Pseudocyst of the pancreas.

1. Early diagnosis of pseudocyst of the pancreas. 2. Determination of the incidence of various etiological factors in Faisalabad area. 3. Evaluation of the various management options. DESIGN: Retrospective study. SETTING: Department of Surgery Punjab Medical College, Faisalabad. PERIOD: April 1993-1996. PATIENTS AND METHODS: Fifteen patients. 13 males [86.67%], 2 females [13.33%]. Age ranging between 6 to 50 years [Mean age=28 years]. 11 cases [73.33%] secondary to blunt abdominal trauma, 2 cases 13.33% secondary to Choledocholithiasis and 2 cases 13.33% secondary to alcoholic pancreatitis. 13 patients [86.67%] underwent Cystogastrostomy [CG] and 2 patients [13.33%] underwent External drainage [ED]. One patient [6.67%] with a history of alcoholism died secondary to recurrence of pseudocyst and bleeding during postoperative period

Nodular goitre. Presentation and prevalence of complications.

OBJECTIVE: To evaluate the presentation and prevalence of different preoperative complications in patients with nodular goitre. DESIGN: Patients of either age and sex with nodular thyroid swelling [goitre] admitted from January 1992 to November 1992. SETTING: Surgical Unit-Il of Services Hospital, Lahore SUBJECTS: Forty patients of either sex and age presenting with nodular goitre were included. MAIN OUTCOME MEASURE: Mode of presentation and prevalence of different preoperative complications in patients with nodular goitre. Peak incidence of nodular goitre was in age group between 20-40 years. 75% patients belonged to this group with male to female ratio being 1:4. Simple non toxic multi-nodular goitre was present in 57.50%, adenoma in 27.50%, toxic adenoma in 2.50%, secondary toxic goitre in 2.50% where as 10% patient had malignant goitre. 70% of patients of present study did not have any symptoms other than a swelling in front of neck. 30% patients had some symptoms like respiratory obstruction in 50%, dysphagia in 8.33%, hoarseness in 16.66%, weight loss and anorexia in 33,33%, toxicity in 16.66"lo, histo-pathological evidence of malignancy was found in 10% of patients and papillary carcinoma was heading the list

Skin Cover

Skin is the major barrier between the body and the exterior and maintains the "milieu interieur". As skin is the best dressing it should be replaced at the earliest. There are broadly 2 methods of covering skin defects. a. Direct approximation to close clean lacerations, surgical incisions and small areas of skin loss. This also includes z-plasty. b. Transplantation, where area of skin loss is too wide to be closed directly. Transplantation includes either grafts or flaps. Grafts are split skin [thin, medium and thick] used to cover larger skin defect where bone, joint, nerves, blood vessels, tendons are not exposed baring face and hands and feet. Full thickness skin graft is used to cover defects of face, hands and feet where contraction of the graft can be catastrophic. Flaps are used where the above conditions persist and are either skin only [random pattern, axial pattern], fascio cutaneous, muscular or myocutaneous, composite, or microvascular free flaps. In extensive burns or where skin loss is extensive secondary to trauma where above methods may be inadequate, skin substitutes may be used, where available, or tissue expansion employed

Surgical treatment of carcinoma of the pancreas

1. To highlight the surgical treatment of carcinoma of the pancreas. 2. To discuss its various treatment modalities. DESIGN: Case study PERIOD: June 1994 to June 1996. SUBJECTS: A total of 30 patients [09 females [30%] and 21 males [70%]. Age ranged between 24 to 80 years [mean being 52 years]. SETTING: Allied Hospital Faisalabad DIAGNOSTIC CRITERIA: Ultrasound, CT scan, operative findings and biopsy. PATIENTS AND METHODS: Nineteen patients [63.33%] had cholecysto jejunostomy [C.J]. Nine patients [30.00%] had choledocho duodenostomy [CDD] and two patients [6.66%] had Hepatico jejunostomy [HJ]. All had prophylactic antecolic Gastro jejunostomy [GJ]. All were T3 or higher stage tumours. 1. None of the patients underwent curative resection. 2. All underwent various types of palliative surgical bypass. CONCLUSIONS: Palliative surgery for carcinoma pancreas has tow advantages; 1. It gives long term relief of symptoms. 2. Only surgical explorations offers potential for curative resection

Acute renal fialure in surgical patients

1. To highlight the occurrence of Acute Renal Failure [ARF] in surgical patients. 2. To identify high risk patients. DESIGN: Retrospective study. SETTING: Department of Surgery Allied Hospital Faisalabad. PERIOD: June 95 to May 96. PATIENTS AND METHODS: 21 patients 11 males [52.38%] and 10 females [47.62%] including 2 children both males [9.52%] Their ages ranged between 8 to 63 years. [mean 35.5 years]. 6 patients [28.57%] presented in acute renal failure [ARF] on admission, whereas the remaining 15 patients [71.43%] developed Acute Renal Failure [ARF] in the postoperative period. 15 patients [71.43%] went into ARF in the postoperative period. Out of these, 8 patients [overall 38.10%] had surgery for malignant disease, 1 patient [4.76% overall] had surgery for obstructive jaundice and 6 patients [28.57% overall] had surgery for kidney/ ureteric stones. The remaining group of patients who presented with ARF on admission included "Crush Syndrome." following skeletal/ soft tissue trauma, 3 patients [14.28%], obstructive uropathy 2 patients [9.52%] and major burns [70%] 1 patient [4.76%]. All patients underwent haemodialysis. Six patients [28.57%] died despite active management

Role of ultrasound and computerized tomography in pancreatic masses

A total of 25 patients with abdominal mass suspected to be that of pancreatic origin were subjected to ultrasound and or CT scans between January 1993 and December 1995. There were 19 males [76%] and 6 females [24%] ranging between 6 to 85 years. There were 2/25[8%] Pancreatic abscess. 6/25 [24%] Pseudocyst of the pancrease [post traumatic] and 17/25 [68%] pancreatic exocrine neoplasm [most probably CA]. Cases of acute pancreatitis were excluded from the study. Ultrasound was found to be an excellent modality for diagnosis of intra- abdominal cystic lesions and for initial screening of pancreatic neoplasm. Whereas CT is at present the best modality for diagnosis, staging and management of pancreatic neoplasm. In the view of the fact that cancer of the pancreas exhibits a deceptively silent growth pattern, by the time they are diagnosed, they are rarely curable. In this study patient population deemed potentially at high risk of developing pancreatic CA is high-lighted