Acute appendicitis mean platelet volume

Objectives: To study mean platelet volume [MPV] in acute appendicitis and its correlation with leukocyte count

Study Design: Case control study

Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from January 2013 to February 2014

Subjects and Methods: Subjects with clinical suspicion of acute appendicitis were selected according inclusion and exclusion criteria. A sample of 49 acute appendicitis patients and 37 controls were studied. The Blood samples were collected in sodium citrate vacutainers and processed on Sysmex KX 21 analyzers. The main analysis was the comparison of the difference of MPV between acute appendicitis and controls. Data was analyzed on SPSS version 21.0 by student's t-test, Chi-square test and Pearson's correlation [r] was used to evaluate association of MPV with platelet counts and leukocytes. A p-value of

Results: The mean platelet volume and leukocytes were significantly elevated in patients with acute appendicitis. MPV and leukocytosis in controls and cases were noted as 7.93 +/- 2.1 vs. 9.10 +/- 2.9fl [p=0.0001] and 6980 +/- 120 vs. 13980 +/- 340 micro L[-1] respectively. MPV was positively correlated with leukocytosis [r=0.419] [p=0.0001], while Platelets showed a negative correlation

Conclusion: Elevated MPV and leukocytosis are observed in acute appendicitis. MPV may be exploited for clinical diagnosis of acute appendicitis but in a proper clinical context along with leukocytosis

Reasons and morbidity of conversions in laparoscopic cholecystectomy

To identify variables and morbidity that lead to conversion to open surgery in laparoscopic cholecystectomy [LC] patients. Descriptive case series. Surgical Department of Liaquat University Hospital Jamshoro, from June 2005 to May 2008. All patients with symptomatic cholelithiasis were included. Patients with previous abdominal surgery, gall stone cholangitis and pancreatitis were excluded. A total of 619 patients [68 males and 551 females] underwent laparoscopic cholecystectomy. Forty [6.46%] patients were converted to open surgery. Regarding preoperative variables males had higher conversion rate of 72.5%[p <0.0001]. Mean age of the converted group was 55.2 +/- 2.5 year and mean age of laparoscopic group was 42.6 +/- 3.8 year [p 0.0003]. Conversion was more in patients with acute cholecystitis [p value <0.0001]. Obscured anatomy of Calot's triangle [45%] and equipment failure [15%] were major reasons for conversion. Operative complications leading to conversion were bile duct injury [5%], haemorrhage [7.5%], duodenal injury [1%], colonic injury [1%] and common bile duct stones [5%]. Patients in conversion group had higher rate of postoperative morbidity. This included wound infection [10.0%], fever [12.5%], bile leakage [5%] and intra abdominal collection [5%]. It increased the hospital stay to 4.3 +/- 0.3 days which for the laparoscopic group was 1.6 +/- 0.1 day [p <0.0001]. Possibility of conversion can be predicted pre-operatively with variables like male gender, old age, acute cholecystitis and during surgery by obscured anatomy at Calot's triangle

Pilonidal sinus: excision with primary midline closure versus open method

Objective: To compare the efficacy of primary closure versus open method after excision of pilonidal sinus

Design: Comparative study

Setting: Department of Surgery Liaquat University of Medical and Health Sciences, Jamshoro, Sindh - Pakistan, from January 2003 to December 2006 [4 years]

Material and Methods: Cases of chronic pilonidal sinus were included in this study whereas acute sinuses and recurrent sinus were excluded. Patients were conveniently selected for excision with closure and without closure [group A and group B]. Both groups were followed up for 18-months. Efficacy assessed and compared on the basis of operating time, duration of postoperative hospital stay, time off work and recurrence rate

Results: Each group comprised of 20 patients. The mean age of all 40 patients was 27-years [17-42 years]. Males were 37 [92.5%] and females were 3 [7.5%]. Respective observations for both groups were mean operative time 91 min [85-95 min] and 69 min [60-75 min], mean postoperative hospital stay 6 days [4-8 days] and 11 days [9-13 days], mean time of wound healing was 11 days [9-13 days] and 39 days [19-42 days], mean off work time was 21 days [10-26 days] and 42 days [22-46 days]. Recurrence rate was 11.1% and 5.2% in group A and group B respectively

Conclusion: Though it takes longer to excise pilonidal sinus with primary closure and it has higher recurrence rate, it appears more beneficial due to reduced hospital stay, reduced healing time and early return to work

Frequency of hodgkin's lymphoma in patient with cervical lymphadenopathy presenting in a public hospital in Pakistan

Objectives: To determine the frequency and pattern of presentation of Hodgkin's lymphoma in cervical lymph node at Liaquat University Hospital, and to see its pathological variants. Study design: Case series. Study Setting: Surgical departments of Liaquat University Hospital. Study Duration: Five years from January 2000 to December 2004

Sampling: Non-probable purposive. Inclusion Criteria: All patients of cervical lymph node enlargement of more than four weeks duration irrespective of age and sex. Exclusion Criteria: Cervical lymph node less than 1cm. Study Variables: Study variables used were age, sex, symptom, clinical finding, stage and histopathology. Data Analysis: Data analysis was done by using SPSS version 10

Results: A total of 500 patients with enlarged cervical lymph nodes were studied, amongst them 40 [8%] patients were diagnosed with Hodgkin's lymphoma [32 males and 8 females]. Mean age of 40 patients was 23 years [range 9-44 years]. Out of these 40 patients, in 8 [20%] patients it was difficult to differentiate lymphoma clinically from tuberculosis on clinical examination. Cervical swelling was the commonest symptom [100%] while fever, night sweats and weight-loss were present in 45% patients, 55% of patients were in stage III and IV [advance disease]. Mixed cellularity was the commonest histological variant. All 40 patients after diagnosis and staging were referred to Nuclear Institute of Medical Radiotherapy for further management

Conclusion: Although tuberculous cervical lymph node enlargement is very common, but Hodgkin's lymphoma has a definite possibility of occurrence [8% in our study]. Therefore all patients with enlarged cervical lymph node should not be treated with anti-tuberculosis therapy on empirical basis. Diagnosis should be confirmed by biopsy, otherwise patients may land up with advanced stage of Hodgkin's lymphoma with poor prognosis

Clinical pattern and management outcome of phyllodes tumor of breast

To determine the clinical and histopathological pattern, surgical protocol and need of adjuvant therapy for phyllodes tumour of breast Case series. Surgical department of Liaquat University Hospital Jamshoro, from November 2000 to October 2006. All female patients with phyllodes tumor of breast diagnosed after triple assessment were included. Non probable purposive sampling technique was used. Female having carcinoma breast were excluded. After taking consent data related to age, parity, site, size of tumor, treatment options, histopathology and metastatics work up done [in case of malignant disease]. Patients were advised follow up for minimum period of two years. Data was collected on proforma and analysed by SPSS version 10. A total of 35 patients with phyllodes tumor were studied. Out of these 23[67.5%] were benign, 5[14.3%] were borderline and 7[20%] were malignant. Mean age was 24 years. All patients were assessed by triple assessment. Nine[25.7%] patients had lumpectomy and 26[74.3%] underwent mastectomy. Patients with proven malignancy and borderline disease on histopathology were submitted for adjuvant chemoradiotherapy. Patients were followed for minimum period f two years. There was one recurrence after lumpectomy among benign disease [16.66%] while there was no recurrence after mastectomy with or without chemoradiotherapy. Phyllodes tumor must be vigorously treated with wide local excision or mastectomy followed by adjuvant chemoradiotherapy in malignant or borderline tumor to minimize recurrence

Role of Diosmin in the treatment of hemorrhoids

To determine the role of diosmin in the management of haemorrhoidal disease. Interventional study. Department of Surgery, Liaquat University Hospital Jamshoro/Hyderabad and Sindh Employees Social Security Institute [SESSI] Hospital Kotri, from 1[st] January 2003 to 31[st] December 2004. A total number of 147 patients [99 males and 48 females] with haemorrhoids presented to outpatient department. All of them after evaluation of symptoms and signs of haemorrhoidal disease were prescribed diosmin [Tab. Daflon 500-mg 2xBD] for four weeks and patients were reviewed weekly for four weeks. Improvement of symptoms and proctoscopic findings were observed, and comparison done between first visit and last visit. Patients were followed for the maximum period of six months. Out of total 147 patients 142 [96.5%] came up to 3-months and 136 [92.5%] followed up to 6-months. Out of these 136 patients 67 [49.3%] patients had no recurrence of symptoms while 43 [31.6%] patients had no improvements in symptoms and 26 [19.1%] patients had recurrence of symptoms after temporary relief. Therefore these 69 [50.7%] were submitted for surgery. It was concluded that diosmin improves haemorrhoidal symptoms significantly for sufficient time so patients should initially be treated with diosmin