Amoebic liver abscess and gender differences

The study was undertaken to elucidate the clinical profile and to find out the of results of Ultrasound guided aspiration of liver abscess in the Department of General Surgery, Baqai Medical University Hospital Nazimabad Karachi, from April 2007 to April 2012. 60 cases were included in the study, which were diagnosed to have amoebic liver abscess with 96.5% male and 3.5% female patients. The diagnosis was based on persistent fever, pain in right upper abdomen with pointing tenderness over liver, serodiagnosis, ultrasound evidence of liver abscess and CT scan in selected cases. Those having abscess larger than 5 cm subjected to percutaneous transhepatic ultrasound guided aspiration of liver abscess and the abscess size and resolution was monitored. Parental antibiotic cover for 4 to 6 weeks was provided to all patients. Fever was the most frequent symptom as diagnosed in 57 [94%] patients, followed by pain in right upper abdomen in 54 [90%] patients and diarrhea in 6 [10%] patients, anorexia and weight loss in 18 [30%] patients. 11 [18.3%] patients had hepatomegaly, 8 [13.5%] showed deranged LFTs and 9 [15%] patients had right sided pleural effusion. Out of total cases, 54 [90%] patients had right lobe abscess, 2 [3.3%] patients had left lobe abscess and three [5%] patients had multiloculated right lobe abscess. One [1.6%] patient had multiple abscess in both lobes of liver. Serology test for Entamoeba histolytica was positive in all patients Ultrasound guided needle aspiration employed in 38 [63.5%] patients and 22 [36.5%] patients were managed conservatively. In 8 [13.3%] patient's second attempt of aspiration employed. In one [1.5%] patient right chest drain was passed. Patient with amoebic liver abscess with fever and pain in right upper abdomen were noted. Our study showed amoebic liver abscess had seven times higher incidence in male than in female

Frequency of restrictive pulmonary dysfunction in type-1 and type-2 diabetes mellitus

Objective: to determine the frequency of restrictive pulmonary dysfunction in type 1 and type 2 diabetic patients and to measure the severity of pulmonary dysfunction

Material and Methods: this study included 255 patients of type I and type II diabetes who had followed up in the out patient departments of Pulmonology and Medicine in Mayo Hospital, Lahore. Forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1] were measured using standard spirometry

Results: mean age was 47.26+/-19.076 years. 230 [90.2%] were males and 25 [9.8%] were females. 58 [22.7%] were type 1 diabetics and 197 [77.3%] were type 2 diabetics. 37 [14.5%] had restrictive pathology, 6 [2.4%] had obstructive pathology and 212 [83.1%] had normal lung function tests. 35 [13.7%] had mild restrictive dysfunction and 2 [0.8%] had moderate restrictive lung dysfunction

Conclusion: These data support the notion that the lung is a target organ for diabetic injury. Additional research is required to identify pathophysiologic mechanisms and to determine clinical significance

Effectiveness of wound infiltration with local anesthetic agent after abdominal surgery

To assess the effectiveness of local infiltration of wound with 20 ml of 0.5% bupivicain after abdominal surgery in term of delay in postoperative analgesic demand. This case control study was carried out at the Surgical Unit of City Hospital, Kohat Road Peshawar from January 2004 to January 2005. Two hundred patients, who underwent abdominal surgery selected by non-probability convenient sampling, were randomized by odd or even numbering into two equal groups: Group1 [the study group] and Group 2 [the control group]. In group 1 patients [n=100] the wound and surrounding tissues were infiltrated with 20 ml of 0.5% bupivicain and in Group 2 patients [n-100] the wound was not infiltrated. Post-operative pain was assessed with visual analogue scale [VAS]. Patients in Group 1 were more comfortable during the postoperative period and average delay in analgesic demand was 5.1 +/- 0.8 hour as compared to a 2.4 +/- 1.1 hour in group-2. Eight [8%] patients in the group 1 required no supplementary analgesia at all. Patients in study group-1 were mobilized much earlier [8.8 +/- 1.2 hours] as compared to control group-2 [18.1 +/- 1.5 hours]. There was no significant difference in the incidence of wound related complications between the two groups. Mean hospital stay in group-1 was 51.20 +/- 2.5 hours as compared to 73.20 +/- 3.7 hours in group-2. Wound infiltration with bupivacain is an effective method of minimizing postoperative pain