Mechanical cystolithalopaxy in children

Primary vesical stones in children are common in Pakistan. In this paper a new technique is being described for the treatment of vesical stones in children. The stones are visualised with the optical Verres needle inserted in the bladder suprapubically and are then broken with the classical mechanical lithotrite inserted per urethra. Nine children [mean age 6 years] with stones [mean diameter 1.1 cm] were treated using this technique. The mean operating time was 20 minutes. All the patients were free of stones at the time of discharge and there were no complications. Long term follow-up is required for the establishment of this technique

Post transplant infective complications in Pakistan

Despite the recent advances in transplant surgery, the two major complications which still haunt transplant patients are rejection and infection. The recipients of a kidney transplant are much more susceptible to infections since they are immunosuppressed. A study on 85 cases of renal transplants performed at Karachi National Hospital was carried out to analyse the incidence, onset and pattern of the infections and to find out the causative organisms and the management of the infective complications in these patients. This study showed that common post-transplant infections in Pakistan in early and late post-transplant periods involve usually the urinary tract, respiratory system and gastrointestinal system. The infection pattern is also different from other countries. The common infection being malaria, typhoid, tuberculosis and gastro-enteritis. The reasons for this are poor hygienic conditions and the lack of a basic health care system in Pakistan. Our study has shown that 67 out of 85 patients [79%] contracted different infections. A total of 114 episodes of infections were encountered in the 67 patients. 34% of the infections [39 out of 114] occurred during the first month after the transplant and 66% [75 out of 114] occured after the first month of transplant. The most common infection was urinary tract infection [35 out of 114 - 31%] occuring commonly in the early post-transplant period [19 out of 39 cases - 49%]. The most common causative organism responsible for urinary tract infection was found to be E. Coli. The most common infection in the late transplant period was malaria [22 out of 75 cases -29%]. This study further shows that the patients who received ALG/OKT3 either as prophylaxis or as therapy were more prone to infections. Therefore, we can conclude that transplant patients are more prone to infections especially by those organisms which do not normally cause any harm to the general population but may result in a fatal outcome in transplant patients. Hence extreme measures should be taken to prevent such infections

comparative study on the prophylactic use of OKT3 and cyclosporine

Despite the availability of various new drugs, acute rejection still remains the leading complication of renal transplant. A comparative study on the prophylactic use of immunosuppressants OKT3 and cyclosporine was carried out with 18 patients in each group who had completed one year since transplant. This study showed that the graft and patient survival rates were not different in both the groups. However, with the use of OKT3 in the initial post-transplant period as an induction therapy, the number of rejection episodes were much less compared to cyclosporine. Considering the association between the duration of graft survival and early rejection episodes it is assumed that the long term graft survival results would also be better. This study also demonstrated that infectious episodes were higher with OKT3 compared to cyclosporine. We recommend that OKT3 should be used as an induction therapy only when strongly indicated

review of 100 cases of appendicectomy

Over a period of six months appendicectomies were performed at Civil Hospital Karachi [n=61] and Karachi National Hospital [n=39],. Of these 49 cases were dealt with by open conventional surgery, 12 by laparoscopic method and 39 by laparoscopic directed techniques. There were 58 male and 42 female patients while maximum number of cases were seen in the 3rd decade of life. Our study conclude that appendicectomy by laparoscopic technique has distinct advantages over the conventional open method, as it results in less post operative pain, shorter hospital stay, low complication rate and better cosmetic results

Rigid ureteroscopy for removal of stones: astudy of 2500 patients

Until recently, the only treatment available for ureteric calculi was open ureterolithotomy. However, with the introduction of ureteroscopy, stones can now be removed with Dormia under vision or broken into small pieces with ultrasound, electrohydraulic probe or lithoclast. In this study, we present a review of 2500 cases with ureteric stones of different sizes and at different levels treated with rigid ureteroscopy. The success rate was 92.05% in the lower one-third, 84% in the middle one-third and 26.55% in the upper one-third of the ureter. This method is safe and also results in shorter hospital stay