Importance of immature platelet fraction as predictor of immune thrombocytopenic purpura

Background and Objective: Immune thrombocytopenic purpura [ITP] is a clinical syndrome in which a decreased number of circulating platelets [thrombocytopenia] manifests as a bleeding tendency, easy bruising [purpura] or extravasation of blood from capillaries into skin and mucous membranes [petechiae]. The diagnosis of ITP can be made clinically on the basis of symptoms, we need to see if ITP can be confirmed in patients by quantification of residual RNA containing immature platelets [megakaryocytic mass] or immature platelets fraction [IPF] using automated hematology analyzers [Sysmex XE-2100]

Methods: In order to check the efficacy of IPF% parameter of Sysmex XE-2100 a total of 231 patients of thrombocytopenia were included in this study. Complete blood count [CBC] was estimated. The data was statistically analyzed by SPSS version 17

Results: About 62 patients were diagnosed as ITP and 169 patients were diagnosed as non ITP on the basis of clinical history. The mean IPF % value of ITP patients was 16.39% and the IPF % value of Non ITP patients was 7.69% respectively. There was no significant difference in IPF% values with respect to time between sampling and acquisition of complete blood count. The diagnostic sensitivity of IPF% as biomarker for ITP and non-ITP was 85.71% [95% CI: 84.04% to 85.96%] and 41.76% [95% CI: 39.87% to 43.65%]

Conclusion: The mean IPF % value by Sysmex XE-2100 can be used to predict ITP

Bile duct injuries during open and laproscopic cholecystectomy:management and outcome

To evaluate the management of twenty two patients, with bile duct injuries during open and laproscopic cholecystectomy who were referred to the tertiary center. It is a prospective cohort study conducted at Department of Surgery, Sindh Government Lyari General Hospital, affiliated with Dow University of Health Science Karachi. Patients who sustained bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were included. Time between cholecystectomy and recognition of injury, method of repair and post operative outcome was recorded. Strassburg classification was used to delineate the type of bile duct injury. Twenty two patients of bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were managed. Mean age of patients was forty six [thirty four - fifty six] years. Injury was sustained in fifteen patients during laproscopic cholecystectomy and in seven patients during open cholecystectomy. Overall fourteen patients had Strassburg E1 and E2 and eight patients had E3 and E4 injuries. In nineteen patients, Roux-en-Yhepaticojejunostomy was done, while three patients underwent lateral choledochorraphy with T-tube drainage. One patient died of septicemia, while one patient was re-explored for revision of hepaticojejunostomy for stenosis of bilioenteric anastomosis. Other minor complications were treated conservatively. Bile duct injury after open and laproscopic cholecystectomy can be successfully managed in a tertiary center by hepatobiliary surgeon. Principles of management include anatomic definition of injury, control of sepsis, staged approach involving interventional radiology and refined operative technique

Prevalance of helicobacter pylori in dyspeptic patients at Lyari General Hospital

To find out the frequency of Helicobacter Pylori among patients having dyspepsia. Observational, cross sectional study from Jan. 2005 to Oct. 2005. Department of Surgery at Sindh Govt. Lyari General Hospital, Karachi. Patients presenting with dyspepsia, irrespective of age and sex were included in the study. Complete history of all the patiens was taken and thorough examination done. Upper G.I.Endoscopy was performed, biopsies taken and the specimen sent for histopathology. A total number of 63 patients were studied, out of which 31 were males and 32 females, with ages ranging from 12-68 years. Majority of the patients were in the third and fourth decades of life, and presented with upper abdominal pain and retrosternal burning. Other symptoms seen included regurgitation, dyspepsia, water brash, nausea, vomiting and hematemesis in some cases. Histopathology of gastric biopsy showed Helicobacter pylori associated gastritis in 30 [47.62%] patients, while 33 [52.38%] patients had gastritis which was not associated with Helicobacter pylori infection. The incidence of Helicobacter pylori associated gastritis and gastritis not associated with Helicobacter pylori is more or less equal in dyspeptic patients

Varicocelectomy

To find out the age incidence of varicocele in our population, and to compare the results of high versus low ligation for varicocele. An analytical study from August 2001 to July 2005. Surgical Unit I, Sindh Govt. Lyari General Hospital, Karachi. This study was carried out in 22 patients who presented with varicocele. The biodata and clinical features of all these patients were noted. Half of the patients i.e. 11 underwent high and the remaining half low ligation. The post-operative complications were recoeded and the results of the study were analyzed statistically. Out of the 22 patients, 21 [95.45%] had varicocele on the left and one [4.54%] on the right side. One case [4.54%] presented in Grade-I, while 14 [63.64%] presented in Grade-II and seven [31.82%] in Grade-Ill. Postoperative hanging of testis and persistence of pain were major complaints in high ligation, while scrotal haematoma and postoperative hydrocele were more commonly seen in low ligation. In our study there were less post-operative complications in high ligation; furthermore they were less time consuming and the patients were mobilized earlier