Single incision laparoscopic cholecystectomy with conventional instruments and ports: initial experience at tertiary care public sector Hospital

Objective: To find out safety and feasibility of single incision laparoscopic cholecystectomy [SLIC] using conventional instruments

Methods: This study was conducted at surgical department of LUMHS Jamshoro Pakistan from Jan: 2014 to Dec: 2015. All cases of symptomatic cholelithiasis that consented for laparoscopic surgery were included. The exclusion criteria were acute cholecystitis, acute gall stone pancreatitis, common bile duct stones and patients with co-morbid. A midline 3cm incision made supraumbilically and 10mm port placed. Two 5mm ports placed on either side of umbilicus slightly superior and laterally in order to triangulate. A 2/0 prolene suture placed through the infundibulum of the gall bladder to achieve retraction. The rest of the procedure is like standard 4 ports laparoscopic cholecystectomy

Results: Total no of cases were 50. The age ranged from 30-59 years [mean 35.20 years +/- 4.886.] There were 43[86%] females and 07[14%] males. The mean operating time was 80 minutes [range 50-120 +/- 16.020]. Four [8%] cases were converted to standard four ports laparoscopic cholecystectomy due to bleeding and difficult dissection in Calot's triangle. Minimal blood loss was observed during the procedure with no postoperative complications. The range of hospital stay was 1-2 days [mean 1.08 +/- 0.274]

Conclusion: SILC is a safe and feasible procedure with conventional laparoscopic instruments without additional cost of single port and articulated instruments. The cosmetic results are excellent with minimal increase in the operating time

Comparison for efficacy of general exercises with and without mobilization therapy for the management of adhesive capsulitis of shoulder - an interventional study

Objective: The aim of this work was to evaluate the effectiveness of exercise with manual therapy and exercise alone in adhesive capsulitis of the shoulder

Method: This randomized study was conducted at institute of physical medicine and rehabilitation Dow University of Health Sciences, Karachi between January, 2014 and July, 2014. Forty four participant age between 25-40 years were recruited. Twenty two participants were allocated to exercise and manual therapy group and 22 participants were allocated to exercise only group. Exercise and manual therapy group received general exercises and Maitland mobilization on shoulder joint whereas exercise group only received general exercises. Both interventions were carried out 3 times a week for 5 consecutive weeks. Pre and post intervention scores of Visual analogue scale [VAS], range of movement and Shoulder Pain and Disability Index [SPDI] were recorded. Paired sample t-test was used to analyze the results within groups

Results: After 5 weeks of intervention both groups made significant improvements in all outcome measures [p < 0.001]. Intra group analysis showed no significant difference between two groups [p > 0.05]. Mean VAS and SPADI difference was 2.23 and 22 in General exercise and manual therapy group and 2.33 and 23 in General exercise group respectively

Conclusion: Both exercises with manual therapy and exercises alone are equally effective in the management of adhesive capsulits of the shoulder joint

Hypotension after spinal anaesthesia; efficacy of ephedrine and phenylephrine for treatment during elective caesarean section

Aim of the study is to compare the efficacy of Ephedrine and Phenylephrine for treatment of hypotension after spinal anaesthesia for elective caesarean section. Randomized Clinical Trial. Operation theatre Department of Anaesthesiology, Combined Military Hospital Quetta. Six month from 16th Sep 2011 to 15th March 2012. Seventy women undergoing LSCS for singleton pregnancy under spinal anesthesia were randomly assigned in group A and B [35 in each group]. All patients preloaded with Lactated Ringer's solution 15ml/kg body weight 10 minutes before administration of spinal anaesthesia. Mean Arterial Pressure [MAP]] was recorded before administration of spinal anaesthesia considered as Base-line MAP and then at 1 Minute, 3 minutes and at 5 minutes after administration of spinal anaesthesia. When hypotension developed [MAP falls >20% from base line], intravenous single dose of ephedrine administered in group A patients, while in group B, Phenylephrine was given. Blood pressure was recorded after 1 minute following drug administration and up to 3 minutes at 1 minute interval. Patient handed over for procedure after 10 minutes of spinal block. The SPSS version 13 was applied to the data. Mean and standard deviation were computed for numerical variables like age, weight, height, systolic blood pressure, Diastolic blood pressure, and Mean Arterial pressure; whereas frequency and percentages were employed to assess the categorical variable like efficacy. Chi-square test was used to compare the efficacy of intravenous bolus of ephedrine and phenylephrine. Statistical significance was taken at p<0.05. There was significant difference in the efficacy of both the drugs, in the treatment of maternal hypotension. 74.29% were successfully treated in group [A] with a single dose of Ephedrine, as compared to group B where 51.43% were successfully treated with a single dose of Phenylephrine. [p-value = 0.048]. Intravenous ephedrine has more efficacy than phenylephrine in the treatment of maternal hypotension after spinal anesthesia for elective cesarean section

Intra-operative hypotension; induction of anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery

To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery. Cross-sectional study. Department of Anaesthesiology, Combined Military Hospital, Quetta. One year from 20-08-2010 to 19-08-2011. Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for at least 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Mean age of the patients was 47.70 +/- 8.47 years. Out of 92 patients, 38 patients [41.3%] were male while remaining 54 patients [58.7%] were female. Distribution of cases by hypotension after induction of anesthesia shows, hypotension at 30 minute in 55 patients [59.8%] and hypotension at 60 minute in 37 patients [40.2%]. Out of 55 hypotensive patients [at 30 minute] 17 patients [30.9%] had mild hypotension, 32 patients [58.2%] had moderate hypotension and 6 patients [10.9%] had severe hypotension. Out of 37 hypotensive patients [at 60 minute] 8 patients [21.6%] had mild hypotension, 25 patients [67.6%] had moderate hypotension and 4 patients [10.8%] had severe hypotension. Hypertensive patients continuing their routine angiotensin system inhibitors therapy [<10 hr preoperative] have a variable risk of developing moderate hypotension within 30 minutes after induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy

Frequency of malignancy in solitary nodule and multinodular goiter

To determine the frequency of malignancy in solitary nodule as well as multinodular goiter. Prospective observational study. Two years study from November 2006 to October 2008 was conducted in Liaquat University Hospital, Jamshoro and People's Medical College Hospital, Nawabshah. The study comprises 50 patients. All were admitted from OPD of both hospitals. The patients were evaluated fully after history and examinations and specific investigations of thyroid profile, scan, FNAC, indirect laryngoscopey and general assessment. All patients with solitary nodule and multinodular goiter included. Out of 50 patients 49 underwent surgery and tissue sent for histopathology. In this study of 50 patients of nodular goiter, 42 [84%] were female and 8 [16%] were male. The maximum number of patients were in age group 16-70 years. In 27 patients of multinodular 24 were female and 3 male. In 23 patients of solitary nodule 18 were female and 5 male. Regarding the histopathological results 10 [20%] patients showed malignancy, 8 [16%] in solitary nodules and 2 [4%] in multinodular goiter. Papillary.carcinoma seen in 7 [14%], follicular carcinoma in 2 [4%] and 1 [2%] as anaplastic carcinoma. Thyroid malignancy more common in solitary nodule as compared to multinodular goiter

Unnatural female deaths Peshawar

The aim of the study was to know the extent of violent deaths among females in Peshawar, the most vulnerable age group, weapons of infliction and the mode of death. Design: Non interventional [descriptive] type study. Place and Duration of Study: This study was conducted from 1st January, 2001 to 31st December, 2001 in the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. Subjects and Out of 679 deaths, presented for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar 89 were females. These were grouped according to age, mode of death and weapons of infliction. Females formed 13% of all the autopsies done in Peshawar. The age group most commonly involved was 21-40 years [50.56%]. Firearms were the predominant weapons of infliction [70.78%] and the intent was mostly homicidal [77.52%]. Fatal violence against women is uncommon in Peshawar. Suicide is rare. Young women are mostly killed by firearms

Five years audit for presence of toxic agents / Drug of abuse at autopsy

To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and yearwise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning. Design: Non-interventional [descriptive] type. Place and Duration of Study: This study was conducted over a period of five years [1997'2001] at Forensic Medicine Department, Khyber Medical College, Peshawar. Methodology: The study included 3508 autopsies conducted at Khyber Medical College, Peshawar. Out of these, 52 cases were those caused by fatal poisoning. These were analyzed according to age, gender and the toxic agent involved. t-test was applied as the test of significance. Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38%. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine [heroin] was the most commonly involved agent, 65.38%, of the total cases. The incidence of poisoning was more during the third and fourth decades of life. Diacetylmorphine [heroin] was the main causative agent involved in young males due to accidental over- dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives

Analysis of medico legal autopsies at Faisalabad

To collect and publish scientific information regarding different variables of MEDICO LEGAL autopsy to be used by health and law enforcement agencies for future planning. Data source: Cases autopsied at the department of forensic medicine, Punjab medical college, Faisalabad. Non-interventional descriptive Setting Department of forensic medicine, Punjab medical college, Faisalabad. Period: July 2001 to June 2002. Material and method: Study includes 236 cases of MEDICO LEGAL autopsy including both sexes. After legal formalities and examination of the clothes, a detailed external and internal examination of the dead body was conducted. Specimens were sent for further examinations where necessary. Findings were tabulated and analyzed. Majority of the victims [52.5%] was between the age of 20-39 years. Male cases outnumbered the female cases. Firearm was the most common causative agent in MEDICO LEGAL deaths. Homicide was the dominant manner of death. Maximum number of injuries was inflicted on the chest. A peak in MEDICO LEGAL deaths was noted in extreme summer. Homicide as a dominant manner in MEDICO LEGAL deaths and firearm being the commonest weapon of offence are eye openers. Strict legislation regarding holding of firearm weapons and justice without delay are the major steps which can help in improving the situation

Suicidal deaths; Assessment in Peshawar

To find out the incidence of suicide, the gender and age groups involved, the methods used for committing the act and to note seasonal trends if any. Data source: Cases brought for autopsy at the department of forensic medicine, Khyber Medical College, Peshawar. Non- interventional descriptive. Department of forensic medicine, Khyber Medical College, Peshawar. Period: January 1991 to December 2000. Materials and All 39 cases of deaths labeled as suicide on the basis of autopsy findings, police inquest and interview with relatives of the victim were selected from the autopsies. The cases were grouped on the basis of age, sex, method of suicide used, region of the body involved and the seasonal distribution of the cases. The rate of suicide in Peshawar is 0.21 per 100,000 per year. Males were the predominant victims with a male to female ratio of 2.9:1. The age most prone to suicide was 20-29 years followed by 10-19 years. The primary method used for suicide in both sexes was by firearm followed by hanging. The head was the region of the body used for suicide in 59.37% of firearm victims followed by the chest and the abdomen. Two peaks were noted in the months of September and March. The incidence of suicide in Peshawar is amongst the lowest in the world