Frequency of carcinoma in gall bladder specimens sent for histopathology in a university hospital

OBJECTIVE: To find out the frequency of carcinoma of gall bladder in the cholecystectomy specimen sent for histopathology

DESIGN: Retrospective study

SETTING: Department of surgery, Liaquat University Hospital, Jamshoro and Depart of Pathology, Liaquat University of Medical and Health sciences Jamshoro

DURATION: From January 2007 to December 2008

METHOD: A retrospective histopathological analysis of specimen collected after cholecystectomies during January 2007 to December 2008 along with patient's notes, hospital records were analyzed. In addition demographic details were also collected. Data was entered into SPSS 13 and analyzed

RESULTS: 521 cases that were operated for cholelithiasis, nineteen were found to have carcinoma of gall bladder with incidence of 3.64%. The age ranged from 35 to 70 years, with mean age of 54 years in females and 55 years in males. Male to female ratio was 1:3.75. Adenocarcinoma [89.47%] was the most common histological variant

CONCLUSION: We conclude that carcinoma Gallbladder is having a high incidence of 3.64%, occurring at an early age with female preponderance. Since preoperative clinical examination and other radiological investigations cannot diagnose it efficiently in asymptomatic cases, therefore we suggest every gallbladder specimen should be routinely subjected to histopathology for early and curable management

Experience of laparoscopic cholecystectomy during a steep learning curve at a university hospital

Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature. Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. Mean age was 42 years with females [88.29%] preponderance. Majority of the cases were operated by consultants [85.10%] within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 [6.38%] cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients [11.70%] had intra-operative complications including complete transaction of CBD in only one [1.06%] male patient. Five patients [5.31%] had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients [4.25%] died due to multiple organ failure. We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.

Prospective basic clinical audit using minimal clinical data set

Audit is a means of quality control for medical practice by which the profession should regulate its activities with intention of improving overall patient care. Objective of this study was to report 1 year basic clinical audit of a general surgical ward and comparison of results with available data. All patients admitted and managed in department of surgery unit-II, Liaquat University Hospital, Jamshoro/Hyderabad from January to December 2007 were included in the study for basic clinical audit. Data of all surgical patients admitted during this period were retrieved from the departmental register. Details of surgical procedures and complications were recorded from the patients' charts. Total number of patients was 1434, out of which 844 [58.85%] were males and 590 [41.14%] were females. Majority [70.02%] of the patients were between 16 to 50 years of age. Elective surgeries were performed in 487 [33.74%] and emergency surgeries in 430 [29.79%] cases, whereas rest of the 526 patients [36.28%] were managed conservatively. Consultant was the primary surgeon in less than 50% of the procedures compare to post graduate trainees and registrars. The most common surgeries performed in elective wing were inguinal hernia repairs [25.66%] and cholecystectomies [22.99%]. In emergency wing, most of the surgeries were exploratory laparotomies [38.13%] and appendicectomies [22.79%]. Average duration of hospital stay in elective wing was 1-10 days and in emergency wing it was 2-21 days. There was an overall complication rate of 6.3% and a mortality rate of 2.44% respectively. We conclude that surgical audit has potential benefits for patients, clinicians, and provision of services for a continuous education, research and improved practice habits and should be perform on yearly basis. We also recommend the proper computerised audit programs and committees for its monitoring and evaluation

Postoperative complications of reversal of loop ileostomy

Objectives: to determine the morbidity associated with reversal of loop ileostomies

Methods: this was a prospective interventional study conducted at Liaquat University Hospital Jamshoro, from September 2005 to August 2007. All patients who had their loop ileostomies reversed during the study period were included. The various postoperative complications were noted during postoperative hospital stay

Result: seventy-nine patients fulfilled the selection criteria during the study period. Typhoid perforation was most common indication of loop ileostomy construction and reversal account for more than three-fourth of all cases majority of them were males [75.94%]. Mean interval for ileostomy reversal was 90 days. Thirteen patients [15.6%] developed postoperative complications after reversal of loop ileostomy, most of these were settled on conservative treatment. Postoperative wound infection [9.6%] was the most common complication. Only four patients [4.8%] had surgical intervention to manage these complications

Conclusion: loop ileostomy reversal is associated with low morbidity

Mucoepidermoid carcinoma of parotid presenting as unilocular cyst

An interesting case of a 09 years old girl is reported who presented with a painless, mobile, spherical, fluctuant and brilliantly translucent swelling in front of left ear. The fine needle aspiration revealed turbid dark yellow colour fluid. This cystic swelling was completely excised and the specimen on histopathology was reported as low grade Mucoepidermoid carcinoma. Recovery was uneventful. This unusual presentation of Mucoepidermoid carcinoma as a preauricular cyst is one of the rare unique reported case

Diagnostic accuracy of Alvarado scoring system in acute appendicitis

Objective: Acute appendicitis is one of the commonest surgical emergency. There are different scoring systems in use to diagnose the appendicitis. Aim of this study was to document the diagnostic accuracy by application of Alvarado Scoring System in clinical practice for acute appendicitis. Design: Descriptive case series. Setting: Surgical Unit-II, Liaquat University Hospital Hyderabad, Sindh - Pakistan; from January 2003 to September 2004

Methods: All the patients with suspected appendicitis were admitted in the ward. A profroma was designed and relevant findings were documented. These were observed regarding the increase or decrease in severity of symptoms and hence the change in the initial score according to Alvarado Scoring System was documented at the time of admission. Decision regarding surgical intervention was made on the basis of change in the score

Results: A total of 227 patients with clinical features suggesting acute appendicitis was admitted in the ward. Among them, 150 [66.07%] were males and 77 [33.92%] were females. Age ranged from 10-62 years. Main symptoms at presentation included pain in right iliac fossa 67.8%, fever 66.9% and nausea and vomiting 49.7%. Thirty two patients were received with Alvarado Score of 1-4 and three out of them required surgery. Thirty five patients were in the score of 5, twenty three out of them required surgery. One hundred sixty patients were in the score of 6 and above, all of them required surgery. Out of 185 patients who underwent surgery, 178 patients had appendicitis. The negative appendicectomy rate was 3.78%

Conclusion: It is concluded that according to Alvarado the patients with score up to 4 probably do not require surgery and among the patients with score up to 5, most of them need surgery while the patients with the score of 6 and above will require surgery

Management of acute organophosphorus insecticide poisoning: an experience at a university hospital

Objective: To document the management and subsequent outcome of patients with organophosphorus [OP] poisoning in intensive care unit of a university hospital. Design: Descriptive, retrospective study. Setting: Intensive Care Unit of Liaquat University Hospital Hyderabad, Sindh - Pakistan, from May 2004 to October 2006

Methods: Medical records of patients of OP poisoning admitted to intensive care unit of our hospital from May 2004 to October 2006 were reviewed. Diagnosis was confirmed from the history and clinical findings. Management, complications and subsequent outcome were noted

Results: Total 111 patients of OP poisoning were admitted in the ICU during the study period. Majority of patients i.e. 67[60.4%] were males and 44 [39.6%] were females. Mean age was 25.26+/-8.52 years with 85.6% within the age limit of 12-30 years. Majority of patients [89.2%] had suicidal attempt. In 94.6% patients, ingestion was the route of exposure. Mean ICU stay was 2.3+/-3.2 days while 20[18%] patients needed mechanical ventilatory support. Overall mortality rate was 9%

Outcome of ileostomy in the management of ileal perforation

Objective: To evaluate the role of a defunctioning ileostomy in the prevention of morbidity and mortality in patients with small bowel perforation. Design: A prospective randomized study. Place and Duration of Study: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad between October 2005 and September 2006

Subjects and Methods: Total 108 patients who underwent laparotomy for ileal perforation were included

Results: There were 67 males and 41 females. The age of patients ranged from 15 to 72 years with 80% of the patients being in age group of 17-70 years. Typhoid was the commonest cause for ileal perforation which was seen in 69 [63.8%] patients, followed by intestinal tuberculosis which was present in 23 [21.3%] patients. Out of a total of 108 patients, a proximal defunctioning ileostomy was constructed to protect the primary repair or the intestinal anastomosis in 57 patients [group I]. In the remaining 51 patients, primary repair or intestinal anastomosis was done without a defunctioning ileostomy [group II]. Two [3.5%] patients in group I and 7 [13.7%] patients in group II died postoperatively. Six of the 51 patients in group II who underwent primary closure of perforation or resection and end-to-end anastomosis without a defunctioning ileostomy developed postoperative faecal fistula. None of the patients with defunctioning ileostomy developed this complication

Conclusion: We conclude that construction of a temporary ileostomy to provide defunctioning for repair of ileostomy perforations reduce the incidence of fatal complications like faecal fistula. Ileostomy, however, is associated with a number of ileostomy-specific complications. We recommend that defunctioning ileostomy should be preferred over all other surgical options in cases of ileal perforations

Selective nasogastric decompression after elective laparotomy

Objective: This study was conducted to evaluate the need or other wise for use of nasogastric decompression after elective laparotomy, as many studies suggest that routine nasogastric decompression is unnecessary after elective laparotomy and may in fact be associated with an increased incidence of complications. Despite these reports the nasogastric tube is routinely used for decompression, believing that its use significantly decreases the risk of post-operative nausea, vomiting, aspiration pneumonia, wound dehiscence and anastomotic leakage. Design: Descriptive case-series. Place and Duration of Study: Surgical Unit-II, Liaquat University Hospital Jamshoro from July 2005 to July 2007

Patients and Methods: Seventy patients were included in this study. A proforma was designed and all the findings were recorded. All the patients were observed regarding the development of complications like, post-operative nausea, vomiting, pulmonary complications, abdominal distention and return of bowel sounds

Results: Out of 70 studied cases 45 [64.2%] were males and 25 [35.7%] were females. Age ranged from 10 years to 70 years and mean age was 33 years. Postoperative pulmonary complications like atelectasis and pneumonia were seen in 3 [4.2%] out of 70 patients. The commonest operation performed was reversal of ileostomy and resection with end-to-end anastomosis. Postoperative nausea and vomiting were seen in 10 [14.2%] cases

Conclusion: The study did not support the routine use of nasogastric decompression