ABSTRACT
Background: Tumor lysis syndrome (TLS) is a group of metabolic derangements after the malignant cells die with treatment and leads to complications such as acute renal failure, cardiac arrhythmias, seizures, multiple organ failure, and sudden death. TLS is a common potentially preventable complication of hematological malignancies which are the most common cancers in our province. But the data about frequent complications in the course of their management such as TLS is rudimentary. Objective: The main objective of this study was to determine how frequently TLS occurs in our patients. Design and methods: A descriptive cross-sectional study was designed and conducted in Pathology Department, King Edward Medical University, Lahore (February 2014-July 2014). Newly diagnosed patients of hematological malignancies were enrolled in the study. The clinical parameters such as age, gender and laboratory parameters such as laboratory diagnosis, Complete Blood Count, Serum Potassium, Serum LDH, Serum Phosphate, Serum Uric Acid, Serum Calcium, and Serum Creatinine were evaluated. Results: A total of 130 patients were enrolled in the study. Eighty were males and 50 were females. Mean age was 47.02 ± 15 years. Thirtytwo patients (25%) fulfilled the criteria for TLS in our setting. TLS was twice more common in females and in 61-80 year age group (36.67%). The frequency of TLS in each hematological malignancy was as follows: ALL 6.15%, AML 5.38%, NHL 5.38%, CML 4.62%, CLL 2.31% and HD 0.77%. Conclusion: TLS is not an uncommon complication of hematological malignancies in our part of the world. It usually occurs after treatment and can be diagnosed and monitored by routinely available biochemical tests. A high index of suspicion is required to optimize the oncology care as this can adversely affect the clinical outcome of these patients
ABSTRACT
One hundred and four patients, underwent urgent surgery for acute gallbladder and biliary tract diseases. Sixty-eight of the patients were females and thirty-six males the female to male ratio of 1.8:1. the mean age of the female to male patients was 52 years and 55 years respectively. The clinical presentation laboratory ultrasound, computed tomogram and ERCP had a very good rule in the diagnosis. Urgent surgical interference was done for all patients within 5-38 h [mean of 6 +/- 4 h] of hospitalization. The studied cases were divided into four groups according to the indications and the surgical preocedures. The first group of 46 patients [44 per cent] underwent urgent cholecystectomy. The second group of 22 patients [21 per cent], cholecystectomy combined with choledochotomy. The third group of 19 patients [18 per cent] underwent cholecystostomy. The fourth group of 17 patients [16 per cent] for urgent biliary enteric anastomosis. Four pregnant female patients, were included in first group. Postoperative complications were encountered in 17 patients [16 percent]. There were 5 deaths, a mortality of 4 percent. It is concluded that urgent gallbladder and biliary tract surgery is indicated in cases of progression of the inflammatory process or inflammatory mass progression of jaundice, acute cholangitis, despite conservative treatment, perforated gallbladder with biliary peritonitis and injury of the common bile duct during ERCP