Open versus closed method of establishing pneumoperitoneum for laparoscopic cholecystectomy

To compare the efficacy and safety of the Hasson cannula [open] and Veress needle [closed] method to gain access in the abdominal cavity for laparoscopic cholecystectomy. Randomized controlled study. Ward 26, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2007. All patients undergoing laparoscopic cholecystectomy during the study period were enrolled. Younger [< 20 years] and elderly [> 65 years] patients and those with co-morbid conditions were excluded. The remaining were randomized into two study groups. In one group, the Hasson cannula was used, while in the other Veress needle was used to establish pneumoperitoneum. Surgeries were performed by experienced surgeons of the ward. Variables comparing the safety and efficacy of the two methods were studied. There were a total of 60 patients in each group. In the Hasson cannula group 15 [25%] had complications of gas leakage, one developed a port-site hematoma and two patients developed wound infections. No complications occurred in the Veress needle arm. The mean access time in the Hasson cannula group [4.6 +/- 1.1 minutes] was less than that of for the Veress needle arm [5.4 +/- 0.7minutes]. Complications of visceral or vascular injury, port-site hernia or gas embolism did not occur in either arm. Although complications occurred using the Veress needle technique, the Hasson cannula technique was faster. Further studies on larger sample sizes are necessary to establish corroborative evidence and formulate guidelines

Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi

To study the health and needs of geriatric patients. A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management. Four hundred and two [402] subjects above the age of 65 were surveyed. Most of the subjects were retired [40.5%] married [76.4%] men [69.7%]. Ages ranged from 65 to 90 years, the mean being 70.57 years and 291 [72.4%] had five or more health problems. Mobility impairment, urinary incontinence, dyspnoea, fatigue and visual impairment had the worst impact on the life of the individual. Hypertension [42.5%], diabetes mellitus [28.1%] and arthritis [26.6%] were the most commonly reported chronic ailments. Two hundred and three [50.5%] respondents were taking three or more different medications daily. A large number of people had religion [61.4%], reading [36.1%], socializing [53%] and watching television [49.5%] as a regular activity. Eighty five [21.1%] respondents reported having financial problems. Three hundred and sixty five [90.8%] respondents had spiritual needs and 264 [72.3%] reported that their spiritual needs increased with aging