Comparison of fibroblastic proliferation and collagen deposition in response to CO[2] laser surgery and scalpel

CO2 laser is the advocated treatment for the removal of various soft tissue lesions in oral cavity in recent years. A number of clinical advantages are reported by CO2 laser as compared to scalpel. The objectives include oral tissue fibroblastic response after CO2 laser surgery and to compare advantages and disadvantages of CO2 laser and scalpel after an oral surgical procedure with special reference to fibrosis and collagen deposition. A comparative study, conducted at animal laboratory of Post Graduate Medical Institute, Lahore for about three months. This study was conducted on 150 Sprague - Dawley Albino rats, which were divided into 3 equal groups of 50. Partial glossectomy was done with 3 watts CO2 laser for group [A], with 6 watts CO2 laser for group [B] and with scalpel for group [C]. The fibroblastic activity and collagen deposition was observed and compared histologically, 24 hours, 3[rd] day, 7[th] day, 14th day and 28[th] day after surgery. Histologically fibrosis and collagen deposition were highly significant in A and C groups as compared to group B. Six watts CO2 laser wound was much better as compared to scalpel in terms of lesser fibroblastic activity and collagen thickness hence having a good wound healing response

Feasibility of early surgical intervention in postoperative entero-cutaneous fistulae

To study the out come and benefits of an early surgical intervention in postoperative entero-cutaneous fistulae. It's a retrospective descriptive study conducted at department of surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen [213] post-operative fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula, out put per 24 hours, duration since development, complications due to fistula, nutritional status, operative procedure, operative time, post-operative complications, total post-operative stay, follow up schedule, outcome. The results were statistically analysed on SPSS-12. A total 213 patients comprising 184 males [85.6%] and 29 [13.5%] females with a mean age of 36.08 years and a range of 64 [78-14] years presenting with post-operative enter-cutaneous fistula are included in the study. Maximum number of patients [171, 79.5%] developed fistula between 4[th]-6[th] postoperative day and a vast majority of fistula occurred in the ileum [207, 97.18%] either as a result of anastomotic failure [103], leak from primary closure [99] or from un-noticed missed perforations [5]. Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical intervention proved life saving [p<0.001]. A strong relation was found pre-operative albumin levels and surgical closure of the fistula [p<0.001] and associated mortality [p<0.001]. High out put fistula is unlikely to close spontaneously on conservative measures. Early surgical intervention can be life saving

Pattern of acute intestinal obstruction: is there a change in the underlying etiology?

To study the changing pattern of acute intestinal obstruction at a teaching institute. Patients and It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 +/- 13.07 years. Postoperative adhesions accounted for 41% [n= 95] of the total cases, followed by abdominal tuberculosis [25%, n= 58], obstructed/ strangulated hernias of different types [18%, n= 42]. There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction

Small bowel perforations due to deliberate ingestion of injurious foreign bodies-a personal experience

Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature

Emergency laparoscopic cholecystectomy in acute cholecystitis

To study the presentation and outcome of cases operated for Gynecomazia. A retrospective study spread over four years i.e. June 2002 to May 2006. Different hospitals of Karachi including Civil Hospital. 46 males who were admitted for surgery of Gynecomazia. All patients included in this study were evaluated in detail clinically and by appropriate investigations. They were counselled about the condition, and operated via a peri-areolar or sub-mammary incision, and the outcome noted in terms of healing and complications. Out of the 46 cases, majority [71.74%] presented in the age group 11-20 years with peak incidence around 16 years of age. The main symptom was breast enlargement, though pain or discomfort was also seen in 12 [26.1%] patients. The size of the breasts varied between 4-8 cms, and 34 [73.9%] cases were bilateral. Surgery was done for macromastia in 7, long standing gynecomazia in 11 and cosmetic reasons in 28 cases. Wound infection and hypertrophic scar formation constituted the few complications noted. Gynecomazia is the commonest condition affecting male breasts. In majority of the cases counselling and observation is all that is required for management, as they subside spontaneously or on medication. Surgery is indicated in those cases that do not subside or on patient demand

Laparoscopic cholecystectomy in the elderly patients. An experience at Liaquat University Hospital Jamshoro

Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 [30.05%] were males and 121 [69.94%] were females. Co-morbid conditions were identified in 53.17% [n=92] patients and included hypertension in 38 patients [21.96%], Diabetes Mellitus in 23 patients [13.29%], COPD in 19 [10.98%] patients, Coronary artery disease in 9 [5.20%] and cardiac arrhythmias in 3 [1.73%] patients. Indications for surgery included simple biliary colic in majority of patients [69.94%] and complicated stone disease in 52 [30.05%] subjects. There were 37 [21.38%] emergency laparoscopic cholecystectomies and 136 [78.61%] patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen [8.09%] patients required conversion to OC [Open Cholecystectomy] due to various reasons. Mean hospital stay was 6.28 days. Overall 23 [13.29%] patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age