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

comparative study of gap and interpositional arthroplasty with temporalis myofacial flap for TMJ ankylosis treatment

The objects of this study were to evaluate the effectiveness of gap and interpositional arthroplasty with temporalis myofascial flap in the treatment of the temporomandibular joint [TMJ] ankylosis. This descriptive case series study consisted of twenty five patients. It was carried out at Oral and Maxillofacial Surgical Department, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh from January 2010 to December 2012. Orthopantomogram [OPG] and 3-D Scan was the standard radiograph and was taken in every case. Nineteen had unilateral and six bilateral TMJ ankylosis. Most patients were in 2nd decade of life age group [16]; followed by 3rd decade [05] and 1st decade of life [04]. 18 were female and 7 were male; Major etiological factor was fall [21] followed by forceps delivery [03] and ear infection [01]. Inter-incisal distance [IID]/mouth opening were noted preoperatively, immediately after completion of operation that was 35mm and postoperatively at follow-up. The incidence of TMJ ankylosis varies from country to country and closely related to the social and financial issues of the patients. TMJ ankylosis is challenging problem for the patient, as for the surgeon. Over the years many modifications were made in TMJ surgery for better results and Gap arthoplasty with temporalis myofascial flap as the interpositional graft is one of common treatment modality which is done at our center

Efficacy of strictureplasty in tuberculous strictures of small intestine

To assess the efficacy of strictureplasty for tuberculous stricture of small intestine. This is a retrospective descriptive study, conducted at Liaquat University Hospital Jamshoro [LUH] during period of 5 years from July 2004 to June 2009. Sixty patients of small intestinal tuberculosis presented with stricture of small intestine and underwent strictureplasty were the subject of this study. The procedure was done conventionally in all cases, in 70% intestine was closed in two layers while in remaining it was done as single layer. Early complications were seen in 23 cases which included anastomotic leakage with fistula formation [9 cases [15%]], burst abdomen [5 cases [8.34%]] and subdiaphragmatic abscess [9 cases [15%]] The late complications observed after mean follow up of two years include intestinal obstruction that necessitated readmission was seen was in 9 cases [15%], however the re-exploration was required in five cases. Incisional hernia was seen in 9 cases [15%].Though the post operative complications are frequent after strictureplasty yet the procedure is safe and simple for tuberculous stricture of small intestine as it requires minimum expertise, less operative time and above all preserve gut's length

Salivary count of Streptococcus mutans in caries prediction

The purposes of this study were to give the characteristics of Streptococcus mutans isolated from saliva, and the salivary level of S. mutans and its relationships with dental caries. Dental caries is a common infectious disease worldwide. The aetiology of the disease is multifactorial, life habits and streptococcus mutans infection being the most imporatent factors. Paraffin stimulated saliva was taken from 40 subjects of three age groups in sterilized glass tubes. The saliva sample was serially diluted on GSTB agar plates. The plates were incubated anaerobically at 37 °C for 48 hours in candle extinction jars. S. mutans were identified on the basis of morphologic and biochemical characteristics. Viable cell count of S. mutans [CPU I ml] was also done on GSTB agar plates. S. mutans were found in all samples in significant percentage. The results indicated that subjects that had dental caries harboured high level of S. mutans 10[6]> CPU I ml. In age group III, the percentage of subjects with high level of S.mutans and dental caries was found to be higher as compared to age group I and age group II.

effect of commercially available local brand of toothpastes against oral bacteria

The objective of the study was to find the antimicrobial effect of local brands of toothpastes containing different active ingredients, against aerobic and anaerobic oral flora and Streptococcus mutans; the causative agent of dental caries and dental plaque. The efficacy of eight locally formulated dentifrices was checked against aerobic and anaerobic oral bacteria of 30 subjects. Sterilized swabs were applied on the subject's teeth and inhibitory zones against these bacteria were measured by agar diffusion method. The magnitude and duration of Streptococcus mutans percentage reduction was evaluated against 1:100 and 1:1000 w/v dilutions of six dentifrices containing different active ingredients. The Streptococcus mutans were treated with selected dentifrices for 0,5,10,15,30,60 and 120 minutes. The CPU was done using spread plate method. Triclosan containing toothpastes showed maximum inhibitory zones against aerobic and anaerobic oral bacteria followed by fluoridated, whitening and herbal dentifrices. The maximum percentage reduction of S. mutans was shown by triclosan containing toothpastes followed by fluoridated and herbal dentifrices. All dentifrices showed antibacterial activity against aerobic and anaerobic oral bacteria, maximum being that of triclosan containing toothpastes. The longest and largest reduction of S. mutans was shown by triclosan containing dentifrices