The changing survival scenario in gangrenous sigmoid volvulus: a four-decade study.

There is a suspicion that mortality in gangrenous sigmoid volvulus has considerably declined over the recent years. This study was aimed to assess if this is a genuine trend, applicable to the patients, of this study too, and to identify factors responsible for the change, if any. Seventy-eight patients operated for gangrenous sigmoid volvulus, in the last four decades of the just gone century, were analysed. Nine clinical parameters were studied to identify factors responsible for mortality and to see if there was a change in clinical presentation in the later decades. Mortality in the 4 studied decades varied between 15.4% and 65%. Differences were significant (p<0.05) only between the decades of the seventies and eighties and between bunched pre 1980 (48%) and post 1980 (20%) decades. A sea change in survival scene occurred at the end of the decade of the seventies. The change was not accompanied by a concomitant improvement in clinical presentation (p>0.05). Two facts which could explain improved survivals in the post. 1980 period were, the increased recognition of gangrene extending beyond the area of constriction and improved survival after primary anastomoses (p<0.05). These indicated a more accurate assessment of viability and the distance between the cut bowel ends, a stricter selection of cases for primary anastomosis and using Hartmann operation in doubtful situations. Mortality in gangrenous sigmoid volvulus, without knotting in the Indian population has genuinely declined from over 50% in an earlier time to 20% in the later 20 years of the last century, the watershed in the changed scenario being the year 1980.

Study on the anatomical dimensions of the human sigmoid colon.

Although the sigmoid colon is commonly afflicted with disease, studies on its anatomical dimensions are scarce. It is suspected that dimensions of the sigmoid colon change with age. This study documents data on the anatomical measurements of the sigmoid colon in 70 Indian subjects (51 live and 19 cadavers). Seven parameters of sigmoid colon anatomy measured included length and width of the sigmoid colon and mesocolon at specific points. Three mesocolic indices (width to length ratios) were calculated. Comparisons of measurements in the live and cadaver subjects and in the two sexes were made. The relationship of change in parameters with age was assessed. Appropriate statistical methods were used and the differences were considered significant at P < or = 0.05. The study showed wide ranging variations in the values of various measured parameters of the sigmoid colon. Seven patterns of the shape of the sigmoid loop were identified. In the commonest pattern the sigmoid mesocolon was vertically longer than wide (dolichomesocolic), the sigmoid loop having its maximum convexity located just a little proximal to the apex. Patterns where the width of the mesocolon was greater than the vertical length (brachymesocolic) were also observed. The gender analysis showed that the sigmoid mesocolon of the female was brachymesocolic (wider than long), whereas that of the male was dolichomesocolic (longer than wide). This might explain the higher incidence of sigmoid volvulus in the male. This study also showed that the measurements of the sigmoid colon and its mesocolon do not change significantly within the age range of 16-60 years in the two sexes. Also noteworthy is the observation that in the cadaver the sigmoid colon shows considerable shrinkage, particularly of its mesocolon; consequently the data from cadaver subjects, though valuable for anthropometric use, have limitations when used for clinical applications.

Healing process in the ureter: an experimental study in dogs.

OBJECTIVE: This study set out to describe the basic milestones in the pattern of healing in the ureter in order to understand why problems in healing arise when the ureter is severed, usually through anastomotic leakage or stricture formation. METHOD: Transection and anastomosis of the ureter were performed on dogs. The anastomotic segment was removed at days 6, 14, 21 and 42. Mucopolysaccharide levels, collagen content and breaking strength were measured on these samples and on anatomically similar segments from normal dogs. A minimum of five observations were carried out at each time point. The mean values of the estimations in various groups were compared. Differences were considered significant at p < or = 0.05. RESULTS: Mucopolysaccharide levels peaked at day 6 and then fell gradually to near normal (p > 0.05) by day 42. The collagen content rose to a maximum at day 14 and then fell to near normal levels (p > 0.05) by day 21. Breaking strength rose gradually to peak by day 21 and then fell to reach day 6 level (> 0.05) at day 42. At no time point did it reach anywhere near normal value. Full healing in the ureter takes at least six weeks. CONCLUSION: The healing process in the injured ureter is different to that in other tissues. It is probable that clues to anastomotic healing problems of the ureter lie in the paradoxical pattern of collagen formation.

Gangrenous sigmoid volvulus: a clinical study of 76 patients.

BACKGROUND AND AIMS: This study investigated the clinical picture of gangrenous sigmoid volvulus presented by Indian patients to describe the various patterns of gangrene and to identify the risk factors leading to the very high mortality from this disease. PATIENTS AND METHODS: A structured protocol including nine parameters was used to study risk factors in 76 patients treated at two major teaching hospitals in India. The clinical picture of patients at the two hospitals did not differ significantly. RESULTS: Contrary to expectations, we found gangrene in 26% of cases extending beyond the area of constriction into the rectum/descending colon. This extension was sometimes patchy and had an ill defined line of demarcation, which may lead to an error in judgment and cause a failure of anastomosis, which can be fatal. Risk factors were age over 60 years, the presence of shock on admission and a history of previous episodes of volvulus. CONCLUSION: This study identified three risks for survival. It is suggested that all patients with nongangrenous sigmoid volvulus undergo a recurrence-prevention procedure immediately or electively. We also found that extension of gangrene beyond the confines of the constriction is not uncommon, calling for caution on the part of the treating surgeon.

Nonresective alternative for the cure of nongangrenous sigmoid volvulus.

PURPOSE: Recurrence in sigmoid colon volvulus is a very vexing problem, because it occurs after all types of treatment including a resection of the sigmoid. A nonresective procedure that prevents recurrence in the long term has been devised and tried during the period 1968 to 1992. METHODS: The procedure involves extraperitonealization of the whole sigmoid colon via a left paracolic gutter incision in a manner akin to an extraperitonealized colostomy and placing it in the left half of the infraumbilical abdominal wall. This article presents a study of 84 patients who underwent this operation and who were followed-up. Some very useful practical points for ensuring the success of the procedure are also presented. RESULTS: The subjects comprised 58 male and 26 female patients, aged 10 to 81 (median, 60) years. The operating time ranged from 40 to 70 (median, 50) min. The operative mortality (9 percent) and morbidity of the procedure including cardiopulmonary complications (7 percent), incidence of small-bowel obstruction (1 percent), and incisional hernia formation (2.3 percent), were reasonably low. The incidence of wound-healing problems was significantly (P < 0.02) reduced in the 1980s and 1990s. Seventy-six patients were available for follow-up ranging from 0.5 to 25 (mean+/-standard error, 6.671+/-0.573; median, 6) years. Forty-eight patients were followed-up for five or more years. No patients developed recurrence of volvulus during the entire follow-up period. CONCLUSIONS: This nonresective, recurrence-free procedure provides a cure for nongangrenous sigmoid volvulus. It may be performed safely, even in relatively poor-risk patients, with acceptably low morbidity and mortality rates.

Multiple glomangiomas of lower limb.

A young man with multiple painful nodules on the left lower limb is presented. Histology of one of the nodules proved the diagnosis of glomangioma.

Patterns of erythropoiesis and anaemia in malaria.

Of 138 patients with malaria, 90 were found to be having Plasmodium falciparum in their peripheral blood smears. Megaloblastosis alone or in combination with the other patterns of erythropoiesis was observed in 82.1 percent cases of chronic P. falciparum malaria as compared to 36.3 and 26.5 per cent cases of acute P. falciparum and P. vivax malaria respectively. Iron deficiency was observed in 15.5 percent cases of chronic P. falciparum, 18.2 per cent cases of acute P. falciparum and 13.3 per cent patients of P. vivax infection. Of patients with chronic falciparum malaria, 33.3 percent revealed features of both megaloblastosis and defective iron utilization and transient hypoplasia of marrow was observed in 8.9 per cent of these cases.

Efficacy of various anthelmintics against third-stage larvae of Ancylostoma caninum in the brain of mice.

In an experimental larval infection of Ancylostoma caninum in mice, the efficacy of various anthelmintics against the larvae migrated and established in the brain is reported for the first time. Albendazole and flubendazole were the most effective drugs. Thiabendazole, benacil, phenacizole, oxfendazole and mebendazole showed significant larvicidal activity. Tetramisole, levamisole, fenbendazole, Sch 18099, pyrantel pamoate, morantel tartrate and oxantel pamoate did not show any significant activity even at relatively high dose levels.

Histamine and mast cell study in the gastric tissue of south Indian patients suffering from duodenal ulcer with pyloric stenosis.

Patients undergoing surgery for pyloric stenosis secondary to duodenal ulcer were the subjects for the study. Two pieces of full thickness gastric wall (all coats) were obtained at laparotomy. The pieces were immediately split into two halves. One of these was used for histamine assay where as the other was used to study the mast cell population. Histamine content and mast cell population was found to be less in gastric mucosa of our patients as compared to values from normal human gastric mucosa. There was lack of correlation between mast cell population and histamine content which suggests that there could be some other storage sites for histamine.

The efficacy of some newer broad spectrum anthelmintics against third-stage larvae of Ancylostoma caninum in the mouse.

The efficacy of eight anthelmintics against Ancylostoma caninum larvae in the skeletal muscles of mice was evaluated. Levamisole (5 X 40 mg/kg), thiabendazole (5 X 400 mg/kg), oxfendazole (5 X 100 mg/kg), albendazole (5 X 100 mg/kg), flubendazole (5 X 200 mg/kg), benacil (5 X 200 mg/kg) and phenacizole (5 X 200 mg/kg) showed marked larvicidal activity (98 to 99%). Sch 18099 did not show larvicidal activity even at 5 X 400 mg/kg.

Complications of TUR of the bladder neck in the female. A study of 238 procedures.

Transurethral resection of the bladder neck in the female is unpopular because of complications and indifferent results. This retrospective study of 238 procedures (carried out over the period 1940-72) documents the various complications and shows that the fears generally held are exaggerated. Most complications are of moderate incidence and can be easily and satisfactorily managed. The incontinence rate (4.7% in this study) can be further reduced by selection of cases after careful urodynamic evaluation and avoiding certain types of cases. It is related more to the type of patient than to the procedure itself.