Effect of early release of tourniquet in total knee arthroplasty

To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Comparative study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss [determined by Gross method] and other study variables were noted as per objective and computed. There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 Land 1.108 Lin group-Aand B respectively [p = 0.27]. Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay

Mini-open cholecystectomy in the management of cholelithiasis

To analyze the outcome of open mini-cholecystectomy in terms of operative success and complications. Retrospective review of record. Shifa International Hospital, Islamabad, from January 2002 to September 2005. all the patients who underwent mini-open cholecystectomy for cholelithiasis during the study period were reviewed. The data was collected on a computerized proforma. The patients undergoing classical open cholecystectomy were excluded. Statistical analysis was performed using SPSS for Windows version 11. A total of 200 cases were operated [180 females, 20 males; M:F ratio 1:9]. The mean age was 43 years [range 21-72 years]. The average operating time was 45 minutes. Complications included biliary leak in one patient [0.5%], bleeding 1 [0.5%], wound infection 4 [2%] and death in one case [0.5%]. The overall rate of complications was 3.5%. There were 5 patients who required extension of the incision for reasons like carcinoma gallbladder [1], control of bleeding [1], bad adhesions [1], difficult anatomy [1] and biliary leak from the liver bed [1]. The mean hospital stay was 1.5 days [range 1-3 days]. Mini-open cholecystectomy appears to be a safe and has its application where laparoscopic facilities are not available

Sentinel node localization in breast carcinoma

To determine the success rate of sentinel node dissection and the sensitivity of sentinel node to determine the presence of axillary node metastasis in women with clinically node negative breast cancer. Case series. Place and Duration of Study: The study was conducted at Department of General Surgery Pakistan Institute of Medical Sciences, Islamabad [PIMS] and Nuclear Oncology and Radiotherapy Institute, Islamabad [NORI] from January 2002 to December 2003. A total of 15 patients of early carcinoma breast were recruited in the study. Five patients were injected with radiocolloid and later with isosulfan blue in the subareolar region. Ten patients were given isosulfan blue only. All the patients were subjected to standard axillary clearance after sentinel node biopsy through separate incisions. Sentinel node was examined by intra-operative frozen section and all of the dissected lymph nodes were examined histopathologically for tumour deposits. Sentinel lymph node was successfully excised in all the cases 15/15 [100%]. In 14 of the patients the sentinel node pathology was truly predictive of axillary nodal status. Sensitivity of the test was 93.33% and the positive predictive value was 100%. Sentinel node biopsy should be followed by standard axillary lymph adenectomy until the results of multiple prospective randomized trials define the role of this technique in the management of carcinoma breast