ABSTRACT
Objective: To evaluate the surgical complications of renal transplantation in adult end stage renal disease patients
Study Design: Retrospective observational study
Place and Duration of Study: Armed Forces Institute of Urology [AFIU] Rawalpindi, from Apr 2009 to Apr 2014
Material and Methods: Frequency of the surgical complications of renal transplant was assessed in 105 adults with end stage renal disease subjected to renal transplantation at Armed Forces institute of Urology Rawalpindi, from Apr 2009 to Apr 2014
Results: Total 105 adults were included in the study with the median age of 38 years; [ranging from 18 to 61 years]. There were 88 [83.8 percent] male and 17 [16.2 percent] female patients. All were live related transplants. Vascular complications were the most common [6.66 percent] followed by urological complications [2.85 percent]. Graft loss occurred in 3.8 percent and surgical mortality was 0.95 percent
Conclusion: Vascular complications after renal transplantation need prompt detection and remedial steps to avoid graft loss. Urological complications, on the other hand, increases morbidity, often needs corrective radiological or surgical intervention, but rarely leads to graft loss
ABSTRACT
Objective: To present our experience of treatment of complex anterior urethral strictures using penile skin flap
Study Design: Descriptive, case series
Place and Duration of Study: Department of urology Combined Military Hospital Malir Cantonment, Karachi and Armed Forces Institute of Urology, Rawalpindi from Jan 2012 to Feb 2014
Material and Methods: Total 18 patients with complex anterior urethral strictures and combined anterior and bulborurethral strictures were included. Patients underwent repair using Orandi or circularfacio-cutaneous penile skin flap depending upon the size and site of stricture. First dressing was changed after two days and an in dwelling silicone two way foleycatheter was kept in place for three weeks. Graft was assessed with regards to local infection, fistula formation and restricturing. Re-stricture was assessed by performing uroflowmetery at 6 months and 1 year. Ascending urethrogram was reserved for cases with less than 10 ml/sec Q max on uroflowmetery. Repair failure was considered whenthere was a need for any subsequent urethral procedure asurethral dilatation, dorsal visual internal urethrotomy, or urethroplasty
Results: Overall success rate was 83.3%. Of all the patients operated 1[5.6%] had infection with loss of flap, 3[16.7%] had urethral fistula and none had re stricture confirmed by uroflowmetery
Conclusion: In our study the excellent results of the penile skin flap both in anterior urethral strictures and combined anterior and bulbar urethral strictures are quite encouraging. It is easy to harvest and seems anatomically more logical
ABSTRACT
Objective: To present our complications of percutaneous nephrolithotomy [PCNL] during initial one year using modified Calvien system
Study Design: Observational prospective cohort
Place and Duration of Study: Armed Forces Institute of Urology [AFIU] Rawalpindi from 1[st] January 2014 to 31[st] December 2014
Material and Methods: The study was conducted at AFIU, Rawalpindi from 1[st] January 2014 to 31[st] August 2014. All of the consecutive 103 patients who underwent PCNL were included. Single-stage PCNL was performed in all the cases under general anesthesia. Pneumatic and ultrasound probes [alone or in combination] were used to fragment the calculi. Stone fragments were removed using graspers. A 16 Fr Foley catheter was used as nehrostomy tube. It was clamped on the first postoperative day. Foley catheter and ureteric stent was removed one day later. Intravenous antibiotics were given during admission period, i.e. 3-5 days. The complications were classified according to modified Clavien system. The data was analysed using the Statistical Package for the Social Sciences [SPSS] version 16
Results: Sixty nine [67%] patients were males and thirty four [33%] were females. Their ages ranged from 7 years to 81 years with mean age 41.7 +/- 16.34 years. PCNL was performed on right side in 48 [46.6%] cases while 55 [53.4%] underwent PCNL on left side. Overall complication rate was 21.35%. Grade 1 complications in 7.7%, grade 2 in 7.8%, grade 3a in 2.8% and grade 4a complications in 2.9% were seen
Conclusion: PCNL is associated with low incidence of major complications even in the hands of beginners when carefully performed
Subject(s)
Humans , Male , Female , Child , Adult , Middle Aged , Aged , Aged, 80 and over , Prospective Studies , Cohort Studies , Kidney CalculiABSTRACT
Objective: To evaluate the effectiveness and safety of treatment for proximal ureteral stones with pneumatic lithotripsy compared to holmium: yttrium-aluminum-garnet [HO: YAG] laser therapy
Study Design: Randomized control study
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi from Sep 2014 to Mar 2015
Material and Methods: This randomized control trial was conducted at Armed Forces institute of Urology Rawalpindi. A total of 73 patients who underwent treatment between Sep 2014 and Mar 2015 were included in the study. Of the patients, 37 had pneumatic lithotripsy [PL group] and 36 had ureteroscopic HO: YAG laser lithotripsy [LL group] using rigid 8 Fr-ureteroscope for the fragmentation of the ureteric stones. Patients were evaluated for stone clearance after 3 weeks, with X-ray KUB, ultrasound and plan CT KUB [where indicated]. All the data were recorded in a proforma and analyzed in SPSS version 11
Results: There was a difference between the two groups according to overall stone clearance rate 83.8% for PL group vs. 86.5% for LL group. Proximal stone migration was seen in 16.2% of cases in PL group while in only 5.5% of cases in LL group. The overall complication rate was 35.1% in PL group while 30.5% in LL group. The mean procedure time was 28.8 +/- 4.5 minutes for PL group while it was 35.5 +/- 8.6 minutes for LL group
Conclusion: The pneumatic and holmium: yttrium-aluminum-garnet laser lithotripsy both are established choices for treatment of ureteral stone but in terms of stone clearance rate and decrease incidence of proximal stone migration HO: YAG lithotripsy is better than pneumatic lithotripsy
ABSTRACT
The threatened limb due to peripheral occlusive arterial disease, embolism or trauma requires early recognition and urgent treatment if the limb is to be saved. To determine the pattern of presentation and outcome of surgery in cases of critical limb ischemia. Descriptive study. This study was conducted at surgical ward, Combined Military Hospital, Rawalpindi, from Dec 2006 to Dec 2007. A sample size of 30 patients was taken by convenience sampling. Informed written consent was obtained from all patients. Patients suffering from rest pain with ischemia features, trophic lesions, extensive gangrene, ulcers and demonstrable presence of occlusive arterial disease were included in the study. Moribund patients, extensive cardiopulmonary disease or advanced malignancy were not included in the study. Thirty patients were included in the study. The mean age was 56 +/- 13. There were 28 males [93.3%] and 2 females [6.7%]. They were all married and belonged to middle and low middle social economic class. Out of 30, there were 2 [6.7%] cases of trauma while 28 [93.3%] had peripheral vascular involvement secondary to thromboembolism. Vessels involved were femoral artery in 9 [30%] cases, popliteal artery in 18 [60%] cases and brachial artery in 2 [6.7%] cases. Rest pain was present as a primary feature in all the patients [100%], while tissue loss or gangrene was seen in 22 [73.33%] cases. A total of 14 [46.7%] amputations, 6 [20%] bypass procedures, 4 [13.3%] lumbar sympathectomies, and 2 [6.7%] embolectomies, were carried out, whereas 4 [13.3%] patients were managed conservatively. Of the patients having rest pain 46.7% were amputated, whereas of patients having ischemic tissue loss 73.3% were amputated. 13 patients who underwent primary amputation had ankle brachial pressure index [ABPI less than 0.4 [86.7%]. ABPI was more than 0.4 in 4 [13.3%] patients whereas it was less than 0.4 in 26 [86.7%] patients. Overall, critical leg ischemia has a very poor prognosis. If surgical, or endovascular, improvement of the blood supply to the leg is not provided in due course; half of the legs will be amputated within a year. One of the main goals of vascular surgery is to prevent major amputations
Subject(s)
Humans , Female , Male , Ischemia , Arterial Occlusive Diseases , Amputation, Surgical , Peripheral Vascular Diseases , Critical IllnessABSTRACT
To compare the frequency of hypocalcaemia in thyroid surgery after ligation of inferior thyroid artery trunk and ligation of Inferior thyroid artery branches at gland surface. Quasi experimental comparative study. Department of Surgery, Combined Military Hospital Rawalpindi, from February 2008 to August 2008. The patients were assigned to two equal groups, Group 'A' and Group 'B'. Estimation of serum calcium [Ca] levels was done before surgery in both the groups. In group 'A' patients underwent thyroid surgery with ligation of inferior thyroid artery [ITA] trunk, while in group 'B' terminal branches of ITA were ligated on gland capsule. Following the surgery serum calcium levels was measured 6 hours after surgery. Afterwards levels of serum calcium were checked daily for three days. The two groups were compared for the frequency of transient hypocalcaemia. Four patients in group A [13.3%] developed transient hypocalcaemia [serum corrected Ca < 2.0mmol], while in group B three patients [10%] developed transient hypocalcaemia. Fishers Exact test was applied and this difference was found statistically insignificant at p=1.0. Over all frequency of transient hypocalcaemia in this study was 11.6%. Ligation of ITA trunk does not increase the risk of hypocalcaemia in thyroid surgery.
ABSTRACT
To determine the diagnostic accuracy of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy using histopathologic examination of the excised lymph node as gold standard. Cross sectional study. Combined Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Pathology [AFIP] Rawalpindi, from January 2007 to January 2008. A total of 70 patients suffering from cervical lymphadenopathy were selected. After obtaining informed consent FNAC was obtained from the lymph node. Afterwards same lymph node was removed under local anesthesia for histopathology. All specimens were sent to AFIP for histopathology reporting. Sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the modalities were calculated. Data was analyzed using SPSS version 10. Mean and standard deviation for age and gender were calculated. Mean age of the patients was 38.14 +/- 16.88 year. FNAC findings showed a sensitivity of 79.5%, specificity 47.61%, positive predictive value 78%, negative predictive value 50% and diagnostic efficacy 70%. FNAC appears well established method of diagnosis, as its results compared favorably in many respects with those obtained from traditional surgical biopsy.
ABSTRACT
To compare lateral internal anal sphincterotomy with 2% diltiazem in the treatment of chronic anal fissure in terms of fissure healing and complications. Randomised controlled trial. Surgical unit Combined Military Hospital Lahore, from August 2008 to February 2009. Sixty patients were randomly assigned into two treatment groups. Group A was assigned to apply 2% diltiazem paste while, in group B lateral internal sphincterotomy [LIS] was done. Response to the treatment was assessed in terms of fissure healing, pain relief and occurrence of complications. Follow up of the patients was carried out at the end of 2[nd]d, 4[th], and 6[th] week of treatment. To compare lateral internal anal sphincterotomy with 2% diltiazem in the treatment of chronic anal fissure in terms of fissure healing and complications. In group A six patients had healing of fissure after 4 weeks and a further 4 at 6[th] week. In group B 14 patients had healing at 2 weeks, 10 at 4 weeks, and 5 at 6 weeks. One patient in group B and 20 in group A had no healing. In this study overall healing rate after 6 weeks with diltiazem was 33.33% and 96.66% with LIS. Lateral internal sphincterotomy is better than 2% diltiazem cream
Subject(s)
Humans , Female , Male , Sphincterotomy, Endoscopic , Diltiazem , Anal Canal/surgeryABSTRACT
Rocket injuries in the war are common,but the retained unexploded rocket injury is quite rare and uncommon. We report an unusual case of unexploded rocket in knee area that required removal with unique safety measures, so as to prevent patient from potentially catastrophic situation
ABSTRACT
To compare the efficacy of Alvarado and Teicher scores in the diagnosis of acute appendicitis, using postoperative histopathology as gold standard. Comparative, cross sectional study. Department of surgery, Combined Military Hospital Rawalpindi, from 22nd June 2006 to 26th February 2007. Hundred cases of clinically diagnosed/suspected of acute appendicitis were included in the study by convenience [non-probability] sampling. Selected patients were graded according to Alvarado and Teicher scores, and underwent appendicectomy. All appendicectomy specimens were sent for histopathology reporting. A 2 x 2 table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the scoring systems. Using Alvarado and Teicher scores, a sensitivity of 95% and 89.55%, specificity of 69.69% and 66.66%, positive predictive value of 86.48% and 85.71%, negative predictive value of 88.46% and 76.66%, negative appendicectomy rate of 13.5% and 15.49% and diagnostic efficacy of 87% and 83% were found, respectively. Alvarado score has better diagnostic accuracy as compared to Teicher score in the diagnosis of acute appendicitis