Acute appendicectomy is better choice for appendicular mass

To compare the cost effectiveness, hospital stay and morbidity in each type of management of appendicular mass i.e. early surgical intervention and conservative management. A randomized comparative study. South Surgical Ward, Mayo Hospital Lahore from July, 1999 to January, 2001. 40 patients were included dividing in two equal groups. Group A patients were explored early and group B patients were managed conservatively. Cost effectiveness, hospital stay and morbidity were determined in each group. Mean hospital stay was 2.85 days [2-4 days] in group A and 6.25 days [5-8 days] in group B [p value< 0.001]. Mean expenditure in group A was Rs.1255 and Rs. 2183.75 in group B [p value < 0.001]. 100% patients in group A got complete pain relief within three days while it took 7 days for 90% of patients in group B [p value<0.001]. Oral fluids were started earlier in group A as compared to group B [p value<0.05]

Role of antibiotic prophylaxis in clean and clean contaminated elective surgery

Antibiotic prophylaxis is a recognized concept in surgery. We studied the need for prophylaxis in clean and clean contaminated surgery in the setting of third world tertiary care center. A randomized single blind study was conducted with three arms. 278 patients of ASA and 2 were included in this study. They were randomized to prophylaxis with Cefuroxime, triple regime and placebo. The placebo wing was terminated prematurely due to unacceptable infection rate and Cefuroxime was found to be equal or better than triple regime in our study

Presentation of cancer of the gallbladder at Mayo Hospital, Lahore

Carcinoma of the gallbladder is a progressive malignant disorder with a poor and painful prognosis and high mortality rate'. Our study highlights the enhanced presentation of the carcinoma of gallbladder in patients having cholecystectomies in general ward and its possible aetiological factors in the population of Pakistan in general and Punjab in particular. Analysis of case records and histopathology reports of 100 patients who underwent cholecystectomies was done, with the objective to determine the incidence of cancer of gall bladder and highlight the possible aetiological factors. Out of a total of 100 patients 89% were females and 11% were males. The total incidence of cancer of the gall bladder in these patients was 16% the highest yet reported in literature and if was seen that it was more common in females [13%] who are relatively quite young in age. The aetiological factors held responsible were the unmistakable association of gallstones, the delayed treatment, repeated attacks of cholecystitis, multiparty, congenital abnormalities of biliary tract and infections of the biliary system. Though various modalities of treatment have been described but bulk of the above can be controlled and prevented

Incidence and management of Strangulated Inguinal Hernia

This is a retrospective study of forty patients, admitted in Mayo Hospital, Emergency with a diagnosis of strangulated inguinal hernia from 1-6-1997 to 31-12-1998. This study aims at collection of facts and figures about incidence, agetsex presentation, mode of presentation, duration of strangulation, treatment offered operative and post operative complications, and any concomitant illness of the patient. The study revealed that 90% of the affected patients were male and 60% of them fall in the 51-70 years age group. Postural treatment remained effective in 70% of the patients, who presented in Emergency with history of less than 24 hours. In 70% of cases, level of constriction was at the neck of sac and in 80% of cases, small gut and omentum was found to be a content of sac. Partial omentectomy and resection with end to end anastomosis of small gut was performed most of the times

Intracavernous injections of papaverine and phentolamine for treatment of impotence

Intracavernous injections of papaverine hydrochloride with phentolamine mesylate rapidly produce transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. A total of 45 men with impotence underwent trial of intracavernous drug induced erection with a mixture of papaverine and phentolamine. Full tumescence and maximum rigidity'occurred in 38 patients. Good results were seen in patients with impotence of neurogenic origin due to diabetes mellitus

clinical audit of management of peripheral vascular injuries

This is a retrospective analysis of the management of 21 cases with vascular injuries who presented in the Casualty Department of Mayo Hospital in the period from September 1993 to September 1995. Evaluation of results and comparison with other studies is presented. The mean age of the patients was 26 years with a male to female ratio of 20:1. Femoral vessels were the most frequently involved and gun shot was the commonest mode of injury. Ligation of vessel was done in six where as 15 cases underwent repair. Disruption of repair occurred in 4 cases out of which two underwent amputation. There is one mortality in 21 cases. Successful management depends on meticulous surgical technique, team work and prompt repair

Changing trends in abdominal tuberculosis

The study was carried out to determine changes in the presentation of abdominal tuberculosis, and the type of surgery offered over the last two decades. A total number of 467 cases of abdominal tuberculosis were admitted in the three surgical units of three major Hospitals of Lahore, between 1985-1995. Out of these 66.8% were females, mostly in the second and third decades of their life. Majority [72%] belonged to lower middle class urban [79%] population. The dominant symptoms were periodic abdominal pain and vomiting [92%]. Most patients [73%] were admitted through the emergency department. The commonest operative findings were ileocaecal hyperplastic tuberculosis [21.4%] and frozen abdomen [22.9%]. Segmental resection [18.6%], bypass procedures [16.4%] and right hemicolectomy [13.2%] were the most common operative procedures. The mortality was 3.7% and morbidity 9.8% in operated cases