Assessing the severity of intraabdominal Infections; the value of APACHE II Scoring System

Intra -abdominal infection continues to defy advances in surgical care with considerable mortality. It is characterized by a spectrum of presentations of varying disease severity. The need to ensure standards for comparing studies and antibiotic trials on intraabdominal infection led to the emergence of several scoring systems. There is paucity of information on this subject in local literature, even though a Nigerian scientist pioneered one of the earliest stratification systems. This is a review of literature on one of the scoring systems that has made an impact in the standardization of intraabdominal sepsis:the APACHE II scoring system. This study will review the genesis, bedside application, uses, limitations and alternatives as a scoring system for intraabdominal infection. Over two decades of use, it is simple and continues to be a reliable indicator of severity of intraabdominal infection

Diabetic Extremities in Kaduna

A 5-year retrospective review of 35 patients, suffering from diabetes mellitus with complication of the disease affecting the hands and feet is made between November 1994 and October 1999. The age range was 35-70 years with mean age of 48.5 years. M:F ratio was 2:1. The mean blood sugar at presentation was 12.9 mmol/L. There were 4 diabetic hands and 31 diabetic feet. There were 17 amputations, 12 serial wound dressing and 6 debridments. Mean duration of hospitalisation was 47.3 days. Early presentation and aggressive surgical approach to these patients is recommended (Nig J Surg Res 2000; 2:57-61) KEY WORDS: Diabetes, Extremitie

The retained surgical sponge following laparotomy; forgotten at surgery, often forgotten at diagnosis. Our experience.

Retained surgical sponge following laparotomy is an oversight with potentially serious repercussions for the patient, the operating team and the hospital. The diagnosis requires a high index of suspicion as the variety of presentations can easily be confused with commoner postoperative complications. We present 5 cases managed at Ahmadu Bello University Teaching Hospital, Kaduna from 2000-2005 with review of literature to highlight the diagnostic, therapeutic and preventive challenges in this part of the world. A patient presented with intestinal obstruction and severe malabsorption, another, severe intraabdominal sepsis and organ failure which led to death and three with enterocutaneous fistula. Confirmation of retained surgical sponge was made only at surgery in three patients and after expulsion of the sponge per rectum in two. The possibility of retained surgical sponge should be considered as a remote cause of postoperative abdominal symptoms especially if such surgeries have been conducted in peripheral clinics or hospitals in our environment. Surgeons in this country also have a particular duty to ensure that the sponges used during laparotomies are removed and to supervise preventive measures to ensure that they are not retained, as the precarious financial position of our patients make further postoperative investigations and relaparotomy even more difficult