A dissertation of ten surgical conditions.

This dissertation consists of ten different surgical conditions divided into four sections. Five in general surgery, two in urology, two in Orthopaedic and trauma and one in Ear, Nose and Throat (ENT). Surgery being a very wide subject, selection of the above conditions was not easy. The five conditions in general surgery included mainly those which were presented as acute emergencies except one. This is because acute conditions can affect healthy and young individuals and may lead to catastrophic results if the diagnosis is missed especially in our environment where diagnostic facilities are limited. In Perforated peptic ulcer, emphasis are placed on early diagnosis, resuscitation and appropriate emergency treatment. The controversies on treatment between simple plication and definitive surgery are discussed. It is concluded that since our patients present late, and in moribund conditions, minimum surgery like simple plication with omental patch is recommended. Those patients who will need further surgery can be determined later during follow up. Burn injury is the second condition discussed. The role of adequate and the right fluid and electrolyte replacement during the early phase is emphasized. The author however, thinks that most burn injuries can be managed with the facilities available in our set up. However, the community should be alerted on the importance of early reporting to hospitals and that the mortality and morbidity rates are worsened by the extent of burned surface area and time interval between injury and commencement of treatment. Traumatic rapture of the spleen was the third acute condition dealt with. Early diagnosis followed by emergency appropriate treatment is emphasized. Diagnosis was based on clinical evaluation and in all the patients it was correct. The immunologic role of the spleen in adults and splenic removal is discussed in details. The value of early diagnosis in sigmoid volvulus and the time of intervention is emphasized. Mortality and morbidity rates are closely related whether the bowel is viable or gangrenous. The last discussion in general surgery is on abdominal incisional hernias. The author was particularly interested to relate the occurrence of these hernias and suture materials used in the initial operation. Techniques available for repair are discussed. Urological conditions are commonly met in general surgery. Urethral strictures is one of the commonest which in most cases presents with acute urinary retention. Surgical management is emphasized and recommended in some patients as definitive treatment. Carcinoma of the urinary bladder is another common urological presentation. Most patients come late to hospital making palliation the only possible treatment. Recommendations are given for possible improvement for early detection of such patients. Fractures of the famoral shaft are among the commonest trauma conditions. The author is of the opinion that conservative treatment by traction is enough in a small hospital set up, but those cases that need surgical intervention are individually considered. The management of chronic osteomyelitis is one of the difficult orthopaedic condition. Sequestrctomy and saucerization and leave the wound open is recommended. Systemic antibiotics are added to surgery when indicated based on culture and sensitivity results. The last section covers one of the most interesting cancer seen in the ENT Unit. Nasopharyngeal carcinoma is commonly seen in adults above 40 years, and males are affected most. Patients present late in our environment and palliation remains the treatment of choice. The author gives suggestions and recommendations for early detection and effective follow up of such patients