E-Log system in monitoring of residency program: trainees' perspective

To record residents' perspective about the utility of newly introduced E-Log system at the College of Physicians and Surgeons Pakistan [CPSP]. Sequential mixed method design using survey questionnaire and in-depth interviews. CPSP, Regional Center, Lahore, from March to June 2014. Data was collected from registered trainees through a web-based survey questionnaire on a scale of 1 to 7 about the utility of E-log system. In-depth interviews were conducted with 7 students using non-probability purposive sampling. The interviews were tape recorded and subsequently transcribed. Quantitative data was analyzed using SPSS version 20 and qualitative data was analyzed using content analysis by identifying themes and patterns. A total of 4399 responses were received. Motivation was 4.61 +/- 1.98; 4.33 +/- 2.00 remained acknowledgment of control of one's training by the new system. Ease of use got a mean score of 4.56 +/- 2.15. The overall acceptance of the students regarding E-Log system was high. Scheduling IT workshop at the start of training will add to the student satisfaction regarding utility of E-Log system

Are drains really required in thyroid surgery

Background: Traditional use of drain in thyroid surgeries was to avoid any possible hematoma. The aim of the present study was to prospectively determine whether the use of the drain in thyroid surgery really helps the patient or it just adds morbidity to patients' post operative recovery phase

Patients and Methods: 132 patients who underwent total thyroidectomy without drain placement for benign conditions of thyroid were evaluated for outcome in terms of in hospital stay, wound infection, hematoma formation and re-exploration owing to untoward bleed. The study was conducted for 42 months with one month followup period. Results were compared with the control group from hospital records during the same study period

Results: Hematoma developed in 4 [3%] patients, infection in 2 [1.5%], hypocalcemia in 28 [21%] and recurrent laryngeal nerve [RLN] palsy 01[.75%] patients. There was no re-exploration for hematoma nor any in hospital mortality. In hospital stay was 1.8 days on average

Conclusion: Use of drain in thyroid surgery has no added benefit in terms of patient outcome rather it may increase the cost of treatment, patient's morbidity and hospital stay

Postgraduate trainee performance with structured assessment techniques in competency-based model of training

To determine the effect of changes in curriculum and structured assessment on the performance of candidates at the end the first phase of residency program by comparing pass percentages of candidates with older residency program. Interventional study. From 2007 to 2009 at the College of physicians and Surgeons Pakistan. Results of midterm assessment [intermediate module, IMM] for the years 2006-2007 [Historical group] in 9 specialties were compared with those of years 2008-2009 [Interventional group] after implementation of curricular changes. The changes were evaluated with structured assessment technique. Results for the IMM exams for years 2006 to 2009 were included in the study. Percentage changes in results of both groups were subjected to statistical analysis. The average pass percentage for theory examination in the Historical group was 52.6% +/- 13.87, and 59.96 +/- 14.88 in Intervention group. The pass percentage in old-residency program for the clinical examination was 61.6% [ranging from 48.0% to 78.4%] which was less when compared with the new residency system that was 73.9% [ranging from 61.55 to 82.45%]. The curricular changes and structured assessment at set competency standard resulted in better performance and higher pass percentages of candidates of midterm assessment

Stray bullet in inferior vena cava

A young boy presented in emergency with history of being hit by a stray bullet injuring the right hypochondrium. Ultrasound of abdomen showed hemoperitoneum and the radiograph showed bullet in the pelvis. Exploratory laparotomy showed injuries to liver and cystic duct with tract leading retroperitoneally into the inferior vena cava. The bullet was found wandering inside the vena caval lumen. Stray bullets are presumed to remain limited to the soft tissues. However, the trajectory, impact velocity and the involved region ultimately determine the outcome and influence management

Transhiatal esophageal surgery for malignancy - A 7-year experience at a tertiary care hospital

The aim of this study was to determine the outcomes of transhiatal esophagectomy for dysphagia for esophageal malignancy in terms of short and long-term morbidity and mortality and to determine the survival series. Case series study. South and West Surgical Ward, Mayo Hospital, Lahore, from January 2001 to December 2007. All patients referred electively or admitted through OPD presenting with features of progressive dysphagia due to malignancy were included in the study. The patients were investigated for site of stricture and extent of growth into the surrounding structures. All underwent transhiatal esophagectomy and gastric tube or colon was used as the conduit to restore continuity. Patients with squamous cell variety were referred to oncology department for chemoradiotherapy postoperatively. Morbidity and in-hospital mortality were recorded. A total of 42 patients were operated electively for malignant stricture esophagus through transhiatal approach. Site of lesion were 5 [11.9%] upper, 13 [31%] middle and 24 [58%] at lower end of esophagus. The TNM staging were stage I, IIa, IIb, III and IV in zero [0], 5 [11%], 10 [22%], 24 [57.8%] and 3 [7.1%] respectively. Mean operating time was 154 minutes and average blood loss of 371 ml. Postoperative complications included pneumothorax 16.7%, pulmonary complication [16.7%], anastomotic leakage [9.5%], wound infection [3.4%], recurrent laryngeal nerve injury [4.8%] and stricture formation [4.8%]. Only 3 [7.1%] 30-day in-hospital mortality was recorded. Transhiatal esophagectomy is the surgical treatment of choice for resection of carcinoma esophagus specifically at the lower and mid-esophageal levels. The frequency of complications is lower as compared to transthoracic approach and the early stage of presentation can lead to high 5-year survival ratios

Comparative study of ultrasound guided fine needle aspiration cytology with open/laparoscopic biopsy for diagnosis of carcinoma gallbladder

To determine the accuracy of fine Needle Aspiration Cytology [FNAC] in cases of gallbladder mass. Comparative Study. Surgical Units of Mayo Hospital, Lahore and Lahore General Hospital, Lahore in collaboration with the Department of Radiology, Sir Ganga Ram Hospital, Lahore and Department of Pathology of PGMI, Lahore, from September 2006 to September 2007. Ultrasound guided fine needle aspiration cytology was done in all cases and histopathological findings were confirmed with open/laparoscopic biopsies. The results of these two modalities were compared. Fifty cases with mean age 60.71 +/- 11.073 years presented with mass gallbladder underwent FNAC. Smears showed adenocarcinoma 23, undifferentiated carcinoma in 7, dysplasia and suspicion of malignancy in 5, hemorrhagic background without malignant cells in 12 and inflammatory cells with no malignancy in 3 cases. Results compared with open/laparoscopic biopsy showed a sensitivity, specificity and Positive Predictive Value [PPV] of 72.91%, 100% and 100% respectively. Ultrasound guided FNAC is a safe and less invasive diagnostic modality for diagnosing carcinoma gall bladder preventing the patient to undergo major surgery and helps in better quality of life