Revisional laparoscopic sleeve gastrectomy in failed gastric banding and effects of exercise and frequent sweet-eating on its outcome

Objective: To find out effectiveness of revisional laparoscopic sleeve gastrectomy [RLSG] in the patients who had laparoscopic adjustable gastric banding [LAGB] and failed to reduce or regained the weight and effectiveness of sweet abstaining and exercise on postoperative weight loss

Methods: This retrospective observational study was conducted at AlMoosa Hospital, Al-Ahsa, Kingdom of Saudi Arabia from December 2011 to November 2016. The patients who failed to reduce, regained the weight or had complications after LAGB, were performed RLSG. They were followed-up at three, six, twelve and twenty-four months intervals. Their weight, percent excess weight loss [%EWL] and body mass index [BMI] at pre-RLSG were compared with post-RLSG. The data was recorded in SPSS 22 and analyzed

Results: Thirty-six patients with male/female ratio of 1:5 underwent RLSG. Twelve [33.3%] were frequent sweet-eaters and twenty-four [66.7%] were not. Fourteen [38.88%] did not have exercise, while twenty two [61.11%] had daily regular exercise. Their mean pre-RLSG weight, percent excess weight loss [%EWL] and BMI were compared with post-RLSG at the period of three, six, twelve and twenty-four months. Their mean weight reduced from 111.69 kilograms to 96.94, 87.25, 79.56 and 76.11 kilograms respectively. Their mean of the percent excess weight loss [%EWL] reduced to 22.08, 45.75, 59.64 and 66.42 kilograms respectively. Their mean pre-RLSG BMI was 43.50 kg.m[-2], which reduced to the mean of 37.79, 34.02, 30.97 and 29.70 respectively. There were no post-operative complications in thirty [83.3%], mild like wound infection and seroma in four [11.1%] and bleeding in two [5.6%] patients. None of the patients had leakage. The patients who kept themselves abstained from sweet consumption and performed regular postoperative exercise had better results. They also had considerable reduction in appetite after RLSG

Conclusion: RLSG is an effective procedure after failed LAGB in terms of weight loss having minimal rate of complications. Moreover, abstaining from sweet consumption and continuing exercise postoperatively has better results

What should be the approach when laparoscopic sleeve gastrectomy fails to reduce the weight?

Laparoscopic sleeve gastrectomy [LSG] is considered to be a better option to reduce the weight due to its simplicity and effectiveness. In some cases, it fails to reduce or the patients regain weight. The revision surgery may be a challenge for a bariatric surgeon due to variety of restrictive as well as malabsorptive surgical procedures available and their complications. The review of literature was conducted on Pubmed to find out the best revision surgical procedure. The valuable suggestions observed were that the laparoscopic revision sleeve gastrectomy [LReSG] is the better option in dilated stomach, while the other procedures of revision may be selected according to the mechanism of failure of the primary surgery

Surgery as a preferred modality of treatment for the patients of chronic anal fissure with sentinel piles

To find out the preferred modality of treatment by patients having chronic anal fissure with sentinel pile. Prospective, Observational Study. This study was conducted at the Department of Surgery, Baish General Hospital, Kingdom of Saudi Arabia from January 2008 to December 2011. Forty eight patients had chronic anal fissures associated with sentinel piles. They had been explained the multiple modalities of treatment available along with their advantages and disadvantages. Some patients preferred surgery as 1[st] line of treatment while others conservative. Lateral sphincterotomy associated with fissurectomy was the surgical procedure applied, while 0.2% GTN cream as conservative modality. Out of total 48 patients, 39 were treated by surgery [P=0.2]. Thirty two [Group-A] were treated by surgery as 1[st] line of treatment [P=0.2], while 7 [Group-C] as 2[nd] line after failure with 0.2% GTN cream [P>0.05]. Healing rate and patients' satisfaction were excellent. A total of sixteen patients [41.02%] developed different post-operative complications, out of which, one patient [2.56%] had marked bleeding. One [2.56%] had transient flatus incontinence. Eight [20.51%] suffered from severe pain treated by opiate-derivative analgesic. Six [15.38%] had urinary retention. A total of 16 patients [Group-B] were initially treated conservatively with 0.2% GTN cream [P>0.05]. Out of 16, nine [56.25%] were quite satisfied with conservative treatment, while seven [43.75%] had failure and switched to surgery as 2[nd] line of treatment. None of the modality of treatment is without complications. Lateral sphincterotomy associated with fissurectomy is an effective treatment and gives patients a sense of satisfaction to the patient to get rid of sentinel pile

4-year study of lymph node biopsy in the patients belonging to the Labour class

To evaluate the rate of tuberculosis and other diseases in the patients having lymphadenopathy and find out the value of lymph node biopsy in various diagnoses. Retrospective study. This study was conducted at the Department of surgery, Sindh Employees Social Security Hospital Landhi, Karachi and Kulsoom Bai Valika Social Security Hospital S.l.T.E, Karachi, from April 2010 to July 2013. A retrospective study of the case sheets and biopsy reports was done. The reports of the patients of all age groups ranging from 1 to 70 years who underwent lymph node biopsy were evaluated. The patients were initially treated by local G.Ps for various complaints associated with superficial lymphadenopathy. After the failure of relief by the treatment of variable period, they were referred to our hospitals. All of our patients belonged to socio-economically low labor class. Out of 55 operated patients of lymph node biopsy included in this study, 19 [34.54%] were males and 36 [65.45%] were females. The majority of the patients 42 [76.36%] were those having cervical lymphadenopathy. Others were having axillary 08 [14.54%], inguinal 02 [3.63%] and mesenteric 03 [5.45%] lymphadenopath. Twenty three [41.81%] had reactive changes, 27 [49.09%] had TB, 02 [3.63%] had malignancy and 03 [5.45%] had other lesions. TB infection is alarmingly high in our society which is affecting the young generation. Health care authorities should address the issue. Moreover, the common tools like FNAC should be used prior to excision biopsy as it is easy, cheap and with fewer complications. It can give accurate diagnosis in many of the cases of superficial lymphadenopathies

Utilization of Markov chain technique to generate high-density wind speed data for the coastal belt of Pakistan

In order to estimates the reliable wind potential of any region, the high density wind speed data of 10-minutes or an hour interval is necessary. In most part of the Pakistan, available wind speed data is usually consists of monthly averages. In such a case, the Markov chain method based on transition matrix approach is used to synthesize the hourly wind speed data from the available averaged monthly wind speed data. The coastal belt of Pakistan is consider as a favorable regime for the development of wind energy activities and mainly targeted for the energy estimation. The first-order Markov chain technique has been used to synthesize and generate the wind speed data for the height of 10m from the monthly averaged wind data into the daily wind speed data for the coastal regions of Pakistan. Furthermore, the trends of both the daily original airport wind speed data and the synthesized wind speed data for the coastal regions of Pakistan. Furthermore, the trends of both the daily original airport wind speed data and the synthesized wind speed data have been analyzed and significant compatibility is observed

Systematic review on [vitamin e and prevention of colorectal cancer]

Colorectal cancers [CRC] are highly prevalent cancer all over the world and need appropriate and timely prevention and treatment. Since years it has been argued that antioxidant vitamins have a potential role in the prevention of several neoplasm including colorectal cancer though the answer remained controversial. Most of the observational studies in past have shown that Vitamin E has some protective effect in the primary prevention of colorectal cancer, however its exact role is not yet established. On the other hand recently conducted experimental studies have shown variable results regarding the role of vitamin E in preventing colorectal cancers. Thus this review was conducted to study the role of vitamin E in preventing colorectal neoplasm. This review study was conducted from September 2008 to February 2009. We searched multiple electronic sources including [PUBMED] MEDLINE, Cochrane Database for identifying existing Systematic Reviews, OVID data base and other library sources to identify relevant studies for this review. Data was collected using data extraction form. Meta analysis was performed in Review Manager version 4.3. We identified four trials on vitamin E role for primary prevention of CRC, includes 94069 participants [47029 in vitamin E Vs 47040 in placebo], aged 40 years or above, who were randomized to vitamin E supplement versus placebo. The outcome measure in our review was incidence of colorectal cancer in the follow up period of 7 to 10 years. We found no sufficient evidence of vitamin E role for decreasing risk of CRC incidence [RR: 0.89, CI: 0.76, 1.05; p-value = 0.18]. It has been identified in the review that Vitamin E does not have protective role in the prevention of colorectal cancer. Further studies on diverse population are required to determine the role vitamin E for the primary prevention of colorectal cancer

Role of B-scan ultrasonography for posterior segment lesions

Objective: To determine the usefulness of B-scan ultrasonography and to observe the relative frequency of conditions for which ultrasound B-scan examination was requested in Ophthalmology. Design: A descriptive study. Setting: Department of Ophthalmology, Ziauddin Medical University and Dr Akil Bin Abdul Kadir Welfare Eye Hospital Karachi, Sindh - Pakistan, from February 2002 to March 2005

Methods: We performed 320 B-scans over a period of 3 years. Patients were selected from out patient department. We used "SONOMED" and ALCON ultrasound machines

Results: In the total 320 ultrasounds performed, 102 did not demonstrate any pathology on Bscan ultrasonography. Vitreous disorders were present in 98 patients, 58 showed retinal detachment, 16 showed intraocular tumors and tumor like conditions, 9 patients showed optic nerve lesions and 6 patients showed intraocular foreign bodies. The remaining 31 patients had different types of miscellaneous lesions

Conclusion: Diagnostic ultrasonography has proved to be very helpful method for medical diagnosis in Ophthalmology. Opacities in the vitreous were the commonest problems followed by retinal detachment for which ultrasound was advised. It is also important to correlate B-scan findings to the clinical condition of patient

Blood transfusion is associated with increase resource utilization and bacterial infection

To observe the association of blood transfusion and clinical outcome in cardiac surgery patients. Forty patients underwent cardiac surgery during a period of two months in a single institution. Coronary artery bypass surgery [CABG] was performed in 21 [52.5%] patients, Mitral valve replacement [MVR] in 15 [37.5%] patients, aortic valve replacement [AVR] in 2 [5%] patients and Atrial septal defect [ASD] was closed in 2 [5%] patients. The mean age of the patients were 41.7 +/- 18 years, 80% were male. Twenty five [62.5%] patients required blood transfusion. Transfusion group showed chest wound infection [7.5%], pulmonary oedema [12.5%] and shortness of breath [10%]. Total leukocyte count and platelets count were significantly lower in transfusion group. We conclude that blood transfusion is associated with increased rate of infection and pulmonary oedema, with high cost and resource utilization. Blood transfusion should be used with appropriate caution

Review of 560 cases of Yag laser capsulotomy

To review the pattern of different types of posterior capsular opacification and relative frequency of complications after YAG laser capsulotomy. Descriptive case series. Ziauddin Medical University and Dr. Akil Bin Abdul Kadir Welfare Eye Hospital, Karachi from May 2002 to June 2004. Five hundred and sixty patients were treated for capsular opacification with Neodymium YAG [Nd: YAG] laser during study period. All procedures were done on Ziess Visual YAG II Plus. After capsulotomy, the visual acuity improved in 526 patients [93.92%] and no improvement was seen in 34[6.08%] patients. Out of 560 patients, 314[56.07%] patients presented with Elschnig Pearls, 237[42.33%] had capsular fibrosis and 9[1.60%] had capsular wrinkling. The main complications were temporary increase in intraocular pressure [5 mm Hg or more] and mild anterior uveitis. However, these complications were found to be transient in nature, with most of these patients settling down during first week of their treatment. Four patients developed retinal detachment, eight showed long term elevation of intraocular pressure and 2 developed cystoid macular edema. Nd: YAG laser is an effective and safe method for the management of posterior capsular opacification

Cryosurgery in chronic fissure-in-ano; a clinical trial

To determine the effectiveness and safety of cryosurgery as an out-patient, minimally-invasive modality of treatment for chronic fissure-in-ana.Observational study.At Ankelseria Nursing Home. Karachi. from July 1999 to June 2003. Male patients of various age groups having chronic fissure-in-ano were treated. Basco and Spembly cryosurgical instruments and nitrous oxide gas were used. Probe was passed through proctoscope and applied to anal papilla, upper 1/3[rd], middle 1/3[rd], lower 1/3[rd] and skin tag in sequence for 1[1/2] to 2 minutes. Local anesthetics were used in selected cases having severe pain after the procedure. Out of 11 cases, cryosurgery failed in 3 patients [27.27%] because they had severe pain and underwent operation within 3 days. Eight patients [72. 72%] responded well to the treatment. Pain relief was 50% in 5 patients after 2 weeks: while after 4 weeks 4 had 50% relief and 7 had 75% relief After 8 weeks all 8 were free of pain. After 8 weeks ulcer was completely healed in 6 and partially healed in 2 cases. Anal papilla was eradicated completely in 3 and partially in 2. Skin tags completely disappeared in 3 and had no effect in 2 patients. Followup for 6 months showed complete pain relief and ulcer healing in all, except 3 cases. Cryosurgery is simple, safe, minimally invasive and effective modality of treatmentfor chronicfissure-in-ano

Trichobezoar and gastric polyps: a rare association

A 10 year old female child presented with upper abdominal pain and huge abdominal mass in epigastrium extending to both hypochondria and umbilical regions. Investigations revealed a trichobezoar with gastric polyps. At operation, a large trichobezoar occupying almost whole of the stomach was removed along with gastric polyps. Biopsy suggested hyperplastic polyps