ABSTRACT
Objective: To determine the diagnostic accuracy of methylene blue dye to detect axillary lymph node metastases in patients with breast carcinoma by taking histopathology as gold standard
Methods: This quasi experimental study was done at Department of Surgery of Dow University Hospital Karachi during January 2013 to September 2015 after the approval of Hospital Ethical Committee. A total number of 85 patients with biopsy proven carcinoma were included in the study. 1% methylene blue dye was infiltrated in the peri tumoural area of the diseased breast. The blue stained node called sentinel lymph node [SLN] was recognized and carefully dissected out. SLN and mastectomy with axillary clearance specimen was sent for histopathology in two separate bottles and the report of the histopathology was compared
Results: The axillary lymph nodes were positive for carcinoma in 61 cases out of 85[71.7%].Two of the patients had negative sentinel lymph node but positive non sentinel lymph node [false negative], and in three cases sentinel lymph node were involved only but not the rest of the axilla [False positive]. The sensitivity, specificity and accuracy were 96.8%, 86.36% and 94.1% respectively
Conclusion: Methylene blue dye technique is a reliable and safe diagnostic modality for detection of Sentinel lymph node in breast cancer patient because of its high accuracy
ABSTRACT
Objective: To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy
Methods: This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A [Haemorrhoidectomy by Ligasure] and group B [Milligan Morgan Haemorrhoiectomy]. Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day
Results: Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 - 60 years. Third degree Heamorrhoids were present in 37 [67.3%] of patients while remaining 18 [32.7%] had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6 +/- 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34 +/- 25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method
Conclusion: The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups
ABSTRACT
To find out the number and variety of different surgeries performed at the operation theatre of the Dow University Hospital. From January 2011 to December 2011, hospital operation theatre record was reviewed. Main outcome measures were age, gender, medical record [MR] number, name of operations with their indications, specialty and type of anesthesia used during the procedure, type of surgery. Monthly trend of surgeries were also evaluated. The total numbers of operations performed during first year of operation theatre working were 539 cases. Number of emergency surgeries done was 42 [7.79%] and elective were 497 [92.2%].Surgeries performed by General Surgery, Gynecology and Plastic surgery department were 319 [59.18%], 61 [11.3%], 54 [10.0%]. MR Number was not present in record register in 306 [56.7%] cases, indication for surgery was not written in 274 [50.8%] cases and name of surgery was missing in 18 [3.3%] cases. The most common case performed were different types of biopsies while other common cases performed in the year 2011 were incision and drainage, cholecystectomies and hernia repair. The record maintained was overall satisfactory however needs further improvement. Computerization of records with training of staff about its proper maintenance can improve its quality with international standards
Subject(s)
Hospitals, Teaching , General SurgeryABSTRACT
The cholesterol content is important in classifying gallstones as either cholesterol or pigment stones. Most of the gallstones are cholesterol stones. There is a multifactorial and complex relationship between blood cholesterol, Low Density Lipoprotein, and High Density Lipoprotein levels and cholesterol gallstone formation. Evidence showed that more than half of patients with gallstones have altered serum lipids which are a risk factor for ischemic heart diseases. This study was done to find out frequency of altered lipid profile in patients with gallstones admitted for cholecystectomy at Dow University Hospital Karachi Pakistan. case series study. This study was conducted at the Surgical Unit-2, Dow University Hospital, OJHA Campus, Karachi for a period of 14 months from January 2012 to March 2013. All diagnosed patients of cholelithiasis were included in this case series study. Lipid profile was performed for all patients before performing cholecystectomy. Post operatively gallbladder specimens were sent for histopathology and stones for chemical analysis. A total number of 45 patients were included in this study, out of which 40 were female. The mean age of patients was 47.7 +/- 13.3 years. On chemical analysis, Cholesterol was found in all of the stones. The histopathology of all patients showed chronic cholecystitis. The total mean serum cholesterol level was 199.3 +/- 36.8 , HDL cholesterol was 43.5 +/- 7.7, LDL +/- 23.9 cholesterol was 127.2 +/- 23.9, and triglycerides were 139.1 +/- 37.5. Serum total cholesterol was elevated in 28/45 patients [62.2%], LDL cholesterol was elevated in 26/45 [57.7%], triglycerides elevated in 18/45[40.0 %,] whereas HDL cholesterol was below normal in 16/45 [35.5%] of patients. Most of the patients operated for Lap Cholecystectomy had altered lipid profile. Patients presenting with Cholelithiasis should be investigated for altered lipid profile, which is a major risk factor for developing cardiovascular disease if left untreated
ABSTRACT
To find out quality of surgical case notes according to modified Adjusted Note keeping and Legibility [ANKLe] score in Dow University Hospital. For this audit, medical records of all the patients admitted in Dow University Hospital surgery department were reviewed from February 2012 to April 2012. The modified ANKLe score [total 24] is formed by the combination of, the content [out of 20] and legibility [out of 4] to give an overall score out of 24. A score of at least 20 [content score 17/20; legibility score 3/4] is considered as acceptable. It means that a surgical record is legible and the majority of the essential content is recorded. A total of 236 records were evaluated. Overall mean +/- standard deviation [SD] of ANKLe score was 18.4 +/- 2.1 out of maximum score of 24. Content and legibility has overall mean scores of 14.4 out of 20 and 3.9 out of 4 respectively. Only two variables, patient's name and consultant on call were documented in 100% of records while the least documented variable were social history 2 [0.2%]. Legibility scoring system provides that 218 notes out of total set of 236 notes [that is 92.4% of overall notes] have achieved a score of 4. The benchmark of 80% was achieved in 26.1% for total ANKLe score, 6.8% for contents and 99.1% for legibility. Overall, quality of records is not good but legibility part scores exceptionally high
Subject(s)
Records/standards , Forms and Records Control , Quality Control , Hospitals, UniversityABSTRACT
To find out the quality of medical records in the department of surgery at Dow University Hospital, a tertiary care teaching hospital. Medical records of all patients admitted in surgery department of surgery at Dow University Hospital from February 2012 to April 2012 were reviewed. By analyzing two sets of medical notes, a numerical score out of total 100 was calculated which is used as a representative value of quality; 100 being most accurate. For each omission of any of the criteria of CRABEL score, one point was deducted and the total scores was presented as percentage. The overall CRABEL score was 72.1 in all surgical case notes. Most frequents points were deducted in subsequent entry section with total deduction of 30.3% while least deduction was seen in discharge section with total deduction of 4.4%. Quality of Record keeping in surgical department of surgery is 71% in relation to CRABEL score. Subsequent entry section is the major factor in decrease in the quality of notes