ABSTRACT
Objective: To determine the current preoperative informed consent practice in cases undergoing surgical procedures
Study Design: Observational / descriptive study
Place and Duration of Study: This study was conducted at the Surgery Department of PMC Hospital and PUMHS Nawabshah Sindh from Jan-2014 to April-2015
Materials and Methods: Following informed consent, 165 cases were incorporated in this study. Cases were randomly selected with suitable sampling technique and their surgical procedure was done electively, whereas those cases, which were treated conservatively and not capable of answering because of unconsciousness, eclampsia and shock, were not included in this study. Data was recorded on preplanned proforma concerning demographic information of cases, their knowledge regarding surgery carried out on them and the extent of data supplied them regarding risk, advantages of surgical procedure and other treatment choices
Results: Twenty nine [15%] cases were of age group of 20-35 yrs, whereas 104[53.88%] were of age group of 36- 50 yrs. Well-versed consent was obtained from the cases by surgeon in 63[32.64%] cases, by inhabitants in 105[54.40%], house officers in 10[5.18%] and by nurses in 15[7.77%] cases. This was ensured from the records of patients. When/ the patients were inquired, weather they completely grasped the data given to them, 86[44.55%] declared "yes" whereas 107[55.44%] did not grasp the data offered to them
Conclusion: Our study concluded that the majority of our contributors were conscious regarding the surgery done on them however they were provided little facts about risk, complications and advantages of the surgery
ABSTRACT
Objective: The objective of this study was to find out the diagnosis of diagnostic laparoscopy in patients having chronic abdominal pain
Study Design: Descriptive / cross sectional study
Place and Duration of Study: This study was conducted at the Surgery Department of PMC hospital and PUMHS Nawabshah from February 2014 to March 2015
Materials and Methods: All the undiagnosed cases of chronic abdominal pain [by conventional methods and investigations such as clinical examination, urine examination, US abdomen etc], abdominal pain more than 3 months, cases age more than 18 years either gender and clinically diagnosed as chronic were selected in this study, while all the cases with known cause of pain, Acute inflammatory disease, cases having acute intestinal obstruction, coagulation abnormalities, critical illness, severe/decompensated cardiopulmonary failure and medically unfit for anaesthesia and surgery were not selected in this study. Diagnostic laparoscopy was performed in all selected cases and findings were entered in proforma
Results: Total 45 patients underwent diagnostic laparoscopy majority of the young patients was found. Female were found in the majority 60% as compare to males 40%. 13 [28.88%] patients had pain in right iliac fossa, 08 [17.78%] patients had hypogastrium pain, 10 [22.22%] cases were found with whole abdominal pain, 10 [22.22%] patients had pain in left iliac fossa and 04 [8.89%] patients were noted with pain at right hypochondrium. According to laparoscopy findings, appendicitis and adhesions were most common 14[31.11%] and 10[22.22%] respectively, following by Abdominal tuberculosis, Hernia, Mesenteric lymphadenopathy, Ovarian cyst and Dense adhesions + Thickened gall bladder wall with percentage of 06[13.33], 03[6.67%], 02[4.44%], 04[8.89%] and 02[4.44%] respectively, while 04[8.88%] cases were noted without any disease
Conclusion: Diagnostic laparoscopy in good tool for diagnosis of chronic abdominal pain, according to the assessment the commonest basis of chronic recurrent abdominal pain in this study was appendicitis followed by abdominal tuberculosis and adhesions
ABSTRACT
To determine the socio-demographic characteristics, clinical profile and outcome of the tetanus patients. Case Series SICU of Peoples University of Medical and Health sciences [PUMHS] Nawabshah, from January 2010 to December 2012. The information obtained from the attendants of patients who presented with clinical features of tetanus and classified into generalized and cephalic types and; severity was classified into mild, moderate severe and very severe. Treatment was started immediately with protocol of supportive care; neutralization of circulating toxin and eradication of the source of tetanospasmin. Details of socio-demographic data, clinical features, complications and outcome were recorded and entered in a questionnaire before analysis. Twenty two cases of tetanus were studied included males were 16 and females were 6. Six of 22 [27.3%] patients had prior tetanus immunization while the other sixteen [72.7%] patients were not vaccinated or did not know their tetanus immunization status. Lower limbs were most common of portal of entry 15 [68.2%]. Most of patients [95.5%] have generalized tetanus and 5 [22.7%] patients had very severe disease. Body stiffness/spasm [100%], trismus [100%] and dysphagia [68.2%] were the three commonest presenting complaints. Complications of tetanus were documented in 16 [72.7%] patients. Overall mortality was 68.2%. Tetanus prevalence is still high in interior Sind and is associated with high morbidity and mortality rate
ABSTRACT
Typhoid perforation of ileum is a serious complication of typhoid fever. There are different surgical methods of repairing the perforation. The aim of this study was to report the surgical experience regarding treatment of typhoid ileal perforation in our setup. It wa a retrospective, observational study carried out at Departments of Surgery Unit I and Pathology, Peoples Medical College and Hospital Nawabshah from July 2003 to June 2008. Forty-four patients were admitted through causality as cases of acute abdomen, 28 [63.63%] were males and 16 [36.36%] females, with age range of 10-45 years. The diagnosis of typhoid perforation was made on clinical grounds, laboratory investigations, x-ray, ultrasound examination, and operative findings. Exploratory laparotomy was carried out and perforations were managed. The variables studied in the post operative period were wound infection, wound dehiscence, entero-cutaneous fistula, residual abscess, mortality, hospital stay and incisional hernia. Fever with abdominal pain and distension were the symptoms in all subjects followed by diarrhoea, vomiting and constipation Widal test more than 1:320 was positive in 35[79.45%] cases and typhi dot [IgM in all cases and IgG in 15] was positive in all cases. Blood culture was positive in 32 [72.7%] cases. X-ray abdomen revealed pneumoperitoneum in 22 [50%] cases. Ultrasound shows free peritoneal collection in 40 [90.90%] cases. On operation the abdominal cavity was heavily contaminated in 12 [27.27%] patients while in 32 [72.72%] patients the peritoneal cavity was having moderate contamination. 36 [81.81%] patients had single perforation and 8 [18.18%] patients had more than one perforation. In 32 [72.72%] patients perforations after freshening the ulcer were closed by single layered interrupted extra mucosal technique with vicryle 2/0, 4 [9.09%] needed resection and anastomosis and in remaining 8 [18.18%] loop ileostomy was made. The typhoid ileal perforation still carries high morbidity and mortality. The typhoid ileal perforation should always be treated surgically. There are many operative techniques to deal typhoid ileal perforation but no one is fool proof. Regardless of the operative technique timely surgery within 24 hours with adequate and aggressive resuscitation is a way to decrease the morbidity and mortality