Early wound complications following modified radical mastectomy with axillary clearance

To identify the pattern of early wound complications after modified radical mastectomy with axillary clearance and to determine the risk factors predisposing to these complications. Descriptive case series. Surgical Unit II, Peoples University of Medical and Health Sciences Nawabshah, from January 2008 to December 2010. One hundred and fifty patients were included in this study who underwent Patey's modified radical mastectomy with axillary clearance These patients were followed up for one month postoperatively in OPD. Age of the patients was between 30-80 years. Seroma formation was the most common complication seen in 50 [33.3%] patients, wound infection in 15 [10%] and flap necrosis in 4 [2.6%] cases. More than 1000 ml discharge in drain was noted in 30 patients. Wound infection found more in patients with prolonged operation time [>150 minutes] and in those with seroma formation. Seroma formation was the most common complication as well predictive factor for wound infection and flap necrosis

Role of investigations and Alvarado score in acute appendicitis at peoples medical college hospital Nawabshah

Role of investigations and Alvarado score in acute appendicitis at Peoples Medical College Hospital Nawabshah. Prospective observational study. Two years study from October 2008 to November 2010. Was conducted in Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from OPD [Out Patients Department] and COD [Casulty Department]. The patients were evaluated fully after history, clinical examination and specific investigation, blood CP, X-Ray abdomen, supin and erect posture, X-Ray KUB, ultra sound of abdomen and general assessment. All Patients of pain in right iliac fossa included all patients were manage on the basis of Alvarado score, Complete Blood Picture and Ultra Sound report. In this study 50 patients of acute appendicitis in which 25 were female and 25 were male. The maximum of patients were in age group 15 to 40 years. Peak age group 25 years. Out of 50 patients 42 patients were present leucocytosis. On the behalf of Ultra sound report 38 patients were diagnose acute appendicitis. 10 patients were diagnose perforated appendix, 2 patients were diagnose appendicular abscess. 8 patients were present Alvarado score 3 to 4.30 patients were present Alvarado score 6-7, 12 patients were present Alvarado score 8-9, Patients were operated through procedure of appendectomy then tissue sent for histopathology. Acute appendicitis is a common cause of acute abdomen. Anorexia, migrating pain, tenderness and rebound tenderness are evidence of acute appendicitis

Frequency of malignancy in benign enlarge prostate at peoples medical college hospital Nawabshah

To determine the frequency of Malignancy in Benign enlarge prostate. Prospective observational study: Two years study from October 2008 to October 2010. Was conducted in Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from OPD [Out Patients Department]. The patients were evaluated fully after history, clinical examination DRE and specific investigation of PSA X-ray Lumbo sacral spine Trans rectal, Endo luminal ultra sound flow metery Trans rectal biopsy C.T scan and Bone scan and General assessment. All Patients with enlarged prostate included out of 50 patients 48 patients under went surgery and tissue sent for histopathology. In this study of 50 patients of enlarge prostate total number of patients were in age group 55 to 75 years, Out of 50 patients 9 patients suspected malignant on the basis of DRE. But PSA will raise in 7 patients. Regarding the histopathology the results 7 patients showed malignancy adeno carcinoma. Prostate carcinoma more common enlarged prostate as compared to fibro tic prostate

Surgical site infection in elective sugery

To determine the causes and rate of surgical rate site infection [SSI]. Descriptive study. Surgical Unit II, Peoples Medical College and Hospital Nawabshah, from August 2009 to July 2010. Patients of different wound categories were included in this study and followed up for 30 days postoperatively. The wound infection which occurred within 30 days of operation was considered as surgical site infection. The diagnosis of infection was made on clinical rather than on bacteriological basis. Total number of patients was 300. Out of 212 patients from 12-50 years of age 14 [6.6%] developed SSI, whereas among 88 patients above 50 years, 14 [15.9%] developed wound infection. Most patients had body mass index between 20-28 kg/m[2]. Obesity was more common in females and BMI more than 35 kg/m[2] appeared to be a risk factor for SSI. Most common organisms were Staphylococcus aureus [50%], E. coli [14.3%], Klebsiella [14.3%] and other organisms found in 5-7% cases. Wound infection occurred in 28 [9.3%] patients. The achievable preventive measures should be taken to save the economic burden on patient, hospital and community as a whole

Postoperative outcome of minicholecystectomy and conventional cholecystectomy

To investigate the effects of different incision lengths following elective Cholecystectomy Prospective cross sectional, comparative study. This study was conducted at Surgical Unit II Peoples Medical University of Health Sciences Nawabshah from January 2009 to December 2010. In this study, 100 patients were taken as a sample size. In this study, sampling technique was Purposive, non probability. Main Outcome Measures were postoperative pain, Length of hospital stay, Cost of treatment, Time until return to work, Complications. Most surgeons still prefer the open approach when dealing with common bile duct stone. The technique of open Cholecystectomy might compete with laparoscopic Cholecystectomy in avoiding prolonged operating time and major expenses. Mini-Cholecystectomy requires less operating time, less postoperative pain, and early return to work than standard conventional open Cholecystectorny. There were 37 female and 13 male in MC group, and 42 female and 8 male in CC group. Median age was 55 [range 20-80 years] median BMI was 23 [range 17-30]. 15 patients in MC and 18 patients in CC group were with acutely inflamed gall bladder and remaining were with chronic gall stone disease. In MC group of 50 patients the mean hospital stay was 2.5 days with shortest 1 day and longest 5 days. 35 [70%] patients were discharged within 2 days 10[20%] on 3[rd] and 5 patients remained for 5 days. Minicholecystectomy offers less pain, earlier recovery and better cosmetic results than conventional open Cholecystectomy

Frequency of malignancy in solitary nodule and multinodular goiter

To determine the frequency of malignancy in solitary nodule as well as multinodular goiter. Prospective observational study. Two years study from November 2006 to October 2008 was conducted in Liaquat University Hospital, Jamshoro and People's Medical College Hospital, Nawabshah. The study comprises 50 patients. All were admitted from OPD of both hospitals. The patients were evaluated fully after history and examinations and specific investigations of thyroid profile, scan, FNAC, indirect laryngoscopey and general assessment. All patients with solitary nodule and multinodular goiter included. Out of 50 patients 49 underwent surgery and tissue sent for histopathology. In this study of 50 patients of nodular goiter, 42 [84%] were female and 8 [16%] were male. The maximum number of patients were in age group 16-70 years. In 27 patients of multinodular 24 were female and 3 male. In 23 patients of solitary nodule 18 were female and 5 male. Regarding the histopathological results 10 [20%] patients showed malignancy, 8 [16%] in solitary nodules and 2 [4%] in multinodular goiter. Papillary.carcinoma seen in 7 [14%], follicular carcinoma in 2 [4%] and 1 [2%] as anaplastic carcinoma. Thyroid malignancy more common in solitary nodule as compared to multinodular goiter

Outcome and management of abdominal trauma at Liaquat University Hospital Jamshoro and Peoples Medical College Nawabshah

Out come and Management of Abdominal Trauma. Prospective observational study. Two years study from September 2006 to December 2008. Was conducted in Liaquat University hospital Jamshoro and Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from COD [Casualty out Patient: Department] of both hospitals. The patients were evaluated fully after history, clinical examination and specific investigation of X-ray abdomen supine and erect posture ultra sound of Abdomen contrast C.T and D.P.L Diagnostic Peritoneal Levage and General assessment. Al Patients of abdominal trauma included out of 50 patients 46 [92%] Patients an Underwent surgery Laparotomy. In this study of 50 patients of penetrating abdominal trauma 42 [84%] were males and 8 [16%] were Females the maximum number of patients were in age group 16 to 7 years in 40 [80%] Patients had fire arm, were the 6 [12%] cases of stab injury while remaining were the 4 [8%] of Blunt Trauma. Small intestine was the commonest organ injured 13 [26%] fallowed by liver 12 [24%] large intestine 7 [14%], Splenic injury was 7 [14%], Stomach 6 [12%], pan crease in 3 [6%], renal 2[4%]. Abdominal trauma is a serous emergency after Penetrating injury compared Blunt trauma

Increased risk of carcinoma gall bladder in longstanding cases of cholelithiasis

To find out the incidence of carcinoma of gall bladder in longstanding cases of Cholelithiasis with history of more than 5 years. A prospective observational clinico-pathological study. Departments of surgery, Nawabshah Medical College Nawabshah. From March 2000 to Feb: 2005. Total 180 cases were included in the study among all the 520 cholecystectomies performed during this period, which were symptomatic proven cholelithiasis cases for past 5 years or more. Most patients were from rural area with urban rural ratio 30:70. All the specimens of removed gall bladder were examined histologically. Female to male ratio was 4:1 and age incidence was 5 1-72 years. Out of 180 cases included in the study 12 [6.6%] patients were of carcinoma of gall bladder with female to male ratio 3:1 and peak age incidence was 65 years. The longer duration of disease with gall stones increases the risk of carcinoma in gall bladder. The patient diagnosed cholelithiasis should be counseled for early operation and all the specimens of removed gall bladder should be examined histopathologacally

Usefullness of topical glyceryl trinitrate in chronic anal fissure

To assess the effectiveness of topical Glyceryl Trinitrate in the treatment of Chronic Anal Fissure. Prospective Observational study from April 2004 to March 2005. Surgical Unit II, Peoples Medical College Hospital, Nawabshah. A total of 46 patients with Chronic Fissure-in-Ano. The data of all the patients who were recruited for the use of 0.2% topical Glyceryl Trinitrate was collected and analyzed for gender, age, symptoms' duration, site, and associated diseases. These patients were followed at regular intervals of four, six, eight and 12 weeks, and six and 12 months to assess the outcome, adverse effects and recurrence. Out of the 46 patients, six did not came back for follow-up, hence they were excluded. Amongst the remaining 40 cases, there were 14 males and 26 females, with ages between 16-64 years. In 26 [65%] patients, the fissure healed completely during eight weeks duration, whereas 10 [25%] patients experienced headache. Recurrence occurred in six [15%] patients; in them lateral internal sphincterotomy was performed. Topical Glyceryl Trinitrate is a good treatment option, as the success rate was 65%, with only 15% recurrence. It is well tolerated and has no chances of faecal and flatus incontinence

Outcome analysis of transvesical prostatectomy in our setting

To evaluate the outcome of suprapubic transvesical prostatectomy in our setting. Prospective and descriptive audit from July 2002 to July 2005. Department of Surgery, Peoples Medical College Hospital, Nawabshah. A total of 120 patients with lower urinary tract obstruction due to benign prostatic hyperplasia [BPH]. The details of all the above mentioned patients were recorded and the data analyzed for age, presentation, accompanying problems, blood transfusion, hospital stay, complications and mortality. The age range of the patients was from 50-90 years, mean age being 64.73 years. The indications for surgery were retention of urine in 64 [53.33%] cases, prostatism in 53 [44.17%] and haematuria in three [2.5%] cases. Associated problems were seen in 73 [60.83%] patients, including bladder stones in 19 [15.83%], inguinal hernia in 15 [12 .5%], haemorrhoids and renal stones in four [3.33%] each, and medical problems in 30 [25%] patients. The average operation time was 67.5 minutes and 51 patients needed blood transfusion [1-3 units]. Complications were seen in 49 [40.83%] cases including haemorrhage and urinary tract infection in eight [6.67%], clot retention in six [5%], wound sepsis in seven [5.83%], and transient incontinence and suprapubic urinary leakage in five [4.17%] cases each. The post-operative mortality was in 1.67% [two cases]. Transvesical prostatectomy [TVP] performed under spinal anesthesia is a safe and effective way of managing BPH. Its success has a durable effect and is a satisfactory modality in situations where facilities for transurethral resection of prostate [TURP] are not available

Parotid swellings

Different types of parotid swellings along with methods of their treatment and subsequent complications were studied at the Department of Surgery, Peoples Medical College Hospital, Nawabashah during a six years period. Of the total 23 swellings, 14 were pleomorphic adenomas, 4 were cases of tuberculosis, two were lipomas, two malignant growths and one was adenolymphoma. Except two all patients underwent surgery. Two treatment options were adopted i.e. either enucleation or superficial parotidectomy. Most common postoperative complication was facial nerve palsy [neurapraxia type]. Other complications were flap gangrene, haematoma, seroma, salivary fistula and Prey's syndrome. Superficial parotidectomy was found to be a safer treatment option than enucleation