ABSTRACT
Background: Postoperative complications after thyroidectomy are problematic for patients and surgeons. The postoperative outcome of thyroidectomies is related to risk factors concerning the patient, the thyroid disease and the surgeon
Objective: To analyze the risk factors for postoperative complications after thyroidectomy in patients of simple multinodular goiter
Methodology: A prospective study was conducted in Surgical unit of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan on 114 patients diagnosed and surgically treated for simple multi nodular goitre [MNG] between 1[st] July 2012 and 30 June[th] 2014 meeting the following criteria: bilateral MNG; operation by surgeons with experience in endocrine surgery; no associated parathyroid pathology; no initial thoracic approach; and minimum follow-up of 6 months. Age, sex, time of evolution of symptoms, thyroid weight, recurrent goiter and type of surgery [total thyroidectomy or near total thyroidectomy] were analyzed as risk factors for complications. Data was analyzed using SPSS version 16.0. P-values < 0.05 were considered statistically significant
Results: During the study period 114 thyroidectomies were performed. There were 20 [17.5%] males and 94 females [82.5%] with age of 48.5 +/- 13.6 years. Male to female ratio was 1:4.7. Total thyroidectomy performed in 57[50%] patients and near total thyroidectomy was also performed in 57[50%] patients. Total complications occurred was 29 [25.43%] in 114 patients. Transient hypoparathyroidism was the major complication seen in 17 [14.9%] patients and permanent hypoparathyroidism was seen in 3[2.6%] patients. 3[2.6%] patients suffered from transient recurrent laryngeal nerve palsy [RNLP] and 2 [1.8%] patients suffered from permanent RNLP. Hematoma formation was present in 3[2.6%] patients and wound infection was present in 1[0.9%].There was significant association of transient hypoparathyroidism with duration of goiter [p-value=.016], presence of compressive symptoms [p-value= 0.000] and type of surgery [p-value=.017]. Permanent hypoparathyroidism was significantly associated with recurrence of goiter [p-value=.02]. Permanent RNLP was significantly associated with compressive symptoms [p-value=.007]. There was no significant between hematoma formation and risk factors. So duration of goiter, presence of compressive symptoms, weight of thyroid gland, type of surgery and recurrence were the significant risk factors for complications in patients of simple MNG
Conclusion: In conclusion duration of goiter, presence of compressive symptoms, recurrence of goiter and surgical resection are significant factors for post thyroidectomy complications. By performing early surgery and total thyroidectomy complications rate can be reduced
ABSTRACT
Background: Eclampsia contributes significantly to maternal and perinatal morbidity in our country
Objective: The objective of this study was to determine the frequency of the disease, its management and outcome in tertiary care hospital; moreover the effect of introduction of modified dose of MgSo4 in the control of eclamptic seizures was also assessed
Patients and Methods: This descriptive study was carried out in Gynae unit I, Sheikh Zayed Hospital, Rahim Yar Khan from 1[st] January 2008 to 31[st] January 2009. Diagnosis was based on history and on clinical findings of hypertension, oedema, protienuria superimposed with fits. All pregnant ladies presenting with fits, oedema, proteinuria and increased blood pressure were included in this study and their history, physical findings and baseline investigations were noted. Patients with history of fits in pregnancy, during labour or in perpuerium other then eclampsia were excluded from the study. All the patients with eclampsia were treated with MgSO4 gm intravenous loading dose and 10 gm intramuscular maintenance dose. The data was entered and analyzed in SPSS version 15
Results: 12049 pregnant patients were admitted during this time period in labour room. Out of these, eclamptic patients delivered were 120 [0.99%]. Primigravida were 49%, multigravida were 51%. Regarding mode of delivery patients delivered vaginally were 80 [66.6%] and with caesarean section were 40 [33.3%]. Regarding fetal outcome fresh still births were 15 [12.5%]. Early neonatal deaths were 10 [0.8%]. Perinatal mortality rate in our study was 20.8%. Regarding maternal outcome 17 patients out of 120 eclamptic patients develop complications. 4 patients developed renal failure [3.3 %]. 2 patients develop Hellp syndrome, 4 patients shifted to ICU due to Hellp syndrome and DIC. 5 patients [4.1%] died despite of intensive care. These patients were received in critically ill condition. Almost all of these patients present with eclamptic fits were unbooked patients. In this study MgSo4 was the drug of choice to control the seizures. It helps in reducing the maternal morbidity and mortality which is comparable with the other studies in world
Conclusion: This study is in the favor of the findings that MgSo4 is superior drug in the reduction of maternal morbidity and mortality. Eclampsia occurring in unbooked patients is still one of the major cause of maternal mortality and morbidity and antenatal care will significantly reduce the incidence and improve the outcome especially in teenage nullipara who are mostly susceptible