ABSTRACT
Objective: To determine the aerobic microbial flora in bile of patients having cholelithiasis
Methods: Study included seventy patients of cholelithiasis, out of which 56 [80%] underwent open cholecystectomy, while 14 [20%] were operated by laparoscopic cholecystectomy. Bile for culture was taken per operatively in all patients
Results: Mean age of patients was 44.17 +/- 13.20 and majority of patients were in age group 35- 72. Female to male ratio was 3.4: 1. Pain in right hypochondrium was major presenting feature in 65 patients [93%]. Mean pain duration was 26.21 +/- 23.44 months. Bile culture was positive in 25 [36%] patients.13 [62%] culture positive patients were diabetics. Postoperatively 7 patients [10%] developed fever while 4 patients [5.7%] developed wound infection
Conclusion: SThe frequency of positive bile culture in patients of cholelithiasis was 36%, in this series, commnest organisms being E. coli and Klebsiella. Wound infection 5.7% could have been due to endogenous or exogenous contamination. As all patients who developed wound infection were culture positive in this series, peri-operative antibiotic prophylaxis is recommended in patients undergoing biliary surgery
ABSTRACT
Objective: to ascertain the diagnostic accuracy of clinical findings only, clinical findings supplemented with limited investigation [CBC and urine C/E], clinical findings routine investigations and detailed investigations in acute appendicitis. To study the histopathology and bacteriology of acute appendicitis
Material and Methods: a Study was carried in department of surgery Services Hospital, Lahore. 150 patients who were operated for appendectomy with suspicion of AA were included. Patients were randomly allocated to 3 groups. Group A clinical findings only, Group B Clinical findings supplemented with limited investigations [CBC and Urine C/E], Group C clinical findings and detailed investigations [investigations done in addition to group B.]. Before operation patients signs and symptoms were recorded on specialized proforma on which relevant lab investigation, operative findings, post op sequel, result of histological examinations, appendix culture reports and follow up visits were also recorded. Analysis was done to determine the diagnostic accuracy of three groups using computer based Epi-info-6
Results: 150 patients divided in 3 groups were operated for appendectomy. 50 patients [group-A] on the basis of clinical suspicion, 50 patients [group-B] on clinical suspicion and routine investigations [CBC and Urine C/E], 50 patients [group-C] with clinical suspicion, routine investigations and special investigations [X-ray erect posture and abdominal U/S]. Out of 150 patients 111 had acute appendicitis [74%]. Diagnostic accuracy was not significantly different between group A and B, but it was significantly higher in group-C than group-A. Most prevalent organism found was Klebsiella followed by E.coli. Sensitivity was high in group-A [94.2%] but only insignificantly high in group-B [95.7%] and group-C [99.6%] specificity was low in group-A[22.6%] better in group-B [49.4%] and higher in group-C [76.9%]
Conclusion: appendicitis still remains primarily a clinical diagnosis. With highest rate of diagnostic accuracy there is highest rate of perforations and vice versa. It can be stated that although negative findings on laparotomy in suspected acute appendicitis is not without risks, the hazards of perforated appendix are much more serious
ABSTRACT
Objective: the objective of this study is to determine the role of C-reactive protein in the diagnosis of acute appendicitis
Material and Methods: seventy patients with suspicion of acute appendicitis were collected for this study. The patients were collected on the basis of history, clinical examination and laboratory investigations. Operation was done in all patients and appendix was sent for histopathology. Histopathology was considered as gold standard
Results: the mean age of patients was 22.40+/-7.95 years. The mean C-reactive protein of the patients was 21.64+/-19.63?g/ml. There were 14.3% patients of C-reactive protein range of less than 6?g/ml and 85.7% patients of C-reactive protein range of more than 6?g/ml. In the histopathology findings, there were 94.3% patients of acutely inflamed appendix and 5.7% patients of normal appendix. The sensitivity was found to be 86%, specificity 91 %, and positive predictive value 86%, negative predictive value 87% and accuracy 89%
Conclusion: a normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in the patients would probably reduce the rate of unnecessary appendectomies