Evaluation of modified Alvarado score for frequency of negative appendicectomies

Appendicitis being the commonest surgical emergency is primarily diagnosed clinically but posses diagnostic difficulty usually, especially to junior surgeons, demanding the need for tool/scoring system that can be easily applicable, accurate and reproducible in the diagnosis of appendicitis, with low negative Appendicectomy rate. This study is designed to assess one such scoring system, i.e., Modified Alvarado Score. A total of 100 consecutive male and female patients with age 10 year and above presenting with symptoms suggestive of acute appendicitis were included in study, assessed according to eight variables of Modified Alvarado scoring system and were accordingly placed into 3 groups. Group-I patients having score 1-4 were discharged, Group-II patients having score 5-7 were observed while Group-III patients having score 8-10 were operated. Status of appendix of operated patients was assessed histo-pathologically. Out of 100 patients included in study, 58 patients were operated on the basis of said scoring system. Of the operated patients 52 [89.65%] had acute appendicitis, thus yielding a positive predictive value of 89.66% while negative appendectomy rate of 10.34%. Frequency of negative appendicectomy was 7.69% [3/39] amongst males and 15.79% [3/19] in females. Post-operative complication rate including wound infection, pelvic abscess, chest and urinary tract infection was 22.41% [13/58]. Frequency of the negative appendicectomies can be reduced through standardization of the diagnostic procedure, by applying Modified Alvarado score in the diagnosis of suspected appendicitis cases as compared to simple clinical assessment

Precipitating factors for diabetic ketoacidosis

To determine the frequency of various precipitating factors for Diabetic Ketoacidosis [DKA]. This descriptive, cross-sectional study based on purposive sampling method was conducted at Medical ward VI, Islamabad Hospital, Pakistan Institute of Medical Sciences, Islamabad from 15[th] July 2005 to 14[th] January 2006. Forty Two patients of type 2 diabetes mellitus who at the time of admission had diabetic ketoacidosis were analyzed to sort out the precipitating factor by history, physical examination and investigations both laboratory and radiological. Out of 42 patients 19 [45%] were male while 23 [55%] were female. 21 [50%] had infection, 11 [26.19%] were non-compliant to the treatment, 09 [21.40%] had other co-morbidity [stroke, acute pancreatitis etc] as precipitating factor while one [2.3%] had his first presentation of diabetes mellitus as diabetic ketoacidosis. A mortality of 7.15% was recorded in the study. Infection, non-compliance to treatment and comorbid conditions are the major precipitating factors for diabetic ketoacidosis

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1[st] June 2007 to 31[st] May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumo'peritonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique

Role of total leukocyte count in diagnosis of acute appendicitis

Acute appendicitis is a common surgical emergency. Diagnosis may be difficult with little help from radiological and laboratory investigations. Total leukocyte count is one of the helpful investigations, being evaluated in this study. The patients presenting with right ower quadrant abdominal pain whom were diagnosed as having acute appendicitis and later underwent appendicectomy were included in the study. The preoperative leukocyte count was compared with histo-pathology findings of removed appendix. Sensitivity and specificity of TLC was calculated by standard formulas. The sensitivity and specificity of TLC as calculated in this study is 76.5% and 73.7% respectively while positive predictive value is 92.5%. TLC although not a diagnostic criteria for acute appendicitis but still is helpful investigation in decision making

Laparoscopic Cholecystectomy: An early experience at Ayub Teaching Hospital Abbottabad

Laparoscopic Cholecystectomy first introduced in 1987, is becoming more and more popular and now it has become gold standard in symptomatic gallstone disease. The current descriptive study is carried out in Department of General Surgery, Ayub Teaching hospital, Abbottabad to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality. The data of all patients who underwent Laparoscopic Cholecystectomy form January to December 2007 was entered in standardized proforma and analysed on SPSS 10. Out of 60 patients, 51 [85%] were female and 9 [15%] were males; the age range from 17 to 65 years mean age being 40.30 years, majority were in age 30-40 years group. Two [3.3%] patients had bile leak, 1 [1.3%] patient developed port site wound infection 1 [1.3%] patient developed collection in pouch of Morrison and in 1 [1.3%] patient stone were recovered from the epigastric port site wound. There was no bile duct or colonic injuries. The conversion rate was 5%. There was no mortality. Laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease and is up to the accepted standard in our set up as compared to national and international data