Routine or selective histopathology of gallbladder specimen after cholecystectomy for gallstone diseases

Objectives: To determine the incidence of incidental gallbladder cancer [IGBC] and to assess the need of routine histopathological examination of all gallbladder specimens after cholecystectomy for benign gallstone diseases Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA

Subjects: This study included all the patients who underwent elective or emergency cholecystectomy for gallstone disease at King Saud Medical City, Riyadh, Saudi Arabia between January 2012 and September 2015. Patients with preoperative suspicion of gallbladder cancer on imaging, or underwent cholecystectomy for gallbladder polyps or porcelain gallbladder were excluded from the study. Medical record of all the selected patients was reviewed and the data were collected. Interventions: Histopathological examination of gallbladder Main outcome measures: IGBC, routine histopathological examination of all gallbladder

Results: A total of 2396 patients underwent cholecystectomy for gallstones disease. All gallbladder specimens were sent for histopathological examination. IGBC was detected in nine gallbladder specimens [0.4%]. Out of 2396 patients, morphologic abnormalities were observed in 518 specimens [22.6%]. There was no reported case of IGBC with normal appearance of gallbladder specimen. Five patients underwent simple cholecystectomy for stage T1b, three patients of stage T2 tumor had further liver resection and one patient received only palliative care

Conclusions: The incidence of IGBC was 0.38%. All cases of IGBC were detected in abnormal looking thick wall gall bladder. Therefore, selective histopathology of abnormally looking specimen is recommended to reduce the cost and work load of pathologists

Impact of weekend admission on the outcome of patients with acute gastro-esophageal variceal hemorrhage

Objectives: To evaluate the impact of weekend admission on the outcome of patients with acute variceal hemorrhage [AVH] Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA Main Outcome Measures: AVH, weekend admission and clinical outcome

Subjects: Nine hundred and thirty-seven admitted during the period 1[st] January 2005 to 31[st] July 2013 and documented to have AVH. The selected patients were divided into two groups based on the admission day [weekday or weekend admission]. The data regarding patients characteristics and outcome in both the groups were retrieved from medical records and compared by using c2 test / Fisher's exact and student T- test

Results: Weekday admissions included 685 patients, while the weekend group comprised of 252 patients. The demographic, clinical and laboratory characteristics of patients admitted with AVH in both the groups were comparable. Statistically, there was no significant difference in the need for blood transfusion [46% versus 48%, p = 0.5868], and surgical intervention [5.4% versus 4.7%; p = 0.6595] between the groups. There was a little, but statistically significant delay in endoscopic intervention in the weekend group [7.56 +/- 7.8 hours versus 9 +/- 2.32; p = < 0.0001]. However, this delay did not lead to adverse outcome for patients [mortality rate 6.8% versus 5.25%; p = 0.389]

Conclusions: The weekend admissions were not associated with increased mortality in patients with AVH. Moreover, the length of hospital stay, need for blood transfusion, and rate of surgical intervention were similar in weekdays and weekend admissions

Vogt Koyanagi Harada disease: treatment and visual prognosis

Vogt Koyanagi Harada [VKH] disease is a chronic, bilateral, granulomatous panuveitis associated with central nervous system, auditory and integumentary manifestations. The study was conducted from January 2001 to December 2010 at the Department of Ophthalmology, Khyber Teaching Hospital, Peshawar. A total of 9 patients with diagnosis of Vogt Koyanagi Harada disease were included in the study. Extracted data included age, gender, duration of disease, initial and final visual acuities, treatment and complications. Initial visual acuity was ranging from 6/24 to perception of light. All the patients were treated with systemic and topical corticosteroids. In addition, one patient also received cytotoxic therapy. Final visual acuity was 6/18 or better in all cases [100%]. One patient developed bilateral cataract, glaucoma and sub-retinal fibrosis at the macula. The cataract and glaucoma were managed as per established protocols. The visual prognosis of Vogt Koyanagi Harada disease is generally favourable if the disease is identified early and adequately treated and the associated complications are addressed properly

Cosmetic outcome of Y-V medial canthoplasty in blepharophimosis syndrome

To determine the cosmetic outcome of Y-V medial canthoplasty with medial canthal tendon shortening in Blepharophimosis syndrome. Quasi experimental study. Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from June 2005 to April 2008. Thirteen patients of Blepharophimosis syndrome aged 4 years and above were included in the study. Oculoplastic assessment including measurement of horizontal length of palpebral fissure, ptosis and intercanthal distance were done. All patients underwent Y-V medial canthoplasty with medial canthal tendon shortening by a single surgeon. Same measurements were repeated one week postoperatively and then 6 weeks after surgery and results compared with pre-operative findings. Twenty six eyes of 13 patients were included in the study. Ten [77%] patients were female and 3 [23%] were male. Mean age of all patients was 13.54 ñ 6.99 years with a range from 4 to 28 years. Mean horizontal length of palpebral fissure of all 26 eyes was 22.88 mm before surgery and increased to 26.77 mm after surgery. Vertical pre-operative and postoperative height of palpebral fissure was 5.69 mm and 5.34 mm respectively. Mean pre-operative intercanthal distance of 37.46 mm was reduced to 32.08 mm postoperatively. Epicanthus inversus which was present in all [100%] eyes before surgery was successfully treated in 22 [84.6%] eyes after surgery. Y-V medial canthoplasty with medial canthal shortening in Blepharophimosis syndrome has excellent cosmetic outcome

Role of postoperative antibiotics after appendectomy in non-perforated appendicitis

To determine the role of postoperative antibiotics in reducing the surgical site infections [SSIs] after open appendectomy in patients with non-perforated appendicitis [NPA]. Randomized controlled trial. The Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 2010 to July 2011. Three hundred and seventy seven patients, who underwent appendectomy for NPA and fulfilled the selection criteria, were randomized into two groups. The patients in group A received a single dose of pre-operative antibiotics [cefuroxime sodium and metronidazole], while the group B patients received one more dose of the same antibiotics postoperatively. Patients of both the groups were followed-up for 30 days to assess the postoperative infective complications. Group A had 195, while group B comprised of 182 patients. The groups were comparable in the baseline characteristics. Statistically there was no significant difference in rates of SSIs between both the groups [p = 0.9182]. Mean hospital stay was 2.29 +/- 0.81 and 2.35 +/- 0.48 days for group A and B respectively [p = 0.4403]. None of the patients developed intraabdominal collection. Single dose of pre-operative antibiotics [cefuroxime and metronidazole] was sufficient in reducing the SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients

Non-viral microbial keratitis: etiology, clinical features and visual outcome

To determine the etiology, clinical features and visual outcome in non-viral microbial keratitis. An observational study [case series]. Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan, from January 2007 to December 2009. Charts of all patients with infective keratitis treated at the department were reviewed. The data collected and recorded on a standardized form included age, gender, predisposing factors, microbiology results of culture and sensitivity, clinical features, treatment given, complications and visual acuity at last follow-up [at least 2 months]. Among a total of 228 cases, 148 were male [64.9%] and 80 were female [35.1%]. Mean age of the patients was 42.8 +/- 21.9 years. Trauma was the most common [31.5%] predisposing factor followed by previous ocular surgery [8.8%] and use of topical steroids [6.6%]. The most common isolate among positive cultures was Staphylococcus aureus isolated in 31.4% [11/35] eyes followed by fungal hyphae in 25.7% [9/35] and Gram negative bacilli in 17.1% [6/35] eyes. Visual outcome was good [> 6/18] in 19.6%, moderate [< 6/18 to 3 6/60] in 22% and poor [< 6/60] in 58.4%. The main predisposing factors in the studied group of patients with non-viral keratitis were ocular trauma and injudicious use of topical steroids. The most common microorganism involved was Staphylococcus aureus. Visual outcome was moderate to poor even after successful treatment

Thyroid surgery complications: frequency of thyroid surgery complications and its association to the extent of procedure

Objectives: To Determine the frequency of thyroid surgery complications and its Association to the extent of procedure

Study Design: Cross sectional comparative study

Setting: Surgical and Radiological Department of District Head Quarters [DHQ] Hospital, Madina Teaching Hospital [MTH] and Allied Hospital Faisalabad

Duration: From December 2007 to December 2009

Subjects: 90 patients admitted with goiter due to benign diseases

Methods: In Group A, 30 patients underwent unilateral lobectomy. In Group B surgical procedure was Total Thyroidectomy. In Group C patients underwent Subtotal Thyroidectomy. Post operative complications were noted in each group and all three groups were compared

Results: we compared different complications like hemorrhage, respiratory distress, thyroid storm, and hypocalcaemia, injury to recurrent laryngeal or external laryngeal nerves or to cervical sympathetic chain, wound infection, and recurrence of goiter and hypocalcaemia. After excluding hypothyroidism as complication, [as all the patients in group B developed a hypothyroidism], in group A, one patient developed fore mentioned complications and in group B, ten patients developed complications. In group C complications noted in three patients were more as compared to group A but less as compared to group B

Conclusion: More extensive procedures are associated with greater number of complications in thyroid surgery

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost Gallstones

Laparoscopic Cholecystectomy [LC] is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed

Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Survery. National Institute of Science and Technology, Islamabad, from June through August 2008. Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures

Ophthalmoscopy- a useful but neglected skill by the non-ophthalmologist doctors

The purpose of this study was to assess the views of hospital doctors on ophthalmoscopy and their ability to examine the ocular fundi and diagnose abnormalities. A questionnaire based cross-sectional study. Khyber Teaching Hospital Peshawar, Pakistan, where study lasted from June 2007 to September 2007. An indigenous questionnaire was designed and distributed among non-ophthalmologists doctors of different specialties of the hospital. The subjects were asked to rank the frequency of using ophthalmoscope and difficulties facing in using it. A list of common ophthalmoscopic findings was also given in questionnaire and doctors were asked about their recognition using ophthalmoscope. A total of 71 non-ophthalmologist doctors were included in the study. Twenty four [33.8%] belonged to medical and allied specialties, 39 [54.9%] to surgical and allied specialties, six [8.5%] to paediatrics and two [2.8%] to emergency department. Only 28 [39.4%] had ophthalmoscope at their work place, 9 [32%] of which were non functional. Only 14 [19.7%] use ophthalmoscope daily, 26 [36.7%] occasionally and 31 [43.7%] do not use it at all. Only 20 [50%] of the 40 doctors who perform ophthalmoscopy, dilate pupil and the rest do not. Regarding competency of using ophthalmoscope only 22 [31.2%] doctors were confident in ophthalmoscopy, 17 [24%] had difficulty in focusing fundus, 22 [31.2%] had difficulty in recognizing findings and 10 [14.7%] did not know its use. Almost all [96%] mentioned the need of a training course to improve their skill of ophthalmoscopy

Short term results of primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children at primary children medical center university of Utah USA

To study short term results of primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children. A descriptive hospital based study. Pediatric Eye Unit, Primary Children Medical Center, University of Utah USA, where study was conducted from 1 st July 2004 to 31 st December 2007. Thirty five children aged 2 years to 13 years with congenital cataract who underwent phaco aspiration with posterior capsulotomy and anterior vitrectomy with acrysof hydrophobic acrylic foldable intraocular lens implantation in year 2004 to 2007 were included in the study. Outcome measures were visual acuity, clarity of the visual axis, postoperative inflammation and intra ocular pressure measurement. Out of 35 children 4 had bilateral cataract and 31 had unilateral cataract. There was family history of congenital cataracts in 3 children. Preoperatively 25 eyes [64.1%] had visual acuity of < 20/80, 12 eyes [30.8%] had 20/80 and 2 eyes [5.1%] had 20/60. Two weeks postoperatively 28 eyes [71.7%] had visual acuity of 20/20, 8 eyes [20.7%] of 20/40 and 3 eyes [7.6%] 20/60. One year after surgery 9 eyes [23.07%] had visual acuity of 20/20, 12 eyes [30.76%] 20/40, 6 eyes [15.39%] 20/60, 3 eyes [7.70%] 20/80 and 9 eyes [23.08%] had visual acuity of <20/80. Two weeks postoperatively 31 eyes [79.50%] were emmetrope and 8 eyes [20.50%] had astigmatism. One year after surgery 33 eyes [84.6%] were myope and 6 eyes [15.4%] had astigmatism. At the end of first year postoperatively children age 2-5 years showed mean change of refraction of 2.5 diopters, 6-9 years showed 2 diopters and 10-13 years showed 1 diopter change after one year. Postoperative inflammatory membranes occurred in 9 eyes [23.07%]. Five eyes [12.8%] responded to topical steroids while 4 eyes [10.2%] required pars plana membranectomy. Visual axis/ posterior capsular opacification occurred in 10 eyes [25.64%]. Secondary posterior capsulotomy was performed in 9 eyes [23.07%] while Neodynium Yag Laser capsulotomy was performed in one eye [2.56%]. Intraocular pressure recorded during postoperative period was normal in all the ages. The primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children with posterior capsulotomy and anterior vitrectomy is a safe technique resulting in good visual acuity and normal intraocular pressure measurement postoperatively. Visual axis/posterior capsular opacification, postoperative inflammatory membranes and myopic shift are recognized complications of hydrophobic acrylic intraocular lens implantation

Refractive errors in children attending out-patient department of ophthalmology, Khyber teaching hospital, Peshawar

The objectives of the study were to estimate the occurrence of refractive errors in children age up to 15 years, attending outpatient department of Ophthalmology Khyber Teaching Hospital Peshawar, identify their types and provide them with glasses. A repetitive hospital based study. Place and duration of study: Eye Department, Khyber Teaching Hospital, Peshawar, where study was conducted from 1st October 2006 to 31st March 2007. All children age upto 15 years with refractive errors coming to Outpatient Eye Department Khyber Teaching Hospital from 1st October 2006 to 31st March 2007 were included in this repetitive study. Detailed ocular examination was performed on each patient. It consisted of visual acuity testing, pupillary reaction, ocular motility examination, anterior segment examination and direct ophthalmoscopy. The refractive error was noted with type and the patients who needed glasses were provided free glasses. Out of 2340 children 300 [12.8%] had refractive error. Mean age of children was 6 years. Forty five [15%] children were below 3 years, 180 [60%] were between 3-10 years and 75 [25%] were between 11-15 years. One hundred thirty five [45%] were male and 165 [55%] were female. Myopia occurred in 85 [28.33%] Hypermetropia occurred in 75 [25%] and astigmatism in 140 [46.67%] children. Myopic astigmatism occurred in 19 [6.3%], hypermetropic astigmatism in 38 [12.7%] and mixed astigmatism in 83 [27.7%] children. Free glasses were provided to all the children. Anisometropia occurred in 19 [6.3%] patients. Bilateral amblyopia occurred in 10 [3.3%] patients. Unilateral amblyopia occurred in 10 [3.3%]. This study showed that the uncorrected refractive error was a major problem among children. Females were almost equally affected as males. Astigmatism was the most common problem. Treatment for refractive errors is perhaps the simplest and most effective form of eye care

Outcome of primary repair in penentrating colonic injuries

To assess the outcome of primary repair in penetrating colonic injuries in terms of regional/local morbidity [suture line breakdown, intra-abdominal abscess] and mortality. Design: Prospective, interventional study. Place and Duration of Study: Surgical Unit II at Lahore General Hospital, Lahore, over a period of 3 1/2 years from June 1999 to December 2002. Patients and Out of 38 consecutive patients with penetrating colon injuries, a selective group of 25 patients [65.7%] undergoing primary repair [simple suture, resection and anastomosis without covering colostomy and right hemicolectomy] were included in this study. The morbidity and mortality variables were recorded and statistically analyzed. Majority of our patients were of younger age group [mean 25 years]. Twenty patients [80%] were male. The commonest mode of injury was firearm injury [72%]. The time interval between injury and repair was 3-11 hours [mean 7 hours]. Simple repair of colon with interrupted stitches was the commonest procedure performed [44%], followed by right hemicolectomy [32%]. Colon related complications developed in 3 patients [12%], which included two fecal fistulae and one intra-abdominal collection. One patient died of septicemia [4%]. Hospital stay ranged between 6-16 days [mean 8 days]. Primary repair is a safe method of managing penetrating colon injuries in carefully selected patients