Comparative study of clinical profile in patients with solitary versus multiple gall stone

Background: Gallstones represent a major health problem across the world.[1] In the United States the prevalence is about 10% and increasing up to 30% in advance age people.[2] Its Prevalence in Islamic Republic Pakistan is around 15 to 20 %.[3]

Objective: Aim of our study is to assess the differences in clinical presentation between single and multiple gallstones

Design: Comparative study

Setting: This study was conducted at surgical department of Liaquat University Hospital Jamshoro, Sindh, Pakistan

Duration: 1[st] Feb 2010 to 31[st] January 2014

Sample size: Total one hundred patients

Methodology: All sonographically diagnosed patients of gallstones admitted into the ward. Clinical presentation like signs, symptoms and preoperative ultrasound findings of all patients were noted on predesigned performa, than after all necessary preoperative workup patients fit for surgery underwent cholecystectomy under elective conditions. The gallbladder was incised and the gallstones were exposed. The number of stones [single or multiple] in each gallbladder was recorded and on this basis all patients were divided into two groups. Group "A" labeled as a single stone and group "B" multiple stone

Results: The age range from 20 to 70 years, mean age was 44+/-5.5 years. Incidence of disease is about five times higher in female than males [80% female, 20% male]. 80% of patients had multiple stones, 20% patients had single stones. Majority of patients of group "A" has colicky type of pain and located in right upper quadrant and majority of group "B" patients has dull pain and located in Epigastrium. Other clinical symptoms like dyspepsia, vomiting and fever have no major difference in both groups. Sonographic findings are also almost same in both groups

Conclusion: It is concluded from our study that the clinical and Sonographic presentation is almost same in both groups, except site and type of pain

Outcome of laproscopies for subfertility military and combined military hospitals Rawalpindi

The purpose of the study was to determine the common causes of subfertility among patients reporting to Military and Combined Military Hospital [Rawalpindi] by means of diagnostic laparoscopy in a selected group and to compare our findings with other international data. Descriptive study. It was a conducted in two sister hospitals of Army; Military and Combined Military Hospital [Rawalpindi] from September 2010 to August 2011. A total of 120 women with primary, secondary or unexplained subfertility were carefully selected by purposive sampling according to inclusion and exclusion criteria of the study design. The patients were subjected to diagnostic laparoscopy and pathologic causes documented accordingly. Outcome measures were based on tubal, uterine and ovarian pathology. Results were recorded and then compared with international data. Out of a total of 120 sub fertile women who underwent diagnostic laparoscopy, 82.5% had revealed pathologic abnormalities and 17.5% were with normal pelvic findings. Among the patients with abnormal pelvic findings PID with tubal occlusion was found in 40% of the patients, simple ovarian cysts in 30% of the patients and 12.5% had endometriosis. Primary subfertility was present in 53.3% of patients and 46.7% of patients had secondary subfertility. Maximum number of patients [58.3%] were in age group of 20-25 years and maximum number of patients [59.2%] had duration of infertility of more than 5 years. The laparoscopic procedures are less invasive, more convenient and more precise for the diagnosis of subfertility. Indeed diagnostic pelviscopy is the standard means of diagnosing the tubal pathology, peritoneal factors, endometriosis and intraabdominal causes of infertility. Not only does this help in identification of unsuspected pelvic pathology but also contributes to decision making of infertility treatment. Therefore, because of its potential diagnostic as well as therapeutic benefits, all patients with subfertility should undergo pelviscopy

Port site complications in patient after laproscopic cholecystectomy

To assess the frequency of port site complications in patient after laproscopic cholecystectomy. Observational study. This study was carried out in the Department of Minimal Invasive Surgical Centre [MISC] at Liaquat University of Medical and Health Sciences Jamshoro Pakistan, from Oct 2009 to 31[st] May 2011. This study consisted of Four hundred and fifty patients, admitted for laparoscopic cholecystectomy. Base line and specific investigations were done in all patients, especially ultrasound of abdomen for assessment of gallstone disease. Inclusion criteria were that all patients diagnosed as case of gallstone disease on the basis of history, clinical examination and investigations specially ultrasound of abdomen. Exclusion criteria included complicated gallstone disease, unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of gall bladder, patient with acute pancreatitis and patients with obstructive jaundice. Postoperatively the patients were followed for up to 6 months and observed port site complications. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 315[70%] were female and 135[30%] male. Ratio male: female ratio of 1:2.3. Age ranging from a minimum of 20 year to 65 year with mean age was 38 + 3.4 years. Complications were port site infection in 4 [0.88%] cases, followed by port site bleeding in one [0.22%] case and epigastric port site diathermy burn in one [0.22%] case. In conclusion, we recommend all 10 mm trocar sites be closed care fully. Over stretching of infra / supra umbilical port should be avoided. Gallbladder should be removed in endo-beg

Frequency of normal appendicectomy in a tertiary care hospital

To determine the frequency of normal appendicectomy in a tertiary care hospital. prospective observational study. This study was carried out in Surgical Unit-I, Liaquat University Hospital Hyderabad, from Oct 2010 to Oct 2011. This study consisted of hundred patients admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. Detailed History was taken from all the patients with special reagard to the Pain in RIF, Pain starting around umbilicus, nausea, vomiting, fever and Altered bowel habits. Detailed Clinical examination of the patient was done. Site of right iliac fossa was especially examined for assessment of tenderness and recorded in proforma. Systemic review was also done to see any co-morbidity. All patients underwent base line and specific investigations especially ultrasound of abdomen as diagnostic modality for assessment of acute appendicitis. Inclusion criteria were all these patients who after counseling for this study and gave written consent. Irrespective of their age and sex admitted in Surgical Unit-I through outpatient department/ casualty and diagnosed as case of acute appendicitis. Exclusion criteria included all history of previous operation on lower abdomen. Follow up of all these patients was done. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Out of 100 patients included in this study 65 were male [64%] and 36 patients were female [36%]; with male to female ratio of 1.7:1. There was wide variation of age ranging from a minimum of 10 year to 70 year. The mean age was 26.78 year. Symptoms of patients were pain in RIF in 99 [99%], pain starting around umbilicus in 42 examination of patients revealed tenderness at Mc Burney's point in 99 [99%] patients, while guarding was present in 80[80%] patients, rebound tenderness was present in 84[84%] patients and 33 [33%] patients had fever. Ultrasonographic findings revealed Wall thickness of appendix in 58[58%] patients where as normal appendix in 42[42%] patients, Free fluid in the R.I.F and pelvis was found in 36[36%] patients, Thickening of the surround intestinal lobes was seen in 40[40%] patients and Mass ob abscess formation in 8[8%] patients. Operative and histopathological findings were acute appendicitis in 59[59%] patients where as normal appendix in 21[21%] patients, adherent to bower or omentum was found in 7[7%] patients, pus was seen in 5[5%] patients and perforated 3[3%] patients. In conclusion, we found 21% of appendices to be histopathologically normal after emergency appendicectomies performed in this hospital. There was no mortality