Outcome and management of abdominal trauma at Liaquat University Hospital Jamshoro and Peoples Medical College Nawabshah

Out come and Management of Abdominal Trauma. Prospective observational study. Two years study from September 2006 to December 2008. Was conducted in Liaquat University hospital Jamshoro and Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from COD [Casualty out Patient: Department] of both hospitals. The patients were evaluated fully after history, clinical examination and specific investigation of X-ray abdomen supine and erect posture ultra sound of Abdomen contrast C.T and D.P.L Diagnostic Peritoneal Levage and General assessment. Al Patients of abdominal trauma included out of 50 patients 46 [92%] Patients an Underwent surgery Laparotomy. In this study of 50 patients of penetrating abdominal trauma 42 [84%] were males and 8 [16%] were Females the maximum number of patients were in age group 16 to 7 years in 40 [80%] Patients had fire arm, were the 6 [12%] cases of stab injury while remaining were the 4 [8%] of Blunt Trauma. Small intestine was the commonest organ injured 13 [26%] fallowed by liver 12 [24%] large intestine 7 [14%], Splenic injury was 7 [14%], Stomach 6 [12%], pan crease in 3 [6%], renal 2[4%]. Abdominal trauma is a serous emergency after Penetrating injury compared Blunt trauma

Knowledge and attitude of patients towards hepatitis B and C

To assess the level of knowledge and attitude of patients towards Hepatitis B and C in a public sector hospital, especially with reference to educational level. Descriptive and cross sectional study, from April to August 2006. Surgical Unit-I, Nawabshah Medical College Hospital, Nawabshah. All patients admitted in Surgical Unit-I NMCH, during the study period. Data was collected on a preformed questionnaire. Results were compiled and compared with national and international literature. During the study period 500 admitted patients were asked questions regarding Hepatitis B and C. Amongst them 280 were males and 220 females. Only 10% males and 5.9% females were educated beyond primary level, and 20.4% males and 10% females to primary level, while 76% were illiterate. Patients educated beyond primary level had more knowledge than illiterate persons about the condition, especially regarding the cause, organ of involvement prevalence in society, presentation, and vaccination for Hepatitis B. One alarming thing found in this study was lack of knowledge about risk factors, especially amongst illiterate persons. There was also lack of responsibility and poor attitude of even educated persons towards the treatment of these diseases. Both literate and illiterate persons were following customs of community and relying on homeopathic or herbal medicines for their treatment. There is a significant lack of knowledge and poor attitude of people towards Hepatitis B and Hepatitis C in this area

audit of peripheral lymphadenopathy

To evaluate the causes of Peripheral Lymphadenopathy. A descriptive and cross sectional study conducted from July 2004 to June 2006. Department of Surgery and Pathology, Nawabshah Medical College and Hospital, Nawabshah. A total of 116 patients with Peripheral Lymphadenopathy. The patients were evaluated for outcome parameters in relation to age, sex. Site and specific cause of peripheral lymphadenopathy. A total of 116 patients including 64 [55.17%] females and 52[44.82%] males were evaluated for peripheral lymphadenopathy. Their ages ranged between nine months to 70 years with a mean age of 27.14 years; majority belonged to the age group 11 to 20 years. Forty seven [40.51%] patients had cervical lymph nodes enlargement, 42 [36.20%] mesenteric, 24 [20.86%] axillary and 3 [2.85%] inguinal nodes enlargement. Tuberculosis and malignancy were the main causes of lymphadenopathy with an incidence of 53.44% and 13.79% respectively. Nine [7.75%] cases had acute lymphadenitis and 27 [23.25%] reactive hyperplasia, while in tow [1.72%] cases no pathology was detected. Peripheral Lymphadenopathy without any obvious cause presents a diagnostic dilemma

Indications and complications of indwelling ureteral stenting at NMCH, Nawabshah

To analyze the pattern of clinical indications and complications of Indwelling Ureteral Stens. A prospective study from November 2002 to November 2005. Department of Urology, Nawabshah Medical College Hospital [NMCH], Nawabshah. All patients who underwent J. J. Stenting were included in the study. These patients were evaluated by taking a detailed history, performing comprehensive clinical examination and doing various investigations like blood urea, serum creatinine, renal ultrasound, X-ray KUB, IVU, and preliminary cystoscopy. Majority of stents were placed endoscopically under local/spinal anaesthesia and were removed easily under topical anaesthesia cystoscopically. Of the total 120 cases, 95 [79.2%] had upper urinary tract obstruction and nine [7.5%] upper tract urinary leakage, while eight [6.7%] patients required stenting during upper urinary tract sugery and another eight [6.7%] after upper tract endoscopic manipulation. In majority of cases stents were successful in providing free drainage. No mortality was seen during the use of stents, but certain minor and major complications were encountered in 95 [79.2%] cases. This study show that the decision of ureteral stenting must not be taken lightly, as it is not free of complications. Certain precautions and guidelines must be observed whenever they are deployed. It is important to remember that the ureteral stent is a double edged weapon and can behave as a friend or an enemy

Common bile duct pathologies at Nawabshah

To determine the causes, prentation, management and outcome of Common Bile Duct [CBD] pathologies. Descriptive analytical study from January 1995 to December 2006. Surgical Unit-I, Nawabshah Medical College and Hospital, Nawabsheh. All patients who presented with CBD pathologies. Data of all the patients with CBD pathologies was collected and entered on a proforma, including their complaints, positive examination findings, investigation, diagnosis, procedure performed and its outcome. During the study period 45 patients presented with CBD pathology. Amongst them 14 were males and the rest females [31], with a mean age of 36.7 years. Around 67% patients had choledocholithiasis as the commonest cause. Exploration of the CBD with T-tube insertion was the commonest procedure, performed in 69% patients. About 4% patients had retained stones and 20% developed wound infection. Mean hospital stay was 13 days. Most common pathology involving the CBD was secondary stones; 95% patients had associated gall stones also

Frequency of intestinal tuberculosis in operated cases intestinal obstruction

To review the cases of intestinal tuberculosis in operated cases of intestinal obstruction. Prospective/retrospective descriptive study. Surgical ward-2, Jinnah Postgraduate Medical Centre, Karachi from 1st March, 2000 to 28th February, 2002. Total 246 patients of intestinal obstruction were operated in this period, amongst them 62 patients were found to be intestinal tuberculosis. All these patients were admitted through Accident and Emergency Department. Intestinal tuberculosis as a cause of intestinal obstruction was found in 62 [25.2%]patients. Mean age was 27.36 years. There were 32 [51%] male and30 [49%] female. Symptoms and signs of intestinal obstruction were found in all patients while peritonitis secondary to intestinal obstruction was found in 18 [29.03%] patients. Other symptoms of tuberculosis such fever, night sweats, weight loss was also present in significant number of these patients. After relevant investigations exploratory laparotomy was performed. Small intestinal stricture was commonest cause of intestinal obstruction found in 38 [61.29%] patients Mass in right iliac fossa found in 18 [29.03%] patients Six [9.67%] pa- tients had adhesions as a cause of intestinal obstruction with strictures as an incidental finding. Perforation of the small bowel secondary to intestinal obstruction was found in 18 [29,03%] patients. Stricturoplasty was the commonest procedure performed in 20 [32.25%] patients. Right hemicolectomy was second commonest procedure after stricture-plasty performed in 16 [25.80%n] patients. Other procedures performed include resection of the strictured or perforated segment followed either by end to end anastomosis or by end ileostomy. Me- senteric lymph nodes found enlarged in all patients and taken for biopsy. Antituberculous therapy was given to all patients. Frequency of intestinal tuberculosis is significantly high in our population and it is increasing at alarming rate

Usefullness of topical glyceryl trinitrate in chronic anal fissure

To assess the effectiveness of topical Glyceryl Trinitrate in the treatment of Chronic Anal Fissure. Prospective Observational study from April 2004 to March 2005. Surgical Unit II, Peoples Medical College Hospital, Nawabshah. A total of 46 patients with Chronic Fissure-in-Ano. The data of all the patients who were recruited for the use of 0.2% topical Glyceryl Trinitrate was collected and analyzed for gender, age, symptoms' duration, site, and associated diseases. These patients were followed at regular intervals of four, six, eight and 12 weeks, and six and 12 months to assess the outcome, adverse effects and recurrence. Out of the 46 patients, six did not came back for follow-up, hence they were excluded. Amongst the remaining 40 cases, there were 14 males and 26 females, with ages between 16-64 years. In 26 [65%] patients, the fissure healed completely during eight weeks duration, whereas 10 [25%] patients experienced headache. Recurrence occurred in six [15%] patients; in them lateral internal sphincterotomy was performed. Topical Glyceryl Trinitrate is a good treatment option, as the success rate was 65%, with only 15% recurrence. It is well tolerated and has no chances of faecal and flatus incontinence

Prevalence of hepatitis 'B' and 'C' in surgical patients

To find out the prevalence of Hepatitis-B and C in our surgical patients. Prospective, descriptive study carried out from May to October, 2005. Surgical Unit I, Peoples Medical College Hospital, Nawabshah. Patients of either sex, more than 13 years of age undergoing surgery. All the patients in the study underwent screening for Hepatitis-B and Hepatitis-C The information of the patients was recorded on a prepared proforma, and analyzed. The prevalence of Hepatitis-B was found to be 8.6% [5.8-12.12] and Hepatitis-C 11.6% [8.3-15.6], whereas in 20.33% [16.0-25.1] cases both Hepatitis-B and C were present. The high prevalence of Hepatitis-B and C found by the study suggests a routine, rather mandatory screening of all patients proceeding for surgery