Surgical site infections in general surgical wards at a tertiary care hospital

Surgical site infections are important cause of morbidity and mortality in admitted patients world over. To determine the pattern of surgical site infections in General Surgical ward of a tertiary care hospital. Analytical cross-sectional study conducted at Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years from January 2010 to December 2011. All cases were admitted in surgical ward with various surgical problems either as elective or emergency cases who developed wound infection later were included in the study. Cases of wound infection operated elsewhere, diabetic foot, and abscesses were excluded. Data collected included age, gender, primary diagnosis, mode of admission, comorbid factors, type and duration of surgery, expertise of the surgeon, use of antibiotics and hospital stay. After operation, wound was examined for evidence of infection from third post-op day onward. Any discharge was submitted for bacteriological examination. The wounds were followed till healed. A total of 1913 patients underwent surgery, including 983 cases [51.5 %] operated as elective and 932[48.5 %] as emergency. Postoperative wound infections occurred in 165 cases giving an overall incidence of infection in 8.6% cases. Infection rate in elective cases was lower [4.6%] than that in the emergency [12.7%] cases. Sixty one patients [37%] developed minor infection or stitch abscess, 104[63%] has frank suppuration requiring opening and drainage of wound; while 5[3%] cases developed deep seated infection of intra-abdominal spaces. E. coli was the commonest bacteria for wound infection [39%]. Post operative wound infection rate was 8.6%. The infection was significantly higher in cases who underwent emergency surgery and E. coli was the commonest pathogen to cause infection

Knowledge, attitude and practices about needle stick injuries in healthcare workers

To assess knowledge, attitude and practices about needle stick Injuries in health care workers. Hospital based study carried out at Pakistan Institute of Medical Sciences, Islamabad, from August 2010 to November 2010. A self administered 19 items questionnaire was prepared which contained information about needle stick injuries, its awareness, frequency of injury and the protocols that were followed after an injury had occurred. These questionnaires were given to 500 health care workers working in different wards and theaters of the hospital after obtaining their informed written consent. The health care workers included doctors, nurses and paramedical staff of Pakistan Institute of Medical Sciences, Islamabad. The data was entered and analyzed using SPSS version 15. A total of 500 health care workers filled the questionnaire and returned it. Out of these 416[83.2%] reported ever experiencing needle stick injuries in their professional life. Health care workers working in Emergency department were most frequently affected [65%] followed by those working in different wards [27%] and operation theatre [8%]. Most [93.6%] workers had knowledge about needle stick injuries and only 6.4% were not aware of it. Needle stick injury occurred from a brand new [unused] syringe in 51.2% cases, while in 32.8% cases, the needle caused an injury after it had been used for an injection. In 5% cases, injury occurred with blood stained needles. The commonest reasons for needle injury in stick injuries were heavy work load [36.8%] followed by hasty work [33.6%] and needle recapping [18.6%]. About 66% health care workers were already vaccinated against hepatitis B. Only 13% workers followed universal guidelines of needle stick injuries and no case was reported to hospital authorities. Health care workers had inadequate knowledge about the risk associated with needle stick injuries and do not follow standard preventive measures. A standard protocol regarding the training and compliance to follow preventive measures should be followed in all health care institutions

Huge sub-mandibular gland tumour

Salivary gland neoplasms are a diverse group of tumours and appropriate treatment depends on adequate understanding of the pathophysiologic behaviour of each tumour type. Most [95%] salivary glands occur in adults. Benign tumours are slow growing tumours and attain a considerable size before presenting to surgeon. We report a case of huge tumour of left submandibular gland that presented in our surgical outpatient department, and had developed over last twenty years. It was diagnosed as a benign mixed tumour of salivary gland and was successfully excised. Histopathology confirmed it to be a benign pleomorphic adenoma

Mass closure and layered closure in major abdominal laparotomies - a comparative study

To compare the number of complications after continuous layered closure with continuous mass closure in major abdominal laparotomies and to describe the frequency and types of complications after each procedure. The study was conducted in Surgical Unit-I in Nishtar Hospital, Multan from January 2008 to December 2008. A total of 50 patients included in two equal groups were included in the study. It was be comparative/descriptive study. Patients were admitted in surgical unit-I, Nishtar Hospital, Multan through emergency and outpatient department. They were operated by a consultant surgeon and senior staff. The patients were equally divided between the two methods of closure. In group-A, 17 [70%] were male and 8 [30%] were female while in group-B there were 16 [64%] male and 9 [36%] female. Age of the patient varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] patients were from elective operation and 17 [68%] from emergency. In group-A, 6 [24%] had midline incisions while 19 [76%] had paramedian incisions. In group-A clean wound were 12 [848%] and clean contaminated were 12 [52%]. In group-B clean wound were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patient with chest infection, 2 [8%] with haemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [6%], billiary tract 6 [24%], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscencc occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength

Two-port laparoscopic cholecystectomy-a new technique

Laparoscopic cholecystectomy is now the procedure of choice in all the gall bladder diseases and there is increase in the skills of surgeons with newer equipment. Normally the laparoscopic cholecystectomy is performed by using four ports or three ports. Two ports laparoscopic cholecystectomy is rarely performed as it demands greater expertise and skills. Also this technique is less expensive and less scar formation than four port laparoscopic cholecystectomy. We present a case of a middle aged female who underwent successfully laparoscopic cholecystectomy by using only two ports

Iatrogenic bile duct injuries: Experience at PIMS

Cholecystectomy is one of the most familiar and commonly performed elective operation in general surgery. However, bile duct injury is a rare but one of the worst complications of this procedure. Although infrequent in expert hands, it is usually encountered when comparatively inexperienced surgeons are operating. These injuries present at variable time after the primary surgery. The prompt recognition and active management affects the morbidity and mortality associated with it. We evaluated the data of the hospital to find out the nature of injuries inflicted to extra hepatic bile duct and its management. This is a study of 20 cases of iatrogenic bile duct injury managed at the Department of Surgery Unit 1, PIMS. The study includes cases that had undergone cholecystectomy, open or laparoscopic in previous 11 years and sustained injury to the biliary tree and were managed accordingly. Patients with hepatobiliary malignancy were excluded. Twenty cases were found to have various types of bile duct injuries. All patients were females, and their average age was 35 years. In four cases the injury occurred during surgery at our hospital, while remaining 16 cases were referred from other hospitals. All the patients were explored and managed accordingly. They had uneventful recovery and had good outcome at 6 months. Although the fact is that, the sooner an injury is recognized and treated, the better is the outcome. However, in this study the duration of injury had no effect on final outcome

Analysis and outcome of 30 patients with tuberculous meningitis

The study was conducted to see the presentation of tuberculous meningitis [TBM] and its associated complications in thirty patients. Place: Medical departments of Holy Family Hospital, Rawalpindi General Hospital and District Headquarters Hospital, Rawalpindi Study Design: Descriptive Study Thirty patients were selected on non-probability convenient sampling from December 2000 to mid of July 2001. Patients who had history and clinical examination and investigations suggestive of TBM were included in the study. Result: Mostly, patients were young; the mean age was 29.67 years with the highest age specific incidence between 12--24 years age group. Being a chronic disease, the presentation to hospital was late with mean duration of illness 29.13 days. Majority presented with fever, headache, vomiting, neck stiffness and altered conscious level. Different complications were seen in the patients; hydrocephalus was seen in 60% and cranial nerve palsies in 50% cases. Fits were not seen in any of the patients in this study. Cerebrospinal fluid [CSF] and CT Scan were most helpful in diagnosis. There was lymphocytic pleocytosis, with low sugar and high proteins in 93.3% cases. CT scan showed basilar meningeal enhancement with or without ventricular dilatation in majority of the patients. However, positive smear AFB for CSF and sputum was low and seen in 6.6% cases. Pulmonary infiltrates on chest x-ray were seen in 33.3% and miliary pattern in 13.3% only. Regarding the outcome, 30% fully recovered, 46% made partial recovery while 23.3% died of TBM. Advanced stage at presentation and delayed treatment were associated with poor outcome in majority. TBM is a serious illness often with atypical clinical, biochemical and radiological features

Transverse ectopia of the testis: a case report

A case of transverse ectopia of the testis in a man of 30 years is presented. The patient was admitted for a right inguinal herniorraphy and the finding of ectopic testis was accidental