Background Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48%. Objectives This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional. INTRODUCTION Abdominal wall hernias are common and are a significant cause of morbidity. Stomas are commonly constructed following colorectal surgery to protect distal anastomosis or when sepsis prevents primary anastomosis. There is a risk of a wide range of morbidity following both stoma formation and stoma reversal (Chow et al., 2009). Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48% (Tilney et al., 2008). They occur over time and are generally under-reported, which may be due to the elderly nature of the population, the significant co-morbidities or early discharge from follow-up (Cingi et al., 2006). One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair.Risk of hernia is greater after colostomy closure than after ileostomy closure(Bhangu et al., 2012). A meta-analysis published in 2012 investigated the incidence of incisional hernia following closure of stoma, The overall mean incisional hernia rate following stoma closures was 7.4%. The authors reported a lower risk of hernia following reversal of ileostomy when compared to respectively (Bhangu et al., 2012). A further systematic review found a similar incidence for stoma site incisional hernias to be 8.3% (0–33.9%) (Nguyen et al., 2014). Two factors should be noted with regard to the incidence of stoma site hernia. Firstly, that the long-term risk is not known and secondly, that clinical examination alone is shown to have a lower detection rate of incisional hernia post stoma closure when compared to clinical imaging (Bhangu et al., 2012; Cingi et al., 2006). Therefore, studies focusing on only clinical examination may be underestimating the prevalence, as radiological detected herniae may become symptomatic over time and may be missed in studies with a short follow-up period. AIM OF THE WORK This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.
Subcuticular sutures used for cosmetic skin approximation usually produce a satisfactory scar. Non‐absorbable monofilament sutures further increase the advantages of subcuticular closure1,2, but in lengthy wounds it is difficult to use fine material such as 3/0 or 4/0, as it may break on withdrawal. Several methods have been employed to secure the loose ends of running subcuticular stitches. Beads and bulky knots may produce an unsightly scar at the ends of the suture line. For several years the author has used a technique for non‐absorbable subcuticular sutures that allows sound wound approximation, minimal scarring and can be applied to lengthy wounds.
Background According WHO Egypt has high incidence in RTA and burn. Controversy between studies and reviews on the best dressing on donor site, while evidence support the use of moist wound dressings other centers believe that the impregnated gauze is cost effective. Objective Comparison between 3 types of dressings: The Conventional method (Vaseline gauze), Calcium alginate and Hydrocolloid sheets to determine which donor-site dressings are associated with the best outcomes for faster healing rate, less Pain, decreased Infection rate, healing quality and cost-effectiveness. Patients and Methods This study was conducted on 60 patients 35 males (58.33%) and 25 females (41.67%) in Ahmed Maher Teaching hospital divided into 20 patients in each, the conventional by Vaseline gauze group, the hydrocolloid using group and the Ca alginate group. Results The hydrocolloid showed highly significant overall results in faster epithilization and healing rate with mean 9.35 days ± 1.8 days and significant pain reduction post operatively and comfort during dressings and it was satisfactory in the reduction in change frequency as most patients healed between 7 – 10 days and in most cases the requirement for dressing change was every 5 days. Conclusion Modern wound dressings should become the standard of care in Egyptian burn centers and hydrocolloid is advised when multiple reharvesting for huge skin defects and increase satisfaction with considerable cost effectiveness. Vaseline gauze showed the worst results, but cost effectiveness by direct method is doubted if compared by the indirect and global cost of analgesics, hospital stay and medical stuff burden of dressing frequency.
Background Brest feeding is an important process that’s not only important for baby nutrition but also it strengthens the relation between the mother and her baby. Female breast undergoes multiple physiological changes during pregnancy and lactation.if the female not well educated about them and how to deal with them it will be a source of great horror to the female and her family as they consider any pain or unknown change in the breast as cancer until proved otherwise. Objective To assess breast care during pregnancy and its preparation for lactation and the value of this care in preventing breast infection. Patients and Methods This is a prospective study included 85 female patients coming to breast clinic and obstetric clinic of El Demerdash Hospital from September 2017 to August 2018. 40 of them presented during the third trimester of their pregnancy and the remaining 45 presented during lactation period. Sixty –three of them were multipara, the others were primigravida. Thirty of them gave a history of problems with previous lactation. Results In our research, females who came and were followed during pregnancy were educated about the importance of breast feeding to the baby and to the mother during their visits to the obstetric clinic. They were taught how to take care of their breast preparing it for safe and comfortable nursing. 35% of them were previously suffered from breast engorgement in previous lactation but when they followed our instructions about 27% of them developed breast engorgement which relieved rapidly without progressing to further complications. Also 5% previously developed breast abscess which was avoided in current study. We had also two of our participants that had retracted nipple one of them had previous experience of lactation that stopped shortly after birth but when we reassure her and learn her how to prepare her nipples by gentle massage, lubricants and use of plastic shells after delivery she could overcome her problem and continue breast feeding. Females who came during lactation were not prepared properly during pregnancy and 44% of them suffered from breast engorgement which was relieved with proper management but one of them developed breast abscess. Conclusion Every female have to learn about the right position of nursing and how to make proper care of her breasts and when she has to seek medical advice. This will help her to adapt the act of nursing and overcome any annoying problem that she may face during this period.
Background Acute appendicitis is one of the most common causes of acute abdomen. It may be either complicated or uncomplicated. Sometimes the acute inflammation of the appendix may be enclosed by the patient’s own defense mechanisms to form inflammatory phlegmon. Complicated appendicitis is a palpable appendiceal mass, phlegmon, or a localized abscess. A phlegmon is an inflammatory tumor consisting of the inflamed appendix, with the greater omentum and adjacent viscera. Aim of the Work To determine the preferred approach taken to the management of the appendicular mass, to compare between acute appendectomy and delayed surgical intervention for appendicular mass, and to determine patient outcome following appendectomy for appendicular mass. Material and Methods: Study A retrospective study. Study Setting The study has been conducted in Ain Shams University Hospital (El-Demerdash) and military hospitals in Cairo and Alexandria under supervision of thesis supervisors. Study Period The study retrospectively analyze data of patients diagnosed as appendicular mass between January 2017 and December 2017. Study Population: Inclusion Criteria Patients with acute abdomen, diagnosed as appendicular mass by clinical examination and imaging (US and CT). Exclusion Criteria Females with right ovarian problems. Cases with right ureteric stones. Cases of recurrence. Abdominal ultrasonography and CT did not confirm the mass. Results The present study was a descriptive, retrospective, study that included 20 patients diagnosed with appendicular mass attended to surgery clinics at El-Demerdash and Military hospitals between January 2017 and December 2017. The patients were divided into two groups: Group I including 10 patients started conservative treatment then received delayed appendectomy. Group II including 10 patients received early appendectomy. Conclusion In conclusion, early appendicectomy is a safe and superior option in patients with appendicular mass compared to delayed appendicectomy. The results indicate that early appendicectomy leads to shorter hospital stay and return to normal activities than delayed appendicectomy. Moreover, postoperative difficulties and complications were less following early appendicectomy. The early appendectomy appears to achieve more favorable outcomes in patients with more severe symptoms, high fever, and high inflammatory markers. Nonetheless, more studies are necessary to confirm our findings.
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