Surgical site infections in general surgical wards at a tertiary care hospital

Surgical site infections are important cause of morbidity and mortality in admitted patients world over. To determine the pattern of surgical site infections in General Surgical ward of a tertiary care hospital. Analytical cross-sectional study conducted at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years from January 2010 to December 2011. All cases were admitted in surgical ward with various surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infection operated elsewhere, diabetic foot, and abscesses were excluded. Data collected included age, gender, primary diagnosis, mode of admission, comorbid factors, type and duration of surgery, expertise of the surgeon, use of antibiotics and hospital stay. After operation, wound was examined for evidence of infection from third post-op day onward. Any discharge was submitted for bacteriological examination. The wounds were followed till healed. A total of 1913 patients underwent surgery, including 983 cases [51.5 %] operated as elective and 932[48.5 %] as emergency. Postoperative wound infections occurred in 165 cases giving an overall incidence of infection in 8.6% cases. Infection rate in elective cases was lower [4.6%] than that in the emergency [12.7%] cases. Sixty one patients [37%] developed minor infection or stitch abscess, 104[63%] has frank suppuration requiring opening and drainage of wound; while 5[3%] cases developed deep seated infection of intra-abdominal spaces. E. coli was the commonest bacteria for wound infection [39%]. Post operative wound infection rate was 8.6%. The infection was significantly higher in cases who underwent emergency surgery and E. coli was the commonest pathogen to cause infection

Huge sub-mandibular gland tumour

Salivary gland neoplasms are a diverse group of tumours and appropriate treatment depends on adequate understanding of the pathophysiologic behaviour of each tumour type. Most [95%] salivary glands occur in adults. Benign tumours are slow growing tumours and attain a considerable size before presenting to surgeon. We report a case of huge tumour of left submandibular gland that presented in our surgical outpatient department, and had developed over last twenty years. It was diagnosed as a benign mixed tumour of salivary gland and was successfully excised. Histopathology confirmed it to be a benign pleomorphic adenoma

Two-port laparoscopic cholecystectomy: an early experience

Laparoscopic cholecystectomy is the procedure of choice in all the gall bladder diseases and there is increase in the expertise of the surgeons with newer equipment. Usually the laparoscopic cholecystectomy is performed by using three or four ports. Two ports laparoscopic cholecystectomy is a rarely performed procedure as it demands greater expertise and skills. Benefits of this technique are related to the cost this being cost effective with less scar forming as compared to the conventional approach of laparoscopic cholecystectomy. We present a series of eight cases of laparoscopic cholecystectomy performed by using only two ports. All procedures were completed successfully and no extra port or conversion to open procedure was required. Mean operation time was 50 minutes. No intra and post operative complication occurred in this series. Hospital stay was one day

Two-port laparoscopic cholecystectomy-a new technique

Laparoscopic cholecystectomy is now the procedure of choice in all the gall bladder diseases and there is increase in the skills of surgeons with newer equipment. Normally the laparoscopic cholecystectomy is performed by using four ports or three ports. Two ports laparoscopic cholecystectomy is rarely performed as it demands greater expertise and skills. Also this technique is less expensive and less scar formation than four port laparoscopic cholecystectomy. We present a case of a middle aged female who underwent successfully laparoscopic cholecystectomy by using only two ports

Iatrogenic bile duct injuries: Experience at PIMS

Cholecystectomy is one of the most familiar and commonly performed elective operation in general surgery. However, bile duct injury is a rare but one of the worst complications of this procedure. Although infrequent in expert hands, it is usually encountered when comparatively inexperienced surgeons are operating. These injuries present at variable time after the primary surgery. The prompt recognition and active management affects the morbidity and mortality associated with it. We evaluated the data of the hospital to find out the nature of injuries inflicted to extra hepatic bile duct and its management. This is a study of 20 cases of iatrogenic bile duct injury managed at the Department of Surgery Unit 1, PIMS. The study includes cases that had undergone cholecystectomy, open or laparoscopic in previous 11 years and sustained injury to the biliary tree and were managed accordingly. Patients with hepatobiliary malignancy were excluded. Twenty cases were found to have various types of bile duct injuries. All patients were females, and their average age was 35 years. In four cases the injury occurred during surgery at our hospital, while remaining 16 cases were referred from other hospitals. All the patients were explored and managed accordingly. They had uneventful recovery and had good outcome at 6 months. Although the fact is that, the sooner an injury is recognized and treated, the better is the outcome. However, in this study the duration of injury had no effect on final outcome

Psychiatric morbidity among medical out-patients in Kuwait: evaluation of a somatic inventory to identify the psychaitric from the non-psychatric patients

The aim of this study was to evaluate the Bradford Somatic Inventory [BSI], a 21-item questionnaire, to identify psychiatric patients attending a general hospital medical clinic in Kuwait. The sample consisted of 100 new general hospital medical out-patient clinic attendees. All patients were administered the BSI, and their psychiatric status was established by administration of the Present State Examination. All the patients who met the criteria of the International Classification of Diseases, 10th revision [ICD-10], were grouped as 'psychiatric' while the remaining subjects were regarded as 'non-psychiatric' patients. The frequency of endorsement and the total BSI scores were computed to determine sensitivity, specificity and positive predictive values of the BSI. Fifty-one of the psychiatric patients met the ICD-10 diagnostic criteria. The psychiatric group reported a significantly higher number of BSI symptoms and had a significantly higher mean BSI total score than the non-psychiatric patients. Using a cut-off score of 13/14, the BSI-21 yielded a sensitivity rate of 72.5% and a specificity rate of 73.47%. Evaluation of a shorter version, the BSI-15, comprising the most frequently endorsed items by the psychiatric patients, revealed similar results. Conclusions: The findings suggest that the BSI-21 is a potentially useful screening instrument to identify psychiatric patients attending general medical out-patient clinics. The shorter version, BSI-15, is easier to administer and equally effective in discriminating the psychiatric from the non-psychiatric group of medical patients

Psychiatric morbidity among the general hospital medical patients in Kuwait: characteristics of psychiatric patients

A considerable number of medical out-patients seen in a general hospital are known to suffer from psychiatric rather than/in addition to the physical disorder. Moreover, a substantial number of such patients, passing undetected by the physicians, end up being physically examined and investigated, at times far too extensively. This study was aimed at determining the prevalence of such patients in a general hospital in Kuwait. The sample consisted of 100 new medical out-patient clinic attenders. Each patient was administered a semi-structured interview. The items of the interview were derived from the Present State Examination, and the 10th revision of the International Classification of Diseases was used to assign psychiatric diagnoses. Fifty-one out of the 100 patients suffered from psychiatric disorders. In only 5 cases was the disorder recognized. Psychiatric disorders were commoner in females and were not related to the nature of the physical disorders. Conclusions: Inclusion of some screening questions about mood disorders in the standard medical interview may help detect some of the psychiatric patients presenting in the general medical out-patient clinics. In addition, periodic clinical meetings between psychiatrists and physicians may enhance physicians' awareness of the potential psychiatric morbidity amongst the medical out-patients

Pituitary tumours and schizophrenia

It has been observed that there is an association between cerebral tumours, especially pituitary adenomas, and schizophrenia, and a number of such cases have been reported in which psychosis was the presenting feature. A case of pituitary adenoma is reported in which the occurrence of the tumour was followed, three years later, by the development of schizophrenia. The psychotic manifestations coincided with a recurrence of the tumour, which seems to have acted as a perpetuating rather than a causative factor in the development of schizophrenia

Mini-open cholecystectomy

This article reviews open cholecystectomy through a short [7 to 8 cm] transverse incision. The purpose is to compare and contrast the safety of the procedure, post operative discomfort, scar, hospital stay, cost effectiveness and return to work, as compared to laparoscopic cholecystectomy. So far 12 cases have been operated. The procedure was completed without any complication. Mean operating time was 60 minutes. Average hospital stay was 2.5 days and patients resumed work on an average on the 12[th] day. These was no significant morbidity except for vomiting in 12 cases and fever in 2 cases in first 24 hours post-operative period