ABSTRACT
To assess the role of video assisted thoracoscopic talc pleurodesis in the surgical management of malignant pleural effusions by comparing this procedure with pleurodesis via talc slurry through an intercostals chest tube. Prospective analysis of fifty patients with malignant pleural effusion which were divided into two groups. Group one included twenty patients while group two included thirty patients. Department of Thoracic Surgery and the Department of Oncology, Combined Military Hospital, Rawalpindi. October 2008 till November 2010. Fifty patients of malignant pleural effusion were included in the study. They were divided into two groups. Group one included twenty patients whereas group two included thirty patients. Patients in group one were subjected to videoassisted thoracoscopic talc pleurodesis. Patients in group two were subjected to pleurodesis via talc slurry through an intercostal drainage tube. Fifty patients were included in the study. The mean follow up time was 5.7 months for group one and 5.5 months for group two. Out of the twenty patients in group one 95% had successful pleurodesis [defined as satisfactory pleurodesis three months post procedure]. Adverse effects included fever in three patients [15%], empyema in one patient [5%] and malignant invasion of the scar in one patient [5%]. Out of the thirty patients in group two 70% had successful pleurodesis. Adverse effects included fever in five patients [17%], empyema in one patient [3%], and pulmonary infection in one patient [3%]. No mortalities occurred during the procedures in either of the group. Videoassisted thoracoscopic talc pleurodesis is a safe and effective method of producing reliable pleurodesis in patients with malignant pleural effusion. It is superior to pleurodesis via talc slurry through an intercostal drainage tube in terms of producing a reliable and complete pleurodesis. It should be performed early in patients presenting with malignant pleural effusions to avoid the risk of respiratory failure, this being directly linked to the general and respiratory status of the patients at the time of the procedure
ABSTRACT
To evaluate the role of ultrasound in the diagnosis of patients with suspected Infantile Hypertrophic Pyloric Stenosis [IHPS] who do not have a clinically palpable 'pyloric lump' or olive by taking surgery and follow-up as gold standard. Validation study. Radiology department at National Institute of Child Health [NICH], Karachi from January 2008 to March 2010. Appropriate technical and ethical approval for the study was obtained. Twenty eight consecutive patients [22 males and 6 females] with clinical suspicion of IHPS without a definite palpable 'pyloric lump' referred to radiology department of National Institute of Child Health [NICH] were included in the study. All patients underwent ultrasonography by an experienced consultant radiologist. Patients were categorized as having or not having IHPS. The results were compared with follow up at surgery for those declared as having IHPS on ultrasound and clinical follow up for those not having IHPS on ultrasound. Sensitivity, specificity, negative predictive value [NPV] and positive predictive value [PPV] of ultrasound were calculated. Twenty four patients were diagnosed with IHPS. Four were diagnosed as not having IHPS. Out of these 4 patients 1 was subjected to barium meal examination. Patients were followed up to confirm the ultrasound findings or otherwise. Ultrasonography yielded a sensitivity of 96% and specificity of 100% in diagnosing IHPS in patients without a palpable 'pyloric lump' or 'olive'. The positive predictive value of ultrasonography in these patients was 1.00 and the negative predictive value was 0.75. Ultrasonography should be the initial investigation in patients with clinical suspicion of IHPS and an impalpable pyloric lump to improve early diagnosis in these babies