A dissertation of ten surgical conditions
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Date
1984
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University of Dar es Salaam
Abstract
This dissertation consists of ten different conditions divided into three sections: Five in general surgery, three in surgical onclogy and two in orhopaedics and trauma. As surgery is a very wide subject the choice of conditions has not been an easy task. However as much as possible the conditions reflect the commonest seen at the centre and in which the author participated fully in the management. In the discussions, special features of the conditions, areas of controversy, recent advances are emphasized, and in each case a conclusion is drawn. The five conditions in general surgery are mainly those which present in an acute phase except for one. This is because the author thinks that acute conditions which can affect healthy young individuals may lead to catastrophic results if the diagnosis is missed especially where diagnostic facilities are very limited. In sigmoid volvulus, the first condition emphasis is placed on the value of early diagnosis as both the morbidity and mortality rates are closely related to conditions of the bowel at the time of intervention whether is viable or gangrene. Peptic ulcer which was once thought rare in the African is the second case. The controversies on treatment between simple and definitive surgery are discussed. It is concluded that as long as our patients are seen late during the course of the illness and the inexperience of the majority of doctors dealing with the patients, minimum surgery i.e. simple plication is recommended. Patients needing further surgery can be determined later during follow up. In ruptured spleen, role of the spleen in immunology is discussed in detail and balanced between the splenic presentation and removal. Again in our situation where sophisticated facilities like C.A.T scans are not available, most splenic ruptures should be treated by splenectomy. Burn in adults is another common condition encountered in this hospital. The role of adequate and the right fluid and elecrolyte replacement during the early phase is discussed and the author is of the opinion that most of the burn injuries can be managed with the facilities available if community is educated on the importance of early hospital report after the injury, as the mortality rate was found to be related to the extent and time interval between injury and commencement of treatment. The last discussion in general surgery is on pancreatic pscudocysts. This condition is very rare and only three conditions were seen, however due to the difficulty in pre-operative diagnosis, another elected to discuss this rare but interceting condition. Malignant conditions are said to be on the increase in developing countries and are the frustrations of the medical staff. Patients in variably present late and treatment very unsatisfactory leaving these unfortunate patients to die in misery. Breast carcinoma is among the commonest malignancies seen here. Patients are relatively young than the average European patient and majority are in an advanced stage. The discussion focus on the postulated actiology and role of estrogen status in treatment. Finally the treatment of this widely studied but controversial malignancy is discussed. Emphasis is made on the recent conclusion that breast carcinoma is a systemic disease and in treatment both local and systemic therapy should be emphasized. Another common malignancy seen here is the debilitating cancer of the Oesophagus. By and large when the patient is seen only palliative therapy is possible here. Thus emphasis should be placed on early symptoms which the patient may ignore in order to yield better results. Kaposi sicoma has been studied extensively in neighbouring Uganda which has one of the highest incidence in the world. The discussion centres mainly on the diversity of presentation which depends on the age of the patient and the different modes of treatment. The last section deals with conditions treated in orthopaedic and Trauma department. Tuberculosis of the spine or Pott’s disease is now mainly a third world problem. Both conservative and operative treatments are discussed. It is concluded, like has been shown by the numerous studies by the Medical Research Council, that conservative methods yields acceptable results. Fracture of the femur is among the commonest trauma conditions seen, and the author is of the opinion that conservative treatment by traction is enough especially in a small hospital set up.
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Keywords
Surgery, Operative
Citation
Museru, L. M. (1984) A dissertation of ten surgical conditions, Masters dissertation, University of Dar es Salaam. Available at (http://41.86.178.3/internetserver3.1.2/detail.aspx?parentpriref=)