Biomedical subjects
Publications and source records attributed to F S Rakas.
A newborn baby presented with a lump in the right hypochondrium. She had a bout of upper gastrointestinal bleeding. At operation, a pyloroduedenal duplication cyst was successfully removed. The relevant literature is reviewed.
We have reviewed a series of 124 consecutive cases of hepatic hydatid cysts in 102 patients treated surgically in Benghazi, Libya, over a period of five years. Overall mortality was 3.9%. The rate of post-operative complications was 37.5%. Cysts already complicated with infection, intrabiliary communication or intra-peritoneal rupture accounted for 30.6% of the cases. They were all treated by means of removing the endocyst and external tube drainage of the residual cavity. In this subgroup, the post-operative complications' rate was 89%. In the 74 uncomplicated cysts, removal of the parasite was followed by omentoplasty in 25 cases and external tube drainage in 49 cases. Postoperative complications occurred in 16% of the omentoplasty group and 8.2% of the drainage group. It is concluded that omentoplasty for the obliteration of the residual cavity may be used in uninfected and relatively inaccessible cysts. In the majority of cases, however, external tube drainage retains its value as a simple and safe procedure.
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Intrabiliary rupture of a hydatid cyst of the liver is a rare complication. It can give rise to jaundice due to cholangitis, and common bile duct obstruction caused by hydatid membranes and daughter cysts. A case of intrabiliary ruptured hydatid cyst presenting as abscess of the liver is reported with a brief review of relevant literature.
A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.
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Thirty patients below the age of 12 years were surgically treated for hydatid cysts of the liver. Twenty-two (73.3%) had a single cyst located in either hepatic lobe and eight (26.7%) harboured more than one cyst. Preoperative complications occurred in eight (26.7%) patients, which included jaundice in one, rupture in two and infection or bile staining in five. In one patient in the uncomplicated group of 22 (73.3%), left lateral hepatic segmentectomy was performed and in the rest, an endocyst was removed and an ectocyst was partially excised, with or without external tube drainage. No postoperative complications occurred in this group. However, three out of eight children with preoperative complications developed bile drainage which ceased spontaneously within 3-8 weeks. This study showed that the simple procedure of removal of an endocyst and partial ectocystectomy were suitable for the treatment of hepatic hydatid cysts in children.
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920 children below the age of 12 years were admitted with complaints of pain in the right lower abdomen and a suspected diagnosis of acute appendicitis. In 720 patients, clinical diagnosis was made and immediate operation was performed. In 644 of them (89.5%) an intraabdominal lesion was found but in 76 (10.5%) no disease was encountered. Rest 200 patients were observed in the ward and progression was noted at regular intervals. Eight of these patients did not improve while on observation and they were operated. Five others did not have acute appendicitis but in them definite medical diagnosis was made. However in remaining 187 observed patients abdominal signs gradually resolved and needed no surgery but no definite diagnosis also could be made. They appeared to have non-specific abdominal pain. The conclusion of the study was that inhospital observation of patients with right lower quadrant abdominal pain and questionable appendicitis upto three days was a safe way to reduce the rate of negative appendicectomies and unnecessary surgical exploration.