Evaluation of the aetiological spectrum of obstructive jaundice

Jaundice is a common problem in medical and surgical gastroenterological practice. The surgical jaundice can be caused by the obstruction of the bile duct as with gall stones, strictures, malignancy, such as cholangiocarcinoma [in which the jaundice is persistent and progressive], periampullary carcinoma, carcinoma gall bladder 6 and carcinoma head of pancreas. The objective of this descriptive study was to evaluate the Etiological spectrum of obstructive jaundice. A prospective, descriptive study was carried out at Surgical Unit-II Holy family Hospital, Rawalpindi, from mid of May 2006 till March 2007. Sixty patients, who presented in the surgical OPD of Holy family Hospital, were included in the study. Thorough history and physical examination was followed by biochemical tests and various investigations like USG abdomen, ERCP, CT-Scan, and MRCP and histopathology. The data was analyzed using SPSS ver 14.0. Of the 60 patients; 40 [66.66%] were male and 20 [33.33%] were female, their mean age being 49.50 years. Malignant obstructive jaundice was seen in 34 [56.66%] patients while 26 [43.33%] had benign etiology. Amongst the commonest symptom; clay coloured stools [75%] was more frequent in patients with malignant disease whereas abdominal pain [51.66%] was most common in benign conditions. Commonest malignancy was Carcinoma [Ca] of the head of pancreas 18/60 [30%] followed by Ca gall bladder 8/60 [13.33%], cholangiocarcinoma 7/60 [11.66%], and periampullary carcinoma 1/60 [1.66%]. Choledocholithiasis 21/60 [35%] was the commonest benign cause followed by stricture of common bile duct 3/60 [5%] and acute pancreatitis 2/60 [3.33%]. Obstructive jaundice is common amongst females and the cause is mostly malignant. Ca head of pancreas is the commonest malignancy while Choledocholithiasis is the commonest benign cause. USG, ERCP and CT-Scan are important diagnostic modalities for evaluation of patient with obstructive jaundice with ERCP having the additional advantage of being therapeutic as well

Evaluation of levels and patterns of spinal cord injuries in the Earthquake victims

To determine the extent of spinal cord injuries among patients affected by the earth quake of October 8[th] 2005 in Pakistan. Cross-sectional study. The study was conducted from 10[th] October to 10[th] December 2005 in surgical and neurosurgical units of Rawalpindi Medical College and allied hospitals [Holy family hospital, Rawalpindi general hospital and District Headquarter hospital] and Melody relief and rehabilitation center, Islamabad. Level and patterns of spinal cord injuries was evaluated according to ASIA [American spinal injuries association] scoring system in one hundred and ninety four patients. Stability of spine and number of patients operated for spinal cord injuries was also assessed. One hundred and ninety four patients comprised of 74%[n=144] females and 26%[n=50] males. 78%[n=151] patients were of 16-39 years of age. 62%[n=120] of patients had injury at lumbar level, 25%[n=48] at thoracic level, 9%[n=18] at thoracolumbar level, a few had injuries at cervical and sacral level. 46.4%[n=90] patients had spinal cord injuries which were graded "A" according to ASIA scoring system. 4.12%[n=8] graded as "B",10.82%[n=21] graded as "C",9.2% [n=18] graded as "D" and 13.91% [n=27] graded as "E". In 69%[n=134] patients` spine was stable and 31%[n=60] had unstable spine. 77% [ n=150] patients were operated and in 23%[ n=44] patients, operation was not indicated. Majority of spinal cord injuries occurred at thoracolumbar level leading to paraplegia. Those with ASIA score "A" would be bedridden for life. Proper rehabilitation programs should be inculcated to enable them to live an independent life

Comparison of store and forward method of teledermatology with face-to-face consultation

To compare the accuracy of store and forward method of teledermatology with the traditional face-to-face consultation. The comparison was done between Institute of Dermatology King Edward Medical College Lahore that served as teledermatology center and Dermatology Department of Pakistan Institute of Medical Sciences Islamabad from where patients were selected. Telmedpakª provided the technical support. Thirty three patients were selected from outpatient department of PIMS and images were taken using a digital camera. Images were stored in computer and were sent to Institute of Dermatology via email for Teleconsultation along with a short history and examination findings. Diagnosis of consultant after face-to-face consultation was then compared with the image based diagnosis that is after teleconsultation. In 81% of the cases the diagnosis on face-to-face consultation was same [p<0.05] while in 18% of the cases the two diagnoses differed. In 9% [n=3] of the cases, image resolution was not good but out of these three, diagnosis was same in two and differed in one case. This study concludes that store and forward method of teledermatology is reliable and can provide a means of increasing access to dermatological care in rural and under-served areas

Laparoscopic complications in the learning phase:our experience in the first 75 cases

To identify factors responsible for serious complications in learning phase of Laparoscopic surgery. Retrospective study of 75 patients undergoing Laparoscopic cholecystectomy. Surgical Units of D.H.Q. and Holy Family Hospital of Rawalpindi Medical College. Seventy five patients of cholelithiasis who had laparoscopic cholecystectomy done. Operative problems, conversion to open cholecystectomy, postoperative complications and hospital stay in patients having laparoscopic surgery. Overall conversion rate was 16% operative complications included one common bile duct injury and one case of duodenaI injury. Postoperative complications were infection of trocar site in 8%and subhepatic collection in 4% cases. Proper selection of patients, two or more experienced surgeons operating together and low threshold for conversion to open procedure reduces the risk of serious complications in the learning phase of laparoscopic surgery

Major disasters-first hand experience at DHQ hospital, Rawalpindi

In the last 5 years surgical department of D.H.Q. Hospital, Rawalpindi has been involved in dealing with three major disasters. The Kashmiri bazaar bomb blast in 1987, the Ohjeri camp bomb blast in April 1988, and most recently the bomb blast on 19th January 1991. We have evolved our own plan to deal with such disasters

Prevalence of simple goitre in tehsil Murree

An epidemiological survey for the prevalence of simple goiter, in tehsil Murree, was performed. 12.6% of randomly sampled population was found to have simple goiter of variable degree. Female ratio was about 1:2. Of females, who had goiter, were found to be between 15 and 30 years of age, followed by those above 30 years. Amongst males, highest incidence was observed between 5 and 30 years are group

Endodermal sinus tumour of the ovary

Endodermal sinus tumour of the ovary is a highly malignant germ cell cell tumour showing selective overgrowth of yolk sac endoderm intimately associated with extra-embryonic mesoblast

Endemic goitre: an affliction of young females in Murree hills

4% of all elective surgery performed at D.H.Q. hospital, Rawalpindi is for goiter. Studies at this hospital and survey of villages Phagwari and Charhan, in the Murree hills show striking similarities. More than 80% of people affected were females. Upto 66% patients with goiter were in the age group 11-30 years

Surgery of prostate in district head quarter hospital Rawalpindi- comparison of open prostatectomy with transurethral prostatectomy

Of 71 cases of prostatectomies performed over a period of 1 year at the District Head Quarter Hospital, Rawalpindi are reviewed. Following Transurethral Resection, Stricture Urethra was the only complication [4%], whereas, a higher overall incidence of complications [32%] was seen where open prostatectomy was carried out. The mean hospital stay following T.U.R.P. was 5.7 days as compared to 12.02 days in open Prostatectomy. Overall mortality was 2%

Carcinoma of male breast

Carcinoma of male breast is very rare and accounts for less than 1% of breast cancers

Surgical audit of acute abdominal pain- study at DHQ hospital, Rawalpindi

Renal colic[45.8%] was the commonest clinical diagnosis in audit of 72 referrals of patients with acute abdominal pain from the casualty department. Only 35 [48.6%] of these patients required admission. Surgical operations were performed in 21 [60%] of these patients. the most commonly performed operation was Appendicectomy 15 [71.4%]. The rate of unnecessary appendicectomy was higher in females 40%

Abdominal trauma in children: experiences at Rawalpindi Hospital

Abdominal trauma which requires exploratory laparotomy constitutes about one third of all emergency surgery performed at the D.H.Q. hospital, Rawalpindi. 13% of these cases, are children, the mode of injury being blunt trauma and firearms. In blunt trauma group the commonest viscera involved are spleen and liver. In fire arms group multiple viscera are involved. One death occurred in this group due to chest infection. In this study it was noted that viscera involved due to trauma follow similar pattern as in adults. Complications were more where more than one viscera was involved

Management of acute and perforated/gangrenous appendicitis: cost analysis of two antibiotic regimens

Two combinations clindamycin and gentamycin-[Group A]' and 'Metronidazole, ampicillin and cloxacillin -[Group B]' were used as part of the treatment in 71 patients of acute and perforated appendicitis. The infection rate in group A was 10% and in Group B was 14%. The results being comparable, the cost of treatment for Group A per patient was considerably less. In patients with peritonitis due to perforated appendix, wound sepsis was high despite appropriate antibiotics

Pseudocyst of pancreas: rare site

Pseudocyst of Pancreas is essentially a collection of fluid in levels sac. A cases is reported in which there was fluid collection between stomach and liver, requiring external drainage