrenaline in a bleeding peptic ulcer is known to arrest bleeding in the majority of patients. However, there are very few studies from India on this subject. Injection therapy was carried out using absolute alcohol in 21 patients with bleeding gastric ulcer and 55 with bleeding duodenal ulcer. Injection therapy successfully controlled bleeding in all 76 patients. Bleeding recurred in two patients who were successfully managed with a second injection of absolute alcohol. Post-injection blood transfusion was required in 16 (76%) patients with gastric ulcer compared with only 12 (22%) of those with a duodenal ulcer. The difference was statistically significant (P < 0.001). No complication of injection therapy was noted. It is concluded that injection therapy using absolute alcohol is a safe and effective therapy for managing patients with bleeding peptic ulcer.
Giardiasis in the adult population of Dakshina Kannada district of south India.
Shenoy S. Urs S. Prabhu G. Mathew B. Antony G. Bharati B.
Kasturba Medical College, Diagnostic Centre, Balmatta, Mangalore, Karnataka, South India.
A 10-year study of Giardia intestinalis infections in adults was conducted in the Dakshina Kannada District of Karnataka State, South India. Coproparasitological investigations were made on 10,000 stool specimens collected from selected patients. The infection rate was 37.1% with a male disease rate of 91.4%. The highest incidence rate was recorded in the age group 15-26 years. A possible reason for this preponderance of giardiasis in these males, is discussed. The optimum time for transmission appeared to be during the warmer months of the year (May to October) which coincided with the greatest amount of rainfall. The most common symptoms were abdominal discomfort, flatulence, diarrhoea, weight loss and anorexia. The predominating symptoms in our series varied with socio-economic level. There appeared to be some correlation between the clinical manifestations and the immune status of the individual.